Midwife prescribing in New Zealand

One thing I did not mention in my last post about the Midwifery council forum was the debate about midwife prescribing.

In New Zealand midwives are able to prescribe within the scope of midwifery practice. There is no list of drugs that midwives can prescribe however the midwives scope of practice is quite clearly defined. It is this definition which enables us to identify when we can and when we cannot prescribe. For example we can prescribe to a woman who has a urinary tract infection during pregnancy as this is often associated with a normal uncomplicated pregnancy and needs to be treated early to prevent complications such as preterm labour. Prescribing is a last resort of treatment in most circumstances. Midwives offer advice to try to reduce the chances of infection or to elliminate infection before it gets to the point where antibiotics are required. Midwives cannot however prescribe for a woman who has a chest infection as this is not directly related to pregnancy and requires a medical consultation, usually with the woman's General Practitioner.

The dilemma discussed at the Midwifery Council Forum was the issue of midwives prescribing to other members of the woman's family, in circumstances where this is of direct benefit to the woman and the progress of her pregnancy. The particular situations where this dilemma arises is with Nicotine Replacement Therapy (NRT) and antibiotics for Chlamydia.

NRT
Midwives are taking part in education about smoke change in pregnancy. Midwives are encouraged to discuss smokechange with women and the benefits of Nicotine Replacement Therapy. Midwives can prescribe NRT to women and this is seen as being within the midwives scope of practice. The issue we were discussing at the forum was whether midwives should be able to prescribe to partners or family members of the woman. Research suggests that a partner who smokes adversely affects a woman's ability to quite or remain smoke free. Smoking during pregnancy has a negative impact on the infant both during pregnancy and for the newborn infant. We know women are likely to be more successful in quitting smoking during pregnancy if their partner is also smokefree . The question then is should midwives be able to prescribe NRT to partners or close family members of the woman? If so what would this mean for the midwives scope of practice. We had a lively debate but did not reach a clear conclusion. What do you think? Should midwives be able to prescribe NRT to the partner of women? If so should this only be to assist the woman to stop smoking? What if the woman does not smoke but the partner wishes to quit?
Clearly their are benefits for the baby if the family are smokefree, but is this part of the midwives role?

Antibiotics for Chlamydia.

Once again there was a lively debate with no clear conclusion on this issue.
Midwives can and do treat women for chlamydia infection in pregnancy. Chlamydia is the most common STI in New Zealand, particularly in those under 25 years of age. It is important to identify and treat partners of women who are diagnosed with Chlamydia infection and this is important to avoid reinfection and serious consequences for the newborn, particularly serious eye infections. The question debated was should midwives prescribe antibiotics for the woman's partner? What about if there is no sexual health clinic nearby and the partner will not visit the GP? What are your thoughts about this and once again what does this mean in relation to the midwives scope of practice? Does the scope need to change to accommodate this type of prescribing?

Midwifery Council will continue to debate these issues and ultimately will make a decision on whether or not midwives can prescribe in these circumstances. I welcome your thoughts and feedback on these issues.