By Ally Dickson. Bay City News.
Zoe Carrasco "fell in love" with reproductive health care while working at a community clinic in East Oakland.
She was in her early 20s at the time. Today, at 36, Carrasco is a graduate of the University of California, San Francisco School of Nursing. A self-described Latina, Carrasco wants to provide comprehensive reproductive care to her Spanish-speaking community, including abortion in California.
However, Carrasco eventually learned that her education would not leave her "clinically competent," a classification that allows a practitioner to perform aspiration abortions, which requires a hands-on physical procedure in the clinic. To achieve this, she will have to complete additional training and find work in a clinic that supports recent graduates.
"If you really want to get clinical abortion training," Carrasco said, "you really have to get out of the school system and find it for yourself."
During her three years in UCSF's nursing and midwifery program, Carrasco attended a 90-minute didactic lecture on medication abortion and a skills lab where she practiced first-trimester abortions with papayas.
Thus, she was fortunate enough to get 16 hours of observational clinical abortion training at Zuckerberg San Francisco General Hospital during the summer of 2021. Her classmates usually received only four to eight hours. She was able to pick up extra hours by filling in for classmates who were unable to cover shifts.
On one occasion, Carrasco took it upon herself to further expand her abortion training at a clinic in New Mexico, logging 35 hours in four days, doubling the hours of clinical experience provided by her school program. There, she took advantage of being able to be in the room during every aspect of an aspiration abortion, whereas her nursing school only allowed observation the day before preparing for the procedure.
In addition, during her time in New Mexico, Carrasco was able to follow a patient through her experience with the abortion procedure, witnessing a doctor-patient relationship from start to finish. At school, Carrasco received counseling training on how to approach patients with compassion and neutrality, but this was real, she said.
"There's so much courage behind a decision like this," Carrasco said. "And everyone at that clinic really honors that."
In addition, he said he admired how the clinic emphasized trauma-informed care and preservation of patient autonomy.
Advocating for abortion education
Meredith Klashman wants to fight for her patients in and out of the hospital. Klashman, a rising third-year medical student in the joint medical program at the University of California, Berkeley and UCSF, just finished her term as co-president of the UC San Francisco Medical Students by Choice chapter.
Teaming with the group Nurses for Sexual and Reproductive Health, Klashman's organization created the Reproductive Health Elective, which is open to all UCSF programs. The elective aims to fill gaps in abortion instruction and reproductive education within UCSF's core curricula, and covers medication abortions, an aspiration abortion skills lab, and inequities in access to reproductive health care.
adamant that abortion training is crucial for nursing and medical students, the student organization advocates for more clinical experience in abortion clinics. Abortion training is extremely important when working in an emergency room, for example, Klashman says.
In an emergency room, a patient might be admitted with an untimely medication abortion, a self-managed abortion, or simply an abortion in their medical record.
"Physicians need to do a little more due diligence in terms of empowering their patients to make decisions," Klashman stressed.
Klashman became passionate about women's reproductive health justice while studying urinary tract infections due to water exposure. Klashman was surprised and disappointed to discover that UC Berkeley's research program did not focus on urinary tract infections in women, despite the preponderance of such cases among women.
Supporting academics who prioritize reproductive justice
One of the masters of the Reproductive Health Elective, and the fifth black full professor in the UCSF School of Nursing, Monica McLemore, co-directs the Abortion Care Training Incubator for Outstanding Academic Nurses (ACTIONS) program. In this capacity, McLemore supports predoctoral and postdoctoral fellows in the School of Nursing who prioritize reproductive justice.
"Abortion care makes sure that people's emotional, informational and spiritual needs are met as they make a decision about their reproductive health. That screams nursing," McLemore referred. "One of the core principles of nursing is to help individuals and families manage transitions."
McLemore has provided abortion services at Zuckerberg San Francisco General Hospital for nearly 20 years, and said he always knew that teaching life would be an important part of his career.
"As a black nurse who has held a nursing license since 1993, not only have I never had a black person take care of me as a member of the healthcare profession, so I'm still very cranky," McLemore pointed out, "but I've never actively had a black nursing professor."
Promoting a policy to increase training on abortion
Bethany Golden is a registered nurse, certified nurse midwife and predoctoral fellow at UC San Francisco through ACTIONS, attended Yale School of Nursing and has worked in private practice, community health, hospitals including NYU Langone Health and Northwestern Memorial Hospital, at Planned Parenthood in California and even abroad.
Despite being a physician for nearly 20 years, Golden has never been able to receive training on aspiration abortion.
"I asked to learn," he said. "No one would teach me because there are few places to get that clinical training."
Striving to address this on a systemic level, Golden said she became a policy advisor for Training in Early Abortion for Comprehensive Healthcare, an organization that teaches clinics on reproductive health care and abortion in California and beyond, commonly known as TEACH.
As of October 2021, through ACTIONS, Golden was also one of the physicians who worked with the California Abortion Futures Council, which recommends the California Reproductive Health Services Corps created under Assembly Bill 1918.
AB 1918 aims to recruit, train and retain a diverse workforce by establishing scholarships, stipends and loan repayment for reproductive health professionals. Those who qualify must commit to completing abortion training and commit to working for three years in California, prioritizing underserved areas.
"My hope would be that what we're looking at would be lifelong professionals and, as a result, a really impactful expansion of our reproductive health care workforce," said Cottie Petrie-Norris, author of the bill.
The bill has already secured $20 million in funding in the current state budget that will go toward scholarships, stipends and loan repayment, and is expected to soon pass the state Senate and receive Governor Gavin Newsom's signature and go into effect in January.
Golden looks forward to the day when she can return to being a student and learn how to perform aspiration abortions.
"I would like to be in a practice where I could provide that service, so I hope to benefit from the expansion of abortion training as well," Golden said.
Nursing and medical students, professors and nurse practitioners continue to fight for changes at the personal and policy level for abortion care, even though Roe v. Wade and the national right to access abortion have been shot down. Carrasco said the U.S. Supreme Court's decision last month was a time to mourn, but also to build momentum.
"There is loss, but there is also an eagerness to move forward and be resilient, especially as someone who is a new provider," Carrasco noted.
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