Midwife exemption formulary (Formularies)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • NHS Highland
  • Primary and Secondary Care Midwives & Student Midwives
  • Adults and Neonates only

This formulary is for the use of Midwives & Student Midwives employed by NHS Highland for the treatment of people who are pregnant and their new born babies in ALL care settings.

For A&B HSCP: If there are any medicines in this formulary that do not match your local (GGC) formulary, please refer to your local formulary for alternative products. 

Student Midwives

From: NMC Practising as a midwife

  • In accordance with Part 3 of Schedule 17 of the Regulations student midwives can administer the drugs included within the midwives’ exemptions (with the exception of controlled drugs) under the direct supervision of a midwife. Student midwives are NOT permitted to administer controlled drugs using midwives’ exemptions, including: diamorphine, morphine and pethidine hydrochloride. They may participate in the checking and preparation of controlled drugs under the supervision of a midwife.
  • A registered nurse during their clinical placement on the shortened programme acts as a student midwife for the purposes of all drug administration.

Midwife exemption formulary

The medicines in this formulary are those included in Annex A of the NMC Practising as a midwife. 

Midwives & Student Midwives must comply with The NMC Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates 

Purpose

  • To ensure that Midwives & Student Midwives safely administer those medicines which their legal status exempts them from the need for a prescription from an authorised prescriber or without the need for a specific Patient Group Direction to women during the antenatal, labour and postnatal periods and to neonates.
  • To list medicines that Midwives & Student Midwives can administer in the course of their professional practice under Medicines Act exemptions.

Note: Medicines not included in this list require a prescription from an authorised prescriber.

Patient Group Directions

PGDs are NOT included in the Midwife Exemption Formulary. For PGDs for Midwives, see: PGD library (NHS Highland intranet access required). 

Emergency use medicines

The following medication, as listed in The Human Regulations, Schedule 19: Medicinal products for parenteral administration in an emergency may be administered by a registrant without a prescription in an emergency for the purpose of saving a life:

  • Adrenaline 1:1000 (1mg/ml)
  • Atropine Sulphate Injection
  • Glucagon injection
  • Glucose injection
  • Naloxone hydrochloride
  • Chlorphenamine injection
  • Hydrocortisone injection

Relevant policy documents

NHS Highland intranet access required

Education and training

Documentation

Ensure to follow the correct processes for the area that you are working in.

  • Inpatient settings: use HEPMA and BadgerNet
  • Outpatient and community settings: use paper Kardex and BadgerNet

Reflux (Maternal)

Medicine Place in therapy Dose Other relevant information

Alginate antacid

Eg: Peptac liquid 
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: 10 to 20mL to be taken after meals and at bedtime, when required.

ESCALATION: If no effect at full dose after 2 weeks, refer to GP. 

The absorption of iron can be reduced by the concurrent use of antacids. Avoid taking these preparations at the same time. 

Pre-pack: 500mL

GSL medicine*

Laxatives (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Lactulose liquid
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: Up to 15mL, twice daily.

Pre-pack: 300mL

P medicine*

Senna/Sennosides

7.5mg tablets
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: ONE to TWO tablets to be taken in the evening.

Pre-pack: NOT available

P medicine*

Glycerol

4g suppository
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

RECTAL: ONE suppository to be inserted gently into the rectum when required.

Moisten with water before insertion.

Pre-pack: NOT available

GSL medicine*

Sodium citrate 

90mg/mL microenema
  • ANTE-NATAL
  • LABOUR
  • POST-NATAL

Breastfeeding: SUITABLE

RECTAL: One dose = 5mL Up to 15mL, twice daily.

Pre-pack: NOT AVAILABLE

P medicine*

Macrogol 

Eg: Laxido sachet
  • ANTE-NATAL
  • LABOUR
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: ONE sachet, twice daily.

Pre-pack: NOT AVAILABLE

P medicine*

Haemorrhoids (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Anusol®

23g cream, 1 x 12 suppositories 
  • ANTE-NATAL
  • POST-NATAL 

Breastfeeding: SUITABLE

TOPICAL: Apply morning and night and after bowel movement.

RECTAL: ONE suppository twice daily

Pre-pack: NOT available

GSL medicine*

Hydrocortisone 0.275% with lidocaine 5%

Xyloproct® ointment
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

TOPICAL: Apply several times a day

For short term use only

Pre-pack: NOT available

POM medicine*

Folic acid and iron (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Folic acid

400 micrograms tablet
  • ANTE-NATAL use

Breastfeeding: SUITABLE

ORAL: once daily

To be taken from preconception and throughout pregnancy

Healthy start Vitamins available from Community Midwife

Pre-pack: NOT available

GSL medicine*

Ferrous fumarate

210mg (68mg iron) tablets,
140mg (45mg iron)/5mL syrup
  • ANTE-NATAL 
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: ONE tablet once daily

ORAL: 5 to 10mL syrup once daily

Reduce to alternate days, if not tolerated

Take on empty stomach or before food

Pre-pack: 84 x 210mg tablets

P medicine*

Ferrous sulfate

200mg (65mg iron) tablets
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: ONE tablet once daily

Reduce to alternate days, if not tolerated

Take on empty stomach or before food

Pre-pack: 28 x 200mg tablets 

P medicine*

Sodium feredetate 

190mg (27·5mg iron)/5mL elixir (Sytron®)

 

  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

For those not able to tolerate other iron products:

ORAL: 10 to 15mL once daily

Reduce to alternate days, if not tolerated

Take on empty stomach or before food

Pre-pack: NOT available

P medicine*

Thrush (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Clotrimazole

1% cream

 

  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

Breast thrush: 

TOPICAL: 2 to 3 times daily

Pre-pack: 20g cream

P medicine*

Clotrimazole

100mg, 200mg pessary
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

 

Vaginal thrush:

VAGINALLY: 100mg once daily for 6 nights

OR

200mg once daily for 3 nights

Pre-pack: NOT available

P medicine*

The 500mg pessary is a POM and requires a prescription to be administered / supplied. It is NOT included in the Midwife Exemption Formulary.

Nausea (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Prochlorperazine 

12.5mg/mL injection
  • LABOUR

Breastfeeding: OCCASIONAL USE

IM: 12.5mg by IM injection

2 doses 8 hours apart

Pre-pack: NOT AVAILABLE

POM medicine*

Cyclizine

50mg/mL injection
  • LABOUR

Breastfeeding: OCCASIONAL USE

IM: 50mg, up to three times a day

2 IM doses, 8 hours apart

Pre-pack: NOT AVAILABLE

POM medicine*

Anaphylaxis (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Adrenaline/epinephrine 

1 in 1,000 ampoule (1mg/mL) injection
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

IM: 500 microgram (0.5mL) by IM injection.

PHONE AMBULANCE at first administration

Repeat after 5 minutes if no response

Pre-pack: NOT AVAILABLE

POM medicine*

Analgesia (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Paracetamol

500mg tablets
500mg suppositories
  • ANTE-NATAL
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL or RECTAL: 1g 4 to 6 hourly

If <50kg, then 500mg 4 to 6 hourly

Max: 4 doses in 24 hours

ESCALATION: Max 4 days treatment

Pre-pack: 32 x 500mg tablets

P medicine*

Pre-pack: 100mL x 250mg/5mL suspension

GSL medicine*

Ibuprofen

200mg tablets
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: 200mg to 400mg, 6 to 8 hourly

ESCALATION: Max 4 days treatment 

Pre-pack: 24 x 200mg tablets

GSL medicine*

Diclofenac

50mg tablets
50mg, 100mg suppositories
  • POST-NATAL

Breastfeeding: SUITABLE

ORAL: 50mg, 3 times a day

RECTAL: 50mg or 100mg suppository, if required

Max 150mg in 24 hours

Pre-pack: 14 x 50mg tablets

POM medicine*

Morphine

10mg/mL injection
  • LABOUR

Breastfeeding: SUITABLE

IM: In-patient dose by IM injection:

  • ≤60kg: 10mg
  • >60kg: 15mg 

Further two doses may be given at 4 hourly intervals

ESCALATION: Max 3 doses to be given before referral to medical staff

Respiratory depression and withdrawal can occur in neonate if used during delivery

Pre-pack: NOT AVAILABLE

POM, CD schedule 2 medicine*

Diamorphine

5mg, 10mg injection
  • LABOUR 

Breastfeeding: SUITABLE

IM: In-patient: 5 to 10mg by IM injection

Then 5 to 10mg after 4 hours

ESCALATION: Max 3 doses to be given before referral to medical staff

Pre-pack: NOT AVAILABLE

POM, CD schedule 2 medicine*

Pethidine

 

While pethidine is included in the NMC list of Midwife Exemptions, it is NOT recommended for routine use in NHS Highland.

Seek medical advice before choosing to administer. 

Opioid reversal (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Naloxone

400 micrograms/mL solution for injection,
400 micrograms/mL solution for injection pre-filled syringe (Minijet®)
  • LABOUR: Reverse respiratory and neurological depression induced by opioid overdose.

Breastfeeding: SUITABLE once mum feels able 

IM: 400 micrograms

Can be repeated every 2 to 3 minutes as per BNF

Pre-pack: NOT AVAILABLE

POM medicine*

Inhalational anaesthetics (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Nitrous oxide 50% /oxygen 50%

inhalational gas (Entonox®) 
  • LABOUR

Breastfeeding: SUITABLE, can resume as soon as mother has recovered

Inhaled for anaesthesia

Pre-pack: NOT AVAILABLE

P medicine*

Obstetric/labour (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Ergometrine with oxytocin

500 micrograms/ 5 units/mL injection (Syntometrine®)  
  • LABOUR: active management of the 3rd stage of labour after delivery of the baby’s anterior shoulder to cause expulsion of the placenta
  • POST-NATAL:  for PPH following expulsion of the placenta, or when bleeding occurs

Breastfeeding: SUITABLE

IM: 1mL by IM injection

Max 2 doses in total, including any doses given for the management of labour

Management of PPH (NHS Highland intranet access required) 

Inadvertent administration to the neonate has proved FATAL.

ONLY for maternal administration.

AVOID use in Hypertension and PET

Pre-pack: NOT AVAILABLE

POM medicine*

Oxytocin

5 units/mL, 10 units/mL injection
  • LABOUR: induction or augmentation of labour, 3rd stage of labour, and treatment of PPH as per Obstetric advice

Breastfeeding: SUITABLE

IM or IV infusion

Management of PPH (NHS Highland intranet access required) 

Oxytocin use in induction & augmentation of labour (NHS Highland intranet access required)

Pre-pack: NOT AVAILABLE

POM medicine*

Ergometrine

500 micrograms/mL injection
  • POST-NATAL: treatment of PPH as per Obstetric advice

Breastfeeding: SUITABLE

IM: 500 microgram by IM injection

IV: 250 to 500 microgram by slow IV infusion

Max 2 doses in total, including any doses given for management of labour.

Management of PPH (NHS Highland intranet access required) 

AVOID use in Hypertension and PET

Pre-pack: NOT AVAILABLE

POM medicine*

Carboprost

250 micrograms/mL injection
  • POST-NATAL: treatment of PPH

Breastfeeding: SUITABLE

IM: 250 microgram by IM injection.

Repeat every 15mins for a max of 8 doses

Management of PPH (NHS Highland intranet access required) 

Do not use in asthma, hypertension, liver dysfunction, decompensated liver disease, diabetes and glaucoma.

Pre-pack: NOT AVAILABLE

POM medicine*

Local anaesthesia (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Lidocaine with prilocaine

 2.5%/2.5% cream (EMLA®)

FOR ANTE-NATAL,  LABOUR and POST-NATAL use

Breastfeeding: SUITABLE

 TOPICAL

Pre-pack: 5g cream

P medicine*

Tetracaine

4% gel (Ametop®)

FOR ANTE-NATAL,  LABOUR and POST-NATAL use

Breastfeeding: SUITABLE

TOPICAL

Pre-pack: NOT available

P medicine*

Lidocaine

1% (50mg/5mL) solution for injection:

 
  • LABOUR
  • POST-NATAL

BREASTFEEDING: Suitable

Local perineal infiltration:  Min 5mL, max 0.3mL/kg or 20mL

Episiotomy or perineal suturing after delivery: 5 to 10mL for infiltration prior to episiotomy followed by 10 to 15mL for subsequent repair. Max volume 0.3mL/kg (up to max 20mL) divided between sites to be repaired.

Repair of spontaneous perineal trauma:
Max volume 0.3mL/kg (up to max 20 mL) divided between sites to be repaired.

Pre-pack: NOT AVAILABLE

POM medicine*

Lidocaine with chlorhexidine

2%/0·25% gel (Instillagel®)

FOR ANTE-NATAL,  LABOUR and POST-NATAL use

Breastfeeding: SUITABLE

Urinary catheter insertion: 6 to 11mL via urethra and wait 3 to 5 minutes before catheterisation

Pre-pack: NOT available

P medicine*

IV fluids (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Compound sodium lactate

(Hartmann's solution)
  • ANTE-NATAL
  • LABOUR
  • POST-NATAL

Breastfeeding: SUITABLE

IV

Pre-pack: NOT AVAILABLE

POM medicine*

Sodium chloride

0.9%: sodium 150mmol/L IV infusion
  • ANTE-NATAL
  • LABOUR
  • POST-NATAL

Breastfeeding: SUITABLE

IV

Pre-pack: NOT AVAILABLE

POM medicine*

Gelofusine

4%
  • ANTE-NATAL
  • LABOUR
  • POST-NATAL

Breastfeeding: SUITABLE

IV: Restricted to emergency situations

AVOID at the end of pregnancy

Possibility of severe anaphylactic reactions, with consecutive foetal and neonatal distress due to maternal hypotension.

Pre-pack: NOT AVAILABLE

POM medicine*

Immunological products and vaccines (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Anti-D (RHO) immunoglobulin solution for injection:
 500 units, 1500 units
  • ANTE-NATAL
  • POST-NATAL

Postnatal, routine antenatal, sensitising event

Breastfeeding: SUITABLE

IM: Anti-D prophylaxis and administration during pregnancy and postnatally (Guidelines)

Pre-pack: NOT AVAILABLE

POM medicine*

Oxygen (Maternal)

Medicine

 Place in therapy Dose Other relevant information

Oxygen 

 
  • ANTE-NATAL: Women who suffer major trauma. sepsis or acute illness during pregnancy
  • LABOUR: Obstetric emergency

For emergency use in presence of maternal hypoxaemia (oxygen saturations less than 94%)

Administer via non-rebreathing face mask with target saturation range of 94 to 98%

Pre-pack: NOT AVAILABLE

GSL medicine*

Oxygen (Neonate)

Medicine

 Place in therapy Dose Other relevant information

Oxygen
  • NEONATAL: At home during neonatal resuscitation.

10L via face mask

If the neonate requires cardiac compressions and/or ventilation support, or is having breathing difficulties, commence oxygen in the home at 10L regardless of the availability of saturation monitoring. 

When possible the oxygen should be titrated to the saturation readings when reliable monitoring is available.

Pre-pack: NOT AVAILABLE

GSL medicine*

Opioid reversal (Neonate)

Medicine

 Place in therapy Dose Other relevant information

Naloxone

400 micrograms/mL solution for injection
  • NEONATE

Second line, after ventilation

IM: 200 micrograms for ONE dose into the anterior thigh

Pre-pack: NOT AVAILABLE

POM medicine*

Vitamin K (Neonate)

Medicine

 Place in therapy Dose Other relevant information

Phytomenadione

2mg/0·2mL injection, in a mixed micelles vehicle
  • NEONATE

Can be given ORALLY or IM

See: Vitamin K guideline combined.docx (NHS Highland intranet access required)

Pre-pack: NOT available

POM medicine*

Oral thrush (Neonate)

Medicine

 Place in therapy Dose Other relevant information

Nystatin 

100,000 units/mL oral suspension
  • NEONATE

ORAL: 100,000 units, 4 times a day.

Continued for 48 hours after lesions have healed.

Give after feeds.

Pre-pack: 30mL

POM medicine*

Nappy rash (Neonate)

 

Medicine

 Place in therapy Dose Other relevant informatio

Emulsifying 

Ointment, 100g
  • NEONATE

 

Pre-pack: NOT available

Not a medicinal product*

Medihoney

Barrier cream sachets, 1 x 20

Barrier cream, 50g
  • NEONATE

 

Pre-pack: NOT available

Not a medicinal product*

Metanium

Nappy rash ointment, 30g
  • NEONATE

 

Pre-pack: NOT available

GSL medicine*

Glossary of terms and Abbreviations

* Explanation of: GSL, P, POM, CD

Classes of medicinal products for humans under the Human Medicines Regulations 2012

GSL: General sales list medicine

  • Medicines that are available as ‘self-selection’ items for sale in registered pharmacies and can be sold in other retail outlets that can ‘close so as to exclude the public’.

P: Pharmacy medicine

  • A medicinal product that can only be sold from a registered pharmacy premises by a pharmacist or a person acting under the supervision of a pharmacist. P medicines must not be accessible to the public by self-selection.

Together GSL and P medicines are collectively known as over-the-counter (OTC) or non-prescription medicines. 

POM: Prescription only medicine

  • A medicine that is generally subject to the restriction of requiring a prescription written by an appropriate practitioner.

CD: Controlled drug

  • A type of POM that is classified into one of five schedules according to the different levels of control attributed to it.
    Schedule 1 (CD Lic POM)
    Schedule 2 (CD POM)
    Schedule 3 (CD No Register POM)
    Schedule 4 (CD Benz POM and CD Anab POM)
    Schedule 5 (CD INV P and CD INV POM).
  • The MEF contains Schedule 2 CDs.

Explanation of pre-pack (previously known as TTO: To take out)

This is a prepack that has been packed down to a size that is appropriate to give to a patient for their own use. Each prepack will have a label with pre-printed instructions and a patient information leaflet.

The Midwife / Student Midwife is to complete the label with any details that are missing in the allocated spaces, including the patient name, date of supply, and administration details, as necessary.

Abbreviations

  • BNF: British National Formulary
  • CD: Controlled drug
  • GSL: General Sales List medicine
  • IM: Intramuscular injection
  • IV: Intravenous injection
  • MEF: Midwife Exemption Formulary
  • NMC: Nursing & Midwifery Council
  • P: Pharmacy medicine
  • PET: Pre-Eclamptic Toxaemia
  • PGD: Patient Group Directions
  • POD: Patient's Own Drugs
  • POM: Prescription only medicine
  • PPH: Post-Partum Haemorrhage
  • SAMS: Self-Administration of Medicines Scheme
  • SPC: Manufacturer's Summary of Product Characteristics
  • TTO: To Take Out

Editorial Information

Last reviewed: 28/08/2025

Next review date: 31/08/2028

Author(s): NMAHP.

Version: 1.1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): M Dunbar, Lead Pharmacist Woman and Child, C Henderson-Hughes, Lead Nurse, Medicines Governance, A Austin, Lead Midwife, Woman and Child, C Murphy, Midwife, S Graham, Clinical Midwifery Manager.

Document Id: AF016