Doctors refusing HB mothers prescriptions

Homebirth mothers being refused prescriptions

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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.''

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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.

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.

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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.

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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.

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 :dunno:

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.

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

Ok, thanks Schmick. Makes more sense now :)

The birth centre would be affiliated though I'm guessing. So Schmickers, in essence this isn't a new thing that has all of a sudden happened, women have always had to get a script filled, but considering the current issues surrounding HB, this is a typical media beat up to turn a non-issue into a scandal? I always thought that the midwives provided those things because that was my understanding based on different things I have read supporting HB - like if you have a bleed then your midwife will have the syncto etc.

Now this is one of those situations where being able to access a homebirth through a hospital clinic or a hospital affliated birthing centre makes sense as the hospitals standing orders would apply to these medications. Though saying that, some hospitals are really cutting back on their standing orders and you now have to have prescriptions for just about everything.

I just cannot believe how much the AMA misses the whole, entire, friggin point. There are lots of women who CHOOSE not to want a doctor to 'treat' their pregnancy. But what the AMA wants, under Pesce, is to force doctors upon women who want a HB whether they want a doctor or not, just so that they get their cut of the friggin economic pie. It's not about safety or women at all. It's about getting a look in. They KNOW how successful the HB programs are overseas and they don't want it catching on!
So, even if an IM comes with you to a GP appt, the doc can still veto and THAT'S considered 'collaborative'.
No, no, no, no, no, no, NO!! If I don't want a doctor involved unless medically necessary, then I don't want a doctor, that's kind of the whole point of going HB!
If synto is so much a part of birth (as it is in Oz), then you would think that out of true concern for safety of birthing women, IM's would have access to this without the need to go through a doctor first. It is absolutely clear which way the bias lies.

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The birth centre would be affiliated though I'm guessing.

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Hmm I dunno? You do have to register with the hospital in case of transfer, but they take anyone at all - so its not like a normal birth centre attached to a hospital where if you are too "risky" you don't get accepted?

Now I'm all confuzzled.. lol

To be fair to doctors, they don't have to prescribe you something just because you ask for it, and unfortunately there is probably no way to check if a letter from an IM is legitimate or not. Also some might not be familiar with the dosing of syntocin and vit K and while yes these can be looked up, the dosing and route of administration comes back to them and personally, I would feel uncomfortable prescribing a drug I was unfamiliar with just because someone I might not have met before came in with a letter from someone I do not know asking for it. If you need the prescription take the IM with you to explain the need. Just about all doctors I have worked with and dealt with personally can be reasonable if presented with a good rationale for why something is needed. I wouldn't be happy with a doctor who gave me antibiotics just cause I went in and asked for them I would expect to be examined and asked questions as to why I thought I needed them, and in a way this is no different.

Well it seems to me it all goes hand in hand with banning home birth. Another way around women having access to a safe HB.
If syntonin isn't accessable by even IM's then some women would reassess their options wouldn't they. Another way of bullying women into doing what they aren't comfortable with, just because they are thinking about the safety of themselves & their babies.
I understand a doctor has the right to say no, but an IM should be able to access something that could save a life!
I'm not sure what I'm trying to say is coming out right :redface:

My midwife had vit k and synto.

I can see both sides of this issue, but really, midwives should be able to access this stuff without a Gp. I know my gp wasn't keen on my homebirth idea but he would have prescribed the meds if I asked. I think some gps are ideologically opposed to homebirth, which is fine, but why are they even in the equation?

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

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Hmm I dunno? You do have to register with the hospital in case of transfer, but they take anyone at all - so its not like a normal birth centre attached to a hospital where if you are too "risky" you don't get accepted?

Now I'm all confuzzled.. lol

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I know with the main hospital in Perth that if you are booked through their birth centre, you are also booked into the main hospital in case of transfer. That is one of the good things about affliated centres, unfortunately though they will also have policies and proceedures and guidelines as well.

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To be fair to doctors, they don't have to prescribe you something just because you ask for it, and unfortunately there is probably no way to check if a letter from an IM is legitimate or not.

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

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.

I agree with muminalice, a letter from an IM or even meeting the IM is no proof that the script request is legit. A proper collaborative relationship where both parties trust one another is what is required IMHO.

hmm... I'm sure the midwife I spoke to said she carries synto, and that I would only need the GP for u/s referrals, blood tests and scripts for vit K & hep B if I wanted them.

I don't think the argument should be so much about GP's having the right to refuse the script (I agree with muminalice's post).. but more that midwives should be able to prescribe these themselves. They are the pregnancy/birth care providers, they should be able to prescribe the relevant drugs.

My dentist can prescribe antibiotics for an infected tooth without sending me to my GP.. a midwife should be able to prescribe synto, and refer for ultrasounds too for that matter, without a GP. JMO.

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

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.

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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.

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

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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.

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.

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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.

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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.

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!

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.

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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.

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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!

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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!

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

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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.

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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.

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.

[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.