journal: What do midwives want to prescribe?

It seems that many fellow-midwives around Australia who are enrolled with me in the Graduate Certificate in Midwifery course at Flinders University are organising themselves into 'Study Groups'.

I have to say that I don't understand what a study group does in this sort of education.  The study I need to do is reading and exploring the topic, and there will be assignments to do - which I think are best done without distraction.

I suppose we are all coming into this course from different places in our career and in our knowledge base.  The Graduate Certificate seems to be a 'qualification' that students can take away from this course, and perhaps this will enhance their career options.  That's a debatable speculation.  Private midwifery practice, which the course is linked to, could be seen by many as a backward step career-wise.

As far as I can see, the only reason I am doing the pharmacology topic is because I was required to sign an undertaking to do it when I applied for Medicare. With my small caseload of 2-4 women due each month I don't expect to want to prescribe much at all because I have very rarely asked women to go to the doctor for Rx.

• I don't screen for GBS (Group B Streptococcus) so there's no need for prophylactic antibiotics. Anyone who is showing signs of infection after spontaneous rupture of membranes needs to be in hospital where they have all the antibiotics you could want. 
• I rarely see mastitis, because babies who are born unmedicated, or with a minimal load of narcotics in their little systems, usually manage breastfeeding so well that they make it look easy.
• I can't imagine women in my care wanting prescriptions for oral contraceptives postnatally - they are well informed about Lactation Amenorrhoea Method (LAM) and natural family planning methods. 
• The Paediatric Vitamin K is available over the counter (OTC) at the local pharmacy. The use of the prophylactic Vitamin K injection in my practice is less than half the babies born at home in my care.
• Panadol and occasionally Voltaren cover postnatal analgesic, even for women who have had caesarean births.  Both are available without prescription. 
• Occasionally a woman in my care has bad haemorrhoids that need more than is available OTC - so that's a good reason for her to see her GP. 
• The occasional IM Maxalon in labour is about all I can think of.  
• I discourage the use of narcotics (Pethidine or Morphine) in labour.
• Anti-D is available from the blood bank for Rh- women who give birth to Rh+ babies.

The situation may change when midwives have clinical privileges in hospitals, but realistically,I don't think anyone is holding their breath for that in Victoria. The hospitals simply don't want us. 

Are midwives who achieve the PBS endorsement allowing them to prescribe from the list going to  want to rely more on drugs than they have done in the past?

I expect that will happen in some places.  I heard that after New Zealand midwives were permitted to prescribe, the rate of induction of labour by midwives was as high as that by the doctors.  I doubt that midwives who are committed to working in harmony with natural physiological processes will suddenly find a great deal of use for medication.  I hope not.


Thankyou for your comments

journal - ready to start

There has been an air of excitement this past week in the topic forum on FLO (Flinders Learning Online) as people introduce themselves and prepare for this course to start on Monday.

Someone wants to set up a facebook study group - isn't that an oxymoron?  For me, study needs to be focused, and fb is one big series of distractions, thoughts popping up all over the place like rabbits in a paddock.

My evolution has not taken me yet to the paperless office.  I prefer to have important stuff in my hand, on paper.  My office is set up with a good printer, and the best I can do in saving trees is to print double sided.


Paper copies
I need paper copies - should I say 'hard' copies?

I have copied the study plan module for week 1, and *of course* printed it out.

The 'assumed knowledge' and 'learning objectives'  are pretty much what I expected.

Students are told we need to set aside 18 hours per week for work on the course.

Time
That's 18 hours of reasonable brain activity time, preferably before lunch for me, which would be 3 hours a day, 6 days a week.  That's 18 hours fitting into a midwifery practice, in which babies often choose to be born in the early morning, as the new day gets started.  The weary old midwife often returns home mid-morning, with another episode of her life-long learning quest bubbling up in her mind!

For example, the three mothers in my caseload who gave birth over an eight-day span this month have been the focus of my life/practice.  When I am with woman everything else is forgotten - placed in another part of my brain, and retrieved when needed (or completely forgotten). 

 
18 hours is a lot of time!  I wonder if it includes all the time I know I will need to simply learn how to do the online process for this particular course?

For example, I have been trying to access the e-readings for the first week's study, using the library process provided. Here's one e-reading listed in the notes:

McKenna, L & McIntyre, M 2006, ‘What over the counter preparations are pregnant women taking? A literature review’, Journal of Advanced Nursing, vol. 56, no. 6, pp. 636-645. 

Perhaps I am expecting something that is unreasonable!  I would like to click the title and be given a .pdf file of that paper.  But that doesn't happen.  After jumping through several hoops I am given a bit of information about the paper - not the paper itself!  I have spent a considerable amount of time and still don't have what I want.  Although I have spent time I have learnt nothing about pharmacology for midwives, and I don't think I am any the wiser about what I should have done.

Oh well, I hope that by the end of this course I will be able to navigate a university library system.  In the meantime, I'll hope some other student who works out how to get the .pdf will take pity on me and send it to me.

e-speak
I am constantly amused by the language of the online sphere.  Today I have

• followed the "breadcrumb trail"
• set up a "pebble pad"
• found ways of "docking a block"
• watched a tutorial on using and making a "wiki"
• and worked out what "toggle" means in the online context

In conclusion, 
I will be happy if, through this course, I can consolidate a good body of knowledge about drugs in pregnancy, birth and breastfeeding, so that the women and babies in my care are in good hands.  It is possible that I may never prescribe most of the items on the PBS formulary for midwives.  The one class of drugs I want, oxytocics, are not listed, so that's a hurdle for the future.

I do not want to learn everything about electronic storage and retrieval systems; I don't want to become more of a granny-geek than I already am; I don't really care about the electronic culture of universities. 

Thankyou for your comments

journal of a new student

The text book: Pharmacology for Health Professionals 2011

This month I am beginning university studies at Flinders (SA), in order to undertake

"an accredited and approved program of study determined by the Board to develop midwives' skills and knowledge in prescribing"

This is a requirement for midwives who have notation on the Register as eligible for Medicare.  It is a new extension of practice for Australian midwives, as I noted in a previous post.

The topic is within a Graduate Certificate of Midwifery; will be by distance education, and is to be completed part time in one semester.  The text book, Pharmacology for Health Professionals, Bryant and Knights, 3rd edition 2011 (pictured) is a weighty tome that appears, on first glance, to be well presented and comprehensive.

I plan to make entries to this journal each week, for my own record as well as for readers who are interested. I would like to record an overview of this journey - not a step by step process. I hope to be honest and objective, not sugar-coating, and not bad-mouthing any aspect of the experience.  There will be times when I expect I will find it difficult to set aside time for focused study.  I won't be the only one experiencing this.  Any midwife who has a caseload has a high degree of unpredictability in life, when we must put the women and babies in our care first. 

I have not been enrolled in a university course since the late 1960s, and I have pretty well forgotten the details of that year! I completed hospital-based nursing studies (Royal Brisbane) in 1972, and hospital-based midwifery (Women's, Melbourne) in 1973.  I studied for, and passed exams for the International Board Certified Lactation Consultant certification on several occasions in more recent decades.  (Oh, I also studied Chinese painting, but that doesn't give me any prior learning credit!)  My other university experience is that I am a casual lecturer, tutor and marker in midwifery at Deakin University.

As I embark on this journey I wonder if my ageing mind will be a problem.  It's not that the knowledge is new learning - it will be good to review current evidence, and to check my 'knowledge' against what the course topic expects.

My style of learning is to take note of anything that varies from my current body of knowledge.  I think of it as a flashing red light, and I use this system in all areas of life.  When I listen to a lecture, or a sermon in Church, or a documentary, or read something, most is unremarkable, because it's what I expect.  But if something different comes up, I take note.  In a sense it's an editorial skill, but in stead of looking at the spelling and sentence construction, you look at the thought content and the conclusions.

When I go into my Flinders Learning Online site, and type in my password, I find topic information, and a forum to which all students of that topic are automatically connected (oh, the wonderful web and electronic databases!). There are 90 students enrolled at present.  Some have written introducing themselves; some have added a picture of themselves ...

There is an email site to which the course posts direct communication, and through which students can contact the faculty.  There are probably other aspects that I haven't found yet - you don't know what you don't know!

Enough for now.  As someone said, "Watch this space".




Thankyou for your comments