Original Research Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives Paula Medway a,b, *, Linda Sweet c,a , Amanda Müller a a College of Nursing and Health Sciences, Flinders University, Australia b Department for Health and Wellbeing, Government of South Australia, Australia c School of Nursing & Midwifery, Deakin University and Western Health Partnership, Australia A R T I C L E I N F O Article history: Received 8 April 2020 Received in revised form 31 May 2020 Accepted 1 June 2020 Available online xxx Keywords: Midwifery Endorsement Medicare-rebatable Prescribing Diagnostic test ordering A B S T R A C T Background: In 2010, the Nursing and Midwifery Board of Australia introduced a new registration standard: Endorsement for scheduled medicines for midwives. The endorsement enables midwives to provide women with Medicare-rebatable care, prescribe relevant medications, and order relevant Medicare-rebatable diagnostics. Translating endorsement education into clinical midwifery practice has been slow, indicating the presence of barriers affecting midwives’ ability to use this standard, despite it increasing their scope for service provision. Aim: To discover the mechanisms affecting midwives’ ability to work to full scope of practice after completing a programme of study leading to endorsement. Methods: An observational (non-experimental) design was used. Midwives who had completed an education programme leading to endorsement were invited to complete a survey. Descriptive statistics were used to analyse the quantitative questions and content analysis was conducted on the qualitative data. Findings: Results indicated that barriers – such as the limitations of Medicare provisions for endorsed midwives and a general lack of support for the role – restrict endorsed midwives’ ability to provide quality maternity services. Having some form of support for the role may act as an enabler, in addition to midwives having personal determination and confidence in their ability to use the endorsement. Recommendations to strengthen the endorsed midwife's role include facilitating endorsement use in the public sector, relaxing Medicare Benefit Schedule and Pharmaceutical Benefit Scheme restrictions, raising awareness of the role and scope, and improving midwives’ pre-endorsement preparation. Conclusion: This study highlights the need for an all-of-system approach to support and develop the endorsed midwife's role. © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved. Statement of significance Problem or issue Opportunities have been slow to eventuate for midwives who have met the study requirements for the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines. The reasons for this have been unclear. What is already known There is a significant knowledge gap in the literature about the midwifery endorsement and its use in practice. What this study adds There are multi-factorial barriers for midwives using the endorsement. Ongoing legislative, organisational, and individual support is required for the endorsed midwife's role to develop. Further research is required to determine if the endorsement is serving its original intent – to increase women's choice and access to a variety of models of maternity care. * Corresponding author at: College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. E-mail address: Paula.Medway@sa.gov.au (P. Medway). http://dx.doi.org/10.1016/j.wombi.2020.06.001 1871-5192/© 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved. Women and Birth xxx (2019) xxx–xxx G Model WOMBI 1132 No. of Pages 10 Please cite this article in press as: P. Medway, et al., Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia’s Endorsement for scheduled medicines for midwives, Women Birth (2020), https://doi.org/10.1016/j.wombi.2020.06.001 Contents lists available at ScienceDirect Women and Birth journal homepage: www.elsevier.com/locate/wombi