The Midwifery scope of practice: Abortion services (March 2020) FAQs
The Abortion Legislation Bill received Royal Assent on March 23, 2020 and is now in force. This amendment updates the primary legislation for abortion, set out in the Contraception, Sterilisation, and Abortion Act 1977 and the Crimes Act 1961. The legislation is available on the New Zealand Parliament website.
How does the Midwifery Council statement on abortion sit within the competencies for entry to the Register?
Competency 3.5 states that the midwife demonstrates an understanding of the needs of women/wāhine and their families/whānau in relation to infertility, complicated pregnancy, unexpected outcomes, abortion, adoption, loss and grief and applies this understanding to the care of women/wāhine and their families/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 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. The Council has identified that there are many matters that need to be considered and addressed by the sector and the MOH in order to enable this to occur and that in the current climate this will take time.
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).
What if the woman/wāhine gestation is greater than 20 weeks?
Safety of the woman is paramount. The woman/wāhine will require multi-disciplinary care.
Can the midwife provide the service to a woman/wāhine 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.
How can women/wāhine be reassured that the processes of informed choice are adhered to and completion of consent process thorough?
The latest Abortions Act has not changed the requirements for informed decision making and consent which sits at the heart of health care in New Zealand. Midwifery Competency 2.15 requires midwives in New Zealand 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 to not impose them on others; further competency 1.10 requires the midwife to provide up to date information and to support the woman with informed decision making. Midwives have a professional obligation to ensure that the processes of informed consent are adhered to.
What do other jurisdictions and professional organisations say?
Internationally, the ICM expects that midwives must have the skills:
- To counsel the person about options to maintain or end the pregnancy and to respect the ultimate decision.
- Provide information about legal regulations, eligibility, and access to abortion services
- Provide information about abortion procedures, potential complications, management of pain, and when to seek help
- Refer to an abortion provider on request
- Provide post abortion care.
For the New Zealand context, these skills and behaviours will help the midwife to provide non-biased information so an informed choice can be made by the person seeking information about abortion care. The consent process is yet to be confirmed but will outline the midwife’s obligations and acknowledge information shared with the women and her choice.
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 the Ministry of Health as part of the service provided. Introduction of this service provided by midwives will consider the context of contractual obligations moving forward. Questions about funding and payment for services will be addressed by the Ministry of Health in due course.
What if a midwife does not provide abortion services?
The midwife must ensure the woman/wāhine knows how to access the contact details of the closest provider of the service requested and further that they ensure that all information provided to the woman is without bias.
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.
What type of education will be developed?
An education package will be developed that ensures midwives are competent to provide abortion services. The Midwifery Council will work with approved accredited education providers to ensure that all midwives have the knowledge and skills to provide abortion-related services in line with the competencies for entry to the register.
Midwives will be not be able to provide abortion-related services until they have completed the education.
Further information can be found on the following Ministry of Health webpages:
ICM Position Statement: Midwives’ Provision of Abortion-Related Services, 2014 p. 1
Cochrane Database for Systematic Reviews: Barnard. S, Kim. C, Park. M.H & Ngo. T.D Doctors or mid-level providers for abortion (Review), 2015
Ministry of Health. 2012. Guidelines for Consultation with Obstetric and Related Medical Services (Referral Guidelines). Wellington: Ministry of Health.
New Zealand College of Midwives, Handbook for Practice, 2015
WHO (2015). Health care worker roles in providing safe abortion care and post-abortion contraception. Geneva, Switzerland: WHO.