NRL News

UCSF Study Strains to Show Non-Physicians Qualified to Perform First-Trimester Surgical or Suction Aspiration Abortions

by | Feb 20, 2013

By Randall K. O’Bannon, Ph.D., NRL-ETF Director of Education & Research

Tracy A. Weitz, PhD, Lead author

Tracy A. Weitz, PhD, Lead author

The abortion industry has had a major problem for a number of years.  There are fewer and fewer doctors who want to get in the business of killing unborn babies. That’s not why they went to med school.

They’ve tried everything. They’ve tried making abortion training mandatory at U.S. medical schools, making abortions seem “easier” with chemical methods like RU-486, and launching web-cam abortions to virtually spread one abortionist around to several satellite locations. But the core problem remains–not enough doctors are signing up to do abortions at medical schools to keep the abortion clinics running at peak killing efficiency.

What to do? Expand the pool of personnel who are eligible to perform abortions. Sounds risky to women, doesn’t it? It should.

Count on the folks at University of Southern California-San Francisco (UCSF), America’s abortion training academy, to leap to the rescue with a new study. In their study appearing in the current issue of the “American Journal of Public Health,” they claim that first trimester surgical or suction aspiration abortions can be done just as safely by nurse practitioners, certified nurse midwives, and physician assistants as they can be by doctors.  If enough doctors can’t be corralled into performing abortions, the folks at UCSF seem to reason, expand the pool by enlisting and training non-physician “providers.”

NRL News Today readers will recall that USCF has been involved in abortion training and research since the 1960s. Many of the nation’s leading abortion advocates and researchers can trace their roots back to the school. 

UCSF is responsible for abortion training not only there in San Francisco, but across the U.S. It coordinates 58 Kenneth J. Ryan Residency Training Programs in Abortion and Family Planning from its Bixby Center for Global Reproductive Health – the exact same center from which the lead authors of this latest study hail. (For more on UCSF’s history of abortion advocacy, see NRL News Today 5/28/10 and our five part series starting 1/3/13.)

The latest study, “Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver,” appears in the March 2013 edition of the “American Journal for Public Health.” A research team headed by Tracy Weitz persuaded the state of California to approve a plan whereby they trained 40 nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) from four Planned Parenthood affiliates and from Kaiser Permanente of Northern California to perform suction aspiration abortions.

After training was completed, researchers compared their complication rates to the complication rates of 96 physicians with an average of 14 years experience who perform abortions.  All told, 11,487 abortions were tabulated in the study, with about half (5,812 for physicians, 5,675 for the NPs, CNMs and PAs) performed by each group.  

Not surprisingly, the conclusion of the authors was that “Abortion complications were clinically equivalent between newly trained NPs, CNMs and PAs and physicians, supporting the adoption of policies to allow these providers to perform early aspirations to expand access to abortion care.”

Equally unsurprising, the actual data is less definitive.  As a group, the number of complications for the NPs, CNMs and PAs were almost exactly twice (100) what they were for the abortion doctors (52).  Researchers glide over this by noting that numbers of “major complications” were equal for both groups (a total of six–twp uterine perforations, three infections, and one  hemorrhage spread between the two groups). The difference, they point out, was really in “minor complications” (97 for the NP, CNM, PA group, 49 for the physicians).

That there were complications at all will surely come as news to a lot of women who had come to think of abortion in the modern age as “safe” and “simple,” but it is not clear that all these “minor complications” were all that minor.  They may have met the clinical definition UCSF set for “minor” in being treated at home or in an outpatient setting, but some of the ones reported sound potentially significant.

They included 33 “incomplete abortions” (24 among NPs, CNMs and PAs), 18 “failed abortions” (11 among NPs, CNMs and PAs ), 19 with hematometra (retention of blood in the uterus, 16 among NPs, CNMs and Pas), along with cases of infection, endocervical injury, anesthesia-related reactions, and “uncomplicated uterine perforation.” Other “minor” complications UCSF counted included “symptomatic intrauterine material,” urinary tract infection, “possible false passage,” “unspecified allergic reaction,” “fever of unknown origin,” “inability to urinate,” and “sedation drug errors.”

It should not be overlooked that these were under more controlled study conditions. The report does not specify, but gives indication that there was a doctor close by when at least some of these NPs, CNMs and PAs were performing their abortions.  Out in the real world, in less populated, lighter staffed clinics, it isn’t clear whether this sort of backup would be immediately available.

It should also be noted that 30.5% of the patients participating in the study never came back to fill out follow-up surveys. Researchers counted them in the study anyway. They said that 41 of those patients did contact the facility when they experienced a complication and that what they “discovered via medical chart abstraction” suggested “a low likelihood of missing complications among this group.” 

Especially in light of the low follow up rate, it is important to note that researchers give no indication that they considered an alternative explanation:  that these women, rather than returning to the abortion clinic where they were injured, may have instead sought help from a local emergency room or their own personal physician.

Of course, what appears to have mattered most to the UCSF team was not the women who were hurt or the 11,487 babies or more who lost their lives, but the fact that they now had published evidence to use in the cause of championing the cause of getting states to allow non-physicians to perform abortions.  Currently, there are four states–New Hampshire, Vermont, Montana, and Oregon–where non-physicians can legally perform surgical abortions.  There are some other states, the study says but does not specify, that allow non-physicians to perform “medical” (chemical) abortions, but not aspiration (surgical) abortions.

The researchers in this study aim to change that. They even argue that under the coming health care reform (ObamaCare), they expect demand for health care services to increase. They suggest that one way to meet that demand is “allow all qualified professionals to perform clinical care to the fullest extent of their education and competency.”

If this policy goes through, there are serious questions about what the consequences will be to women’s health.  There is little doubt, however, that more unborn children will die.

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Categories: Abortion