Training for an unpopular profession
July 4, 2014 7:11 AM   Subscribe

Thinking about what I would like to go back to school for and the thing that I find myself most passionate about is women's health. Specifically I would like to perform abortions in a safe manner for as many women as possible.

I have no interest in medical school.

Nursing degrees would be doable. I've read that in some states certified nurse midwives are able to perform abortions. What is the minimum level of nursing that I would need? Can registered nurses assist during procedures?

Is there a "better" way to accomplish the goal of assisting women access care that is legal but not readily available in all areas?

For a variety of personal reasons this career path really resonates with me. I would be an older non-traditional student returning to school. I know that I would be okay with the blood/guts grossness and also larger ethical issues. As someone who has daughters and had also had an abortion this feels like something I would strongly like to pursue.
posted by anonymous to Education (10 answers total) 9 users marked this as a favorite
The second page of this PDF from the Guttmacher Institute shows which states require licensed physicians to perform abortions, and which don't. Looks like CA, CT, DC, IL, MT, NH, NY, OR, RI, VT, WA, and WV do not.

Each state is likely to have it's own certification policies, so I can't answer your questions on minimum level of nursing education. Since a relatively short list of states allow non-physicians to perform abortions, you might consider making phone calls to get the information you're after.

Good luck!
posted by schroedingersgirl at 7:35 AM on July 4, 2014

That's great! CNM is a great degree, RNs can indeed assist during procedures, as well as being able to prescribe birth control, etc. (all part of the spectrum of women's heatlhcare). Typically, both CNMs and NPs can perform procedures in the states that allow non-physicians to perform them (and bear in mind that abortion doesn't just mean in-clinic "surgical" procedures any more, and medication abortion is equally an option). Nursing Students for Choice would be a great resource for you to look into for further guidance and educational suggestions.

While (or before) you're in school, it might be interesting to you to consider working in a hospital, perhaps in an OR. While the assault on abortion clinics captures a lot of political heat and fire, there are also conflicts that arise within hospital medical centers as women seeking later-term abortions are faced with discrimination, staff disregard, and hospital staff opting out of caring for them. If you have it in you to be a champion of women's rights on staff, that can really help women access quality care at what can be a particularly challenging time in their lives.

Really, though, there's no "'better' way." The ongoing assault on women's bodily autonomy in the United States means that we're all called to act. Researchers develop studies that support evidence-based policy. Advocates bring that policy to life and fight to preserve the rights that are under attack. Professors and community health educators empower populations with the knowledge they need to care for their health and that of others, public health strategists inspire organizations and leaders to protect women's health through organizational policies and funding, doctors and nurses treat patients. This is one of the most engagingly interdisciplinary fields around, and all are necessary to keep abortion rights moving forward.
posted by c'mon sea legs at 7:41 AM on July 4, 2014 [14 favorites]

If you want to perform abortions safely as a profession, I think you're coming at it from the wrong perspective.

Don't ask "how can I get to the point where I could legally perform abortions the fastest with the least amount of training?" What is legal in medicine is not always what is safest. I also think you probably don't want to do the most abortions for the largest number of women possible if that means sacrificing the quality of their care, which it probably would.

Talk to people in the field who are doing what you want to do, and ask them what type of training aside from medical school will allow you to take care of patients in the safest and best way. When the most serious types of complications from abortions occur, how is that dealt with and what kind of backup needs to be there? Abortion is generally a very safe procedure, but it can also kill people or make them seriously ill in rare cases. As a physician, I know what it's like to have your patients suffer or die. You will question yourself and wonder if you could have done a better job. It can haunt you. Make sure the answer is that you did the best you could.

Do what's right for your patients - you wouldn't want your own medical provider to be someone with the bare minimum level of training, you'd want someone who had the best training to be able to take care of your health.
posted by treehorn+bunny at 8:34 AM on July 4, 2014 [33 favorites]

Is there a "better" way to accomplish the goal of assisting women access care that is legal but not readily available in all areas?

Yes. Pick whatever career allows you to make the most amount of money with the least amount of money and immediately start pursuing it. Donate the money you make in excess of what you need to organizations such as Planned Parenthood, Center for Reproductive Rights, Guttmacher Institute, and Ipas.

I realize that you may feel compelled to "do it alone", as it were. However, the barriers to safe and legal abortion extend much further than just availability of trained physicians. There is a coordinated effort to attack abortion rights on a legal level, a political level, and a social level. Yes, physicians-to-be are discouraged from providing abortion, but they are also in many areas legally and practically prohibited from doing so even if they wanted to provide abortions. Until those legal/practical limitations are removed, it doesn't really matter how many qualified professionals are available - they can't perform abortions anyway.

I am a pragmatist, and I think your end goal is best achieved by indirect action. These organizations can use your money much more effectively than you can, and they can do so in a very targeted fashion. The opportunity cost of you going back to school includes the cost of tuition and the money you would have otherwise made during the years in school. A rough order of magnitude cost of an unsubsidized abortion is $500. Say you spend six years in school to become a nurse practitioner (four years for a BS Nursing and two additional years for a Master's) and you spend $60,000 in tuition for those six years. Say you would have otherwise made $50,000/year in a professional career. The opportunity cost for your nursing position is $360,000, which is 720 subsidized abortions. If that's your end goal, your best option is to fund those abortions rather than provide those abortions. It doesn't matter how many nurse practitioners are available who can provide abortions if they can't actually perform them legally or if the patients can't afford the abortions anyway.
posted by saeculorum at 9:04 AM on July 4, 2014 [10 favorites]

I often agree with saeculorum's point, but not in this case. You want to change careers. This is about your own life as much as your political beliefs . You want to be a caregiver under conditions that would scare others away. You have a unique motivation and a specific empathy to justify pursuing a career as a caregiver. Money is important, but not as important as people. If you feel a calling to be a nurse, there is no more noble or meaningful profession in the world. You will be sacrificing to do important work for which not nearly enough passionate people feel the calling you feel.

I say go to nursing school, but then I'm the son of a nurse.
posted by spitbull at 11:55 AM on July 4, 2014 [6 favorites]

Even though you're not interested in going to medical school, Medical Students for Choice might also have some good resources for you in addition to Nursing Students for Choice.

Good luck, and I hope you find a way to accomplish this!
posted by scody at 12:30 PM on July 4, 2014

I wonder if you could get some of the satisfaction you want by becoming an abortion advocate and teaching women how they can get or perform safe abortions without going through the medical system. But I don't know if it is legal to spread this kind of information or if it is legal for women to self-induce with the information you give them. I assume this varies by state.

There was recently a linked article on the blue which gave quite clear instructions on how to use pills to get an abortion, warning that not all on-line sources of the pills were reliable, but also giving the dosing and timing to take the pills. So the information is out there, but it appears it only goes out there when hidden in an article on something else.

It seems to me that if abortion is becoming illegal and you want to support women, one thing that would be extremely valuable for you to do is to teach them what doesn't work and what isn't safe. You don't need a medical diploma to do this and you could start doing it tomorrow.
posted by Jane the Brown at 1:13 PM on July 4, 2014 [1 favorite]

Is there a "better" way to accomplish the goal of assisting women access care that is legal but not readily available in all areas?

Have you thought about going at this from the angle of advocacy and policy work? Training in public health would allow you to work to increase women's access to care (through work for your state or federal government, an advocacy group, as a lobbyist for a law firm or lobbying group, as a consultant, etc), though you wouldn't be literally doing the abortions themselves. Since access to care is a political issue, I think that you might be better able to increase women's access to abortions through wrangling with the politics/policy rather than medicine.

Master in public health programs are considered "professional school," so the programs usually have fairly lenient admissions and large classes, and it may be possible to go part time while working -- but, they're also fairly expensive. Many people get it as a dual degree with an MD or JD, but frankly, I think that the MPH would be the degree that would get you the kind of (public health) job that you'd want.
posted by rue72 at 1:53 PM on July 4, 2014

There are many jobs that enable the work at clinics to continue. For examples, see Planned Parenthood's current list of employment opportunities. If it is important to you to be directly involved in patient care and to see and talk to the women you will be helping, the quickest way may be to become an ultrasound tech or a lab tech. Most clinics do blood testing for Rh factor and ultrasound to determine how far along the conception is to determine options (pill or surgical). It's pretty important that every interaction a woman has throughout her visit is supportive so these jobs are vital but they may not be as satisfying as you want them to be.

If you do some soul searching and find that women's health is what you need to be doing, nursing is definitely the way to go. It seemed that there were 5 nurses per 1 physician at the clinic I observed in. So you may or may not be the one performing the procedure but there will be plenty of involvement and patient interactions, plus you can work with women on other aspects of their health too!
posted by bobobox at 4:07 PM on July 4, 2014 [1 favorite]

The Hairpin had an 'Ask an Abortion Provider' article, wherein study pathways were discussed.

"Abortion training in this country is basically done by “apprenticeship” — if you’re an MD/DO, you’re supposed to learn in residency, but as we saw that doesn’t happen so often, so there are organizations like Medical Students for Choice to connect people to training or fellowships like the Ryan that you can take on in your own time. As a nurse practitioner (or a PA, or a midwife) what we’re allowed to do depends on where and when we’re practicing. We can provide medication abortion (mifepristone and misoprostol) in 15+ states but surgical abortion in far fewer, even though the actual procedure is exactly the same as other ones (like completing a failed miscarriage) that are solidly within our scope of practice almost everywhere. This is basically because the world is a vampire, sent to jail. The actual hands-on training is straightforward, because first-trimester surgical abortion is a very technically simple procedure. Completing 100 to 300 procedures is considered achieving competency, and the reason it takes that many procedures is because complications (like infection) happen so infrequently that it takes that many to see even a single one."

(The Hairpin's Interview with Dr. Susan Robinson, One of the Last Four Doctors in America to Openly Provide Third-Trimester Abortions is also great.)

Links: Medical students for choice | Nursing students for choice
posted by escapepod at 6:49 PM on July 5, 2014 [1 favorite]

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