California is Legally Ready for Midwives to Provide Abortions, But There’s One Problem

Nurses who are trained as midwives in California are scrambling to find more training so that they could provide abortions. Ariela Schnyer chose to be a midwife in California because of the state’s leniency in allowing them to end pregnancies. But three years after graduating from the nurse-midwifery program at UC San Francisco, Schnyer is still fully prepared to provide abortions. 

When the Supreme Court overturned Roe v. Wade, people realized that many would be coming to California from surrounding states. Nurses like Schnyer began thinking that they might need to go to Mexico City to receive the training she needs. 

“It feels frustrating to have that theoretical training, but not be able to jump into the gaps that are going to be here,” she said.

The political leaders of California have declared that their state will be a haven for abortion patients. Researchers at UCLA have projected that between 8,000 and 16,000 move people will come to California in a year for abortions. 

California to be Haven for Abortions

But this will be hampered by the limited training that is being made available so that a clinician can legally provide the procedure. Nurses and midwives from across the state have reported that there are very few opportunities to be trained and the obstacles to that training are steep.

Debbie Bamberger is a nurse practitioner and a board member of Training in Early Abortion for Comprehensive Healthcare. She said that many people have come to the state to become clinicians thinking that they would become abortion providers, but there was no training available to them.

This is intensified because obstetrician-gynecologists are supposed to get abortion training in their medical residencies, but residents can choose to opt-out. In fact, one-fifth of family medicine programs in California routinely offer “opt-out” options in their programs. 

The executive director of TEACH, Flor Hunt, said that if this training is not covered in medical school, physicians are probably going to enter residency with very little to no education regarding abortion. 

“And then if your residency program doesn’t have a meaningful abortion rotation, your chances of then being able to get abortion training are very low,” Hunt said.

The law in California allows for nurse practitioners, physician assistants, and certified nurse-midwives to provide abortions using suction early in pregnancy. This is also called aspiration abortion.

Education programs have been able to provide training in lectures, but have not been able to provide hands-on experience. 

This was Schnyer’s experience. She had a chance to practice with tools used in early abortions on a papaya. But she did not have the opportunity to observe procedural abortions. 

“It is kind of frustrating to leave school without that skill under my belt, in terms of actual clinical training,” Schnyer said. So now she is looking into training at a clinic in Mexico. 

Dr. Katrina Heyrana, a fellow in family planning at County-USC, believes that the recent Supreme Court ruling has “galvanized” doctors from various specialties. 

And the new state budget includes $20 million for the health service corps. It also includes an additional $20 million for scholarships and loan repayment to healthcare providers who commit to providing reproductive healthcare services.

Dr. Heyrana is projecting there will be a bottleneck in training both in-state and out-of-state doctors. 

“We need to train our residents to feel comfortable in providing this care — and now have the added burden of having to train residents in probably over half the country,” Herana said.

It is worth considering why so many people who have been trained to care for the life of people have chosen not to be trained to end pregnancies.