Administrative Rules of Montana › Department 24 - LABOR AND INDUSTRY › Chapter 24.111 - ALTERNATIVE HEALTH CARE BOARD › Subchapter 24.111.6 - Licensing and Scope of Practice - Direct-Entry Midwifery › Rule 24.111.616 - USE OF FORMULARY DRUGS

Current through Register Vol. 13, July 5, 2024
(1) Endorsed
				midwives may use the drugs in
				37-27-302(2),
				MCA, according to the following protocol describing the indication for use,
				dosage, route of administration, and duration of treatment:
Drug
Indication
Dose- in conformance ACOG
							 guidelines
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.
Bag and mask Mask
Bag and mask 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 doses are administered
Lidocaine HCl
1%
2%
Local anesthetic for use during postpartum repair of
							 lacerations or episiotomy
20 cc
10 cc
Percutaneous infiltration only
Completion of repair
Penicillin G (Recommended)
Group B Strep Prophylaxis
5 million units initial dose, then 2.5 million units
							 every 4 hours until birth
IV in [GREATER THAN OR EQUAL TO] 100 ml LR, NS or
							 D5LR
Birth of baby
Methegrine (Methylergonovine
Postpartum hemorrhage only
0.2mg/ml
Intramuscularly only 1 dose
Transport to hospital required if single dose does
							 not stop hemorrhage
Ampicillin Sodium (Alternative)
Group B Strep Prophylaxis
2 grams initial dose, then 1 gram every 4 hours until
							 birth
IV in [GREATER THAN OR EQUAL TO]100 ml NS or
							 LR
Birth of baby
Cefazolin Sodium (drug of choice for penicillin
							 allergy with low risk for anaphylaxis)
Group B Strep Prophylaxis
2 grams initial dose, then 1 gram every 8
							 hours
IV in [GREATER THAN OR EQUAL TO] 100 ml LR, NS or
							 D5LR
Birth of Baby
Clindamycin Phosphate (drug of choice for
							 penicillin allergy with high risk for anaphylaxis)
Group B Strep Prophylaxis
900 mg every 8 hours
IV in [GREATER THAN OR EQUAL TO]100 ml NS (not
							 LR)
Birth of Baby
Epinephrine HCl 1:1000
Treatment or post-exposure prevention of severe
							 allergic reactions
0.3 ml
Subcutaneously or intramuscularly
Every 20 minutes or until emergency medical services
							 arrive
Administer first dose then immediately request
							 emergency services
Lactated Ringer's (LR)
5% Dextrose in Lactated Ringer's solution
							 (D5LR)
0.9% Sodium Chloride (NS)
Sterile Water
To achieve maternal stabilization
Reconstitution of antibiotic powder
I - 2 liter bags
First liter run in at a wide-open rate, the second
							 liter titrated to client's condition
As directed
Intravenously
As directed
Until maternal stabilization is achieved or transfer
							 to a hospital is complete
Birth of Baby
Cytotec (Misoprostol)
Postpartum hemorrhage only
Up to 800 mcg
Rectally is the preferred method Orally is
							 allowed
1-2 doses
Transport to hospital required if more than one dose
							 is administered
Rho(d) Immune Globulin
Prevention of Rho (d) sensitization in Rho (d)
							 negative women
300 mcg
Intramuscularly
Single dose at any gestation for Rho (d) negative,
							 antibody negative women within 72 hours of spontaneous bleeding or abdominal
							 trauma.
Single dose at 26-28 weeks gestation for Rho (d)
							 negative, antibody negative women
Single dose for Rho (d) negative, antibody negative
							 women within 72 hours of delivery of Rho (d) positive infant, or infant with
							 unknown blood type
Phytonadione
Prophylaxis for Vitamin K Deficiency Bleeding
1 dose
0.5% Erythromycin Ophthalmic
							 Ointment
Prophylaxis of Neonatal Ophthalmia
1 cm ribbon in each eye
Topical
1 dose
Tranexamic acid
Postpartum Hemorrhage
1000 mg over 10 minutes given within 3 hours of
							 birth
Intravenous
Initiate transfer after administering first dose. If
							 bleeding continues after 30 minutes or stops and restarts within 24 hours after
							 the first dose, a second dose of 1000mg may be given.
Terbutaline
Stop or prevent premature labor
As per direct order of a licensed physician
As per direct order of a licensed physician
As per direct order of a licensed physician
AUTH:
					 37-1-131,
					 37-27-302, MCA; IMP:
					 37-1-131,
					 37-27-302,
					 MCA