Course Syllabus ©National College of Midwifery 2012
01/2012
Course Title: Postpartum Pharmacology
Credits: 0.5
Course Description:
This course covers pharmacology relating to common problems that arise during the
postpartum period. Many pharmaceuticals are covered including the uses of RhoGAM, Pitocin,
methergine, rubella vaccine, antibiotics, iron, and herbal or homeopathic remedies for the relief
of common postpartum complications and discomforts. This course uses current research in
midwifery and obstetrics to broaden the student’s understanding of the following NARM skills
and MANA core competencies learned under clinical supervision:
NARM Skills
II. General Healthcare Skills
II H. Treats for shock by:
(53)-II H 2. Assessing the cause of shock and providing treatment for shock
(54)-II I. Administers Oxygen
(55)-II J. Recommends the use of vitamin and mineral supplements
II K. Administers the following pharmacological (prescriptive) agents:
56)-II K 1. Lidocaine
(57)-II K 2. Medical oxygen
(58)-II K 3. Methergine
(60)-II K 5. Pitocin ®
(61)-II K 6. RhoGam ®
IV G 6. Responding to postpartum hemorrhage with a range of treatments, including:
(119)-IV G 6 a) Administration of medication
(120)-IV G 6 b) Administration of oxygen
(121)-IV G 6 c) Administration of intravenous fluids or appropriate referral for intravenous fluids
(122)-IV G 6 d) Treatment for shock
V. Postpartum
(137)-V G. Knows treatments for sore nipples
(138)-V H. Knows treatments for mastitis
MANA Core Competencies:
I. Guiding Principles of Practice.
2 M. The ability to develop, implement and evaluate an individualized plan for midwifery care.
2 O. Knowledge and application of various health care modalities as they apply to the
childbearing cycle
IV. Care During Labor, Birth and Immediately Thereafter
The midwife provides health care, support, and information to women throughout labor,
birth and the hours immediately thereafter. She determines the need for consultation or
referral as appropriate. The midwife uses a foundation of knowledge and/or skill which
includes the following:
4 J. Causes of, evaluation of and appropriate treatment for variations which occur during the
course of labor, birth and immediately thereafter.
4 N. Evaluation and care of the perineum and surrounding tissues.
V. Postpartum Care
The entry-level midwife provides health care, support and information to women
throughout the postpartum period. She determines the need for consultation or referral
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Course Syllabus ©National College of Midwifery 2012
01/2012
as appropriate. The midwife uses a foundation of knowledge and/or skill, which
includes, but is not limited, the following:
5 A. Anatomy and physiology of the mother during the postpartum period.
5 B. Lactation support and appropriate breast care including evaluation of, identification of and
treatments for problems with nursing.
5 C. Parameters and methods for evaluating and promoting maternal well-being during the
postpartum period.
5 D. Causes of, evaluation of, and treatment for maternal discomforts during the postpartum
period.
5 F. Causes of, evaluation of, and treatments for problems arising during the postpartum
period.
Learning Activities:
A. Student reads appropriate sections from the Learning Materials/Resources.
B. Student answers the questions listed in the Learning Objectives by researching the
Learning Materials/Resources for the course and correctly cites the sources and page
numbers for each of their answers.
C. Student presents answers the questions listed in the Learning Objectives for review by
preceptor.
D. Student participates in preceptor elaboration/discussion of Learning Objectives.
E. In the case that the required texts are more than 5 years old, the student must research,
prepare & present a summary of current best midwifery care/practices appropriate to a
topic in this course from a current journal article/study, less than 5 years old.
F. Recommended Role-playing and/or Clinical Interactions
Note: The clinical requirement of NARM /Clinical Skills is completed at any time
throughout the ASM apprenticeship during actual clinical practice and is NOT a
requirement to complete this academic course.
Activities specific to NARM skills learned in this section:
1. Role play with your instructor or another student how you would administer the
following medications:
a. Pitocin (for postpartum hemorrhage)
b. Cytotec (for postpartum hemorrhage)
c. Methergine
d. Rhogam
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Course Syllabus ©National College of Midwifery 2012
01/2012
2. Role play with your instructor or another student how you would treat for shock,
including how you would administer oxygen.
3. Role play with your instructor or another student how you would administer IV fluids
and practice inserting an IV on a training mannequin if available.
4. Role play with your instructor or another student how you would administer
homeopathic medications for hemorrhage.
5. Role play with your instructor or another student how you would administer herbal
preparations for postpartum hemorrhage.
6. Make a list of herbal and homeopathic medications that are used postpartum.
7. Create a handout explaining how homeopathic medications are used postpartum for
various remedies, as an educational tool for clients.
8. Gather information/handouts for your clients on how to prevent and treat common
postpartum discomforts, such as sore nipples, healing of the perineum, afterbirth
pains.
Learning Materials / Resources:
Please use textbooks less than 5 years old or most recent edition.
1. Hale, Thomas. Medications and Mothers milk. 14th edition. Hale Publishing. 2010
2. Manning, Loretta. Pharmacology Made Insanely Easy. 3rd edition. ICAN Publishing, Inc.
2009.
3. Perko, Sandra. The Modern Pregnant Woman and Her Infant - A Therapeutic Practice
Guidebook for Midwives, Physicians, and Practitioners. Benchmark Homeopathic
Publications. 2008.
4. Grossberg, George T. and Fox, Barry. The Essential Herb-Drug-Vitamin Interaction
Guide: The Safe Way to Use Medications and Supplements Together. 1 edition.
Broadway. 2007.
th
5. Skidmore-Roth, Linda. Mosby's Handbook of Herbs & Natural Supplements. 4 Edition.
Mosby. 2009.
6. Tatro, David S. Drug Interaction Facts. 1 edition. Lippincott Williams & Wilkins. 2009.
7. Davis, Elizabeth. Heart and Hands: A midwife’s guide to pregnancy and birth. 4th
Edition. Celestial Arts Press. 2004
The following books are older, but are still very useful:
8. Moscowitz, Richard. Homeopathic Medicines for Pregnancy and Childbirth. North
Atlantic Books. 1993.
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Course Syllabus ©National College of Midwifery 2012
01/2012
9. Hoffman, David. The Holistic Herbal: A Safe and Practical Guide to Making and Using
Herbal Remedies. Thorsons. 2003
10. Weed, Susan. Wise woman herbal for the childbearing year. Ashtree publishing. 1987.
11. Tisserand, R., and Balacs, T. Essential Oil Safety: A Guide for Health Care
Professionals. 1 edition. Churchill Livingstone. 1995.
12. Articles for latest developments in herbs and homeopathy may be found in The Herb
Quarterly
13. MEAC Abbreviated NARM Skills Form.
14. MANA Core Competencies for Midwives
15. Midwives Model of Care®.
16. Students must find 1 article/study less than 5 years old. Recommended internet links
as needed for latest developments in midwifery care:
The Cochrane Collaboration
EBSCO
National Library of Medicine
PubMed
Medline
SCIRUS
Medscape
World Health Organization
Evaluation Tools / Methods:
Minimum passing grade for each course is a cumulative 80% / B-. Students and preceptors
are encouraged to work together until the student masters the information.
Final grade for the course is based on preceptor evaluation of the following:
A. Learning Objectives count for 80-90% of the final grade.
The preceptor evaluates each answer based on three elements:
1. Answers should reflect a thorough review of current literature regarding best
current practices in midwifery care.
2. Each answer should be formed in the student’s own words or paraphrased
from the text. The answer should be minimal, not a re-write of the entire text,
but enough to show appropriate comprehension of the learning objective.
3. Student identification of sources and page numbers for each of the Learning
Objectives. (Preceptor should do a random check to determine that sources
cited are correctly identified.)
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Course Syllabus ©National College of Midwifery 2012
01/2012
B. Summary of current journal article / study counts for 10% of the final grade in the case that
other scholarly resources used are more then five years old.
C. Exam counts for 10% of the final grade.
Course credit:
One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional
study or homework. Formal time is defined as the amount of time taken to answer the Learning
Objectives to the level of 80% and to complete any larning activities to the preceptor's
satisfaction, including any time spent face to face with the preceptor. Informal time includes
any time spent actively reading relevant sources and textbook/s, researching Learning
Objectives, and studying for examinations.
Learning Objectives:
A. The student must research, prepare & present a summary of an aspect of current best
midwifery care/practices appropriate to a topic in this course from a current journal
article/study.
B. Student answers the questions below and cites the sources and page numbers.
1. Discuss the clinical pharmacology of RhoGAM. What are its indications and use
postpartum?
2. What are the contraindications of RhoGAM? What adverse reactions may be associated
with it?
3. What is the dosage of RhoGAM and how is it administrated postpartum?
4. Name the substances that can be used to relieve postpartum cramping. Give the
indications for each, the possible adverse reactions to each, the dosage and
administration for each.
5. Discuss the clinical pharmacology of Rubella vaccine. What are the indications for its
use postpartum? What are the contraindications of the Rubella vaccine and what
adverse reactions may be associated with it?
6. What is the dosage and route of administration for the Rubella vaccine?
7. Name two antibiotics for postpartum infections that are considered "safe" for the breastfeeding mother. Give clinical pharmacology of each, the indications for use.
8. What are the contraindications, and adverse reactions associated with the above
antibiotics?
9. What is the dosage and route of administration for each of the above antibiotics?
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Course Syllabus ©National College of Midwifery 2012
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10. Discuss the use of lidocaine postpartum. What is the appropriate dosage and how is it
administered?
11. What are contraindications of lidocaine and what adverse reactions are associated with
its use?
12. Describe the pharmacology of using oxytocic drugs in the management of postpartum
hemorrhage. What is the appropriate dosage and administration route of these drugs?
13. What are the adverse reactions associated with the use of oxytocic drugs and what are
the contraindications of its use?
14. Describe the pharmacology of Methergine (Methylergonovine) in the management of
postpartum bleeding. What is the appropriate dosage and administration route of these
drugs?
15. What are the adverse reactions associated with the use of methergine and what are the
contraindications of its use?
16. Describe the difference in the use of methergine for immediate postpartum hemorrhage
versus delayed postpartum hemorrhage.
17. Describe the clinical pharmacology of using Cytotec (misoprostol) for management of
immediate postpartum hemorrhage. What is the appropriate dosage and administration
route of this drug?
18. What are the adverse reactions associated with the use of Cytotec (misoprostol) and
what are the contraindications of its use?
19. Discuss the use of medical oxygen postpartum. What is the appropriate dosage and
administration route of this drug?
20. Explain the situations when an IV solution is used postpartum. Give the rationale for
choosing the solution, drip-rate and total volume to be infused for each condition.
21. What are the adverse reactions associated with the use of IV fluids and what are the
contraindications of its use?
22. Discuss two herbs that are used in the treatment of immediate postpartum bleeding.
Include what preparations are used, how they are administered, and what
contraindicates their use.
23. Discuss two homeopathic remedies that are used to treat postpartum bleeding. Include
what potency is used and which symptoms are specific to the use of each remedy.
24. Discuss two herbal remedies that are used in the treatment of a retained placenta,
placental fragments or membranes. Include what preparations are used, how they are
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Course Syllabus ©National College of Midwifery 2012
01/2012
administered, and what contraindicates their use.
25. Discuss herbal remedies that can be used in the treatment of impending shock.
26. Discuss herbal support for the healing of lacerations from birth. What herbs are useful in
the process? How can they be administered?
27. Discuss two herbal remedies for after-pains. Include what preparations are used, how
they are administered, and what contraindicates their use.
28. Discuss two herbal galactagogues. Include what preparations are used, how they are
administered, and what contraindicates their use.
29. Discuss two pharmacologic galactagogues that are currently being used--domperidone
and Reglan (metoclopramide,) how they are administered, dosage, and side effects.
30. Discuss two herbal or homeopathic remedies for the treatment of engorgement. Include
what preparations are used, how they are administered, and what contraindicates their
use.
31. Discuss two herbal or homeopathic remedies for the treatment of sore nipples. Include
what preparations are used, how they are administered, and what contraindicates their
use.
32. Discuss iron supplementation postpartum. Include the pharmacology of iron
supplements that are on the market and what contraindications may exist in their use
during breastfeeding.
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