“You should really find a full-scope job,” or, the story of how I decided to be an abortion provider

I have recently accepted a (nearly) full-time position at a reproductive health clinic. They focus on well-woman care, birth control, STI prevention and management, primary care and abortion services. This means many things for me as a new midwife, namely that I won’t be doing what most people associate with midwifery: catching babies. 

I can’t lie, I went through a small mourning process knowing that my hands would not ease the pain of contractions and help bring new life into the world for the foreseeable future. This feeling was brief, as I know that I will have the privilege of expanding my skills by becoming an early abortion provider. At the clinic I will work for, Nurse Practitioners, Physician’s Assistants and Midwives provide medication abortions and assist with surgical abortion procedures.

When I asked for a recommendation recently, one of my beloved former faculty encouraged me to continue to search for a “full-scope” job, so I won’t lose my intrapartum (what we call labor and birth) skills. In her effort to encourage me to seek out a job that looks more similar to our common conception of midwifery, it made me feel as though I had failed in some way. I was choosing something less than “real midwifery.”

New graduate midwives are often warned, “Don’t accept anything less than a full-scope job, you’ll never go back.” Or, even worse, “When you try to find a job in full-scope you’ll be treated just like a new grad all over again and no one will hire you.” Do I know if either of those things are true or false? Absolutely not. I am just beginning this journey, knowing that my hands will welcome new babes into the world again, it is just not my path right now.  

But what I do know is that we must stop ranking full-scope midwifery and reproductive health care as if one is truer midwifery than the other. 

I did not fail to find a full-scope position. I found that as much as I am called to be a birth worker, I am just as excited to dive into the world of being an abortion provider.

I have many friends that are full-spectrum doulas: doulas who are birth workers, but who also provide doula support to women who are terminating pregnancies or placing children for adoption. Their philosophy is one that resonates deeply with me. They meet women where they are and act as emotional guides and witnesses through whatever outcome of a pregnancy the woman desires. 

When I think about the days that brought me the most joy in my training, most people assume that each birth I attended was an overflowing of joy. Although it was an amazing and humbling process, I felt my deepest joys in clinic. I could be found in exam room after exam room bursting with excitement to help a woman chose a birth control option or feeling so honored when I was trusted enough to share in potentially embarrassing questions about sex and pleasure and be able to discuss her concerns in a non-shaming, sex-positive way. 

I think about being an abortion provider, and know that the joy will be different than with births. I know how monumental birth is for families, and the same gravity lies with abortion work. I know that the work I will do will be a thousand times more powerful than the anti-choice protesters I will face every Saturday morning.  I cannot think of a thing that is truer to the midwifery spirit than to be able to be a resource in a difficult time, provide a vital and life-saving service, and literally hand a woman back her vision of her life. 

I start next Monday, first in orientation and my first day of clinic next Friday. Tune in for the beginning of my transition into full-blown independent practice! 

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