Course Syllabus ©National College of Midwifery 2012
01/2012
Course Title: Intrapartum Pharmacology
Credits: 0.5
Course Description: This course covers both allopathic and non-allopathic medications used
during the intrapartum period. Allopathic medicines used in the hospital, (not used by licensed
midwives) are reviewed so students gain understanding of the indications for use, effects, and
possible side effects of medications used in obstetrics. Students learn which allopathic
medications licensed midwives may utilize for normal labor and delivery in the out-of-hospital
environment. Homeopathic and herbal medications for use during labor and delivery are also
covered. 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
I.
Midwifery Counseling, Education and Communication:
(3)I C. Provides education and counseling based on maternal health/reproductive/family
history and on-going risk assessment
(4)-I D. Facilitates the mother’s decision of where to give birth
(5)-I E. Educates the mother and her family/support unit to share responsibility for optimal
pregnancy outcome
(7)-I G. Applies the principles of informed consent
(8)-I H. Provides individualized care
(9)-I I. Advocates for the mother during pregnancy, birth and postpartum
II. General Healthcare Skills
(21)-II A. Demonstrates Universal Precautions
(22)-II B. Demonstrates the application of OSHA regulations as they relate to midwifery
workplace
II D. Demonstrates the use of instruments and equipment including:
(37)-II D 14. Needle and syringe
(39)-II D 16. Single dose ampule
(50)-II F. Uses alternate healthcare practices (non-allopathic treatments) and modalities
II H. Treats for shock by:
(54)-II I. Administers Oxygen
(55)-II J. Recommends the use of vitamin and mineral supplements
II K. Administers the following pharmacological (prescriptive) agents:
(57)-II K 2. Medical oxygen
(60)-II K 5. Pitocin ®
MANA Core Competencies:
I. Guiding Principles of Practice.
The midwife provides care according to the following principles:
1 H. Midwives recognize the empowerment inherent in the childbearing experience and strive
to support women to make informed decisions and take responsibility for their own well-being.
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Course Syllabus ©National College of Midwifery 2012
01/2012
1 I. Midwives strive to insure vaginal birth and provide guidance and support when appropriate
to facilitate the spontaneous process of pregnancy, labor and birth, utilizing medical
intervention only as necessary.
II. General Knowledge and Skills
The midwife provides care incorporating certain concepts, skills and knowledge from a
variety of health and social sciences including, but not limited to:
2 C. Community standards of care for women and their developing infants during the
childbearing cycle, including midwifery and bio-technical medical standards and the rationale
for and limitations of such standards
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
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 A. The normal process of labor and birth.
4 C. Assessment of the birthing environment, assuring that is clean, safe and supportive, and
that appropriate equipment and supplies are on hand.
4 G. Techniques to assist and support the spontaneous vaginal birth of the baby and placenta.
4 J. Causes of, evaluation of and appropriate treatment for variations which occur during the
course of labor, birth and immediately thereafter.
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 covered 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:
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Course Syllabus ©National College of Midwifery 2012
01/2012
1. Teach a class on pharmacological and non-pharmacological methods of pain relief
in labor to a group or pregnant women.
2. Create a list of tools and a bag of supplies to use for non-pharmacological methods
of pain relief during labor.
3. Role play with your instructor or another student how you would administer oxygen
to a woman in labor.
4. Role play with your instructor or another student how you would administer IV fluids
to a woman during labor.
5. Role play with your instructor or another student how you would administer herbal
preparations or homeopathic remedies during labor.
Learning Materials / Resources:
Please use textbooks less than 5 years old or most recent edition.
1. Manning, Loretta. Pharmacology Made Insanely Easy. 3rd edition. ICAN Publishing, Inc.
2009.
2. Fraser, DM, et al. Myles Textbook for Midwives. 15th ed. Churchill Livingstone Press.
2009.
3. Romm, Aviva Jill. Botanical Medicine for Women's Health. Churchhill Livingstone
Publishers. 2010.
4. Varney, Helen. Varney’s Midwifery. Fourth Edition. Jones and Bartlett Publishers. 2004
5. Chapman, Vicky and Charles, Cathy. The midwife’s labour and birth handbook. 2nd
Edition. Blackwell Publishing. 2009
6. Perko, Sandra. The Modern Pregnant Woman and Her Infant - A Therapeutic Practice
Guidebook for Midwives, Physicians, and Practitioners. Benchmark Homeopathic
Publications. 2008.
7. F. Cunningham, Kenneth Leveno, Steven Bloom, and John Hauth. William’s Obstetrics.
rd
23 Edition. McGraw-Hill Professional. 2009.
st
8. Weed, Susan S. Wise Woman Herbal for the Childbearing Year. 1 edition. Ash Tree
Publishing. 1985
9. Frye, Anne. Holistic Midwifery: A Comprehensive Textbook for Midwives in Homebirth
Practice, Vol. 2: Care of the Mother and Baby from the Onset of Labor Through the First
Hours After Birth. Labrys Press. 2004.
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Course Syllabus ©National College of Midwifery 2012
01/2012
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10. Weaver, Pam and Evans, Sharon K. Practical Skills Guide for Midwifery, 4 Edition.
Morningstar Publishing Co. Wasilla. 2007
11. MEAC Abbreviated NARM Skills Form.
12. MANA Core Competencies for Midwives
13. Midwives Model of Care®.
14. 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.)
B. Summary of current journal article / study counts for 10% of the final grade in the case that
other scholarly resources used are more than 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
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Course Syllabus ©National College of Midwifery 2012
01/2012
Objectives to the level of 80% and to complete any learning 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 a topic from this course from a current journal
article/study.
B. Student answers the questions below and cites the sources and page numbers.
1. Name four reasons drugs are used in hospital labors.
2. Discuss the current restrictions and laws around the use of controlled substances by
midwives in the region you intend to practice.
3. Discuss the decisions that must be made regarding medicating a woman in labor.
4. Name the four classifications of drugs that are used for pain in hospital labors. Give an
example of each.
5. Name one pharmaceutical drug used as an antiemetic.
6. Name the drugs commonly used for tocolysis and discuss the rationale for each.
7. Describe which women are candidates for tocolysis and what is the rationale.
8. Name the classifications of drugs which would be more appropriate in false or latent
labor as opposed to active labor and why.
9. Name the non-pharmacological alternatives to pain medication used in and out of
hospital settings.
10. Describe these alternatives including their expected action, their effect on mother and
fetus, their risk-benefit ratio, and their expected success ratio.
11. Choose one of the pharmaceutical drugs used during labor. Explain how the amount,
type, route and timing of administration of this drug might affect the normal progress of
labor.
12. Describe the difference between anesthesia and analgesia.
.
13. Name the pain-relief medications that can be used during second stage and why.
14. Discuss the use of prostaglandins and prostaglandin analogues in labor. What is their
pharmacological action?
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Course Syllabus ©National College of Midwifery 2012
01/2012
15. When is the use of prostaglandins contraindicated? When is the use of prostaglandin
analogue contraindicated?
16. Explain the use of IV Pitocin (synthetic oxytocin) intrapartum.
17. Discuss the following details of IV pitocin use intrapartum. What is the dosage and
timing? What is the expected action? What are the contraindications and side effects?
18. Discuss the situations when IV fluids are indicated intrapartally and what determines the
solution used. For each condition give the desired IV solution and the rationale for each.
19. Give the rationale for the drip-rate total and amount to be infused according to the
condition being corrected.
20. Discuss two classes of antibiotic that are used during labor for the prevention of
neonatal GBS infection.
21. Discuss the dose, route, and frequency of the administration of the above antibiotics.
22. Discuss anaphylaxis reaction.
23. Discuss the use of oxygen during the intrapartum period. Under what circumstance is it
indicated? Include dose, route, and contraindications for use.
24. Research 2 herbal remedies for pain in labor and give their origin, their expected action,
the indications for use, the contraindications, adverse reactions, the dosage and
administration of each.
25. Research 2 homeopathic remedies for pain in labor and give their origin, their expected
action, their indications for use, contraindications, adverse reactions, the dosage and
administration of each.
26. Discuss 2 herbal or dietary supplements that are safe to use after the premature rupture
of membranes for the prevention of infection.
27. Discuss the use of castor oil in the augmentation or initiation of labor. Discuss dose,
contraindications, adverse reactions and indications for use.
28. Discuss the use of homeopathics in the augmentations or initiation of labor. Discuss
dose, contraindications, adverse reactions and indications for use.
29. Discuss the use of herbal or homeopathic remedies in treating maternal emotional
distress during labor.
30. Discuss herbal, homeopathic or dietary treatments of excessive vomiting during labor.
31. Discuss use of oxytocic herbs in labor. Which herbs can be used, when, and how?
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Course Syllabus ©National College of Midwifery 2012
01/2012
32. Discuss the use of an enema during labor. When is an enema indicated and for what
problems?
33. Discuss the use of acupuncture or acupressure during labor. Give an example of a
situation when these techniques could be used and any reasons they might not be safe
in labor.
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