Transforming and Supporting Patient Care - Health Professions ...

242Chapter 10 – Profession of MidwiferyAnti-nauseantsDiclectin is a combination product containing doxylamine succinate (a firstgeneration,sedating anthihistamine) and pyridoxine hydrochloride (vitaminB6). This product is the only antinauseant specifically indicated for nauseaand vomiting in pregnancy and has an excellent safety record for both themother and the developing fetus. HPRAC has classified this combinationproduct as an “antihistamine”, however HPRAC expects this product to beprescribed to treat the nausea and vomiting associated with pregnancy.Cervical Ripening AgentsCervical ripening agents include the prostaglandin E1 analog, misoprostol,low-dose oxytocin, mifepristone, relaxin and other physical mechanisms toripen the cervix. In its scope of practice review of midwifery, HPRACconcluded that the role of midwives involves providing care for normalbirths and deliveries. In that report, HPRAC stated that deliveries requiringcervical ripening agents fall outside the definition of a normal, uncomplicatedbirth and delivery and are therefore outside the scope of practice ofmidwifery. HPRAC also notes a significant risk of harm may be posed tothe fetus and the mother by these agents.Measles, Mumps and Rubella (MMR)MMR vaccines contain live, attenuated measles, mumps, and rubella andthe vaccine is administered by subcutaneous injection in Ontario after achild turns one, usually at twelve and at eighteen months. In the scope ofpractice review of midwifery, HPRAC recommended that the midwiferyscope of practice not be extended to include well baby care, and does notrecommend that MMR vaccines be included in the drug regulation underthe Midwifery Act, 1991.HPRAC’s ConclusionsHPRAC recognizes that there is a growing crisis in maternity care inOntario, and sees midwives as playing an important role in providingprimary maternity care for low-risk women and their newborns. Midwivesrequire the ability to prescribe a number of medications to carry out theirprimary maternity care role and to enable them to participate fully ininterprofessional teams.RecommendationsRecommendation 1: That the Midwifery Act, 1991 be amended to includethe authority to prescribe a specified list of therapeutic drug classes.Dispensing and selling of drugs are not included in this authority.That the existing list of drugs in the regulation under the Midwifery Act,1991 be replaced with a regulation that includes therapeutic classes ofdrugs.HPRAC Critical Links January 2009