Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver

Abstract

Objectives: We examined the impact on patient safety if nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) were permitted to provide aspiration abortions in California.

Methods: In a prospective, observational study, we evaluated the outcomes of 11 487 early aspiration abortions completed by physicians (n = 5812) and newly trained NPs, CNMs, and PAs (n = 5675) from 4 Planned Parenthood affiliates and Kaiser Permanente of Northern California, by using a noninferiority design with a predetermined acceptable risk difference of 2%. All complications up to 4 weeks after the abortion were included.

Results: Of the 11 487 aspiration abortions analyzed, 1.3% (n = 152) resulted in a complication: 1.8% for NP-, CNM-, and PA-performed aspirations and 0.9% for physician-performed aspirations. The unadjusted risk difference for total complications between NP-CNM-PA and physician groups was 0.87 (95% confidence interval [CI] = 0.45, 1.29) and 0.83 (95% CI = 0.33, 1.33) in a propensity score-matched sample.

Conclusions: 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.

FIGURE 1—

Landscape of health professional regulation of abortion provision in the United States. Note. CNM = certified nurse midwife; NP = nurse practitioner; PA = physician assistant.

FIGURE 2—

Unadjusted, adjusted, and adjusted propensity score–matched risk differences in overall complication rates of first-trimester aspiration abortion by nurse practitioner, certified nurse midwife, and physician assistant providers compared with physician providers in California. Note. CI = confidence interval. Both adjusted models included patient age, race/ethnicity, insurance type, gestational age, gravidity, history of cesarean section, positive test for a sexually transmitted infection, an indicator for extreme obesity, an indicator for chronic illness, and an indicator for psychiatric conditions. 2.0 is also the delta.