J Fam Plann Reprod Health Care. 2017 Jan 18.

Vacuum aspiration for induced abortion could be safely and legally performed by nurses and midwives

Sheldon S and Fletcher J


Background: Some 40% of abortions carried out in England and Wales are done by vacuum aspiration. It is widely assumed that, in order to be lawful, these procedures must be performed by doctors.

Aim and design: This study aimed to provide a detailed reassessment of the relevant law and the clinical evidence that supports this assumption.

Conclusions: A close reading of relevant law reveals that this assumption is unfounded. On the contrary, it would be lawful for appropriately trained nurses or midwives, acting as part of a multidisciplinary team, to carry out vacuum aspiration procedures. This interpretation of the law offers the potential for developing more streamlined, cost-effective abortion services, which would be both safe and highly acceptable to patients.

Comment: Safe abortions can be carried out with a mifepristone-misoprostol combi pack, or by (manual) vacuum aspiration. The latter has the disadvantages that it is done in a center or clinic and that it may be a bit painful, but with the advantage that the whole procedure can be done immediately. This paper mentions again that a doctor is not needed, but that the aspiration can be undertaken effectively and safely by a nurse or a midwife. (HMV)