Chapter 10 - DRUG FORMULARY
A licensed midwife may use the drugs described in the midwifery formula according to the following protocol describing the indication for use, dosage, route of administration and duration of treatment:
| Drug | Indication | Dose | Route of Administration | \Duration of Treatment |
| Oxygen | Maternal/Fetal Distress Neonatal Resuscitation | 10-12 L/min 10 L/min 10-12 L/min 10 L/min | Mask or Bag and mask Mask or Bag and mask | Until maternal/fetal stabilization is achieved or transfer to hospital is complete. Until stabilization is achieved or transfer to a hospital is complete. |
| Oxytocin (Pitocin) | Postpartum hemorrhage only | 10 Units/ml | Intramuscularly only | 1-2 doses. Transport to hospital required if more than two (2) doses are administered |
| Misoprostol | Postpartum hemorrhage only | 200 microgram tabs, as 800 micrograms per dose (4 tabs). | Rectal or sublingual, or may be used as ½ rectally and ½ sublingually | 1-2 doses. Transport to hospital required if more than 2 doses are administered. Not to exceed 800 micrograms. |
| (Note that this is off label use of this drug, but an appropriate use.) | ||||
| Methyl- ergonovine (Methergine) | Postpartum hemorrhage only | 0.2 mg | Intramuscularly or orally | Single dose. Every six hours, may repeat 3 times. Contraindicated in hypertension and Raynaud's Disease. |
| Lidocaine HCl 1% Or 2% | Local anesthetic for use during postpartum repair of lacerations or episiotomy | Maximum 50 ml (1%) Maximum 15 ml (2%) | Percutaneous infiltration only | Completion of repair |
| Penicillin G (Recommended) | Group B Strep Prophylaxis Ruptured membranes greater than 24 hours | 5 million units initial dose, then 2.5 million units every 4 hours until birth | IV in >=100 ml LR, NS or D5LR | Birth of baby |
| Ampicillin Sodium (Alternative) | Group B Strep Prophylaxis Ruptured membranes greater than 24 hours | 2 grams initial dose, then 1 gram every 4 hours until birth | IV in >=100 ml NS | Birth of baby |
| Cefazolin Sodium | Group B Strep Prophylaxis Ruptured membranes greater than 24 hours | 2 grams initial dose, then 1 gram every 8 hours | IV in >= 100 ml LR, NS or D5LR | Birth of baby |
| (Drug of choice for penicillin allergy with low risk for anaphylaxis) | ||||
| Clindamycin Phosphate | Group B Strep Prophylaxis Ruptured membranes greater than 24 hours | 900 mg every 8 hours | IV in >=100 ml NS or Birth of baby LR | Birth of baby |
| (Drug of choice for penicillin allergy with high risk for anaphylaxis) | ||||
| Epinephrine HCl 1:1000 (EpiPen) | Treatment or postexposure prevention of severe allergic reactions | 0.3 ml pre-metered dose | As directed | Every 20 minutes or until emergency medical services arrive. Administer first dose then immediately request emergency services |
| Lactated Ringer's (LR) | To achieve maternal stabilization | 1-2 liter bags - First liter run in at a wide-open rate, the second liter titrated to client's condition | Intravenous catheter | Until maternal stabilization is achieved or transfer to a hospital is complete. |
| 5% Dextrose in Lactated Ringer's solution (D5LR) | To achieve maternal stabilization | 500 ml may run in wide open then hydrate to client's condition | Intravenous catheter | Until maternal stabilization is achieved or transfer to a hospital is complete. |
| 0.9% Sodium Chloride (NS) | Reconstitution of antibiotic powder | As directed | As directed | Birth of Baby |
| Sterile H2O Papules | Relief of back labor | 0.1-0.5 cc at the 4 corners of the sacrum, Should be administered rapidly, one after another, over a 30 to 90 second total period | Subdermally, using TB syringe and needle. | 1 to 2 times during labor. Duration of pain relief is 2 to 4 hours. |
| Rh(D) Immune Globulin | Prevention of Rh(D) sensitization in Rh(D) negative women | 300 meg | Intramuscularly | Single dose at any gestation for Rh(D) negative, antibody negative women within 72 hours of spontaneous bleeding or abdominal trauma. Single dose at 26-28 weeks gestation for Rh(D) negative, antibody negative women. Single dose for Rh(D) negative, antibody negative women within 72 hours of delivery of Rh(D) positive infant, or infant with unknown blood type. |
| Phylloquinone (Vitamin K1) | Prophylaxis for Vitamin K Deficiency Bleeding | 1 mg | Intramuscularly | 1 dose |
| 0.5% Erythromycin Ophthalmic Ointment | Prophylaxis of Neonatal Ophthalmia | 1 cm ribbon in each eye | Topical | 1 dose |
| Terbutaline | Severe bradycardia of fetus and during transport. Not to be used prior to 37 weeks | 0.25 mg, single dose | Subcutaneous | May repeat one time no earlier than sixty (60) minutes after administration of the first dose. |
Amended, Eff. 7/18/2018.