Midwives soon to prescribe drugs

Qualified senior nurses overseas have been ordering and administering drugs safely for years and soon their Australian counterparts will be doing the same. By Mardi Chapman

Midwives are another step closer to getting approval as PBS prescribers with the commencement of the first accredited course in administering scheduled medicines.

About 120 midwives have signed up for the Graduate Certificate in Midwifery at Flinders University, which started in July.

Jen Byrne, acting course co-ordinator for midwifery programs at Flinders, says the milestone is long overdue. “The profession has been wanting prescribing rights since the ’90s if not before. We strongly feel midwives should be able to prescribe in the normal course of their role.”

She says midwives in other countries have been prescribing safely for decades. “Legislative changes in New Zealand allowed midwives to prescribe within their scope of practice since 1995. Research shows the quality and safety is very high.”

“In most provinces in Canada, midwives have been able to prescribe and order tests within their scope of practice since the early 2000s.”

The Graduate Certificate in Midwifery includes nine units in pharmacology and another nine units in diagnostics and investigations. While graduates who receive their endorsement will be restricted to ordering from a limited range of diagnostic tests and prescribing from a small formulary, it is regarded as a big milestone for the profession.

Byrne says most of those enrolled are eligible midwives who will study part-time, juggling their private practices and other commitments over two semesters of online study. The course also requires the submission of a portfolio related to their practice.

She says many of the midwives enrolled in the course have been practising for many years and are highly competent. “For some of them this might feel like another hoop to jump through but it will show midwives as autonomous practitioners who can look after women in their own right from the antenatal period, through birth and postnatally.”

“Women won’t need to double dip by visiting GPs for various scripts and tests. This way the midwife decides on the basis of her knowledge and scope of practice what medications to prescribe, store and administer.”

Byrne lists oxytocin, antibiotics, vitamin K, neonatal vaccines and opioids as just some of the products on the midwives’ formulary. “Most midwives wouldn’t use pethidine in the course of a homebirth but it is on the formulary.”

She says there are still issues to be decided with a brand new course such as recognition of prior learning for midwives who have worked in New Zealand and institutional arrangements for students at other universities. There is also a question about whether the course content would eventually be integrated into undergraduate programs.

Australian College of Midwives spokeswoman Associate Professor Hannah Dahlen says the course will only have a shelf life if the pool of eligible midwives is expanded.

“The requirement for midwives to have collaborative agreements with medical practitioners and the ongoing issue of clinical privileges in hospitals is hampering this expansion and consequently the provision of choice in midwifery services to women.”

“We’re still at the beginning of major change – very important reforms for dealing with a system that was set up for doctors.”

One of the reforms still in progress before midwives can sign their first prescription form is the need for amendments to controlled substances and poisons legislation in the various states and territories.

It’s yet another bureaucratic hurdle which continues to prevent Juliana Brennan from prescribing.

Brennan is an eligible midwife in Victoria and the first midwife to receive endorsement for scheduled medicines.

She was encouraged to apply for endorsement based on completion of the pharmacology component of a Master of Clinical Nursing at Monash University in 2006. While AHPRA approved her application in 2011, Brennan is still waiting patiently to write her first script while the Victorian government approves the midwives formulary.

“It’s been a very difficult journey; not just accessing prescribing rights but also visiting rights. There are a number of frustrations that midwives are still working through,” she says.

Joy Johnston, acting president of the Australian Private Midwives Association, agrees that while the opportunity to prescribe is welcome, it’s not a big part of practice. “Mostly we are working with a natural process where the women are well so there is limited need to use medications. That said, we have to go through this process as getting the law and practice linked up is really important.”

“As part of our application to become eligible midwives we committed to complete a course in prescribing within 18 months.”

Johnston, who has enrolled for the graduate certificate, says she is looking forward to the course especially for current evidence regarding medications and related topics such as medications ending up in mother’s milk.

Midwives interested in enrolling in the graduate certificate in 2013 can apply for a scholarship available through the RCNA. Applications close Friday, September 14.

CASE STUDY

Julie Garratt is excited about the future for her midwifery practice and for a strong, sustainable profession.

She has already carved out a unique practice that includes providing midwifery services to asylum seekers at the Inverbrackie Alternative Place of Detention in the Adelaide Hills.

She has also provided midwifery services in India, Nepal and the Philippines – work she considers some of the highlights of her career.

Garratt is soon to apply for clinical privileges and admitting rights at an Adelaide tertiary hospital and a Country Health SA hospital. She is also in the first cohort of midwives commencing the Graduate Certificate in Midwifery at Flinders University this semester.

“It’s an amazing opportunity and will be a huge adjunct to my practice. As a midwife who looks after women in their home, it will be good to carry emergency drugs such as oxytocin and IV fluids.”

“As a lactation consultant as well, it will be helpful to have access to antibiotics for mastitis or domperidone to increase milk supply, if those conditions can’t be solved by increased feeding.”

Garratt graduated with a Bachelor of Midwifery in 2004 and worked in a number of hospitals until she felt competent to practice independently by the end of 2008.

“I always wanted to be an independent midwife, providing home births and working with migrant women.”

Like many midwives, Garratt has had some access to prescription medications under standing orders and has a good understanding of the pharmacopoeia. “I’ve already started the suggested reading and it’s not completely new knowledge. We already have that background and the graduate certificate will consolidate that information. A good understanding of the evidence will be very important to be up-to-date clinically and thinking critically.”

Garratt has organised a small study group of midwives in the Adelaide Hills and a Facebook group for mutual support through the course.

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