The finished document contains dated responses to questions posed by the writer of the course, and summaries of my learning and reflections through the course.
September and October were very busy months for me, with a full caseload. I have not been able to devote all the time I would have liked to, to the course. Babies have been born, and I have been privileged to accompany a small number of women in their birthing journeys. In this brief time I have shared great joy, and great sorrow.
I started this course without much idea of how to navigate an online learning situation. As I now prepare for the exam in a month's time, worth 50% of the mark, I am seeking to consolidate the new knowledge that I have accessed in the past few months. I expect to do well in the exam, and I am satisfied that I will have met my personal learning objectives at the conclusion of the course.
Some of the issues I have reflected upon and explored have already been mentioned in this blog. In summary, here are a few highlights:
Personal Learning objectives:
30 July 2012
- To critically review my knowledge of the medicines which I currently use as a midwife
- To develop a useful body of knowledge about the prescription of medicines which will become part of a midwife’s formulary
- To explore and reflect on published scientific work that is relevant to pregnancy, birth, and breastfeeding.
- To undertake the course of study that will meet my undertaking to the NMBA, to successfully complete "an accredited and approved program of study determined by the Board to develop midwives' skills and knowledge in prescribing"
These objectives are within the topic’s stated learning objectives
Journal of a new student: I have learned a lot about working within an online learning site, and I can now work my way through MIMS online. This is a big achievement. I do not yet feel 'fluent' in a virtual library - I just get lost!
Writing prescriptions: I will need to continue to work on the knowledge and skill of prescribing. The small number of medicines is OK. I think there are many aspects of the various formularies that still need to be ironed out. The Victorian law is in the process of being amended to allow midwives to prescribe.
The two Case Studies in which we explored the prescribing of Metoclopramide for nausea in pregnancy, and Benzylpenicillin for Group B Streptococcus (GBS) colonisation of the genital tract, provided good opportunities for learning and critical thinking. Where I exceeded the word limit, and needed to remove some of what I wrote, I brought it across to this blog, such as in Case Study 2. Blogs have no word limit!
A significant piece of work that this study brought me to is the pharmacology of uterotonics. I am not surprised that the study of pharmacology has confirmed my desire to work in harmony with wonderful natural processes in pregnancy, birth, and nurture of the infant.
This study has given me information which confirms my commitment to protecting, promoting and supporting unmedicated, physiological birth, except in clinical situations where there is a valid reason to intervene. The benefit of synthetic oxytocic treatment in preventing excessive blood loss after birth is undeniable. My reluctance to use these drugs routinely rather than as indicated is related to the majority of women for whom the treatment is not required, and who are thereby exposed to unnecessary medication with attendant risks.
I am also concerned about the extent of possible adverse effects in newborn babies, particularly any sick babies who may need to receive drug treatments, and who may experience adverse drug reactions to syntometrine in mother's milk.
A question on collaboration has given students the opportunity to engage in the maternity reform process that requires a collaborative arrangement as the starting point for women to receive Medicare rebate for a midwife's services. It looks like this:
$$=carrot; collaboration=stick
Collaboration is actually not onerous; it's basic to midwifery practice. The problem with collaboration as the Australian government requires is that it's one-way collaboration, which is an oxymoron. 'co' + 'labor' requires at least 2 parties to participate.
As I look back on (most of) the pharmacology course, it's worth stepping into the assessor role, asking questions about how the course met my learning needs, and how it could be improved.
I am conscious of a great deal of new knowledge that is foundational to an understanding of pharmacology. The course lacked systematic teaching of that basic body of knowledge. I believe this could be corrected by offering weekly lectures for the first month or so, using the webinar function of the interactive online learning site. Although the course is post graduate, most students have not studied undergraduate contemporary pharmacology courses, and even those who have would do well to refresh their minds.
A further step is the application of that knowledge to effective midwifery practice. This is a challenging topic, and could be used for debate between midwives working in various settings.
Are midwives who have achieved the endorsement as 'prescribers' likely to take a liberal attitude towards medicines, and prescribe excessively, like a kid with a new toy?
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