Recent changes to the way maternity services are provided in Australia have opened the doors to midwives being able to prescribe PBS medicines. As Karen Keast discovered, midwives are heading back to university to gain the necessary qualification in droves.

As an obstetrician and gynaecologist, several years ago Dr Kirsten Small faced the mammoth task of writing the very first prescribing course for midwives in Australia, to be launched at Flinders University.

But despite the rivalry that can occur between medical practitioners and midwives, it wasn’t a difficult proposition for Dr Small to compile the course material that would create Australia’s first batch of midwives qualified to prescribe Pharmaceutical Benefits Scheme-subsidised medicines.

As a self-described “woman centered” obstetrician, Dr Small works with two Medicare eligible privately practising midwives on the Sunshine Coast, at a practice called Know Your Midwife.

“I am really used to working with midwives and see them as capable, autonomous health providers and don’t see them as a threat,” she says.

“Having gone from a standard private medical practice in a hospital to working with midwives, this is such a nice way to be able to do it.”

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.

Midwives have been quick to embrace the reforms, with Flinders University revealing it received 160 applications for its first intake for the prescribing course, its Graduate Certificate in Midwifery, last year.

Thirty-four midwives completed the course full-time in one semester, graduating in December, and 79 will soon graduate after completing the course part-time.

Another 59 began the course at the start of this year. Applications are now open for the next intake while 50 have already accepted offers to begin studying the course for semester two.

The online course covers the topics of investigations and diagnostics for midwives and a topic on pharmacology for midwives.

Now, Griffith University is also coming on board to offer a course on midwifery prescribing, with the course now going through the final approvals stage amid plans to accept its first intake for semester two in July.

Its Screening, Diagnostics, Pharmacology and Prescribing for Midwives course, which is also being written by Dr Small, is a one semester online course.

The course is designed to establish advanced, integrated understanding of the knowledge and skills required for safe and effective prescribing within the legal and regulatory frameworks governing midwifery practice in Australia.

Dr Small, a lecturer at Griffith University’s School of Nursing and Midwifery, says the university has been “overwhelmed” with inquiries regarding the course, and she expects its first intake will comprise between 20 and 50 students.

“As soon as it got around we were in the process of writing the course we had people asking about it,” she says.

“There’s been increasing interest in midwives moving into private practice since that option first opened up and some graduates are interested in going straight from their training into private practising midwifery.”

Dr Small says offering an online course, which also features real time web sessions, enables midwives juggling their private practices and families to fit their study in with their busy lifestyles.

And she’s excited to be able to provide a course that helps prepare midwives for contemporary prescribing practice.

“To be able to do this and make sure that midwives around Australia can start their journey off right and to know that their education has been really sound and they can hold their head up…it’s a nice feeling.

“It’s been a long time coming,” she says.

To be eligible for endorsement for scheduled medicines under section 94 of the National Law, applicants must be able to demonstrate they meet a range of requirements, including being a currently registered midwife in Australia, having the equivalent of three years’ full-time post initial registration experience as a midwife and being equipped with an approved qualification to prescribe scheduled medicines. For more information view the Registration Standard for Endorsement for Scheduled Medicines for Midwives here.

Dr Small says midwives have long been involved in prescribing decisions but were just unable to sign the prescription.

“For midwives, they can actually now work to the full scope of their practice without having to dash off to get a doctor to sign a bit of paper for them, when they have already made the right decision,” she says.

“It really respects them as a health care professional in their own right.

“I think it’s also really important for the women that see midwives. It now seems their midwife is more of a one-stop-shop for them, instead of midwives looking after their pregnancy and offering advice, and saying - you need a prescription, go and see a doctor.

“That costs women more and it costs the health care system more. Midwives are still going to use doctors if women are sick.”

Dr Small says qualified midwives will be able to prescribe for a range of medications, from those used to treat uncomplicated urinary tract infections in the early stages of pregnancy to medication for managing morning sickness, simple pain relief for an injury, routine medication for newborns and contraception for the mother post-birth.

Dr Small plans to see the course through its bedding-in phase and then wants to hand it over to an Australian midwifery prescriber.

“It’s exciting but my plan is to not forever hold the monopoly over it,” she says.

“I would love to see in a couple of years we have midwives, who are experienced at prescribing, who can start stepping in and start in an education role.

“It belongs in the hands of the midwifery profession ultimately.”