Rimsha Syed, NSRH’s Communications Manager, had a conversation with Kiernan Cobb (RN, BSN), Director of Nursing at Trust Women in Oklahoma and Kansas, about sexual and reproductive health, the ins and outs of providing abortion care, and the importance of advocating from inside the movement. Kiernan was recently a panelist at NSRH’s Critical Thinking for Critical Care conference and continues to shed light on political pressure in the reproductive healthcare landscape. 

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Rimsha: How does SRH show up in your life?

Kiernan: SRH shows up in my life as a queer person working in healthcare. I am simultaneously facing and working to dismantle barriers to care for queer people. In a political and cultural climate that is reversing rights in all areas of sexual and reproductive health, it is more important than ever for me to be visibly queer doing this work. I have always been out as queer with coworkers, am working on being out about my gender journey, and disclose with discretion my work in abortion care. Working in an at-will employment state that is also very hostile to abortion and queer folks, I hold these identities close at times to protect my job and my family. Workers’ rights are also closely linked to reproductive justice. I work in both emergency and abortion care which can be very tense but very rewarding settings. I am often seeing people at one of few access points they have into the healthcare system. Both ERs in general and my abortion clinic specifically are often providers of last resort after people have been turned away from or lack the resources to access other providers, after the healthcare and political systems have failed them. Oklahoma criminalizes self-managed abortion while imposing harsh restrictions on access to medicalized abortion care. This is a struggle in both my abortion clinic and hospital practice. We cannot serve every patient who needs abortion care and there is always a chance I will see folks who fell through the cracks in our crumbling healthcare system in the ER. 

It is incredibly hard to work under constant political pressure and threat of losing our abortion infrastructure and ability to serve our patients. The job is easy but the work is hard. Before starting in nursing, I worked as an abortion counselor and wanted to expand my scope in this setting. Pursuing my RN allowed me to do a lot more clinically in abortion care. Now, I am facing this problem again, working at the top of my RN license. I’m thinking about how to expand my scope into advanced practice nursing and be able to provide abortions myself. 

Rimsha: Have you received any professional SRH education?

Kiernan: In the same way all nursing is psych nursing, all nursing is sexual and reproductive health nursing. At no point across the lifespan and in no practice setting is SRH not relevant. Yet, schools are reluctant to teach or start these conversations. I received no instruction about abortion care in my nursing school education. Our one lecture on contraception was full of stigmatizing language and incorrect information. The only queer education in my program was from projects I did where I insisted my group be LGTBQ+-focused. I was chastised by a nursing instructor for working in abortion care. This is a disservice to learners and our patients. 

Rimsha: Can you tell me about a day in the life as an emergency and abortion care nurse?

Kiernan: Yeah, my more interesting days are when I was doing double duty at clinics. So for a while, we didn't have a lot of staffing in Oklahoma City. So I would come in at eight or nine to Trust Women, start getting patients pre-medicated with their miso and other things, start IVs, pop in for a few procedures. And then I would leave at 12:30 over to my hospital and work my mid shift from one p to one a over there. Those days were kind of crazy. Luckily, staffing is better now. Right now, I'm full time doing abortion care and PRN in the ER. I'm covering Oklahoma and Kansas clinics starting IVs and giving meds, doing moderate sedation, monitoring, and recovering our surgical procedural abortion patients, and doing some admin stuff as director of nursing. Like today, Wednesday's are always my big day of meetings with our clinic and admin leadership. Working on projects today - I was working on and tracking down all of our PUL (pregnancy of unknown location) patients that had blood draws done, so we can do good follow up care for them, make sure nobody has an ectopic or anything like that. Then I'm working PRN now in the ER. A few days a month, I will go over there. My ER is a level one trauma center and I work on the medical side. Usually from the time I roll in at about 12:45 I'm just going until I leave at 1:00 in the morning.

Rimsha: Wow. Thank you for answering that. My next question is, what does sexual and reproductive health mean to you on a personal level?

Kiernan: Yeah, for me personally, as a queer person, it impacts every area of my life. Something I'm always thinking about when I'm out with my partner, I make a point to be visibly queer in all the spaces that I can until it becomes a safety issue. I'm also out at both of my jobs, I make sure especially in my hospital that I have some kind of queer-coded stuff like a little rainbow pen, things like that, just so that patients feel safe with me. Especially in Oklahoma, where it's not always a very friendly place for queer folks. Obviously, my job in abortion care is completely centered around sexual and reproductive health. It's sometimes hard to bring that into an emergency care situation just because I don't have the time with staffing and with medical emergencies to be able to have those conversations with every patient. But when it's relevant and desired and when I have the time to I'm trying to incorporate that, especially if we get a miscarriage patient. My hospital [helps patients] under a certain number of weeks [of pregnancy]. I don't remember what the cutoff is. Some pregnant patients will come to the medical ER and some will go over to the children's ER, where labor and delivery is. So I still do see a few pregnant folks over there and I try to kind of gravitate towards those patients if other people are not as well versed in sexual reproductive health. I try to make sure that they're getting really good care.

Rimsha: Right, thank you for sharing. So broadly speaking, how do you feel about self-managed abortions, especially seeing more and more states implement such harsh abortion bans and restrictions?

Kiernan: Yeah, so broadly, self-managed abortion is a great option for some folks. Oklahoma is one of the states that criminalizes SMA, so I can't say anything about it in an official capacity to patients. Self-managed abortion is not inherently unsafe, but the criminalization of people experiencing pregnancy loss in Oklahoma makes patients reluctant to seek care. 

And if we have someone that comes into the ER that is suspected of an SMA it is really reminiscent of the case that Texas just had of a medical provider who reported her for that. And Texas doesn't even criminalize it, so it's just a whole can of worms to have those patients come in. As states are restricting abortion access, SMA is a good option. But there are still a lot of folks who either need institutional medical care or just want that familiarity and that kind of backup from a provider. I'm glad that we are, for now, still here and able to provide that care.

Rimsha: Right. What recommendations do you have to nurses and allies who want to challenge these oppressive bans and restrictions, not only in Oklahoma, but also across the country?

Kiernan: I think people need to make their medical practice into activism as well to advocate for their patients to make sure that they're getting good and appropriate care, to make sure that they themselves are trained in a trauma informed way, to make sure that they know what the regulations are in their area [that] they have to work around. And you have to just advocate for patients. A lot of ERs, especially if they're kind of siloed from traditional reproductive care, don't provide the best support to those patients. So just making sure that we, as the providers, are advocating for them and are really well versed in that kind of care.

Rimsha: And how comfortable are you being so vocal and unapologetic in your work? Do you ever have any worries?

Kiernan: Yeah, I do. Basically my entire professional career has been in repro. I started out doing campus organizing stuff for Planned Parenthood. So that was a place that I really learned how to be vocal because that was the whole job. I was never shy about working in abortion care, it's something I'm really passionate about. I was super thrilled to come back into nursing to do abortion care. Working as an abortion counselor in a clinic in Texas is really what got me into nursing because I wanted to be able to do more medically. And I think it's just important to have folks that are really public about what it looks like from inside the movement because we obviously have more than enough people outside saying what they think is going on. [We have] to just push back against  those dangerous narratives and just say we're a part of healthcare, we're here doing this. I have a very unique name and I have my nursing license, all my medical credentials, and stuff are in my name. I'm not hard to find, but it doesn't really stop me from being outspoken in the movement as much as I can.

Rimsha: Right. What does being part of the NSRH community mean to you?

Kiernan: Oh, my gosh, it's so important. I did the Critical Care conference this weekend, I got connected to a bunch of really awesome nurses and nurse practitioners, and the DON (Director of Nursing)  at another clinic. It's a lot of contacts that I wouldn't have had before. When I came on at my clinic, I was the only nurse working here for a really long time. A lot of other folks had colleagues, like medical assistants and doctors and the clinical directors all had other people to lean on. I was the only nurse for a long time. And all the nurses that I knew that were doing abortion care before were at a clinic in Texas that obviously had to shut down to really, really limit capacity after SB8. So having the community of other providers and the educational resources from NSRH was really really helpful for me kind of finding my own way to start out as an abortion nurse.

Rimsha: That's great to hear. Where do you see yourself five to ten years from now?

Kiernan: Well, man, hopefully the landscape is better for abortion access than it is right now in five to ten years. I'm working on applying to master's programs to become, I'm thinking, a family nurse practitioner. As much as I love being in the Midwest and doing care here where it's really really needed, none of the states here let mid-levels do abortions. I would ultimately like to be in a place where I could be the abortion provider in addition to being a part of the care team.

Rimsha: Okay, so what do you find healing? How do you take care of yourself so that you don't burn out doing this work?

Kiernan: It's been hard through COVID to find those things. I was playing roller derby before and I have just started getting back into it. Another thing that was isolating, being the only nurse here, I had to be particularly careful to not get sidelined by COVID or something like that. So yeah, getting back to doing derby. I have a whole bunch of animals that I hang out with. We have foster kittens all the time. Taking care of my little zoo at my house is really healing for me too.

Rimsha: If you were to highlight what you're most proud of so far in your nursing career, what would that be?

Kiernan: Yeah, I think getting the director of nursing job at Trust Women has been the highlight of my career. I had kind of a backwards route to get here, my hospital experience is trauma and critical care and I haven't done anything outpatient before this. I had a strong background in abortion care in general before I got here. And like I said, abortion care is what got me to nursing. I had kind of planned for it to be my retirement job, where I could just hang out, push meds, monitor patients, and then all hell broke loose in the repro landscape. So I got thrust into it really quickly. It's been a big learning curve on the administrative side and also the clinical side. But I think we're doing a really good job. Me and the team here at the clinic are helping to rebuild a lot of our infrastructure that was missing. Doing that, and being able to provide this care in the middle of just a human rights crisis in the Midwest has been really, really important.