Except for the module creation you can easily add some very simple compatibility macros. I don't see how that would be different from your _compat module. However module creation can't be abstracted into a uniform macro in fact, because of it requires to define a PyModuleDef struct and the the modlue's init function got a return value in Python 3. But I'm fine with using some #if PY_MAJOR_VERSION >= 3 here.

After all you have to deal with way less compatibility issues, in extension modules than in actual python code. And if needed you can always do a simple version switch. You don't have to care about changes in the syntax of Python. You also don't have to care about changes of the __*__ magic method, because of you don't call them directly, and when defining classes you use slots for stuff like that.