Implementation and education requirements will likely be finalized late 2026 to early 2027. For further information on regulation, please refer to the BCCNM; for further information on navigation and advocacy, please refer to the MABC.

Education and training for midwives will likely consist of completing an approved course and subsequent certification. This may include existing courses for medical abortion providers, such as those offered by the SOGC, NAF, and McMaster University. Please find links to these courses in our “Resources for Midwives” section. Training and access to POCUS will also be important for midwives to confirm the location of a pregnancy without delaying abortion care.

Yes, abortion care will likely be added to the core competencies for BC midwives, and incorporated into the UBC midwifery program curriculum. All midwives and midwifery students will be required to learn about medical abortion care, even if they are not planning to prescribe Mifegymiso for a variety of reasons. Please note that abortion is already included in the Canadian Association of Midwives (CAM) and the International Confederation of Midwives (ICM) definitions of midwifery scope of practice.

Compensation models have not yet been decided for rural and urban care. With this in mind, the BCCNM and MABC are aware of the extra time and effort midwives will be putting into this additional care. Please stay tuned for more information from governing bodies.

Open-ended conversations with clients are always required and recommended when someone enters care. Instead of assuming someone is seeking midwifery care for a continuing pregnancy, it is important to ask people how they feel about being pregnant and be prepared for the answer to be any number of options. You might consider being vocal about your provision of abortion care services or you may choose not to disclose this publicly. You might consider using non-descriptive signage including: “Ask us about your choices” and having inclusive artwork that does not isolate people seeking to end a pregnancy, whether this is an easy or difficult decision. Please make sure you prioritize your own safety and client safety, whatever this means in your context.

This is unlikely to negatively impact clients choosing to continue their pregnancy to term. Sexual health choice benefits every person in midwifery care, as it increases midwives’ knowledge in sexual health, decreases the need for referrals, increases access to timely care, particularly in a rural context, and acknowledges the spectrum of choice. There may be discomfort from some clients in knowing their midwife provides abortion care. Increasing the public knowledge of abortion care as a spectrum and knowing quick facts about abortion can help destigmatize the process and welcome people with all viewpoints into care. Additionally, you may choose not to disclose your provision of abortion care for this reason.

After this scope expansion rolls out, there will be midwives who choose to prescribe mifegymiso, those who are only comfortable prescribing for missed miscarriage, and those who choose not to prescribe. It is important to acknowledge the value of all members of the care team, whether or not they provide abortion care. It is important to maintain good professional relationships among one another because people of varying viewpoints will always exist in both midwife and client populations. This is also a good reminder to check in with yourself about your viewpoints and values and how you can stay true to yourself while honouring your colleagues’ varying opinions and most importantly, keeping client safety at the forefront of your considerations.

Yes! Low-touch or No-touch abortion care increases access to services for rural and remote communities. Midwives will likely have the ability to provide virtual medical abortion to capture the folks that don't have access to midwifery care in their communities. There is also the potential for development of a resource similar to CHARLiE or MABL specifically for abortion care, which would facilitate terminations in remote communities and significantly reduce costs associated with clients needing to leave their community for procedural abortions/advanced care.

There is currently not enough post-pregnancy care provided for medical abortions; however, midwives have the ability to close this gap through continuity of care. Midwives are uniquely well-positioned to provide excellent abortion care through 24/7 pager coverage, allowing us to support people through what they are experiencing, what is normal/abnormal etc. The follow-up for medical abortion care differs from routine midwifery postpartum care. What is an appropriate follow-up, where these check-ins take place, and how many appointments are required, will likely vary depending on the client and their circumstances. While some clients will appreciate close monitoring and in-depth discussions, others will want to move on quickly. Often, this care sits with people in a deep way, and for a long time, similar to the care that people receive in pregnancy and birth. Consider follow up six weeks later to see how the person is doing, and check-in regarding contraceptive methods.

No, this is not included in the scope expansion. Midwives will continue to refer their clients to other providers for these services.

In the case of complications related to abortion, midwives will most likely consult the OB on-call at their local hospital, or a trusted OB in the community. Midwives can also accompany their clients to the Emergency Room (ER) if appropriate. Particularly in rural communities, it will be important to reduce interprofessional tension by making sure all providers are on board and understand the context so that the client will be well-received.

As midwives, we have the ability to help people feel supported and safe, and shape their experience of care in a positive way. It is important to recognize that having an abortion is not necessarily an easy decision, and it comes with a lot of stigma. Practice compassion for all clients and be open, neutral, and non-judgemental in your approach. In an initial appointment or phone call, always ask people how they are feeling about their pregnancy instead of assuming that they are happy to be pregnant. Read the client’s body language and responses throughout your conversation, and offer to stop at any time. Provide clear and evidence-based information only, and dispel myths or misconceptions when they arise. Be honest when you don't know something, and offer to look it up together or find out the answer and get back to them. In history taking, if someone discloses an abortion or any trauma around that, ask if they want that documented in their medical record or not. It can also be helpful to clarify confidentiality — no one needs to know except the client and midwife, and medical abortion can look like miscarriage if that is what the client needs. Try different language where appropriate — see the definitions section on this website for more.

This is a great question! Midwives and team members who do not want to prescribe mifegymiso can still be involved in many ways, which consist of skills you already have and skills you may soon acquire:

• ordering initial bloodwork based on SOGC recommendations

• performing POCUS for pregnancy location confirmation or ordering a first trimester ultrasound, if indicated

• performing sexual health screening, including pap tests and screening for STBBIs

• using compassion, cultural safety, and an open mind to have hard conversations

• referring to appropriate resources who can provide comprehensive abortion care in a timely manner