Doctors refusing HB mothers prescriptions

[Little Chicken]

They could always call the midwife...give this 'collaborative' stuff an actual try before deciding they can't collaborate with an IM.

The IM would know the dosage. Which they would cover in the letter. It might be easier for the doctor to see the IM, but I'm sure the IM has other things to do, not to mention the unnecessary cost to the mother for an extra consult? Perhaps Maya is right, and it really is a power thing - if my GP wrote a letter, my specialist wouldn't be saying 'hmm not sure I can verify the authenticity of this letter, can you bring him in to chat with me?'

Certainly easier access to the necessary drugs for IM's would make this whole thing a lot simpler and less discriminatory. As Trill says, planned freebirths are a whole different ball game, I'd be advocating a freebirther transfer with good advocacy/support in place if there were complications.

But if there were concerns with a doctors identity, they can always check their medicare provider number to verify, if there was such a system for midwives that made it easier to verify a letter from a professional IM if the doctor had any doubts. Yes they could check with the nurses board if they are registered as a midvife, but it wont tell them if they are a practicing independent one. I am not a midwife but a registered nurse and but I can access drug dosing information and use the right terminology to make a letter look legtimate, forge a midwife colleagues name and find out her regsitration number and provide that as well if I wanted. It is not hard.
I have seen some GP's referral letters and I would want to see them to for some of the stupid and unhelpful information they provide (as in please see patient, she is complaining she is unwell). As well a specialist should examine you and come to thier own conclusions and not just rely on a GP's letter.

[slyder]

Butt out doctors...butt out pesce. My vagina, my choice!

Doctors can have the same attitude - my prescription pad, my (potential) legal risk. My choice.

I wouldn't blame any Dr for refusing to prescribe in this situation.

Simply find another Dr who is prepared to do it and get over it in my view.

[~clover~]

Yes, but noone is asking a doctor to give out a script they don't want to give out.
Why can't these things be accessable by an IM is my question.

[Little Chicken]

Yes, but noone is asking a doctor to give out a script they don't want to give out.
Why can't these things be accessable by an IM is my question.

I probably say that because these drugs have to be 'prescribed', and IM's don't have the provider numbers to make legal prescriptions. Even nurse practioners who can prescribe can only do a very few drugs and none of them would have the strength or potential complications like these have. Campaign for them to have provider numbers.

[Smoke Jaguar]

Liz, spot on.
The AMA WANTS midwives to be disempowered by NOT having prescription rights, and wanting the IM to lose her independence by being dependant on doctors. You'll find the AMA will oppose the ability for IM's to have access to whatever they need to conduct smaller interventions for safety and health in a home setting, the way they can and have for decades in the UK and Netherlands.
Sure, I understand not wanting to write a script based on a letter from an IM you've not worked with. The fact that this is how some IM's need to get their necessary birth tools (even though they largely go unused) into their toolboxes is just archaic and paternalistic. Just the way the AMA wants it to stay so that they 'win' the argument the medical lobby started a couple of centuries ago. Grrr!

[meow]

I'm pretty sure "complying" midwives will have medicare provider numbers and prescribing rights as of Nov 1st. Only problem is, in order to be compliant just one of the conditions is that have insurance which homebirths midwives can't access. So hospital employed midwives will be able to do these things... but then they don't need to if they work in a hospital!
One step forward... oh wait, not really.

[Tegam]

I'm with Arimeh, Midwives are supposed to have all that, plus oxygen etc JIC it is needed. I'm thinking that the women asking for prescriptions for synctocinon are freebirthing and in that case, like it or not, these are drugs that should not be administered by people who don't know what they are doing.

ETA - Plus I think it opens up a whole other issue that JIC something does go wrong, someone is going to want to know where the woman got a script for it, and if it comes back to a Dr who wrote a script based on a letter from a midwife, then it is him on the line as well and why should he be? Why can't they have the option of saying they don't want to fill the script. Why can't the midwife do it? I'm all for homebirths, but gee, if you want it to work it has to work both ways.

Sorry i havent had time to read all the replys but i had a HB and i had to get my old OB in another STATE to write out the scripts for me as i couldnt get a local GP up here (QLD) to do it! The IM carry a stock of it but can only get that stock with a script, so as in my case we didnt use any of it so she now has it for other patients that cant get scripts! Its crazy but its true!

[Schmickers]

The IM carry a stock of it but can only get that stock with a script, so as in my case we didnt use any of it so she now has it for other patients that cant get scripts! Its crazy but its true!

This is a legal minefield. Using medications prescribed for another person for a current client without an order is risky, medico-legally speaking.

I'm pretty sure "complying" midwives will have medicare provider numbers and prescribing rights as of Nov 1st. Only problem is, in order to be compliant just one of the conditions is that have insurance which homebirths midwives can't access. So hospital employed midwives will be able to do these things... but then they don't need to if they work in a hospital!
One step forward... oh wait, not really.

I doubt one of the things they will be able to order is syntocinon. The main purpose of having a provider number is to order some basic scans. Don't be fooled into thinking this will empower hospital midwives, either - it will make antenatal clinics cheaper to run because they won't need a resident doctor in there to order blood tests and scans, and that is about it.

[Roryrory]

I am completely FOR homebirth and IMs but completely understand why drs are not prescribing. I think particularly with the uncertainty around IM insurance ATM even if a dr believed a woman was choosing the "safe" route (ie: fno freebirth" I think I as a lawyer would advise they did not prescribe without really checking with a medical negligence lawyer how to do it while covering their own back. IMO the risk would be too great without specific advice. (I do leasing and commercial law, so wouldn't have a clue what they could or could not get away with). I understand the AMA's stance to - they are protecting their turf and doing what their members would expect of them. I just think the AMA are completely wrong on the facts.

[Tegam]

[QUOTE=Schmickers;2345201]This is a legal minefield. Using medications prescribed for another person for a current client without an order is risky, medico-legally speaking.

Yes i understood this to be the case at the time. However that was her professional risk/decision at the time. I do not know what she practises now.