You’re pregnant, so you think twice about what you put into your body; after all, there are two of you to think about.

{mosimage}Pregnant woman have many concerns about both prescription and over the counter drugs. Although many drugs are safe, many are not, and midwives should encourage their patients to ask about any drug, including the most inocuous, before taking it during pregnancy. This includes herbs and naturopathic remedies. There is basic information about herbs on another page of this website.

In my practice, I usually tell my moms that they can take certain over the counter drugs without asking me each time. These include acetominophen (Tylenol, etc), pseudephedrine HCl (Sudafed HCl, etc), diphenhydramine HCl (Benadryl). I sometimes suggest Benadryl to women who are having trouble with insomnia. My list of OK drugs also includes antacids such as Maalox and Mylanta, Riopan, and Tums. I counsel not to take old-fashioned baking soda or sodium bicarbonate or Alka-Seltzer, which is sodium bicarb and aspirin. For constipation, I tell women to start by increasing the amount of fluid they drink, then to increase fibrous foods such as dried fruits and whole grains. At the same time, I tell them to decrease the amount of rice, cheese, and bananas. If these measures don’t do it, I tell them they can take a bulk former such as Citrucel or Metamucil, or a stool softener such as Colace. I counsel them not to take laxatives. I ask them to let me know before taking anything that is not on this list, or taking these drugs in higher doses than the ones I have suggested.

For more information about drugs in pregnancy, an excellent source of information for midwives and pregnant women is the Motherisk website from The Hospital for Sick Children, Toronto, Ontario. For over 15 years, Motherisk has reviewed data from around the world, and conducted controlled, prospective studies to determine the potential risks of therapeutic drugs during pregnancy. It is now clear that there are many drugs that are safe for use in pregnancy. Motherisk also has information on radiation in pregnancy, social and recreational drugs in pregnancy, herbal remedies, and many other relevant topics.

Certified nurse-midwives and certified midwives can prescribe drugs for their patients in most jurisdictions in the United States. Although midwives believe that pregnancy is a normal physiological event that should not ordinarily require medication, they know that there are times when it is helpful to have the ability to prescribe for their patients. On a daily basis, midwives write prescriptions for prenatal vitamins, antibiotics to treat uncomplicated infections, oral contraceptives, and hormone replacement therapy (since our patients stay with us even after their childbearing years are over!). Some midwives are comfortable with an extended scope of practice in primary care, and write prescriptions for anti-depressants and anti-anxiety agents, asthma medications, anti-hypertensives, and many other pharmaceuticals. Midwives must examine their own comfort level with the boundaries of their scope of practice, particularly as it applies to prescriptive privileges. That comfort level should be determined by the individual midwife’s knowledge, skill, experience, and context of practice, as well as by laws, rules, and regulations.

An excellent online source of information about pharmaceuticals in pregnancy and lactation is at You can search for any drug, and get the category in pregnancy, and effect in breastfeeding. This site also has pages about the effects of maternal exposure to chemicals, drugs, infection, maternal disease, and physical agents. It is well worth checking out and remembering when you need this information.

Other online sources of information about specific pharmaceuticals include the FDA Medwatch website, which gives the latest warnings about adverse drug reactions and interactions, and The Internet Self-Assessment in Pharmacology site is an integrated self-study guide in pharmacology. It includes lecture outlines, pharmacologic information concerning approximately 300 drugs, and exam questions with explanations and grading summaries for each student. You must register to use the site, but registration is free.

You can find the FDA classification of drugs in pregnancy as well as a list of dangerous drugs in pregnancy at the OnHealth site, which also includes other pregnancy-related information and lets you ask a perinatologist your questions.

NS, updated 12/13/01