Medications Prescribable by Midwives in British Columbia
Midwives in British Columbia can prescribe a limited range of medications focused primarily on maternal and newborn care, including oxytocin, NSAIDs, and certain antibiotics, with specific dosing parameters and contraindications for each.
Pain Management Medications
NSAIDs
- Ibuprofen
- Dose: 400-800 mg PO every 6-8 hours
- Onset: 30-60 minutes
- Duration: 4-6 hours
- Contraindications: Third trimester pregnancy, active peptic ulcer disease, severe renal impairment, history of hypersensitivity to NSAIDs 1
Acetaminophen
- Dose: 650-975 mg PO every 6-8 hours (maximum 4000 mg/day)
- Onset: 30-60 minutes
- Duration: 4-6 hours
- Contraindications: Severe liver disease, hypersensitivity 2
- Note: Recent studies suggest possible associations between prenatal acetaminophen use and neurodevelopmental issues, so use should be limited to the lowest effective dose for the shortest time 3
Postpartum Hemorrhage Management
Oxytocin
- Dose:
- Prevention: 5-10 IU IM or slow IV immediately after delivery
- Treatment: 10-40 units in 1000 mL IV fluid at rate necessary to control uterine atony
- Onset: IV: immediate; IM: 3-5 minutes
- Duration: IV: 1 hour; IM: 2-3 hours
- Contraindications: Hypersensitivity, situations where vaginal delivery is contraindicated 4, 5
Tranexamic Acid
- Dose: 1g IV within 1-3 hours of bleeding onset
- Onset: 5-15 minutes
- Duration: 3 hours
- Contraindications: History of thrombosis, active thromboembolic disease 5
Respiratory Medications
Short-Acting Beta Agonists
Salbutamol (Albuterol)
- Dose: 2-4 puffs via MDI every 4-6 hours as needed
- Onset: 5-15 minutes
- Duration: 4-6 hours
- Contraindications: Hypersensitivity, tachyarrhythmias 2
Terbutaline
- Dose: 0.25 mg subcutaneous every 20 minutes for up to 3 doses
- Onset: 5-15 minutes
- Duration: 3-4 hours
- Contraindications: Maternal cardiac disease, pulmonary hypertension 2
Corticosteroids
- Beclomethasone
- Dose: 2 puffs (80-160 mcg) via MDI twice daily
- Onset: 2-4 days (full effect may take 1-2 weeks)
- Duration: 12 hours
- Contraindications: Untreated fungal infections, hypersensitivity 2
Antibiotics
Penicillins
- Ampicillin
- Dose: 500 mg PO every 6 hours or 1-2g IV every 4-6 hours
- Onset: PO: 1-2 hours; IV: immediate
- Duration: 6-8 hours
- Contraindications: Penicillin allergy 2
Cephalosporins
- Cefazolin
- Dose: 1-2g IV every 8 hours
- Onset: Immediate
- Duration: 8 hours
- Contraindications: Severe cephalosporin allergy 2
Macrolides
- Azithromycin
- Dose: 500 mg PO once daily for 3 days
- Onset: 2-3 hours
- Duration: 24 hours (tissue levels persist for days)
- Contraindications: Macrolide allergy, severe hepatic impairment
Special Considerations
Pregnancy-Specific Medications
Methyldopa
- Dose: 250-500 mg PO 2-3 times daily
- Onset: 4-6 hours
- Duration: 12-24 hours
- Contraindications: Liver disease, depression, pheochromocytoma
Labetalol
- Dose: 100-400 mg PO twice daily
- Onset: 1-2 hours
- Duration: 8-12 hours
- Contraindications: Asthma, heart block, severe bradycardia
Breastfeeding Considerations
Most medications prescribed by midwives are compatible with breastfeeding. Specific exceptions should be noted:
- Prostaglandin F2α: Avoid in women with asthma due to risk of bronchoconstriction 2
- Ergometrine: Avoid in women with hypertension or asthma 2
Important Clinical Pearls
Midwives in BC must follow specific prescribing guidelines that limit their scope compared to physicians.
For pain management after cesarean delivery, the recommended approach includes:
- Scheduled acetaminophen 975 mg PO every 8 hours
- NSAIDs (e.g., ibuprofen 600 mg PO every 6 hours)
- Short course of oxycodone only if pain is poorly controlled with the above 2
When prescribing antibiotics, midwives must consider local resistance patterns and patient allergies.
For respiratory conditions during pregnancy, inhaled medications are generally preferred as they have minimal systemic effects 2.
Midwives in BC focus on promoting normal birth and minimizing interventions, which influences their prescribing patterns 6.