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