title: Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver.
abstract: OBJECTIVE
  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.
authors: Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, CA 94612, USA. weitzt@obgyn.ucsf.edu
authors: Tracy A
authors: TA
authors: Weitz
authors: Diana
authors: D
authors: Taylor
authors: Sheila
authors: S
authors: Desai
authors: Ushma D
authors: UD
authors: Upadhyay
authors: Jeff
authors: J
authors: Waldman
authors: Molly F
authors: MF
authors: Battistelli
authors: Eleanor A
authors: EA
authors: Drey
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects* / Q000331:legislation & jurisprudence / Q000379:methods; D000293:Adolescent; D000328:Adult; D002140:California; D005260:Female; D006801:Humans; D009721:Nurse Midwives / Q000331:legislation & jurisprudence; D009722:Nurse Practitioners / Q000331:legislation & jurisprudence; D061214:Patient Safety; D010823:Physician Assistants / Q000331:legislation & jurisprudence; D011247:Pregnancy; D057216:Propensity Score; D011446:Prospective Studies; D014619:Vacuum Curettage / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000379:methods; D055815:Young Adult