Revised: March 6, 2017
The following are the standards for midwives to independently prescribe, order and administer controlled substances as designated under federal and provincial/territorial regulation.
Registered midwives in British Columbia are permitted to prescribe drugs according to the Health Professions Act – Midwives Regulations and CMBC Standards, Limits and Conditions for Prescribing, Ordering and Administering Drugs and CMBC Standards, Limits and Conditions for Prescribing, Ordering and Administering Controlled Substances.
The College of Midwives of BC (CMBC) expects diligence when prescribing all drugs, including controlled substances. The midwife must maintain proper records, supply necessary information to the client regarding the proper use of the drug(s) and maintain adequate security for drug inventories as per the College of Pharmacists Operations and Drug Scheduling Act. The midwife must check each prescription for accuracy prior to its release to clients as a pharmacist would prior to filling a prescription.
Standards, Limits and Conditions for Prescribing, Ordering and Administering Controlled Substances in Midwifery Practice
The standards below provide midwifery indications, routes of administration and upper dosage limits where appropriate and adverse effects and contraindications for the use of controlled substances approved for use in midwifery practice. Midwives may only prescribe, order or administer the following controlled substances within the standards set out in this document and to a client under their professional care where the drug is required for the purposes outlined below.
Please note that the summaries provided regarding medication suitability in pregnancy and lactation are brief. Prior to counselling a patient on the benefits and risks of drug therapy, please review the detailed information in the specific references provided at the end of the document.
- Fentanyl citrate
- Morphine sulphate
- Dimenhydrinate (Gravol®)
- Meperidine (Demerol®)
- Naloxone Hydrochloride (Narcan®)
- Acetaminophen with Codeine (Tylenol® with Codeine No.3)
- Acetaminophen with Oxycodone
- Hydromorphone (Dilaudid-HP®, Dilaudid®)
- Acetaminophen with Tramadol (Apo-Tramadol/Acet®, Tramacet®)
1. Formerly Guidelines for Prescribing, Ordering and Administering Drugs
2. Education (e.g. online module, workshop, course or program of study) and assessment that addresses the competencies required to prescribe narcotics and controlled drugs and/or benzodiazepines in the management of labour, birth and the postpartum period.
3. Principles of securely dispensing and managing drug inventory for prescribing narcotics and controlled drugs and/or benzodiazepines are in place for quality assurance purposes.
Abuse and Diversion of Controlled Substances: A Guide for Health Professionals, Health Canada, 2006CM0700 Appendix A – Fentanyl Protocol for Labour, Fetal Maternal Newborn and Family Health Policy and Procedure Manual, BC Children’s and Women’s Health Centre.
Briggs G G, Freeman, R K, A Reference Guide to Fetal and Neonatal Risk: Drugs in Pregnancy and Lactation, Tenth Edition (2012) Wolters Kluwer Health. ISBN 978-1-4511- 9082-3
CM0700 Appendix B – Morphine Protocol for Labour, Fetal Maternal Newborn and Family Health Policy and Procedure Manual, BC Children’s and Women’s Health Centre.
Drug information. Acetaminophen with Oxycodone. Retrieved February 11, 2013 from Up to Date.
Drug information. Acetaminophen and Tramadol. Retrieved March 18, 2013 from Up to Date.
Drug information. Flumazenil. Retrieved May 7, 2013 from Up to Date.
Drug information. Hydromorphone. Retrieved February 11, 2013 from Up to Date.
Drug information. Lorazepam, Oxazepam. Retrieved May 7, 2013 from Up to Date.
Drug information Meperidine. Retrieved May 7, 2013 from Up to Date.
Drug information. Naloxone Hydrochloride. Retrieved March 15, 2012 from Up to Date.
Drug information. Tylenol with Codeine. Retrieved January 14, 2013 from Up to Date.
Enkin M, Kierse, MJNC, et al, A Guide to Effective Care in Pregnancy and Childbirth (3rd ed.) (2000) Oxford University Press. ISBN 019263173.
Hale W., PH.D., Medications and Mothers’ Milk (Fourteenth Edition) (2010) Hale Publishing. ISBN 9780982337998.
Hale Thomas W., PH.D. Rowe Hilary E. PharmD, Medications and Mothers’ Milk (Sixteenth Edition) (2014) Hale Publishing. ISBN 978-1-9398473-8-6.
Koren, G., Cairns, J.,Chitayat, D., Gaedigk, A., Leeder, S.J. (2013). Pharmacogenetics of Fatal Morphine Poisoning in a Breastfed Neonate of a Codeine Using Mother, MotherRisk
Madadi, P., Moretti, M., Djokanovic, N., Bozzo, P., Nulman, I., Ito, S., Koren, G. (2009). Guidelines for maternal codeine use during breastfeeding, Canadian Family Physician, 55(11), 1077-1078.
Medscape. Acetaminophen with Oxycodone. Retrieved February 11, 2013 from Medscape.
Medscape Reference. Hydromorphone. Retrieved February 11, 2013 from Medscape.
PSBC Support Tool No.5 Discomfort and Pain in Labour, Perinatal Services BC, 2011.
PSBC Guideline: Obstetric Guideline 4 Pain Management Options During Labour, Perinatal Services BC, 2007.
VIHA Protocol for IV Fentanyl administration in labour, NRGH 2013.
Approved: June 24, 2013
Revised: December 9, 2013
Revised: March 17, 2014
Revised: December 7, 2015
Revised: February 29, 2016
Revised: June 6, 2016
Revised: December 1, 2016
Revised: March 6, 2017