Doctors refusing HB mothers prescriptions

[~clover~]

Homebirth mothers being refused prescriptions

DOCTORS, fearing they will be sued, are refusing to prescribe drugs or order tests for women who want to give birth at home, and this is forcing mothers to give birth in hospitals or putting lives at risk, midwives say.

About 10 women say they were turned away from doctors' offices this week after asking for prescriptions for vitamin K, pain relief or syntocinon, a drug that prevents haemorrhaging after birth. Some had also requested ultrasounds to check the positions of their babies. All had engaged private midwives to help them deliver at home.

''This is outrageous, and it is not what I would call working collaboratively with us,'' said the vice-president of the Australian College of Midwives, Hannah Dahlen.

Advertisement: Story continues belowMelissa Maimann, a private midwife, agreed, saying GPs were making homebirths unsafe by denying women access to basic emergency medicine.

''This problem is escalating, and it is unsatisfactory. It's forcing women to get the drugs illegally.''

She said a woman suffering a postnatal haemorrhage could die if no syntocinon was available.

''It's rare but it depends on how far you are from a hospital. Ambulances don't carry syntocinon, so if you lost enough blood quickly enough, yes, you could die.''

Debbie Hollott, 36, wants to have her eighth child at home at the end of this month, but was rejected by two doctors this week after she presented them with a letter from her private midwife.

''I've had really bad experiences in hospital with my seven babies,'' she said. ''It always left me with a very cold feeling, and I didn't want to do it again, but one doctor would not even see me.''

Mrs Hollott, of Woodford, in the Blue Mountains, was given prescriptions for syntocinon and a strong pain killer after visiting a third GP on Monday.

But the president of the Australian Medical Association, Andrew Pesce, denied doctors were being advised to reject women wanting to deliver at home.

''[A midwife] writing a letter is not my definition of being collaborative, and until we have a consensus statement between midwives and obstetricians, you will find that doctors will make the decision that suits them,'' Dr Pesce said.

He said it would be rare for doctors to be sued over an adverse homebirth if they had taken a patient's medical history, carried out an examination and made an ethical decision on treatment.

''But either the doctor is involved or not involved. Are you asking their opinion or just walking in and telling them what to do?''

The president of the Royal Australian College of General Practitioners, Chris Mitchell, said doctors were supportive of homebirth if care was shared between GPs, obstetricians and midwives.

''Of course doctors can have a conscientious objection to a mode of care, but if that's the case, they need to refer them to someone who can help.''

So glad a there is a doctor here who is happy to provide what he can in order to help make a HB safer, rather than just refusing.

[Arimeh]

But I would have thought the IM would have all that stuff with her anyway? I know I had Eden in a birth centre, but its basically a homebirth (just not in my house haha) and the only drug she had there was the one to stop bleeding - cos I did have a bleed after her. So I would imagine if I ever had another child and it was a home birth, my midwife would bring the same stuff to my house as she has in the centre?

Seems strange that they have to ask for the prescriptions? Dunno about the vitamin K cos we didn't give that to eden after she was born.

[Trillian]

But I would have thought the IM would have all that stuff with her anyway? I know I had Eden in a birth centre, but its basically a homebirth (just not in my house haha) and the only drug she had there was the one to stop bleeding - cos I did have a bleed after her. So I would imagine if I ever had another child and it was a home birth, my midwife would bring the same stuff to my house as she has in the centre?

Seems strange that they have to ask for the prescriptions? Dunno about the vitamin K cos we didn't give that to eden after she was born.

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.

[~clover~]

Really? I did kind of think that, but wasn't sure. Well I guess if a IM is supposed to have that stuff ready, then the doc should have a right to say no. It doesn't make any sence

[Schmickers]

The problem here is that syntocinon is a prescription only drug. As is vitamin K. In hospital it is given as part of a standing order, and hospital midwives have access to it as needed, but this is obviously not the case for independent midwives. Yes, most midwives carry it, but unless the woman can get a prescription for it, thry only have two options - either obtain it from a hospital (which is obviously theft, and against the law) or not use it and transfer in at the first sign of bleeding. Oxygen, on the other hand, does not require a prescription and is therefore much easier to obtain.

[Arimeh]

I wonder how my midwife gets access to it then? She's not affiliated with the hospital and I didn't transfer when I had my bleed, but she sure stuck something in my leg to make it stop.. LOL.. and I can't see her wandering through the halls at the hospital preparing to steal it either.. bahahahaha

[~clover~]

Ok, thanks Schmick. Makes more sense now

[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.