Chapter 10 - DRUG FORMULARY

Current through April 9, 2022

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.

Notes

Amended, Eff. 7/18/2018.

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.