In celebration of International Day of the Midwife 2024, we sat down to interview Fanny James, Registered Midwife and Safeguarding Lead at our clinic in Maidstone, Kent. She spoke with us about how and why she started working at MSI UK, her journey to becoming a midwife more broadly, and some of the nuances of being a midwife in abortion care.
“Anything that lends itself to validating somebody’s choice is the best part of my role.“
How and why did you start working for MSI UK?
I always wanted to work in abortion care, and I trained in midwifery. This was very much with a view to work in abortion care, and specifically MSI UK because they hold the contract in the area where I live.*
“The most useful and practical way I could make an impact within abortion care was to help deliver it.”
I used to live in Northern Ireland, and I was involved in the campaign for decriminalisation over there. Through that work, I got to know a lot of other people who campaigned and got involved in lots of grassroots work. We did a lot of looking after people and putting them in touch with networks that could support them. Then, I just started to think that the most useful and practical way I could make an impact within abortion care was to actually help deliver it.
So, I decided to train as a midwife. I moved back to South East England, went to university, and qualified in 2020. The reason I didn’t apply straight away to work at MSI was because it was the middle of the pandemic, and I didn’t want to change jobs at that time. I worked on a high-risk acute labour ward for two years.
Once everything started to relax after the pandemic, I readdressed whether it was time to become a midwife in abortion care and I applied to MSI’s South London clinic.
I did my first three weeks in South London and then a job advert came up for the same role at MSI’s Maidstone clinic, where I live in Kent. Commute-wise, it made more sense to me. MSI were amazing. They supported a really seamless transition, even though I was in the first two weeks of my probationary period. I was moved to the Maidstone clinic, where I’ve been ever since. I love it.
Within six or seven months of being at Maidstone, our Safeguarding Lead went on maternity leave, and I was really interested in the Safeguarding side of things. It’s very different to being in a hospital – we are involved in more safeguarding than I’ve seen in that environment. I applied and was offered the job. I’ve been doing that ever since July (2023), so I progressed quite quickly following my probation.
What made you interested in supporting abortion rights?
Because I had an abortion. That’s it. I mean, it really comes down to that. I had an abortion, and I was so, so well looked after.
In my life, there were loads of things that made having an abortion a difficult decision. I went on to realise that there are not many people for whom it’s an easy one – there are always other things going on in people’s lives.
“I realised the absolute best thing about my abortion, was the abortion.”
Having the abortion had also contributed to me wanting to shake my life up a bit and make the move to Northern Ireland.
Once I moved, I realised that the absolute best thing about my abortion, was the abortion. Everything around it was almost like a ‘storm’ and then in the eye of the storm was my abortion, the actual procedure. In the middle of rejection, hate, confusion and self-loathing, all these difficult emotions, was a treatment within which I was treated with so much dignity, so much kindness, and given control. I could have the choice on where I wanted the treatment to take place, who could go with me – and if I had wanted it, I would also have been afforded total anonymity, along with all that dignity.
“On top of everything I had found difficult about my abortion, I hadn’t had to suffer the total indignity of the procedure itself being illegal.”
Then, I moved to Northern Ireland. I realised that people were going through the exact same thing that I was going through – that the reasons why people choose to have an abortion are the same everywhere – and yet, these women had to order pills ‘illegally’ and find somewhere anonymous to pass the pregnancy. I had a sense of total injustice. On top of everything else that I had found difficult about my abortion, I hadn’t had to suffer the total indignity of the procedure itself being illegal, underground and undignified in the way these women did.
It made me so angry, and I felt sort of grotesquely privileged that I’d been ‘able to be sad’, whilst the procedure was so slick. I got to do it for free, I got to do it with anonymity, and I got to do it with kindness and dignity.
This led to me getting involved with a lot of abortion advocacy work in Northern Ireland, before I decided that the most difference I could make was as an abortion midwife.
Could you tell me what a day in your life looks like as a midwife at MSI UK?
In the clinic, on different days, we have different things going on.
On some days, we deliver surgical abortion care. As a midwife, on these days, you’ll be with the client through consent, surgery and finally helping in the recovery room, supporting people who have just come out of surgery – sometimes emotional or often very hungry.
On other days, we offer medical abortion appointments, where clients will be seen individually by midwives. They’ll have a scan, and the midwife will explain to them how to take the pills. In addition to that, we may offer them an STI screening and have conversations with them about contraception if they want to start a method after their abortion.
We also do provide telemedicine appointments (where clients have their appointment over the phone with a nurse or midwife), so sometimes we work from home, or we can come into the clinic and do them here.
“I loved the variation and having different days every day. There’s just a real variety and change in pace”
I did all of this before my safeguarding role. I loved the variation and having different days every day. There’s just a real variety and change in pace.
I really enjoy the one-to-one time you get when working on a medical abortion list. You get the opportunity to have important conversations face-to-face and you can immediately tell when the person is leaving feeling confident.
Do you have a favourite part of your role?
I like scanning. When I first learned it, I thought there was no way in the world that I’d ever understand how to do it – so now that I can, it’s a really enjoyable skill.
“One of the most common things I hear from clients – which surprises me and still upsets me – is that they’re surprised how nice we are.”
I also like helping people to access treatment. One of the most common things I hear from clients, which surprises me and still upsets me (because it speaks to how women are made to feel about themselves when they make this choice) is that they’re surprised how nice we are. They’ll say things like “I hadn’t thought you’d be this nice to me” or “I never realised you’d be so kind”. It makes me so angry, because it reminds me that we’re still in this place where women expect some kind of ‘punishment’ and stigma for having an abortion, as if they’re doing something wrong. As if, somewhere along the line in this process, they’re guaranteed to encounter stigma.
“Anything that lends itself to validating somebody’s choice is the best part of my role.”
Every single time we’re delivering abortion care to somebody, the main thing is that they’re not being treated as though they’ve done anything wrong.
That’s what I like about abortion treatments – the consultation** before they come into the clinic. I have a window of opportunity to talk to someone about their choice – if they want to. Anything that lends itself to validating somebody’s choice is the best part of my role.
It’s the most important thing. There are so many things that I say to people that I have said more than 100 times in my role, to 100 different people. But, to each of them, it’s the first time they’ve heard it, and they may feel like they’re the only person in the world that’s experiencing that feeling. It’s often a relief for people to hear that they’re not the only ones.
One of the most common things we see are mothers having an abortion because they’ve already got small children. The guilt and the shame can be so overwhelming for some of those women, and sometimes they just need to hear that they’re allowed to make that choice in order continue being the parent that they’re currently able to be. Sometimes we will have incredibly flooring conversations with people about what it means to be a parent or what it means to be a mother. Sometimes, this (having an abortion) is one of the most loving things that someone who is already a mother can do. They just often need to hear it. It’s really powerful being with people when they find that acceptance.
*In the UK, abortions are often performed by independent abortion providers (like MSI UK), under NHS contracts. Independent abortion providers are contracted to provide treatment under different NHS contracts, in different areas. They are contracted and legislated by NHS ICBs (Integrated Care Boards).
** A consultation takes place either over the phone or in the clinic before you have an abortion. During your consultation, you will discuss the different treatment options available and have the opportunity to ask any questions you have.
Read more from our colleagues
At MSI UK, we love interviewing our colleagues to find out more about their work and how their roles contribute to our mission to deliver quality reproductive healthcare. You can read some of our latest interviews here.
