One of my favourite people in the world recently had a baby. I talked to her on Skype shortly afterwards, and with her daughter in her arms, she described the birthing process. “Our living room was basically covered in blood,” she said. “Like, every towel in our house. Pretty much every insane bodily fluid you can think of came out of me.” My friend had found a doula early on in her pregnancy, and along with my friend’s mom and her husband, the doula was there as soon as she went into labour. A normal amount of excruciating pain later, a baby made it out into the world, right in my friend’s blood-spattered living room.
The movement to “de-medicalize” childbirth has made significant progress. Could it be time to expand these options to pregnant women who want abortions?
Despite the continuing efforts of conservative elements in both the U.S. and Canada—in September, Conservative MP Stephen Woodworth brought a motion to study when life begins, which was defeated 203 to 91—polls consistently show that most North Americans are not interested in reopening this debate. But, as Sarah Erdreich explains in her new book, Generation Roe: Inside the Future of the Pro-Choice Movement, legal isn’t the same thing as available.
The American and Canadian legal contexts are different—in the States, 1973’s Roe vs. Wade set out quite an extensive legal framework to govern abortion, whereas in Canada, the 1988 Morgentaler decision simply declared banning abortion unconstitutional. In both countries, however, women’s access to abortion is highly determined by where they live. If you live in P.E.I., there is nowhere in your own province you can go to get an abortion. As of 2005, 87 percent of U.S. counties had nowhere you could go to get an abortion—something that 3 in 10 U.S. women will need before the age of 45, as Ehrdreich writes.
Right now, in both Canada and the U.S., only physicians are legally permitted to perform abortions. But in 2012, California proposed an adjustment to their abortion law: bill SB 1501 would allow midwives and nurses to give abortions as well. As may be imagined, this idea met with a lot of opposition from anti-choice groups; lobbyist Camille Giglio asked a Los Angeles Times reporter when we would be letting janitors do it. Of course, if you don’t think anyone should be giving abortions, you are unlikely to be an expert on the medical training necessary to perform this procedure (maybe the next time Giglio goes to a hospital, a trained nurse with many years of experience will scrub her mouth out with a floor mop).
As it assesses the proposed bill, California has set up clinical trials to compare abortions conducted by midwives and nurses to the same type of abortions conducted by doctors. In a study released this month in the American Journal of Public Health, a team of researchers headed by Tracy A. Weitz from the University of California assessed 11,487 abortions, with roughly half completed by doctors and the other half by newly trained Certified Nurse Midwives, Nurse Practitioners, and Physician Assistants. They found: “Abortion complications were clinically equivalent between newly trained NPs, CNMs, and PAs and physicians, supporting the adoption of policies to allow these providers to perform early aspirations to expand access to abortion care.”
Currently, certified nurse midwives in the U.S. are trained to handle episiotomy (making incisions to widen the birth canal), suturing, and removal of the placenta; they know how to test for common health problems and administer medication; they can insert IUDs, take tissue samples of uterine lining, and insert colposcopes to examine the cervix. From there to the type of abortion bill SB 1501 is proposing (first trimester aspiration, in which the contents of the uterus are suctioned out through the cervix) seems like a natural progression.
It’s hard to gauge what impact allowing midwives to perform abortions would have; in Canada, not all provinces legally recognize midwives, and in the ones that do there are severe shortages—in 2012, the Canadian Association of Midwives reported that 75 percent of Winnipeg women’s requests for midwives had to be declined. It’s also possible that some midwives, like some doctors, would be unwilling to perform abortions. But in regions where midwives are available and pro-choice, adding abortion to the services they can provide could only benefit their clients.
Abortion, like childbirth, is an event in a woman’s reproductive life that she needs to be able to control to the fullest extent possible. Women who use midwives for their pregnancies report higher levels of satisfaction with their experience than women who use doctors, mostly because midwives are able to spend more time with their clients. This seems like a benefit from which women undergoing abortions shouldn’t be excluded.
