Transforming and Supporting Patient Care - Health Professions ...

235Chapter 10 – Profession of MidwiferyPostpartum Uterotonics (Oxytocics)Midwives are asking for access to the oxytocics for use in treatingpostpartum hemorrhaging. Oxytocin is routinely offered to controlhemorrhaging immediately after delivery (management in the third stage).According to the AOM, research shows this reduces chances of postpartumhemorrhaging and excessive blood loss. It can be administered byintramuscular (IM) or intravenous (IV), depending on the care setting. If thepatient does not respond to treatment, a second dose is administered. TheAOM notes that this is within a midwife’s scope of practice and is routinepractice. This is the first line of anti-hemorrhagic treatment.This is emergency treatment, but it will be effective in the vast majority ofcases. Midwives are trained to respond to an emergency situation. Anyprolonged labour would automatically be transferred to a hospital, sohemorrhaging is most likely treated there. The request for this drug suitsmidwives who are working in rural areas who may have a long wait, shouldemergency medical services be required. The midwives’ intervention isuseful because it helps prevent a more serious situation.Proposed standards have been developed for prescribing antihemorrhagicsand oxytocics to treat postpartum bleeding in the CMO draft standard forprescribing and administering of drugs. 25Vaccines for ContraceptivesAs part of their request for an extended class of midwives, the CMO hasrequested that midwives be given the authority to prescribe vaccines forcontraceptive purposes.NarcoticsMidwives have no independent access to narcotics; they may onlyadminister morphine and meperidine under the order of a physician. If anarcotic is administered, a narcotic antagonist is available for the baby as asafety measure. In certain cases, a newborn may be given a narcoticantagonist if the mother was given a narcotic during childbirth.Midwives are seeking direct access to controlled substances for pain relief.Health Canada is considering changes to regulations under the ControlledDrugs and Substances Act (Canada) to permit midwives and otherdesignated practitioners (e.g., nurse practitioners and podiatrists) topossess, administer, prescribe, sell or provide and/or transport certaincontrolled substances as defined by the regulation. 26Emergency MedicationsThe CMO provides a list of equipment all midwives should have with themfor home births. An emergency home birth kit comprises treatment foranaphylaxis, epinephrine, IV solutions and equipment, oxytocin, ergonomene,25Ibid.26Ibid: 8.HPRAC Critical Links January 2009