Wyoming Administrative Code › Agency 036 - Midwifery, Board of › Sub-Agency 0001 - Midwifery, Board of › Chapter 10 - DRUG FORMULARY

Current through July 13, 2024
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.