How do privately practising midwives gain their prescriber number and script pad? The road to prescribing medication is no simple undertaking but worth the effort, writes Karen Keast.

Midwife Daniel Evans is now equipped with a prescriber number and a script pad.

For the Newcastle-based midwife of 10 years, who works for Hunter New England Area Health Service and is also planning to launch his own private midwifery practice, the move to prescribing is a major step forward in his midwifery career.

“It’s so exciting to now have the ability to prescribe medications to women rather than defer to another medical professional,” Mr Evans says.

“Progressing my skills and career outlook in this way has been so beneficial for my future career and for building my own business which is set to get underway later this year.”

Mr Evans is one of the first graduates from Griffith University’s 15-week, online Screening, Diagnostics, Pharmacology and Prescribing for Midwives program.

The university is one of just three in Australia offering a program in prescribing, since courses specifically designed to meet the educational requirements for midwives seeking endorsement as prescribers first became available in 2012.

Western Sydney University Professor Hannah Dahlen, a privately practising midwife and spokesperson for the Australian College of Midwives, also stands among the first batch of midwives with the power to prescribe.

“I’ve just been through all of this and I’ve finally got my prescription pad and I’m set,” she says.

“Most people will do the course over a year because it’s so hard while you’re working full-time.

“Then they have to go through the process of seeking a Medicare provider number and once they get that they will then go and apply for a prescription pad.”

Changes

The 2009-2010 maternity services reforms paved the way for women to have more choice in their birthing experience, and were designed to ease the growing pressure on the nation’s maternity services due to an increasing number of births and workforce shortages.

Now, Australia’s eligible, privately practising midwives are able to access the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Schedule (PBS), providing Medicare-rebateable services to women and prescribing certain PBS-subsidised medicines, resulting in more affordable maternity care to women.

Midwives are also able to work collaboratively with obstetricians and medical practitioners and can access Australian Government-supported professional indemnity insurance.

Medicines

An endorsement under section 94 of the National Law indicates that a midwife is able to prescribe schedule 2, 3, 4 or 8 medicines appropriate for midwifery practice across pregnancy, labour, birth and post natal care.

Some of the medicine groups covered include anaesthetics, analgesia, antibiotics, contraceptives, immunoglobulins, vaccines, vitamins, opioid, intravenous fluid and uterotonics.

Eligibility

Midwives wanting to access a Medicare provider number either need a notation as an eligible midwife or an endorsement for scheduled medicines, according to the Australian College of Midwives’ website.

Midwives with an endorsement for scheduled medicines may also prescribe medication depending on their state and territory legislation.

Midwives can apply for notation or endorsement to the Nursing and Midwifery Board of Australia.

To be eligible for endorsement for scheduled medicines, applicants must be a currently registered midwife in Australia with no restrictions on practice, be able to demonstrate the equivalent of three years’ full-time post initial registration experience as a midwife, and demonstrate evidence of current competence to provide pregnancy, labour, birth and post natal care to women and infants.

They must also have successfully completed an approved professional practice review program for midwives working across the continuum of midwifery care, along with 20 additional hours per year of continuing professional development, and also have demonstrated completion of an accredited and approved program of study to develop midwives’ knowledge and skills in prescribing, or a program substantially equivalent, as determined by the board.

Courses

There are currently three board-approved programs of study - Flinders University’s Graduate Certificate Midwifery (Leading to endorsement for Scheduled Medicines for Eligible), Griffith University’s Screening, Diagnostics, Pharmacology and Prescribing for Midwives program, and the University of Queensland’s Education Program Leading to Endorsement of Scheduled Medications (Eligible Midwife).

Professor Dahlen, who completed her program through Flinders, says the courses are already proving to be incredibly popular with midwives.

“I think there’s a feeling of excitement amongst midwives,” she says.

“It’s been a long time coming. The future is that we should embed this in undergraduate and pre-registration midwifery training, like in New Zealand and America, so you come out ready to prescribe.”

Benefits

Professor Dahlen says the move to midwifery prescribing is an opportunity for midwives to provide women with another service and reduce the fragmentation of care.

“Currently what’s happened with private midwives is if the woman appears to have a urine infection or, for example, if she’s planning a home birth and they need Syntocinon or vitamin K for the birth, they have to send the woman to a GP to then go through a second consult.

“They then have to deal with GPs who refuse to prescribe Syntocinon because they don’t agree with home births, and in some cases we have had women going to four or five doctors before someone has finally agreed to write a script.

“So it cuts out all of that duplication, fragmentation and adversity that women sometimes experience when they choose midwifery models of care.”

Midwives are finally being recognised for the skills they have, and are now being given that recognition and respect, Professor Dahlen adds.

“Even more importantly, what it does, is it says midwives take responsibility for their prescribing and their ordering and currently midwives might do all of these things and then the doctor takes responsibility and that’s not acceptable.”

Professor Dahlen hopes more midwives will navigate their way through the steps to gaining their prescriber number and script pad.

“I would just so encourage midwives to go out there and do it - become eligible, do your course,” she says.

“Even if the opportunities don’t seem apparent at the moment, the doors of the hospitals are about to open so that midwives can get visiting rights across the country, the state and territory governments are issuing policies saying every hospital should open their doors and allow eligible midwives in.

“Go do it now - don’t wait for the doors to open,” she says. “Be part of pushing those doors open.”