Let Midwives and Nurse Practitioners Provide First-Trimester Abortions, Says Federal Court

"First trimester abortions, which typically require only medication, do not require the onsite presence of a licensed physician."


As Georgia, Ohio, and several others states move to ban abortion after a few weeks of pregnancy, Virginia this week brings us a rare bright spot on the reproductive freedom front. A federal judge there just ruled against the state's mandate that only physicians can prescribe abortion pills or otherwise provide first-trimester abortions. And the decision, from U.S. District Judge Henry E. Hudson, could have influence across the United States.

Virginia is one of 34 states that have said only physicians can perform first-trimester abortions, even though "a consensus appears to have evolved" that this is medically unnecessary, as Judge Hudson puts it in his May 6 decision.

This makes the U.S. District Court for the Eastern District of Virginia "the first federal court to strike down a law prohibiting advanced practice clinicians from providing first-trimester abortion care," says the Center for Reproductive Rights (CRR), which represented the groups challenging the Virginia law. Their lawsuit was filed in June 2018 and the district court heard arguments on April 8.

"We are challenging these laws in several other states and hope those courts will follow Virginia's lead," says CRR attorney Jenny Ma.

The Virginia law exempted only physicians from the state's general criminal ban on abortion, and thereby excluded "advanced practice clinicians" such as nurse practitioners and certified nurse midwives from being able to legally provide abortion services.

"There appears to be no controversy between the parties that [advanced practice clinicians] are competent and capable of performing first trimester abortions less expensively in a non-hospital setting," writes Hudson. Nor is there any "genuine issue of material fact as to whether the Physician-Only Law poses a substantial burden on a woman's access to first trimester abortion care."

In addition, Hudson writes, "both parties agree that the constitutionality of the abortion restrictions at issue in this case must be reviewed by applying the undue burden test articulated by the Supreme Court" in Planned Parenthood v Casey. He explains:

The Court in Casey reaffirmed a woman's right to terminate a pregnancy prior to viability. It also recognized a state's legitimate interest in ensuring that abortion is performed under circumstances that ensure the maximum safety for the patient. The Court in Casey, however, emphasized that "a statute which, while furthering…[a] valid state interest, has the effect of placing a substantial obstacle in the path to a woman's choice cannot be considered a permissible means of serving its legitimate ends." The Court defined an undue burden as "shorthand for the conclusion that a state regulation has the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a non-viable fetus."

The judge notes that "as with any medical procedure, the State may enact regulations to further the health or safety of a woman seeking an abortion." But Virginia's physicians-only law, he says, goes beyond that. "After a careful review of the experts' opinions from both sides, a consensus appears to have evolved that first trimester abortions, which typically require only medication, do not require the onsite presence of a licensed physician." The law "is consequently unduly burdensome."

The judge didn't give the plaintiffs everything they wanted: He denied their motion for summary judgement with regard to the physician-only law's restrictions on second-trimester abortions. On several other state regulations related to first- and second-trimester abortion, the case will continue to a trial.

NEXT: He Helped Reveal How U.S. Drone Strikes Were Killing Innocents. The Feds Just Charged Him With Espionage.

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  1. Another example of the only medical practice that has it’s own right to not be regulated. Will this apply to any other medical regulations? Surely not.

    1. Ear Piercing and Teeth Whitening are more tightly regulated than baby killing


        Weird that you need parental permission for a child to get an aspirin but NOT for them to get an abortion.

      2. In what state do you need an MD to pierce ears?

      3. I agree that that’s ridiculous. These abortifacient drugs should be available over the counter.

        1. They are. They’re called cigarettes and booze. Also, what’s the value on a boyfriend that will push your pregnant ass down the stairs? Priceless.

      4. Really? You can get your ears pieced at any shopping mall and you can buy tooth whitener at the grocery store. The reality is that abortions are an over regulated medical procedure. Abortions are an outpatient surgical procedure. You don’t have to wait 24 hours for most other outpatient procedures. You don’t have to have an ultrasound for most other procedures. You don’t have to listen to a script written, not by medical professionals, but by a bunch of legislators. If your less regulation then abortions is a great place to start cutting.

        1. Murder is also overregulated. Heck, pretty much only the government can do it without getting in trouble.

          …Kinda like abortion, for some reason.

  2. More freedoms to allow “Midwives and Nurse Practitioners” to serve customers? You do NOT have to be a 50,000-year-old Philosopher King with 20 PhD’s to perform or prescribe a first-trimester abortion or abortion pill? Hooray for increased freedom, yeah!

    Now WHEN will “Midwives and Nurse Practitioners”… Maybe even high school grads or drunks under the bridge? … Be authorized to authorize me to BLOW ON A CHEAP PLASTIC FLUTE, fer Chrissakes?!??!

    To find precise details on what NOT to do, to avoid the flute police, please see http://www.churchofsqrls.com/DONT_DO_THIS/ … This has been a pubic service, courtesy of the Church of SQRLS!

  3. The states should decide whether a woman should get an abortion, not the federal government.
    After all, aren’t the states allowed to determine if they want the death penalty or not?

    1. No, the woman should decide.

      1. What about the rights of the fetus? Are xe’s or zhe’s liberty interests not to be considered?

        1. Children don’t have the same rights as adults. Babies don’t have the same rights as children. Fetuses . . . well, you get the picture.

          1. Fetuses, if threatened by an abortion doctor, should have the same rights as you and I have (mostly, any more, whatever scraps of freedom that Government Almighty still allows to drop from the edges of the table, to us, the doggies under the table)… The right to perform well enough work-wise to get and retain a job, earn some money, then buy some knives or guns or other methods of self-defense… And DEFEND themselves against abortion doctors or other hostile elements!!!

            Most fetuses that I have known… Cletus the Fetus comes to mind… Are SLOUCHES on these matters, so, what can you do to help those who REFUSE to help themselves?!?!

        2. A fetus should get no rights until it becomes a person. As to when that is is up for debate. But it’s definitely not in the first trimester.

          1. And you get to define who is and is not a person, I guess. Been done before.

            Blacks were not considered full people and now they are.

            By every scientific standard fetuses are living human beings entirely separate from their mothers. And yes, I’m a physician, so I know what I’m talking about.

            1. If they are entirely separate then put the fetus in an orphanage until someone adopts

              Oh wait, you can’t because they aren’t separate at that stage of development

              1. If invite you out to sea on my boat to go fishing, do I owe you a safe trip back or not? If I kick you off my boat 100 miles out into the ocean, have I murdered you or not?

                1. Only if you rip him limb from limb and throw the pieces out a porthole

          2. Because “person” is an easily defined term, while “living human” is really hard.

            After all, it’s always good to have legal (or moral) definitions based upon vague terms instead of concrete ones. I can foresee no negative ramifications from that.

        3. Unfortunately a choice has to be made here. Who gets to set priorities. Does the fetus’ rights supersedes the women’s? I giving it to the women. They are the closest to the decision and so in the best position to make the decision.

  4. The “prochoice” talking points have certainly evolved. Remember “abortion is a decision to be made by a woman in consultation with her doctor?”

    This poor sap is still echoing that talking point:


  5. Judge Hudson is the worst sort of Bush league “law and order and innocence be damned” Republican.

    “In what Hudson described as a “career-defining case”, he prosecuted David Vazquez, a mentally retarded Arlington resident, for a 1984 rape and murder….Vazquez, who had already served 5 years in prison, was exonerated by Hudson’s successor. Faced with the evidence of wrongful conviction, Hudson wrote of Vazquez in his memoirs: “I certainly wish him the best, and regret what happened. However I offer no apologies….

    ” he was named by the Reagan Administration to lead the Attorney General’s Commission on Pornography (the so-called Meese Commission).”

    He was director of the U. S. Marshal’s Service – “According to a Congressional report on the Ruby Ridge incident, “based on his desire to avoid creating discoverable documents that might be used by the defense in the Weaver/Harris trial and his understanding that the FBI would conduct a comprehensive investigation of the incident, [Hudson] decided to conduct no formal internal review of USMS activities connected with the Weaver case and the Ruby Ridge incident.””

    (Shall I praise him for ruling against Obamacare? What does he want, a cookie? Republicans aren’t *supposed* to uphold Obamacare, you low-expectation-having motherfucker)


    1. What a parasite.

      All that time in the public sector. No wonder he cares not about the rights of the fetus. Those that devote themselves to a lifetime of taking tend not to care much about others.

    2. you low-expectation-having motherfucker

      +1 Chris Rock.

  6. Since physicians are supposed to swear an oath to “do no harm”, it seems like somebody else would have to anyway.

    1. You should call the local medical society and inform them of your position. The doctors surely would also wish to benefit from your views on chemotherapy, vaccines, fluoridation, and precious bodily fluids.

      1. Kirkland. Read the Hippocratic oath sometime. The prohibition on deadly medicine is an ancient one, and in the classical times, it explicitly included abortion.

        I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion.

    2. Res non nocere is a principle of medical ethics. Not an oath.

      It is a practical guideline which means in uncertainty choose the course of least chance of harm.

      There are oaths often in graduation ceremonies in medical schools. Mostly they are there to remind the newly minted graduate that you are part of a guild, an ancient profession with its own rules.

      My favorite is the oath of Maimonides. There are versions and he did not write them.

      The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.

      May I never see in the patient anything but a fellow creature in pain.

      Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.

      Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.

      1. Sorry that you have to speak sense to retards. As a physician I agree that taking a life is against my oath. Not to mention abortion is savage and absolutely no necessary.

  7. It is always an apt time in this jurisdiction for another rousing meeting of Libertarians For Statist Womb Management.

    Why not conduct the meeting in conjunction with Libertarians For Big-Government Micromanagement Of Ladyparts Clinics and Libertarians For Statist Imposition Of Superstition-Based Public Policy?

    Carry on, clingers . . . so far and so long as your betters permit, that is.

    1. “your betters permit..”

      Asseverated by a fake cleric thinking he is oh so clever as he lampoons libertarians as closet statists unaware of the irony splattered all over his musings.

      1. I disdain superstitious slack-jaws, half-educated authoritarians, and right-wing bigots, not libertarians. Libertarian is my middle name, you soon-to be-replaced clinger.

    2. As you know, libertarians are split into various degrees and shades of opinion on the abortion choice v/s pro-life stances. So is any other group (unless you’ve selected them, your group, for their stance on this issue).

      Now it seems to me that you like to make overly broad accusations against libertarians. I have not yet found ONE self-proclaimed “libertarian” who will defend Government Almighty’s requirement that I get a prescription before blowing on a cheap plastic flute!

      I would dearly love for you to study up on the “lung flute” (see
      http://www.churchofsqrls.com/DONT_DO_THIS/ ) … And defend the position of your much-worshiped Government Almighty!!!


      1. I’m against. You might flute your eye out with one of them.

        1. Yes!!! Or, one could get addicted to huffing and puffing one’s phlegm and lung boogers away!!!

          1. There’s a reason it’s banned, surely government doesn’t do things for bad reasons.

    3. I don’t want the State to prosecute murder, I want private parties to do so.

      Get over yourself!

  8. “First trimester abortions, which typically require only medication, do not require the onsite presence of a licensed physician.”

    NPs can prescribe medication, but Midwives can?

    1. I guess? Is there other examples of these types of prescriptions? That’s a real question. Are there other jobs that have restricted prescribing abilities like this is suggesting?

    2. Onsite presence or lack of such means a physician is responsible but does not need to be present.

      Both are post graduate degrees. Between 2-3 years after a BSN.

      NP and Nurse Midwifes, difference is basically one specializes in OB.

      First trimester are mostly medical AB.


      So far as I know neither is authorized to perform surgical AB.

    3. Even stranger, since when do midwives want to do abortions?

  9. “a statute which, while furthering…[a] valid state interest, has the effect of placing a substantial obstacle in the path to a woman’s choice cannot be considered a permissible means of serving its legitimate ends.” The Court defined an undue burden as “shorthand for the conclusion that a state regulation has the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a non-viable fetus.”

    My only regret is we don’t treat the 2nd amendment with the same reverence and respect with which we treat the Roe V. Wade amendment.

    1. If judges can add to the Constitution, they can subtract from it, too.

  10. “Virginia is one of 34 states that have said only physicians can perform first-trimester abortions, even though “a consensus appears to have evolved” that this is medically unnecessary”

    The 34 states which have outlawed this practice were not a “consensus” that it was medically necessary?

    1. That was a consensus that it was politically necessary.

      1. If you look up Roe v. Wade, they simply assume that a physician is presiding over the abortion:

        “The State has a legitimate interest in seeing to it that abortion, like any other medical procedure, is performed under circumstances that insure maximum safety for the patient. This interest obviously extends at least to the performing physician and his staff…

        “…Specific and direct harm medically diagnosable even in early pregnancy may be involved. Maternity, or additional offspring, may force upon the woman a distressful life and future. Psychological harm may be imminent. Mental and physical health may be taxed by child care. There is also the distress, for all concerned, associated with the unwanted child, and there is the problem of bringing a child into a family already unable, psychologically and otherwise, to care for it. In other cases, as in this one, the additional difficulties and continuing stigma of unwed motherhood may be involved. All these are factors the woman and her responsible physician necessarily will consider in consultation….

        “for the period of pregnancy prior to this “compelling” point (the first trimester), the attending physician, in consultation with his patient, is free to determine, without regulation by the State, that, in his medical judgment, the patient’s pregnancy should be terminated. If that decision is reached, the judgment may be effectuated by an abortion free of interference by the State….

        1. “For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman’s attending physician….

          “The State may define the term “physician,” as it has been employed in the preceding paragraphs of this Part XI of this opinion, to mean only a physician currently licensed by the State, and may proscribe any abortion by a person who is not a physician as so defined.”

          Apparently, Roe v. Wade is no longer the law of the land.

  11. Reason is all over medical freedom for abortions and getting stoned.

    When will they be interested in medical freedom *generally* to heal ourselves?

  12. Abortion is pre-meditated murder and should be punished with the death penalty.

  13. […] “Let Midwives and Nurse Practitioners Provide First-Trimester Abortions, Says Federal Court,” by Elizabeth Nolan Brown […]

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