Midwives have always been involved in abortion care

As abortion protections have eroded across the country, countless health care providers have stepped out from behind their stethoscopes to talk about why abortion is an important part of reproductive health care. In a November article published in the Journal of Midwifery & Women’s Health, certified nurse-midwives Stephanie Tillman and Dr. Amy J. Levi (who is also women's health nurse practitioner) joined the fray, calling on their colleagues to speak out about the procedure and how midwives can be a part of abortion provision.

“As sexual and reproductive health care providers, midwives’ scope of practice encompasses the full spectrum of abortion care services, regardless of their direct participation in abortion provision,” Tillman and Levi wrote. In the article, the authors  also point out the difference between abortion provision — the actual procedure, medication or surgical — and abortion care — pregnancy confirmation, referral, post-procedure evaluations, etc. Midwifery is generally about bringing the whole patient to the midwife’s care, Tillman said, and abortion care is no exception. 

“Midwifery as a profession must be unwavering in its foundational support for a person’s bodily autonomy, access to evidence-based care, and a person’s right to choose their care provider,” the authors wrote in their paper. “The midwifery model of care, in its intentionality for patient empowerment and holistic application of health care to people and their broader lives, embraces abortion care and provision.”

For Tillman, the history of the Jane Collective, the underground network of women who provided abortions in Chicago before Roe v. Wade, helped inform her position that abortion care and provision has long been a part of midwifery. In 2018, the American College of Nurse-Midwives affirmed that midwives can provide abortions as they’re considered advanced practice clinicians, and outlined the situations in which additional training is necessary; the position paper was updated and affirmed their position in August 2019.

Tillman and Levi wrote the paper in part to reach “midwives who aren't currently practicing in abortion provision ... to call attention to the fact that a lot of the work that we do is part of abortion care,” Tillman told The FBomb. “It is time for midwives to claim their work in abortion care and for the professional community to support abortion as part of midwifery work.”

Levi said she’s noticed a generational shift among midwives. “I think a lot of younger midwives have come into the profession wanting to provide complete sexual and reproductive health care, that it's not just about delivering babies, and that in and of itself has been a fairly important shift in who becomes a midwife and why they become a midwife,” Levi told The FBomb.

Tillman, who is coming up on eight years as a certified nurse-midwife, agreed. She told The FBomb that providing abortion was always on her radar. “I was motivated from the get-go to practice to the full extent of my education, and abortion is one of the ways that nurse practitioners and midwives can be restricted from practicing to the full extent of our education and training,” Tillman told The FBomb. “I'm not willing to be quiet when my ability to practice is hindered.”

Read the full paper, published in the Journal of Midwifery & Women’s Health, here.