Prescribing formulary for midwives with a scheduled medicines endorsement

Under Section 94 of the Health Practitioner Regulation National Law (the National Law) as in force in each state and territory, the Nursing and Midwifery Board of Australia (the NMBA) has the power to endorse the registration of suitably qualified midwives to prescribe and/or supply NMBA approved schedule 2, 3, 4 and 8 medicines for the management of women and their infants in the antenatal, intrapartum and post-natal stages of pregnancy and birth.

A scheduled medicines endorsement identifies those midwives who are considered by the NMBA to be qualified to:

  • administer, obtain, possess, prescribe or supply specified schedule 2, 3, 4 and 8 medicines to the extent authorised under the relevant legislation that applies in the State or Territory in which they practise;
  • use those medicines appropriately for the management of women and infants during the pregnancy, birth and post natal periods, and
  • apply to Medicare Australia for a Pharmaceutical Benefits Schedule prescriber number.

The NMBA has approved the lists of schedule 4, schedule 8 and intravenous medicines (below) for prescribing by midwives with a scheduled medicines endorsement.

Schedule 4 medicines

 

Medicines
group 
Medicine  Route  Duration/
restriction 
Indicator 
Anaesthetics  Lignocaine HCL  Subcut*.  Single dose  Perineal infiltration prior to episiotomy or perineal repair 
Lignocaine HCL with adrenaline  Subcut.  Single dose  Perineal infiltration prior to episiotomy or perineal repair 
Analgesia  Nitrous oxide/oxygen  Inhalation  Single dose  Relief of intrapartum pain

Relief of pain associated with perineal repair 
Paracetamol/codeine phosphate  PO  Max 8 tablets/24 hours  Relief of moderate intrapartum and postnatal pain 
Antibiotics  Amoxycillin#  PO  7 days  Urinary Tract Infection
Postnatal perineal, caesarean section wound infection, endometritis 
Amoxicillin with clavunic acid PO, IM, IV  5-10 days or longer  Urinary Tract Infection ,post natal perineal caesarean section wound infection, endometritis 
Ampicillin  PO
IM 
7 days
2 days 
Urinary Tract Infection 
Azithromycin  PO  7 days  Postnatal perineal, caesarean section wound infection, endometritis 
Benzylpenicillin#  IV  Intrapartum  Group B beta-hemolytic Streptococcus prophylaxis 
Cephalosporin#  PO, IM, IV  10 days
1 day 
Postnatal perineal, Urinary Tract
Infection, caesarean section wound infection, endometritis 
Chloramphenicol#
(Opthal) 
Eye drop,
Eye oint. 
2 days  Neonatal conjunctivitis 
Clindamycin PO*  5 days  Urinary Tract Infection, Group B betahemolytic streptococcus prophylaxis 
Dicloxacillin#  PO  7 days  Postnatal perineal, caesarean section wound infection, endometritis 
Erythromycin  PO

IV 
7 days

1 day 
Neonatal skin infection

Urinary Tract Infection, Postnatal perineal, caesarean section wound infection, endometritis 
Flucloxacillin#  PO  10 days  Mastitis 
Lincomycin#  IM, IV  1 days  Postnatal perineal, caesarean section wound infection, endometritis 
Metronidazole  PO
PR 
7 days  Postnatal perineal, caesarean section wound infection, endometritis 
Nitrofurantoin#  PO  3 days  Urinary Tract Infection 
Antiemetic  Metoclopramide#  PO, IM  Single dose  Relief of intrapartum nausea and vomiting in labour 
Domperidone  IM  Single dose  Relief of intrapartum nausea and vomiting in labour 
Anti convulsant  Magnesium
Sulphate 
IM, IV  Single dose  Pre eclampsia 
Antidote  Calcium gluconate  IV  Single dose  Magnesium sulphate antidote 
Diphenhydramine  PO Single dose  Metoclopramide antidote 
Benztropine  PO  Single dose  Metoclopramide antidote 
Antifungals  lotrimazole Vagina  Topical  6 days  Vulvo-vaginal, nipple Candida infection 
Nystatin  Topical
PO 
3 days
7 days 
Neonatal oral Candida 
Anti hypertensive  Nifedipine  PO  Single dose  Anti hypertensive
Antivirals  Acyclovir  PO  36th week until birth  Genital Herpes Simplex Virus 
Oseltamivir
(Tamiflu®) 
PO  5 days  Influenza 
Benzodiazepines  Temazepam  PO  Single dose  Rest and relaxation in early non-active labour 
Contraceptives  Levonorgestrel#  PO

PO 
Single dose

1 pack 4 cycles 
Emergency contraceptive

Postnatal contraceptive 
Norethisterone
Noriday
Primolut 
PO  1 pack 4 cycles Postnatal contraceptive 
Cyproterone with ethinyloestradiol
Diane 35 ED 
PO  1 pack 4 cycles  Postnatal contraceptive 
Desogestrel with
ethinyloestradiol
Marvelon 28 
PO*  1 pack 4 cycles  Postnatal contraceptive 
Dienogest with
ethinyloestradiol
Valette 
PO  1 pack 4 cycles  Postnatal contraceptive 
Drospirenone with
ethinyloestradiol
Yaz 
PO  1 pack 4 cycles  Postnatal contraceptive 
Drospirenone with
ethinyloestradiol Yasmin 
PO  1 pack 4 cycles  Postnatal contraceptive 
Gestodene with
ethinyloestradiol
Femoden ED
Minulet 
PO  1 pack 4 cycles  Postnatal contraceptive
Levonorgestrel with
ethinyloestradiol
Microcygnon 20, 30, 50,
Nordette,
Triquilar,
Triphasil 28 
PO  1 pack 4 cycles  Postnatal contraceptive 
Norethisterone with
ethinyloestradiol
Brevinor 21 & 28,
Improvil 28, Synphasic 28 
PO  1 pack 4 cycles  Postnatal contraceptive 
Norethisterone with mestranol
Norinyl 
PO      1 pack (4 cycles)  Postnatal contraceptive 
Medroxyprogesterone  IM  Single dose  Postnatal contraceptive 
Dopamine
Antagonist 
Domperidone  PO  7-10 days, taper
dose 
Lactation stimulant 
Metoclopramide  PO  7-10 days, taper
dose 
Lactation stimulant 
Glucosteroids  Betamethasone  IM Single dose  Fetal lung maturation in preterm
labour 
Dexamethasone  IM  Single dose  Fetal lung maturation in preterm
labour 
Immunoglobulins  Human anti-D IgG  IM  Single dose  Rh(D) –ve antenatal woman with anti-D antibodies following Rh(D) +ve pregnancy 
Human anti-D IgG  IM  Single dose  Rh(D) –ve postnatal woman with anti-D antibodies following Rh(D) +ve pregnancy 
Narcotic antagonist  Naloxone hydrochloride  Subcut,
IM, IV*

IM, IV 
Single dose


Single dose 
Respiratory depression in neonate at birth following narcotic use for management of pain in labour


Maternal opioid overdose in labour 
Non steroid anti-inflammatories  Diclofenac sodium#  PO
PR 
3 days  Post-partum analgesia 
Indomethacin  PO
PR 
3 days  Post-partum analgesia 
Prostaglandin  Misoprostol
(Cytotec®) 
PR  Single dose  Post Partum Haemorrhage 
Sympathomimetics  Adrenaline hydrochloride  Subcut, IV  Single dose  Anaphylaxis 
Tocolytics  Nifedipine  PO  Single dose  Myometrial relaxant in preterm labour 
Uterotonics  Ergometrine maleate  IM, IV  Single dose  Prophylaxis for primary postpartum haemorrhage

Post partum haemorrhage due to uterine atony after separation of placenta 
Ergometrine/Oxytocin (Syntometrine®)  IM, IV.  Single dose  Management of 3rd stage of labour
Prevent and treat postpartum haemorrhage associated with uterine atony 
Oxytocin (Syntocinon®)  IM  Single dose  Active management of 3rd stage of labour
Prevent and treat postpartum haemorrhage 
Oxytocin (Syntocinon®)  IV  40 IU in 1L
Hartmann’s Solution
Management of postpartum haemorrhage 
Vaccines  Influenza vaccine  IM  Single dose  Influenza 
Hepatitis B vaccine  IM  Single dose
Parental consent required 
Neonatal vaccination 
Measles, mumps, and rubella (MMR) (NHIG)  IM  Single dose  Maternal vaccination in nonimmune women 
Vitamins  Phytomenadione vitamin K (Konakion®)  IM
PO 
Single dose
Parental consent
Required
At birth; at day 3–5;
at 4th week.
Last dose not required in formula fed neonates 
Prophylaxis for vitamin K deficiency bleeding in neonate 

Schedule 8 medicines

 

Medicines group  Medicine  Route  Duration/restriction  Indicator 
Opioid Pethidine Subcutaneous

IM*
4-6 hourly

repeat dose
Intrapartum pain

Severe postnatal pain
Morphine# Subcutaneous

IM
4-6 hourly

repeat dose
Intrapartum pain

Severe postnatal pain
Fentanyl Subcutaneous Stat dose, after one hour subsequent doses 15 minutely up to 3 times

Maximum total dose 350 micrograms.
Intrapartum pain

*Subcut= subcutaneous; PO= per oral; IM= intramuscular; IV=intravenous; PR=per rectum
#medicines listed on the Pharmaceutical Benefits Scheme Midwife Items

Intravenous fluids

 

Fluid  Route  Indicator 
0.9% sodium chloride solution (normal saline)  Intravenous  Retain patency of intravenous line

Administration of medication
Rehydration during labour

Fluid replacement in postpartum haemorrhage 
Hartmann’s solution  Intravenous  Rehydration during labour

Fluid replacement in postpartum haemorrhage 
 
 
Page reviewed 6/02/2017