Midwives and Abortion Care: A Model for Achieving Competency

Levi, Amy; James, Evelyn Angel; Taylor, Diana

doi:10.1111/j.1542-2011.2012.00182.x

Cited by 14 publications

(13 citation statements)

References 21 publications

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“…24 Prior to participating in the study, licensed NPs, NMs, and PAs were required to have basic life support certification, institutional recommendation to participate, and at least 12 months of clinical experience, including at least 3 months of experience in medication abortion provision or the equivalent. Participating physicians were employed by the health care facility and had received training in either family medicine or obstetrics and gynecology.…”

Section: Study Design and Proceduresmentioning

confidence: 99%

Multiple Determinants of the Abortion Care Experience

et al. 2013

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Because of the highly stigmatized nature of abortion care delivery and the restriction of abortion provision in most states, little is known about abortion care quality beyond procedural safety. This study examined which aspects of abortion care contributed to patient experiences. Data from a prospective, observational study of 9087 women aged 16 to 44 years, from 22 clinics across California, who responded to a postprocedure survey, were analyzed using mixed-effects logistic regression. Patient experience scores were very high (mean overall satisfaction = 9.4 [0-10 scale]) for all clinicians trained in abortion provision (physicians, nurse practitioners, nurse-midwives, and physician assistants). Multiple patient factors (pain rating, expectations of care, sociodemographics) and clinic-level factors (timely care, treatment by clinicians and staff) were significantly associated with patient experience. Study findings demonstrated that clinic environment, treatment by clinical staff, and managed pain levels contributed to a patient's experience of abortion care, whereas clinician type was not significantly associated.

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Section: Study Design and Proceduresmentioning

confidence: 99%

Multiple Determinants of the Abortion Care Experience

et al. 2013

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“…In Cameroon, nurses are not trained for abortion. Therefore, they should be trained in uterine evacuation procedures in order to reduce abortion related complications, as this has been done elsewhere [20]. Surgical methods used (dilatation and curettage or evacuation and MVA) may be very difficult if done by untrained health providers (nurses) especially in the second trimester.…”

Section: Discussionmentioning

confidence: 99%

How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study

2014

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BackgroundComplications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA).MethodsThis retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant.ResultsWomen with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death.ConclusionsClandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.

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“…Levi et al 1 have presented a very clear and compelling history of the American College of Nurse‐Midwives’ (ACNM's) position concerning the role of certified nurse‐midwives (CNMs) and certified midwives (CMs) in the provision of abortion‐related care services. The authors note correctly that the Council of the International Confederation of Midwives (ICM) adopted a supportive position statement about “Midwives’ Provision of Abortion‐Related Services” 2 in 2008.…”

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confidence: 99%