FAQs on Midwifery-Led Abortion Care

What if a midwife does not want to provide abortion services?

The midwife must ensure the wāhine/birthing person knows how to access the contact details of the closest provider of the service requested and further that they ensure that all information provided is without bias.

What if the wāhine/woman gestation is greater than 20 weeks?

Under the Abortion Law Reform, appropriately educated midwives will be able to provide abortion care after 20 weeks within the context of the multi-disciplinary team.

How can wāhine/women be reassured that the processes of informed choice are adhered to and completion of consent process thorough?

Midwives have a professional obligation to ensure that processes of informed consent are adhered to. The Abortion Legislation Act 2020 has not changed the requirements for informed decision making and consent which sits at the heart of health care in Aotearoa New Zealand. Midwifery Competency 2.15 requires midwives to share decision making with the woman and to document those decisions. In addition, competency 4.8 requires the midwife to recognise her own values and beliefs and not impose them on others. Further competency 1.10 requires the midwife to provide up to date information and enable the pregnant person to make informed decisions.

Will midwives be required to comply with all documentation and contractual obligations as required by the Ministry of Health?

It will be necessary for all midwives to provide the appropriate documentation and data capture required by Manatū Hauora | Ministry of Health as part of any abortion services provided.

Will the midwife’s name be available to the general public if they provide services?

There is a list of abortion service providers that is accessible via the Director-General of Health. If the midwife did not want their name to appear on the list as a service provider, they can request for it to be removed.

How does the Midwifery Council Statement 2020 on abortion sit within the current competencies for entry to the Register?

Competency 3.5 states that the midwife demonstrates an understanding of the needs of wāhine and their whānau in relation to infertility, complicated pregnancy, unexpected outcomes, abortion, adoption, loss and grief and applies this understanding to the care of wāhine and their whānau as required.

Midwives as authorised prescribers can prescribe within their gazetted scope of practice.

As it has been agreed that the provision of abortion care to women sits within the midwifery scope then the prescribing of medicines to facilitate this also sits within the scope of practice of a midwife.

Is there an international perspective on this position?

The International Confederation of Midwives (ICM) affirms that anyone who seeks or requires abortion-related services is entitled to be provided with such services by midwives. Certain procedures can only be undertaken by registered health practitioners permitted to do so by their scope of practice. The ICM notes that authorised and well-educated midwives can provide competent and safe abortion-related services, and many governments have modified their laws and policies to empower midwives to provide comprehensive abortion services.

Will midwives be able to perform surgical abortions?

After a structured programme of education midwives will be able to perform these procedures. However, Te Tatau o te Whare Kahu | Midwifery Council (the Council) expects to focus on midwifery-led surgical abortion once pathways for medical midwifery-led abortion have been established.

Is there evidence to support this position?

The World Health Organisation has stated that involving a wide range of health care workers in providing safe abortion and post abortion care is an important public health strategy. Further educating health care workers, such as midwives, nurses and other non-physician providers, to conduct first trimester abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion procedures which of course reduces issues related to equity to access (Barnard, Kim, Park & Ngo, 2015).

Can the midwife provide the service to wāhine/pregnant person that require an abortion for fetal anomalies?

There are already existing referral pathways in place for secondary and tertiary services to ensure 3-way conversations occur.

Under the Abortion Law Reform, changes appropriately educated midwives will be able to provide abortion for fetal anomalies in the context of the multi-disciplinary team.

What type of education will be developed?

Education to enable midwives in the provision of midwifery-led abortion care will be developed and would need to be completed before midwives commenced midwifery-led abortion care. It will take time to develop, accredit and implement that education

A staged approach would focus first on enabling midwifery-led early medical abortion, then midwifery-led mid-trimester and late medical abortion. Medical abortion care involves considerable knowledge, skills and behaviours that already lie in midwives’ sphere of expertise. Surgical abortion would require significant new learning. The Council expects to focus on midwifery-led surgical abortion once pathways for medical midwifery-led abortion have been established.