To be so angry at this pharmacist

[buddhasbelly]

From my other thread under my other username (which I now see no point in hiding - ahtilnextweek) I am pregnant with an unwanted pregnancy.

After my first hospital appointment I was told that things weren't large enough to begin a termination.

I then was told that the morning after pill I took "Levonelle" is far less effective (on an aggregate scale) than the new alternative offered aka you take the new pill £30 after possibility of sex it has a 95% chance of no pregnancy, you take levonelle, the odds very much decrease hour by hour (as instructed by the midwife scanning me). The midwife scanning me was astounded I was not given this info (the picture painted to me was dont pay the money it isn't needed). In reality it could have (I stress could have) prevented an unwanted pregnancy.

I am angry. I am frustrated and if I am told again that I have posted in the 'wrong' place then please take account of the situation. I do not feel there is a right or wrong wherever you post.

Your midwife gave you inaccurate information. EllaOne may be more effective at reducing the risk of pregnancy after UPSI but like Levonelle it depends on the timing. It also has more potential interactions and the criteria for obtaining it can vary between areas. In most areas Levonelle is free depending on your age and where you get it from. EllaOne is rarely free from pharmacies but can be dispensed from sexual health clinics.

Both brands of emergency contraceptive pills are prescription only medicines and so are subject to local prescribing restrictions. Where I work for example we will only prescribe EllaOne if a woman is over 72 hours from UPSI and won't consider a coil insertion.

I understand your distress but I do think your midwife was out of order to make the comments she did. I'm also slightly concerned at the "too early for a termination" issue which is rather irregular. Generally speaking if pregnancy has been confirmed by scan and not just a positive test, and is unwanted then a termination can be arranged. It would be unusual for this to happen before about 6 weeks though.

I am honestly worried about the advice the midwife has given you.

Yes, I wonder if it's her advice that's more inaccurate than the pharmacist's.

buddhasbelly You probably won't want to hear this but we had a similar occurrence the bloody temporary pharmacist told my wife that she couldn't take the morning after pill because she was in some other medication at the time and was totally wrong in that. For what its worth we had a condom burst.

She didn't tell me as I'd have checked it on somewhere like drugs.com or the BNF and noticed the error which it was. The pharmacist at the shop a very good one was horrified and words were had with the young temp who had made an error. I just wish she'd have told me as she had an abortion a few weeks later:(

The pharmacist was very likely following the local NHS EHC (emergency hormonal contraception) guidelines. The fact it was free would indicate it's local protocol to use Levonelle in the first instance. No harm is asking why Levonelle was supplied but I doubt there's a competency issue with the pharmacist based on what you've said. Unfortunately the drug isn't 100% effective (not sure if more current research has emerged but when first licenced it was stated as 85% effective within 48 hours).
Also very confused by the 'too early for termination' statement- really can't think of the medical basis for that. I never think it's wise for healthcare professionals to make judgements about the decisions of other healthcare professionals without speaking to them to fully understand the rational for their decision. It can cause very inflammatory situations (such as this one). Very much wish you the best and I'm sorry that this has happened to you.

Sidge Just out of interest my wife was told she couldn't take the MA pill and that was before even a prescription was considered perhaps she ought to have seen the doctor first. However i might be under some misapprehension but is this medication now available less prescription i.e. a pharmacist can dispense it after asking some questions?.

Its been available via a pharmacist asking questions for years. It was when I took it circa 15 years ago.

So that contradicts sidge's advice then as he or she says that they are prescription only drugs or are we taking about different ones?.

Levonelle has been available to buy in pharmacies for 12 years + and has a strong safety profile. There are some situations when pharmacists can't sell it but GPs can prescribe it under a broader range of circumstances if they feel it's appropriate.

Op I would also query the midwives advice...if you are 5 weeks I had my pregnancy with DD2 confirmed by scan (internal) at just 5 weeks and I was sure of my dates (I have to start medication as soon as possible).
As to the pharmacist vs the midwife ...I understand why you are angry - but you can't turn the clock back and you have to deal with where you are now . I would get everything sorted and then go back and calmly talk to the pharmacist about it - if only to make sure they have good informed reason to give out the advice they did. As others said no MAP is 100% effective and it is hard to actually measure the effectiveness. And HCPs will have different opinions based on the facts they have.
I was once party to a telephone 'discussion' between my GP and my consultant over it (before you could get it OTC). Contraception failure at the worst possible time of the month. GP wouldn't prescribe as I have associated risks, in the end contacted my consultant. I only got one half of the conversation but basically it was about which would be the greater risk - MAP or termination or pregnancy. GP opinion was I might not need the MAP and if I did I was increasing my risks if the MAP didn't work - I could have that risk and still have one of the others. I did get the MAP in the end but it was only after I more or less begged and said I would sign something to take responsibility for my decision. (Don't think they did actually make me - can't remember now). Thankfully that was the only risk.

to anyone that has commented on me not being too far gone and that they have "never heard of that"

Pregnancy was confirmed by the sac - however there was no - as she put it - yolk seen in the middle yet, that current size was approx 5 mm and that in about a weeks time it would be big enough to see said yolk and thereafter I could go through with the termination. She dated my pregnancy, from my last period at approx 4-5 weeks.

The midwife told me she also runs the sexual health clinic in the city for under 25s - she does not give out levonelle there, she gives out ellaone and said she is frustrated that more NHS pharmacists will not give ellaone. She then drew graphs of effectiveness of both pills on the white tissue paper stuff thats on the bed/chairs to protect them to show me the sliding scale of effectiveness of levonelle in comparison to ellaone following sex.

I did point out to the midwife that I suffered severe pre and post natal depression due to my dd's father's abusiveness and that the thought of being pregnant again was incredibly stressful to me but was informed that I would still have to wait a week for a termination.

I'm really sorry that you're in this situation but the midwife should have taken into account your personal past medical history before she went ahead and gave you some graphs drawn on a big big of tissue paper! I'm not sure who she thought she was helping really.

Your midwife spins like she has an agenda. I'm very sorry that she has put you through this. Her graphs sound inaccurate and distressing, so I'd be making a complaint about that.

With regards to your termination, is there another clinic you can get too, or can you ask for a second opinion? You shouldn't need to wait a week, they can see the savings and 4 - 5 weeks is fine for a termination. As it's even more important that this is sorted quickly for you, I'd want to see another midwife.

It's sounding increasingly like the midwife was in the wrong here not the pharmacist.

Why are you clinging to the belief that the midwife must have been right and the pharmacist wrong? Some very knowledgeable people on here have explained why it looks as if the midwife was wrong.

I think your fixated on the wrong thing...

justaboy they are prescription only drugs in that you can't just buy them over the counter or in a supermarket like paracetamol or some hay fever medications. Questions need to be asked before they can be dispensed by someone qualified to do so, and that would be a doctor, nurse or pharmacist (not a pharmacy assistant).

Emergency contraception can't be given if unprotected sex happened more than 72/120 hours ago, if there was more than one episode of unprotected sex since a last period, stuff like that. In many areas it will only be free in a pharmacy if you're under 25, otherwise you have to pay for it or go to a clinic.

The midwife was, in my opinion, out of order because she was confusing her own preferences with local guidelines. Yes, in the local clinic she works in maybe she could choose to give EllaOne instead of Levonelle but if the pharmacist was bound by his or her dispensing criteria then maybe s/he HAD to dispense Levonelle and wasn't allowed to issue EllaOne.

Anyway it's all speculation as none of us know why everyone did or said what they did. I'm sorry you have an unwanted pregnancy to deal with buddhasbelly and hope it's resolved for you soon.

sidge I definitely agree that the pharmacist was likely bound by local guidelines but disagree that the legal classification of the type of MAP supplied by pharmacists over the counter is a POM (prescription only medicine). POMs can only be prescribed by an authorised prescriber in the vast majority of circumstances (PGD's and emergency supplies are exceptions to the rule). In order to be supplied over the counter in a pharmacy the legal classification of the medicine in this country needs to be a P (pharmacy medicine) as opposed to a GSL (general sale list) medicine- this category contains things like small packs of paracetamols you buy in petrol stations and supermarkets.

In this instance the pharmacist supplied for free. My guess is that this was under a patient group directive (PGD) arranged locally by the CCG (clinical commissioning group) hence why I think local rules applied here. PGDs can be used to allow pharmacists to supply a small number of POMs but in this instance the drug is also available over the counter as a P to buy (all be it in slightly different packaging but with no change to whats inside). Supplying a P medicine for free is a way of increasing patient compliance and accessibility of services and (hopefully) reducing the rate of unwanted pregnancy in the case of Levonelle. It's unfortunate that this didn't happen for the OP but from what I've read the pharmacist probably followed local NHS guidelines appropriately.

Thank you carshare I stand corrected. Can you tell I'm not a pharmacist

I know we have PGDs but didn't realise pharmacist used them too, that's useful.

Sidge hehe- I know- I should have confessed earlier up the thread about my pharmacy masters. I totally agree with all of the other points you've made though- I don't work specifically in sexual health so there are things you've said that I've learnt from too

i think the midwife was wrong in expressing her personal opinion to you, you became pregnant despite emergency contraception and i don't think her comments are helpful, just because she believes Ellaone to be more effective it doesn't mean other staff will follow guidelines based on that.
its natural to want someone to blame when thinks don't work out the way you want, but i don't think you can blame the pharmacist.

What are the rules regarding giving medicines? I know pharmacists know medicines inside out and are allowed to dispense things without a prescription, eg the MAP. What about midwives?