Printable version of this fact sheet (PDF file, 76K)
A certified nurse-midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, and who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.
Midwifery practice is the independent management of women's health care, focusing particularly on pregnancy, childbirth, the postpartum period, and care of the newborn; family planning and gynecology; and common primary care issues. Certified nurse-midwives practice within a health care system that provides for consultation, collaborative management, and/or referral as indicated by the health status of the client. Certified nurse-midwives practice in accordance with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives.1
A nurse practitioner (NP) is a registered nurse with advanced academic and clinical experience, which enables them to diagnose and manage most common and many chronic illnesses, either independently or as part of a health care team. A nurse practitioner provides some care previously offered only by physicians and in most states has the ability to prescribe medications. Working in collaboration with a physician, a nurse practitioner provides high-quality, cost-effective, and individualized care for the lifespan of a patient's special needs.
NPs focus largely on health maintenance, disease prevention, counseling, and patient education in a wide variety of settings. With a strong emphasis on primary care, nurse practitioners are employed within several specialties, including neonatology, pediatrics, school health, family and adult health, women's health, mental health, home care, geriatrics, and acute care.2
Physician assistants (PAs) are health care professionals licensed to practice medicine as part of physician-directed teams. They are educated in accredited graduate-level programs. Physicians may delegate to PAs those medical duties that are within the physician's scope of practice and the PA's training and experience. PAs provide a broad range of diagnostic and therapeutic services, from primary care to surgical procedures. In their work with physicians, PAs routinely perform physical exams and take patient histories, order and interpret laboratory tests, manage and treat illnesses, assist in surgery, write prescriptions, and provide health education and patient counseling.
- CNMs provide health care for women throughout their lives. They provide full-scope care during labor and childbirth, and are competent independent providers of prenatal, postpartum, and newborn care; family planning; and gynecological care.
- CNMs are routinely trained in basic surgical techniques of episiotomy, suturing, and manual removal of the placenta.
- PAs perform approximately 80% of the duties commonly done by primary care physicians
- CNMs, NPs, and PAs diagnose and treat common health problems, order and interpret diagnostic tests, and administer medications.3
- CNMs, NPs, and PAs have prescriptive authority in most states.
- When appropriately trained, CNMs, PAs, and NPs perform a variety of procedures, such as endometrial biopsy, intra-uterine device placement, and colposcopy.
- Postgraduate specialty training in anesthesia, surgical assisting, and other advanced procedures, including uterine aspiration, has been an option for members of all three disciplines (depending on state regulations) for many years.
In December 1996, the National Abortion Federation (NAF), with funding from the Kaiser Family Foundation, convened a national symposium to explore how CNMs, NPs, and PAs could participate more fully in abortion service delivery nationwide. The symposium's key findings and recommendations included:
- appropriately trained CNMs, NPs, and PAs possess the skills and expertise to provide this safe and routine elective procedure;
- a very carefully planned state-by-state effort would be needed to overcome legal restrictions limiting the participation of CNMs, NPs, and PAs in abortion service delivery in some states; and
- education and understanding of all aspects of abortion care, including counseling, pre- and post-abortion care, and abortion techniques must be expanded.4
The largest, most influential and well-respected medical and health policy organizations in the United States have issued statements in support of the inclusion of CNMs, NPs, and PAs in abortion care. In 1994, the American College of Obstetricians and Gynecologists stated, "that to address the shortage of health care providers who provide abortions, the College encourages programs to train physicians and other licensed health care professionals to provide abortion services in collaborative settings."5 Additionally, the American Academy of Physician Assistants, the American College of Nurse-Midwives, the American Medical Women's Association, the American Public Health Association, the Association of Physician Assistants in Obstetrics and Gynecology, the International Confederation of Midwives, the National Association of Nurse Practitioners in Women's Health, and Physicians for Reproductive Choice and Health support the participation of these three professional groups in abortion care provision.* In order to address the lack of access to abortion care and to protect the health and well-being of women of reproductive age, it is essential to increase the number of abortion providers.
CNMs, NPs, and PAs are involved in all aspects of abortion care. Listed below are some key aspects of abortion care that may be provided by appropriately trained CNMs, NPs, and PAs:
- provide method-specific counseling and screening;
- determine gestational age and size using patient historical data, and physical exam, as well as ultrasound diagnosis when indicated;
- provide medications for the purpose of inducing abortion, and manage the process of medical abortion including collaborative management of complications, as necessary;
- dilate the cervix;
- assist with vacuum aspiration and surgical procedures;
- perform uterine aspiration for purposes of pregnancy termination or management of abortion complications; and
- provide post-abortion care, including evaluation and collaborative management of complications.
The potential scope of CNM, NP, and PA practice currently varies depending upon each state's regulations, rather than on capacity, training and competency. Unnecessary obstacles to scope of CNM, NP, and PA practice contribute to the rising costs and inaccessibility of health care including abortion care.6 To expand access to abortion care NAF and Clinicians for Choice (CFC) work with other professional and advocacy groups to increase the number of CNMs, NPs, and PAs who provide medical and surgical abortion.
Thank you to the 2005 Clinicians for Choice (CFC) Advisory Committee for contributing to the development of this fact sheet.
* For a complete list of professional organizations' statements on CNMs, NPs, and PAs in abortion care, please visit the CFC web pages at http://www.prochoice.org/cfc/.
- American College of Nurse-Midwives. Definition of Midwifery Practice. June 2004. http://www.acnm.org/display.cfm?id=457
- American College of Nurse Practitioners. What is a Nurse Practitioner? October 2005. http://www.acnpweb.org/i4a/pages/index.cfm?pageID=3479
- Strategies for Expanding Abortion Access: The Role of Physician Assistants, Nurse Practitioners, and Nurse-Midwives in Providing Abortions. Symposium Report. Washington, DC: National Abortion Federation, 1997.
- Supra n. 2.
For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.
For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. - 8:00 P.M.
Saturdays: Noon - 5:00 P.M.
National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
Further reading: Strategies for Expanding Abortion Access: The Role of Physician Assistants, Nurse Practitioners, and Nurse-Midwives in Providing Abortions - available online (PDF file, 209K) or order a bound copy
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