Midwives need to have medications available for safety during birth like pitocin, cytotec, and oxygen for newborn resuscitation. Each state is different depending on your training and certification how medications can be ordered and used. For example in Michigan, CNMs can independently prescribe medications without a physician involvement. For controlled substances, DEA number is required. For CPMs, a written agreement needs to be with a physician or CNM delegating prescription rights or specific aspects of prescription rights to the CPM.
Before ordering stock medications for your practice or prescription for patient to the pharmacy, know your state requirements and scope of practice. Many larger chain stores have free prenatal vitamins. Wouldn’t it be nice to order those for your clients under your midwifery license? Knowing which medications are most affordable for business and consumers alike is vital to your practice. There are certain antibiotics free or really cheap with larger pharmacy chains. There are online pharmacies that are a fraction of the costs to local options.
I have in the past given my Amish women phone number to Canadian pharmacy online and a prescription to order an IUD for fraction of the costs compared to US pharmacies. It isn’t legal for a practice to do this, but position statement of FDA is encouraging consumers not to use international pharmacies for medications but no legal action will be taken against that person. From Birth Control Buzz, women can order a Paragard for $60 versus $800+ in US. Mirena is $210 versus $1200+ costs in US.
As far as direct practice stock medications like Pitocin, Cytotec, ampicillin for group beta strep, epinephrine, Rhogam, and vitamin K, I used SeaCoast Medical. It is a great company and easy to work with. Any site will require you to have documentation showing your DEA number, midwife license, and state regulations allowing you to independently order from their site. SeaCoast Medical would show me brand name, generics, single prices, and bulk prices for item from many different vendors. I knew I was always getting the best price and reps would always call me if a new vendor came in more affordable that hasn’t been placed on website prior to shipping out item.
Oxygen tanks, I would get from a local medical supply company like CareLinc. Provide a prescription for stock use with multiple refills on file at the supply company. I had my families get all their free breast pumps from the supply company down the road from the birth center on their way home. I was known in the town as “McDonald birth center” since women would stay about six hours after delivery and go get their breast pump on ride home. Workers couldn’t believe how amazing the women felt and it set a great marketing brand of our services.
Keep a good inventory of your medications and supplies. As your practice grows, organization is key to not wasting supplies or medications. Last thing you want to do is order more of a medication, because you can’t find it in your office for next women. Check birth supplies part of your routine postpartum care process to make sure that nothing is close to expiring and should be used first next. Be proactive if many rarely used medications are close to expiring like Vitamin K injections and trade with another midwife for some of her farther out expiring medications.
Medications are a vital part of any midwifery practice. Keeping good records and policies on ordering, managing, and documenting medication ordering and use creates midwifery standards. Safety protocols and utilizing our resources properly make a profitable and sustainable midwifery business.