In the International Confederation of Midwives’ handbook Essential Competencies for Basic Midwifery Practice, abortion-related care is mentioned briefly at the end of the section on Competency #5 on Post-partum care. It states that as an additional skill in providing post-partum care, the midwife should have the skill and/or ability to:

• perform manual vacuum aspiration of the uterus for emergency treatment of late post-partum haemorrhage.

Thus, abortion is important as a form of emergency obstetric care, which should be available in case of need for every pregnant woman.

Competency #7 in the handbook is devoted to abortion-related care. The handbook says:

Midwives provide a range of individualised, culturally sensitive abortion-related care services for women requiring or experiencing pregnancy termination or loss that are congruent with applicable laws and regulations and in accord with national protocols.

Knowledge

The midwife has the knowledge and/or understanding of…

• policies, protocols, laws and regulations related to abortion-care services
• factors involved in decisions relating to unintended or mistimed pregnancies
• family planning methods appropriate for use during the post-abortion period
• medical eligibility criteria for all available abortion methods
• care, information and support that is needed during and after miscarriage or abortion (physical and psychological) and services available in the community
• normal process of involution and physical and emotional healing following miscarriage or abortion
• signs and symptoms of sub-involution and/or incomplete abortion (e.g., persistent uterine bleeding)
• signs and symptoms of abortion complications and life threatening conditions (e.g., persistent vaginal bleeding, infection)
• pharmacotherapeutic basics of drugs recommended for use in medical abortion
• principles of uterine evacuation via manual vacuum aspiration (MVA).

Basic skills and/or abilities

• assess gestational period through query about first day of last menstrual period (LMP), bimanual examination and/or urine pregnancy testing
• inform women who are considering abortion about available services for those keeping the pregnancy and for those proceeding with abortion, methods for obtaining abortion, and to support women in their choice
• take a clinical and social history to identify contraindications to medication or aspiration abortion
• educate and advise women (and family members, where appropriate), on sexuality and family planning post abortion
• provide family planning services concurrently as an integral component of abortion-related services
• assess for uterine involution; treat or refer as appropriate
• educate mother on care of self, including rest and nutrition and on how to identify complications such as haemorrhage
• identify indicators of abortion-related complications (including uterine perforation); treat or refer for treatment as appropriate.

Additional

• prescribe, dispense, furnish or administer drugs (however authorized to do so in the jurisdiction of practice) in dosages appropriate to induce medical abortion
• perform manual vacuum aspiration of the uterus up to 12 completed weeks of pregnancy.

SOURCE: Essential Competencies for Basic Midwifery Practice (2010, revised 2013)  Due for review in 2016.

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In the International Confederation of Midwives’ handbook on Standard Equipment List for Competency-Based Basic Skills Training in Midwifery Schools, the following are the only items listed in the various categories that are specific to abortion:

Medicines (as allowed per country-based Essential Medicines List)

• Under uterotonics: misoprostol
• Mifepristone (listed as optional)

Equipment

MVA kit (can obtain from Ipas as MVA Plus (reusable)

Books, Manuals and Videos

• Woman Centered Abortion Care (W-CAC) and/or Woman Centered Post Abortion Care (W-PAC) manual (Contact Ipas)

• Medical Abortion Training Curricula and IEC resources for providers and women (Contact Ipas) (optional/additional)

SOURCE: Kyei AA, Dennis-Antwi JA, Ibinga Koula R, Azfar P. (2012). ICM Standard Equipment List for Competency-Based Basic Skills Training in Midwifery Schools: A Reference Guide for practical skills teaching. ICM/UNFPA Investing in midwives and others with midwifery skills Programme (IMP). 2012.

Lastly, in the International Confederation of Midwives’ curriculum for midwifery training, in Level 2 of the curriculum, that is, in the second six months, midwives should receiving training in the following skills/abilities: unintended pregnancy, medical eligibility criteria for early termination of pregnancy, laws and regulations related to abortion care services, spontaneous abortion, incomplete abortion, uterine involution and sub-involution, pregnancy loss/bereavement, and in Level 3, in the third 3rd six months, training should cover complications, including complications of induced abortion. [Competency 7]

SOURCE: ICM Model Curriculum Outlines for Professional Midwifery Training, Resource Packet #2

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