Pharmacology, Medication, and Screening for Midwives

This article discusses the guidelines for consultation and referral for midwives, administration of medication, adverse drug reactions, and group B streptococcus screening. It also provides recommendations for midwives to ensure quality care and patient safety.

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Pharmacology, Medication, and Screening for Midwives
Name
Institution

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Pharmacology, Medication, and Screening for Midwives
Professional Consultation and Referral Recommendations
Midwives are the primary caregivers to expectant mothers and they should, therefore,
make informed decisions regarding the need of medical attention for a woman under their care
during both prenatal and postnatal periods. The actions of these midwives are guided by The
Australian College of Midwives National Midwifery Guidelines for Consultation and Referral
(Syrio.org, 2018). These guidelines aim at promoting patient care related to the principle of
mutual cooperation between the maternity caregivers and the expectant woman in question.
Additionally, the guidelines have been developed with the intention of facilitating the integration
of care and consultation between midwives and the assigned doctors thus fostering confidence in
the involved women and their families (Syrio.org, 2018).
From the presented scenario, we are informed that Prue has a body mass index of
27kg/m2 and is also rubella immune. Additionally, she has been allergic to penicillin since
childhood and is potentially suffering from a urinary tract infection. In the guidelines developed
by the Australian College of Midwives, UTI is classified with a code B. From the assessment of
Prue’s scenario, it is clear that she could be suffering from a urinary tract infection.
During the booking visit, it is important to discuss with the woman involved her needs.
This discussion helps in the provision of quality care and enhances patient safety. According to
the guidelines published by the Australian Medical College, all conditions with a code A require
discussion. This kind of discussion happens with a midwife or a medical practitioner after which
the midwife continues providing patient care (Beasley, Ford, Tracy & Welsh, 2012). Conditions
that are assigned code B require consultations with a medical practitioner. Care may then

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continue with the midwife or the woman may be transferred to the involved practitioner. Finally,
the conditions assigned code C requires that the patient seeks a referral where the care is referred
to a medical practitioner.
Prue’s condition is defined under code B and therefore it may only require consultations.
The midwife in charge, therefore, needs to seek consultation with a medical practitioner. The
midwife must seek the consent of Prue before initiating the process of consultation where she
clearly has to communicate with the practitioner that she is seeking consultation (Beasley et al.,
2012). She is then tasked with communicating all her findings to Prue and the health practitioner
involved.
During consultations, Prue must be involved in all decision-making processes concerning
her care. Automatic assumption of the responsibilities by the midwife or the healthcare provider
regarding the ongoing care may depend on the clinical situation and the needs and preferences of
Prue. At the end of consultations, a decision is made whether care remains with the midwife or is
transferred to the health practitioner (Beasley et al., 2012). The midwife, however, continues to
provide care within her scope of practice. Further consultations may be made to ensure that Prue
and her unborn child receive high standards of care and thus prevent potential early
complications.
Administration of Medication
Urinary tract infection is an infection caused by an attack of any part of the urinary
system such as the kidney, bladder, and urethra by bacteria (Foxman, 2013). Most infection of
the urinary tract involves the bladder and the urethra. Antibiotics can, however, be used to treat
urinary tract infection (Sheerin, 2011). One of the widely recommended antibiotics for UTI is

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cephalexin. It is a first-generation cephalosporin antibiotic that is very effective against several
gram-positive bacteria (Vazquez & Abalos, 2011). This is the best form of medication for Prue
given that she is allergic to penicillin. Cephalexin binds with specific proteins found within the
bacterial cell walls thus inhibiting the final stage of bacterial cell wall synthesis (Dason, Dason,
& Kapoor, 2011).
Prue should take cephalexin orally after every twelve hours either with or without food.
Strict adherence to the dosage is important for best medical results. I would additionally advise
Prue to take this medication at evenly spaced times. This can be done by taking the medication at
the same times on a daily basis until the prescription is over (Barber, Norton, Spivak & Mulvey,
2013). Prue must not stop taking the drug even if signs of her condition disappear; she has to
complete the full dosage of the medicine. This is so because stopping the medication before
completion may cause the bacteria to keep growing and cause a recurrence of the infection
(Fanun, Papadimitriou & Xenakis, 2011). It is also important that I inform Prue that the capsules
must not be chewed or crushed but be taken a whole with a glass of water. Hand hygiene is
another very important factor when handling any form of medication (Epp et al., 2010). Prue
must ensure that her hands are clean at all times to avoid contaminating the drug.
It is also advisable that Prue is informed of cephalexin’s interaction with other forms of
medication. She, therefore, needs to inform the doctor if she is using any other prescriptions
including over the counter drugs, herbal medicine, and dietary supplements (Cunha, 2010). It is
important to note that the interaction of cephalexin with other drugs such as metformin and
probenecid and cause problems.

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This medication may have some possible side effects like diarrhea, vomiting, stomach
upsets and nausea. This medication is prescribed after the judgment that the benefits are greater
than the risks that come with side effects. Side effects rarely occur but if you experience any of
the above side effects for prolonged periods then it is advisable to promptly contact your doctor
(Cunha, 2010). Additionally, a prolonged use of cephalexin may lead to a new yeast infection or
oral thrush. The yeast infection may be characterized by changes in vaginal discharge. Such
signs must be reported to the doctor immediately. Other possible side effects may include
breathing problems, abdominal pains, blood in stool, severe dizziness, and rashes among others
(Cunha, 2010). The side effects may not be limited to the ones mentioned in this writing.
Therefore, if Prue experiences other side effects not mentioned, she must not hesitate to contact
her doctor.
Adverse Drug Reaction
Adverse drug reaction is an unwanted and harmful reaction that may result from
administration of a drug or several drugs under the normal conditions of usage. Adverse drug
reaction has become a constant challenge in the present healthcare setting (Hakkarainen, Hedna,
Petzold, & Hägg, 2012). It mostly results due to frequent unscheduled hospital admissions. ADR
is almost a normal occurrence in healthcare and can massively affect a patient’s quality of life. It
has led to patients losing faith and confidence in their health practitioners and opt for self-
treatment that may further escalate adverse drug reaction (Alomar, 2014). ADR can be classified
into two categories that are type A which are predictable because they are dose-dependent and
type B which is unpredictable.

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A midwife as the primary caregiver should possess the ability to identify, manage, and
report adverse drug reactions. As a midwife, I will advise Prue that the side effects she is
witnessing are normal occurrences. Since cephalexin had been administered two days ago, she
will have to proceed with the medication because, at the long end, the benefits will outweigh the
side effects. Prue’s adverse drug reaction can be classified as Type A ADR because the side
effects are unintended and predictable. They can be harmful and normally occur due to the
pharmacological profile of a drug (Gupta & Udupa, 2011). It would also be important to perform
a therapeutic monitoring of the blood levels of the medication.
If the situation gets worse and the side effects persist, then as a midwife, I may
recommend a discontinuation of the medication or a reduction of the dosage. A treatment plan is
then developed to counter the adverse drug reaction. After treatment has been done, then in
consultation with a health practitioner, cephalexin may be reintroduced to Prue later (Bourgeois,
Shannon, Valim & Mandl, 2010). This re-introduction is done in a step-wise manner to prevent
the possibility of ADR once again. The guidelines for the management of ADR are provided by
the American Society of Health-Systems Pharmacists. Additionally, it would be important to
advise Prue on drug interaction so that she is aware of the drugs that should not be taken together
with cephalexin.
However if the symptoms become more severe and the side effects become more
persistent, then as a midwife I will be required to report Prue’s adverse drug reactions to the
Therapeutic Goods Association. The Therapeutic Goods Association (TGA) requires that all
cases of ADR are reported to it so that it can carry out investigations on these complications
(Shah & Hajjar, 2012). Additionally, the adverse drug reaction should be reported to the hospital

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and the health practitioner who had prescribed cephalexin. All the findings must be recorded in
Prue’s medical records for future reference.
Group B Streptococcus Screening
Group B streptococcus is a type of bacterial infection that affects expectant mothers. This
infection attacks the vaginal area or the rectum and an affected woman is said to be colonized. A
pregnant woman can pass GBS to her child during delivery (Berardi et al., 2013). Studies reveal
that approximately 25% of women carry this bacterium in their rectum and the vaginal area. The
infection is normally harmless in adults but can cause serious illness among babies known as
group B disease. It is, however, important to note that GBS can cause serious infections among
adults with critical health conditions like liver disease and diabetes (Stoll et al., 2011). This
infection may be transmitted through sexual intercourse but it is not considered as a sexually
transmitted infection because an individual’s genital area may be colonized by bacteria present in
the gastrointestinal tract. Group B strep may cause urinary tract infection in pregnant women,
infection of the bloodstream, and an infection of the amniotic fluid and placenta.
Screening of GBS late in pregnancy and getting treated is important in preventing the
infection from spreading the infection to the infant during childbirth. The American Academy of
Pediatrics, Centers for Disease Control, and American College of Obstetricians and
Gynecologists recommend that the screening for group B streptococcus should be done between
week 35 and week 37 of pregnancy (Valkenburg-van Den Berg et al., 2010). This screening is
not done during the first prenatal visit because the infection can come and go and therefore the
outcomes of the first test are not the best predictor of the presence of the bacteria during
childbirth.

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Screening of group B streptococcus is done by taking a swab of cells from the lower end
of the rectum and the vaginal area. The swabbing is always a painless on and the collected
samples are taken to the lab and grown in a culture. The culture helps in identifying the presence
of the group B streptococcus bacteria (de-Paris et al., 2011). After this screening, Prue is
provided with the results in two to three days. She has to ask for the results in her next prenatal
visit if the medical practitioner does not provide them. Other hospitals may offer rapid group B
streptococcus screening during labor and provide the results within an hour. It is, however,
important to note that this rapid screening may not be as sensitive as the screening that allows the
incubation of the GBS (de-Paris et al., 2011). This is the main reason why The American
Academy of Pediatrics, Centers for Disease Control, and American College of Obstetricians and
Gynecologists all recommend a screening between 35-37 weeks of pregnancy.
Current pieces of evidence reveal that women who test positive for group B streptococcus
colonization should be given a prescription of intrapartum antibiotic prophylaxis during labor,
except for cases of planned cesarean delivery where the intrapartum antibiotic prophylaxis is not
recommended (Berardi et al., 2013). The Centers for Disease Control and Prevention have given
two recommendations to prevent early group B streptococcus infection. These two
recommendations include the universal approach screening and the risk-based approach to
screening (El Aila et al., 2010). The universal approach is where all pregnant women are
screened at 35-37 weeks and all who test positive for GBS are treated with antibiotics during
labor. The risk-based approach, on the other hand, treats all women during labor with antibiotics
if they test positive for GBS during any point in pregnancy or if the woman has previously given
birth to a baby with early GBS infection (El Aila et al., 2010). Further evidence reveals that the
universal approach is more effective than the risk-based approach to preventing early GBS

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infection. It is, however, important to note that the universal approach and treatment using
antibiotics cannot be expected to be 100% effective in the prevention of early GBS infection.
Therefore, a routine screening is recommended to help in further lowering the rates of GBS
infection.
The Center for Disease Control and Prevention further recommends that antibiotics
should be administered after every four hours, beginning at approximately 4 hours before birth.
Studies reveal that the administration of antibiotics four hours before birth reduces the rates of
early GBS infection in 89% of cases every time. The antibiotics were however only effective
38% of the time if they were administered 2 to 4 hours before birth (El Aila et al., 2010). On the
contrary, administration of antibiotics less than 2 hours before childbirth was proved to be
effective 47% of the time. The most recommended antibiotic is penicillin but Prue is allergic to
penicillin and therefore an alternative antibiotic can be recommended if she tests positive for
group B streptococcus.
Several pieces of research have revealed that administration of in-labor antibiotics may
temporally impact on the microbiome of the child. Around seven out of eight studies that were
performed on this topic indicated that the antibiotics had a short-term effect in raising the
numbers of non-beneficial bacteria and/or lowering the number of beneficial bacteria.
As a midwife, I must advise Prue and Michael on the management of GBS to enhance
their decision making. It is important for the couple to know that an incidental finding of GBS in
pregnancy five weeks before labor may be unreliable leading to interventions that may be
unnecessary. It is therefore recommended that screening is done at weeks 35-37 for best results.

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If the screening shows a positive test for group B streptococcus then Prue should be offered an
intrapartum antibiotic prophylaxis.

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