Maine Won’t Let Nurse Practitioners Perform Early Abortions, and It’s Harming Our Patients — So I’m Suing

From the time I was in college, I knew two things: I wanted to be a nurse practitioner, and I wanted to be an abortion provider. As the stepdaughter of a Maine abortion provider, and then a patient advocate at a Maine abortion clinic, I’d seen firsthand the importance of high-quality, comprehensive reproductive health care. I saw the challenges and protestors, too, but that didn’t deter me—I couldn’t imagine a more fulfilling career.

Today, I’m proud to say that I am a practicing nurse practitioner and that I had the gratifying experience of providing safe, compassionate abortion care while living in California. And now that I’m back in Maine, I provide my patients at Maine Family Planning with a range of reproductive health services, including inserting intrauterine contraceptive devices (IUDs) and performing colposcopies, which involve very similar skills as first-trimester abortion care.

I was also one of the first two nurse practitioners trained to help provide medication abortion care through Maine Family Planning’s telemedicine program, and I’ve been safely doing so since 2015. I provide every element of patient care both before and after a physician authorizes the patient, via video conference, to swallow the first of two pills that together end an early pregnancy. (The patient takes the second set of pills at home.)

But even though I safely provided abortion care in California, regularly perform procedures in Maine that are comparable to first-trimester abortion, and provide all of the in-clinic care for patients receiving a telemedicine abortion, Maine law bans me from performing abortions because I’m a nurse practitioner. As a result, I’ve been forced to send away patients in desperate situations, even though I am trained, qualified, and more than willing to provide the care they need.

Fortunately, with the help of the ACLU, I’m fighting to change that.

Our lawsuit challenges a provision in Maine law that requires abortions to be performed solely by physicians and blocks qualified nurse practitioners and nurse-midwives from doing so, despite our rigorous training and extensive clinical experience. Abortion is the only healthcare service singled out in this way.

These harms are not hypotheticals.

Medical authorities and peer-reviewed studies agree that advanced practice clinicians are qualified to provide early abortion care. In fact, advanced practice clinicians have been safely providing abortion care in states across the country — from California to Montana to Illinois to New Hampshire — for years and, in some cases, decades.

But the problem isn’t just that this law is preventing me and my colleagues from providing services that are well within our scope of practice — it’s also harming our patients.

Maine is the most rural state in the country, and the physician-only law severely restricts where and when patients can obtain an abortion. Because of this restriction, women must needlessly travel for hours — and pay for transportation, child care, and time off work that many of my low-income patients cannot afford — rather than getting care from a trained and competent provider in their own communities.

There’s a saying in Maine, reflecting our expansive geography and abysmal public transportation: “You can’t get there from here.” For some patients who need abortion care, particularly in the middle of a snowy Maine winter, that is the sad truth.

Moreover, because of this restriction, abortion care is generally only available in any given location in Maine one or two days of the week. For a patient in a low-wage job with no paid time off, or with significant childcare obligations, this is a serious problem.

These harms are not hypotheticals.

Just last month, I received a call from a patient who needed an abortion and wanted to come into Maine Family Planning’s Presque Isle clinic for care. I was there that day and ready to assist with a telemedicine abortion, but we simply could not find a doctor who was available by video conference. So even though I am qualified to provide this care, and we had the medication on site, the patient’s abortion was delayed by 14 days. To make matters worse, she had to make a five-hour round-trip to Bangor to get care. The state simply has no justification for harming Maine women in this way.

I care about this issue dearly. Time and again, my life experiences have affirmed for me that women need to be able to make our own decisions about pregnancy and parenting — and have access to health care to see those decisions through. My own journey to parenthood was a difficult one that included multiple rounds of IVF, miscarriages, and more anxious and sleepless nights than I can count. That experience only strengthened my resolve that women should be able to control our reproductive destinies, no matter what we decide.

And whatever a woman decides — to become pregnant, to continue a pregnancy, or to seek an abortion, she should have access to quality care from a provider in her community. I’m fighting to make that a reality.

View comments (37)
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TCA-B

The issue is that you are reading this from the frame of your own bias and prejudice, concentrating only on what you see as wrong for yourself and not, as this is written in full, as a healthcare provider responding to the challenges and struggles of her patients in their context and their own need. This is the absolute model of what we need more of in our system...practitioners acting for their patients and fully committed to their needs as human beings.

Sharon Presley

Good for you! Keep up the good fight. Thank you for what you are doing.

Margaret, PA-C

Julie, please ignore the trolls and their judgemental religiosity. Particularly, the men who think they have a right to control a woman's reproductive decisions.

Interesting story. Years ago I worked with an RN who stated unequivocally that she would NEVER work in a an abortion clinic.

Fast forward 10 years later and I reconnect with her through social media. Turns out that in the interim, she got pregnant and found out the fetus had a horrific genetic abnormality. I do not recall specifically what it was. She ended up terminating the pregnancy. She admitted to me that she now had a far greater appreciation for women's rights having gone through that experience. She was no longer so judgemental.

The lesson here, folks, is you cannot comprehend the enormity of a situation until you are actually in it.

We all care for patients whose lifestyles or morality we may not agree with.

Don't agree with abortion? Don't have one, and don't work in a clinic that provides them. But please lose the arrogance. You are not the final judge and jury of others. For the religious here, you do not know the mind of God. No one does.

Sarah

I'm so proud of the work you're doing, and of taking a stand against this unfair and dangerous laws. Especially in states where many folks live in smaller communities, being able to offer telemedicine and access to care with nurse practitioners is so crucial. Being able to have more carers support full spectrum reproductive healthcare is crucial for people who can get pregnant.

Thank you for your hard work and bravery, standing up during these trying times. We're with you.

And all those concern trolls popping up - I've seen far more damage to lives of patients from healthcare denied or delayed. Stop your faux fretting. We know you don't care about individual women, and we also know that when you and your families show up in our clinics we'll support you in getting the healthcare you want regardless of how you vilify us.

DB COOPER

Delighted by your dedication and compassion. Wishing you and your patients all success in the forthcoming battles. I really don't understand why abortion is such a polarizing issue, have been an advocate for female reproductive rights all my adult life. Even before my then girlfriend got pregnant (carelessness on both our partsand quickly and undramatically had an abortion. Good luck. All the best, DB COOPER

Anonymous

I am bemused by the stance of those opposed to early term abortion: they only discuss how having an abortion may harm the mother psychologically, and appear to have an endless store of pity for the embryo. No one ever mentions the fate of the "forced to be born." How often are they condemned to, at best, a life of hunger and misery in the slums. How many unwanted babies are locked in closets for years, burned with cigarettes, beaten unmercifully, even molested as infants? In some undeveloped parts of the world very young "surplus" babies are routinely sold into the sex trade. I have been at clinic defenses where the abortion foes show up with grizzly photos of supposed "real" abortions. It has always disgusted me, but I am glad to say that so far, we on the legal abortion side of the argument have never resorted to displaying the horrible fate of many unwanted babies. The anti-abortion people seem absorbed with the adult women's concerns; they never show pictures or discuss the fate of the "millions of babies" they have left to their pitiful fate.

Another proud n...

Well done Julie! I’m proud of you and your work. You’ve inspired to move forward on the deal I made with myself when Brett Kavanaugh was appointed to the Supreme Court. I believe bringing safe healthcare to women when they need it most, is a tenant of our profession.
What all you haters don’t understand is no woman takes this decision lightly. Why don’t you all start providing free daycare, preschool, and after care to women? Why don’t you help them in an effective way instead of wasting your time bullying and threatening. If you want to make an impact, make child rearing easier for your fellow Mainers! Seems to me that’s the real Christian thing to do.
Julie, you’re an inspiration, thank you for commitment to women’s health!

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