Sunday, September 15, 2013

midwives and medicines

The Nursing and Midwifery Board of Australia (National Board) is consulting publicly on the draft Registration standard for endorsement of registered nurses and/or registered midwives to supply and administer scheduled medicines under protocol and invites comments and feedback from interested parties.  The proposal is that provisions which are already in place for midwives (and nurses) in rural and remote settings be extended across the professions.

For more information, and to access the consultation discussion paper and draft Registration standard, click here.

The National Board is inviting submissions from the public, as well as professional groups and individuals.

Please note that this consultation does not relate to midwife prescribers: eligible midwives who have completed a course of study approved by the National Board, and been endorsed to prescribe scheduled medicines.

Why is this an important issue?

A midwife who is currently recognised as being able to supply and administer scheduled medicines under protocol is usually a midwife employed by a health service or hospital.  The employer has set down protocols under which a midwife is permitted to use a scheduled drug.  This has been in effect, to a greater or lesser degree, for many years.  Oxytocics for prevention or management of postpartum haemorrhage are an obvious category of drugs that every midwife is expected to be able to manage competently.  A midwife may also supply and administer an anti-emetic in labour, antibiotics in labour as prophyllaxis for Group B Streptococcus, or Anti-D to prevent Rhesus immunisation.  These are prescribed by a doctor, dispensed and sold by a pharmacist, and subsequently supplied and administered by a midwife to the woman in her care.

What is the relevance of this consultation for independent midwives?

Midwives who practise privately, being employed directly by the woman rather than by a health service or hospital, may also be affected by any Registration Standard that the National Board develops.  Midwives attending homebirths have historically for many years carried oxytocics, and used them when required.  The midwife may ask women to obtain a prescription for Syntocinon 10units and Syntometrine from their local doctor.  The midwife usually makes decisions about administration on her own authority, with the wellbeing and safety of the mother, in relation to postpartum blood loss, being the primary concern. This process is not covered by any formal protocols or reporting mechanisms.  The midwife does not usually consult about the need for the scheduled medicine with the doctor who signed the prescription - delay could lead to compromise. 

The proposed Registration Standard

"...  will ensure that registered nurses and midwives who work in situations where medical and nursing supervision is low and the clinical risk is relatively high are educationally prepared and competent to supply medicines to their patients/clients."
Women planning homebirth in the care of an independent midwife are usually well, and in spontaneous labour.  Homebirth is a situation where the midwife acts on her own authority.  Whether a midwife is practising solo, or with another midwife, each midwife is responsible to act in a competent and professional manner.  There is no clinical supervision of independent midwifery practice.  Obviously, the 'clinical risk' is relatively high.  This places private midwifery practice within the scope of the National Board's proposed Registration Standard.

The education of all midwives is required to prepare midwives for basic midwifery practice, as stated in the ICM Definition (2011):

... The midwife is recognised as a responsible and accountable professional who works in partnership with women to
give the necessary support, care and advice during pregnancy, labour and the postpartum period, to
conduct births on the midwife’s own responsibility and to
provide care for the newborn and the infant.
This care includes
preventative measures,
the promotion of normal birth,
the detection of complications in mother and child,
the accessing of medical care or other appropriate assistance and
the carrying out of emergency measures.   

MIPP will be preparing a submission to this consultation.

Your comments are, of course, welcome.

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