Wednesday, May 23, 2012

"Midwife Fairies & Elves"

After hearing stories of CPMs in Michigan carrying Pitocin and medications like Cytotec that are illegal for they to even posses, I asked Mindy Wolfe, Reformed CPM to write a guest post on this issue.  Thank you Mindy for sharing your insight!   

As you read, please recognize yet another reason why regulation and oversight are needed in the midwifery model of care.

I've always been a huge proponent of using the right tool for the right job.  In out of hospital birth, probably the most common complication that could arise for mother during the postpartum period is hemmorhage.  A postpartum hemmorhage can quickly become a matter of life and death, which I feel negates the option of homeopathic or herbal treatments.  These routes are simply not fast enough.  The right tools for postpartum hemmorhage are Pitocin, Methergine, and Cytotec because they are faster, more universally effective and safer to dose appropriately because they come in standardized units.  I feel it would irresponsible to attempt out of hospital birth without at least Pitocin on hand in case of postpartum hemmorhage.  No one lives close enough to a hospital to transfer for an uncontrolled postpartum hemmorhage.

That much said, even the right tools are unsafe when used inappropriately.  To begin with, drugs cannot be expired, and they have to be properly handled at all times to ensure their efficiency.  Then, the drug has to be administered properly and by the correct route.(meaning any midwife who cannot quickly and without fail start an IV on a dehydrated woman should not be practicing alone).  The drug also has to be given with full knowledge of the woman's condition and the potential, if not absolute, cause for her hemmorhage.  (Does she have heart disease or pre-E?  Is the placenta out and complete, or will you need to do a manual exploration for missing pieces?)  How often can the drug be administered and with what frequency?  What are the potential side effects?  And it is completely essential that any midwife, regardless of her legal status, accompany her client in case of transfer and very clearly explain any drugs she has given, at what time, for what reason and in what amount.  

All of these questions touch on a big part of the reason why physicians spend so much time in school studying chemistry, physiology, microbiology and anatomy. (among other courses) They need to have an intimate knowledge of every bodily process, so that when they purposely attempt to change a physical process gone wrong they know what to expect.  Does any lay midwife have that level of knowledge, in order to use her drugs correctly and safely? I would actually doubt it.

In those states where midwives are practicing without legal protection, how do they obtain their drugs?  The "midwife fairies" are usually online drug companies or their midwife-friend in another state that can obtain those drugs legally.  Even apart from the large legal concerns, this introduces the valid concern that the drugs might not have been handled properly in order to ensure their efficiency and safety.  

In summary, all birthing women should be attended by a competent provider who has legal access to in-date medication that they know how to use safely in case of postpartum hemmorhage.  Any deviation from that presents a significantly increased risk to the birthing woman.

Want to know more?  Here's a link to a NPR article that talks more about the variance in what midwives are and are not allowed to do.  The article refers mostly to medications that midwives are and are not allowed to carry.  States Vary On What They Allow Midwives To Do. 

What medications are midwives allowed to carry in Michigan?  A Nurse Midwife is considered an "advanced practice nurse" and is licensed by the state of Michigan.  Under the supervision of a physician she is allowed to carry and use specific medications.  Michigan Nurses Association: Perscriptive Authority   

A CPM, DEM, or lay midwife however, is not a licensed medical care giver and is NOT permitted to carry any perscriptive medications, period.  It is illegal for them to do so and would be considered grounds for prosecution.  These cases should be reported immediately to the DEA and the local police.  

1 comment:

  1. So scary! I was just talking with an L & D nurse of 25+ years about the use of Cytotec for PPH. That is one powerful drug! I couldn't imagine using it without proper and extensive training and watching it used many times in the right setting to understand all the ramifications of its use.