An update on midwife prescribing

Midwives who have achieved eligibility for Medicare (MBS) under the Commonwealth Government's National Maternity Service Plan (2010) are also preparing to extend our practices to include prescribing, and participation in the Pharmaceutical Benefits Scheme (PBS).  Midwives with PBS authorisation will be able to prescribe, supply, and administer scheduled medicines. 

Historically, midwives attending homebirth have obtained the few medicines we need in private midwifery practice through a doctor's prescription.  The midwife has administered these drugs without a legislated process.  Oxytocics for the management of post partum haemorrhage by intramuscular injection have been prescribed by doctors for women in our care, and purchased (in boxes of 5 ampoules) from local pharmacies.  The midwife assesses the woman's condition, and administers the drug on her/his own authority.  The management of the third stage pf labour is basic to midwifery, and it is in the public interest that all midwives maintain their competency in the use of oxytocics: that this is not restricted to those who have PBS authorisation. 

A number of Victorian midwives are enrolled in the 6-month Pharmacology course at Flinders University in Adelaide, which is the only such accredited course for midwives seeking PBS authorisation.  We know of a couple of midwives who have completed courses in pharmacology which have been accepted by the regulatory authority (AHPRA) as equivalent. 

Each state and territory have already either undertaken, or are in the process of making, the necessary legislative changes to authorise registered midwives to prescribe under the PBS.  

The Victorian Health Department has appointed the 3CentresCollaboration to consult with stakeholder groups, and to prepare a draft list of Schedule 2, 3, 4 and 8 medicines for prescribing by midwives in Victoria.  The work has advanced to the final checking of the list before it is approved in the law.  The stakeholder groups and experts who have been invited to review the list include relevant midwifery and obstetric colleges, unions and professional organisations, employers of midwives, consumer groups with a remit or interest in midwifery, maternity services or associated services as well education providers (ie midwifery pharmacology course providers). 

The scope of prescribing is limited to medicines appropriate for midwifery practice across pregnancy, labour, birth and post natal care (including neonates up to six weeks).  Midwives who will use their PBS endorsement include those providing private antenatal and postnatal care in a variety of settings and intrapartum care as a private midwifery provider to a private client either at home, or (when midwives are able to have clinical privileges/visiting access) within a health service. 

[MiPP has submitted a response to the draft documents.]
 
Your comments are welcome.

collaboration

Yesterday the Health Ministers announced the extension of the 'exemption', enabling midwives  (1) to continue our work of attending births without indemnity insurance, until 2015, and (2) to make collaborative arrangements with hospitals and health services.

Go to the APMA blog for the wording of the announcement.

Immediate response from the Australian Medical Association (AMA) called on the Health Ministers to reverse their decision about collaboration, stating that “This decision is transferring sensitive patient care and management from a doctor to a bureaucrat. It must not proceed.”


In response, I have left the following message at the AMA media site:

Dr Hambleton, and AMA
I think it would be good to talk to real midwives who have incorporated Medicare into what we offer women.  We are not dangerous.  We are very conscious of the limitations of natural physiological processes in pregnancy, childbirth, and thereafter - and our own limitations when illness or complications present.
I have been practising independently as a midwife for many years, and I attend women who plan homebirth, as well as women who intend to give birth in hospital. 
The collaborative arrangements that have supported the care I provide for my clients, enabling Medicare rebates on antenatal and postnatal consultations, have been mainly with GPs who have never met me.  This is the sort of letter the doctor receives:
Dear Dr D
W has asked me to provide midwifery services for her, with a plan to give birth at home, and a back-up booking at H Hospital.  W’s calculated due date is XX/XX/XX.  With your referral and collaboration I am able to provide Medicare rebates for W for antenatal and postnatal midwifery services.  I am required to demonstrate a collaborative arrangement with a named medical practitioner, to whom she will be referred if the need arises. 
Under this collaborative arrangement, I am required to send you a Maternity Care Plan (draft attached), results of any tests and investigations, and referrals (obstetric or paediatric).  Also I am required to send a discharge summary to you as the patient’s GP.
In preparing a maternity care plan, I have discussed this with W.  The plan is basically to proceed under normal physiological conditions, working in harmony with the natural processes, unless complications arise.  We plan to go to the H hospital without delay for urgent obstetric concerns, or W would be referred to you for non-urgent medical indications.
Thankyou for your assistance in this matter.

I ask that you use the resources of the AMA to enhance collaboration between two distinct professions - not to remove the competition.

Joy Johnston

Your comments are welcome.