DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS  
DIRECTOR’S OFFICE  
BOARD OF MIDWIFERY  
(By authority conferred on the director of the department of licensing and regulatory affairs by  
sections 16145, 16148, 16174, 16186, 16201, 16204, and 16205 of 1978 PA 368, MCL 333.16145,  
333.16148, 333.16174, 333.16186, 333.16201, 333.16204, and 333.16205, and sections 17105,  
17107, 17111, 17112, and 17117 of 2016 PA 417, MCL 333.17105, 333.17107, 333.17111,  
333.17112, and 333.17117, and Executive Reorganization Order Nos. 1991-9, 1996-2, 2003-1,  
and 2011-4, MCL 338.3501, 445.2001, 445.2011, and 445.2030)  
PART 1. GENERAL PROVISIONS  
R 338.17101 Definitions.  
Rule 101. (1) As used in these rules:  
(a) “Appropriate health professional” means any individual licensed, registered or otherwise  
authorized to engage in a health profession under article 15 of the public health code who is  
referred to, consulted with, or collaborates with a licensed midwife.  
(b) "Board" means the Michigan board of licensed midwifery.  
(c) “Code” means 1978 PA 368, MCL 333.1101 to 333.25211.  
(d) “CPM” means a certified professional midwife who has met the standards for certification set  
by the North American Registry of Midwives (NARM). The CPM credential is accredited by the  
National Commission for Certifying Agencies (NCCA). The CPM credential with NARM  
requires a midwife to:  
(i) Validate education.  
(ii) Pass an examination.  
(iii) Complete a workshop, module or course on cultural awareness.  
(iv) Meet general education requirements.  
(v) Maintain current adult CPR and current neonatal resuscitation program certification (NRP)  
with a hands-on component.  
(vi) Complete obstetric emergency skills training.  
(e) “Department” means the Michigan department of licensing and regulatory affairs.  
(f) “Peer review” means the process utilized by midwives to confidentially discuss patient cases  
in a professional forum, which includes support, feedback, follow-up, and learning objectives.  
(2) Terms defined in the code have the same meanings when used in these rules.  
History: 2019 AACS.  
PART 2. PRELICENSURE LICENSED MIDWIFERY EDUCATION  
Page 1  
R 338.17111 Training standards for identifying victims of human trafficking: requirements.  
Rule 111. (1) Pursuant to section 16148 of the code, MCL 333.16148, an individual seeking  
licensure or registration who is licensed or registered shall complete a training in identifying  
victims of human trafficking that meets all the following standards:  
(a) Training content shall cover all of the following:  
(i) Understanding the types and venues of human trafficking in the United States.  
(ii) Identifying victims of human trafficking in health care settings.  
(iii) Identifying the warning signs of human trafficking in health care settings for adults and  
minors.  
(iv) Resources for reporting suspected victims of human trafficking.  
(b) Acceptable providers or methods of training include any of the following:  
(i) Training offered by a nationally-recognized or state-recognized health-related organization.  
(ii) Training offered by, or in conjunction with, a state or federal agency.  
(iii) Training obtained in an educational program that has been approved by the board for initial  
license or registration, or by a college or university.  
(iv) Reading an article related to the identification of victims of human trafficking that meets  
the requirements of subdivision (a) of this subrule and is published in a peer review journal, health  
care journal, or professional or scientific journal.  
(c) Acceptable modalities of training may include any of the following:  
(i) Teleconference or webinar.  
(ii) Online presentation.  
(iii) Live presentation.  
(iv) Printed or electronic media.  
(2) The department may select and audit a sample of individuals and request documentation of  
proof of completion of training. If audited by the department, an individual shall provide an  
acceptable proof of completion of training, including either of the following:  
(a) Proof of completion certificate issued by the training provider that includes thedate, provider  
name, name of training, and individual’s name.  
(b) A self-certification statement by an individual. The certification statement shall include the  
individual’s name and either of the following:  
(i) For training completed pursuant to subrule (1)(b)(i) to (iii) of this rule, the date, training  
provider name, and name of training.  
(ii) For training completed pursuant to subrule (1)(b)(iv) of this rule, the title of the article,  
author, publication name of peer review journal, health care journal, or professional or scientific  
journal, and date, volume, and issue of publication, as applicable.  
(3) Pursuant to section 16148 of the code, MCL 333.16148, the requirements specified in subrule  
(1) of this rule shall apply for license or registration renewals beginning with the first renewal  
cycle after the promulgation of this rule and for initial licenses or registrations issued 5 or more  
years after the promulgation of this rule.  
History: 2019 AACS.  
R 338.17113 Licensed midwifery accrediting organizations.  
Rule 113. (1) The board approves the Midwifery Education Accreditation Council (MEAC), or its  
successor entity, as an accrediting organization for an educational program or pathway.  
Page 2  
(2) A petition may be filed with the board for approval of a midwifery accrediting organization  
for an educational program or pathway, which will be evaluated to determine the organization’s  
equivalence to the standards of other board approved accrediting organizations. The board may  
approve a petition only if the standards and evaluative criteria of the organization are determined  
to be equivalent to the standards of MEAC, or its successor entity.  
History: 2019 AACS.  
R 338.17115 Licensed midwifery credentialing program.  
Rule 115. The board may approve a licensed midwifery credentialing program only if the program  
meets all of the following:  
(a) The standards and evaluative criteria are equivalent to the credential of a certified professional  
midwife (CPM) from the North American registry of midwives (NARM), or its successor entity.  
(b) It satisfies the criteria of section 16148 of the code, MCL 333.16148.  
(c) It is accredited by the national commission for certifying agencies (NCCA), or its successor  
entity, or another accrediting organization approved by the board if the standards and evaluative  
criteria of the accrediting organization are determined to be equivalent to the standards of NCCA,  
or its successor entity.  
History: 2019 AACS.  
PART 3. LICENSURE  
R 338.17121 Licensure.  
Rule 121. (1) In addition to meeting the requirements of sections 16174 of the code, MCL  
333.16174, an applicant for liceFDnsure shall submit a completed application on a form provided  
by the department, together with the requisite fee, and meet all of the following requirements:  
(a) Meet 1 of the following:  
(i) Submit proof to the department of completion of an educational program or pathway  
accredited by MEAC, or its successor entity, or by another accrediting organization approved by  
the board under R 333.17113.  
(ii) If prior to January 1, 2020, the applicant holds a current credential of CPM from NARM,  
or its successor entity, or an equivalent credential from another midwifery credentialing program  
that is approved by the board under R 383.17115, and satisfies both of the following:  
(A) Submits proof to the department that he or she holds a midwifery bridge certificate  
awarded by NARM, or its successor entity, or an equivalent credential from another midwifery  
credentialing program that meets the criteria of section 16148 of the code, MCL 333.16148.  
(B) The midwifery credentialing program is accredited by the NCCA, or its successor entity,  
or another accrediting organization approved by the board only if the standards and evaluative  
criteria of the accrediting organization are determined to be equivalent to the standards of NCCA,  
or its successor entity.  
(b) Submit proof to the department of holding a current credential of CPM from NARM, or its  
successor entity, or an equivalent credential from another midwifery credentialing program, that  
is approved by the board under R 383.17115.  
Page 3  
(c) Submit proof to the department of successfully passing the examination developed and  
scored by NARM or another exam approved by the board under subrule (3) of this rule.  
(d) Submit proof to the department of meeting the English language requirement under R  
338.17127, if applicable.  
(2) The board approves and adopts the examination developed and scored by NARM.  
(3) An applicant for licensure may petition the board to evaluate whether another examination  
meets the requirements of section 16178(1) of the code, MCL 333.16178(1).  
(4) A licensed midwife shall have obtained his or her recredential or maintain his or her CPM  
credential from NARM, or equivalent credential approved by the board, pursuant to R 338.17115,  
during the license cycle.  
History: 2019 AACS.  
R 338.17122 Nonrenewable temporary license.  
Rule 122. (1) If an applicant holds a current CPM credential from a midwifery education program  
that is not MEAC accredited or accredited by an accrediting organization approved by the board  
under R 338.17113, he or she may apply for a nonrenewable temporary license if he or she satisfies  
both of the following:  
(a) Meets the requirements of sections 16174 of the code, MCL 333.16174.  
(b) Submits to the department a completed application, on a form provided by the department,  
together with the requisite fee.  
(2) An individual who holds a temporary license must hold a midwifery bridge certificate from  
NARM or an equivalent credential approved by the board pursuant to R 338.17115, to qualify for  
a license when his or her temporary license expires, pursuant to section 17116 of the code, MCL  
333.17116.  
(3) The term of a temporary license is 24 months and is not renewable.  
History: 2019 AACS.  
R 338.17123 Licensure by endorsement.  
Rule 123. (1) An applicant who currently holds a license as a midwife in another state but who has  
never been licensed as a midwife in this state may apply for a license by endorsement and is  
presumed to meet the requirements of section 16186 of the code, MCL 333.16186, if he or she  
meets the requirements of section 16174, MCL 333.16174, submits a completed application, on a  
form provided by the department, together with the requisite fee, and submits all of the following:  
(a) Proof of completion of an educational program or pathway accredited by MEAC, or its  
successor entity, or by another accrediting organization approved by the board under R 333.17113.  
(b) Proof of holding a current credential of CPM from NARM or another midwifery  
credentialing program approved by the board under R 333.17115.  
(c) Proof of successfully passing the examination developed and scored by NARM or another  
exam approved by the board under R 338.17121(3).  
(d) Proof there are no pending disciplinary proceedings against the applicant before a licensing  
agency in this state, any other state, or country, or any sanctions currently imposed against the  
applicant by a licensing agency in this state, any other state, or country which are based on grounds  
similar to those under article 15 of the code.  
Page 4  
(e) Proof to the department of meeting the English language requirement under R 338.17127, if  
applicable.  
(2) If an applicant is licensed as a midwife in a state that does not require completion of an  
educational program or pathway that is MEAC approved, the department may determine that the  
applicant has met the requirements of subrule (2)(a) of this rule if he or she satisfies both of the  
following:  
(a) The applicant meets all the other requirements for licensure.  
(b) The applicant holds a midwifery bridge certificate awarded by NARM or an equivalent  
credential from another midwifery credentialing program that meets the criteria of section 16148  
of the code, MCL 333.16148, and is accredited by NCCA, or another accrediting organization  
approved by the board, if the standards and evaluative criteria of the accrediting organization are  
determined to be equivalent to the standards of NCCA or its successor entity.  
History: 2019 AACS.  
R 338.17125 Relicensure requirements.  
Rule 125. An applicant for relicensure whose Michigan licensed midwifery license has lapsed,  
under the provisions of section 16201(3) or (4) of the code, MCL 333.16201(3) or (4), as  
applicable, may be relicensed by complying with the following requirements as noted by (√):  
(1) For a midwife who has let his or her Michigan licenseLapsed lessLapsed moreLapsed 7  
lapse and who does not hold a license in another state: than  
years  
3than 3 years,or more  
but less than 7years  
years  
(a) Application and fee: submit a completed  
application on a form provided by the department,√  
together with the requisite fee.  
(b) Good moral character: establish that he or she is of  
good moral character as defined under sections 1 to 7 of  
1974 PA 381, MCL 338.41 to 338.47.  
(c) Fingerprints: submit fingerprints as required  
under section 16174(3) of the code, MCL 333.16174(3).  
(d) Continuing education: submit proof of having  
completed 30 hours of continuing education in courses  
and programs and at least 1 hour in pain and symptom√  
management, 2 hours of cultural awareness, and 1 hour of  
pharmacology related to the practice of midwifery, as  
required under R 338.17141, and which was earned  
within the 3-year period immediately preceding the  
application for relicensure. However, if the continuing  
education hours submitted with the application are  
deficient, the applicant shall have 2 years from the date of  
the application to complete the deficient hours. The  
Page 5  
application will be held, and the license will not be issued  
until the continuing education requirements have been  
met.  
(e) Examination: within the 3-year period immediately  
preceding the application for relicensure, retake and pass  
the examination approved by the board pursuant to R  
338.17121.  
(f) Proof of license from another state verification by the  
licensing agency of all other states of the United States in  
which the application ever held a license as a midwife√  
must be sent directly to the department from the licensing  
agency and include the record of any disciplinary action  
taken or pending against the  
applicant.  
(g) Credential: submit proof of an active credential of  
CPM from the NARM or an equivalent credential from  
another midwifery credentialing program that is approved√  
by the board and accredited by the NCCA or another  
accrediting organization approved by the board. A  
licensed midwife shall maintain his or her credential of  
CPM from NARM, or  
equivalent credential approved by the board, during the  
license cycle.  
(2) For a midwife who has let his or her MichiganMichigan Michigan  
license lapse, but who holds a current and validlicense  
licensed midwife license in another state:  
Michigan  
license lapsedlicense  
lapsed Lessmore than 3lapsed  
than 3 yearsyears,  
7 or more  
but less than 7years  
years  
(a) Application and fee: submit a completed  
application on a form provided by the department,√  
together with the requisite fee.  
(b) Good moral character: establish that he or she is of  
good moral character as defined under sections 1 to 7√  
of 1974 PA  
381, MCL 338.41 to 338.47.  
Page 6  
(c) Fingerprints: submit fingerprints as required under  
section 16174(3) of the code, MCL 333.16174(3).  
(d) Continuing education: submit proof of having  
completed 30 hours of continuing education in courses  
and programs and at least 1 hour in pain and symptom  
management, 2 hours of cultural awareness, and 1 hour  
of pharmacology related to the practice of midwifery,  
as required under R 338.17141, and which was earned  
within the 3-year period immediately preceding the  
application for relicensure. However, if the continuing  
education hours submitted with the application are  
deficient, the applicant shall have 2 years from the date  
of the application to complete the deficient hours. The  
application will be held, and the license will not be  
issued until the continuing education requirements  
have been met.  
(e) Proof of license verification from another state  
where licensed: an applicant’s license must be verified√  
by the licensing agency of all other states of the United  
States in which the applicant holds a current license or  
ever held a license as a midwife. Verification must be  
sent directly to the department from the licensing  
agency and include the record  
of any disciplinary action taken or pending against the  
applicant.  
(f) Credential: submit proof of an active credential of  
CPM from the NARM or an equivalent credential from  
another midwifery credentialing program that is√  
approved by the board and accredited by the NCCA or  
another accrediting organization approved by the  
board. A licensed midwife shall maintain his or her  
credential of CPM from NARM, or equivalent  
credential approved by the board, during the license  
cycle.  
History: 2019 AACS.  
R 338.17127 English language requirement.  
Rule 127. An applicant who attended a nonaccredited program pursuant to R 338.17121, or a  
program outside of the United States, shall demonstrate a working knowledge of the English  
language. An applicant shall demonstrate a working knowledge of the English language by  
satisfying either of the following requirements:  
Page 7  
(a) Submit proof that he or she has obtained a total score of not less than 80 on the test of English  
as a foreign language internet-based test (TOEFL-iBT) administered by the educational testing  
service (ETS).  
(b) Submit proof that he or she completed a midwifery educational program or pathway  
conducted in the English language.  
PART 4. PRACTICE, CONDUCT, AND CLASSIFICATION OF CONDITIONS  
R 338.17131 Definitions.  
Rule 131. As used in this part:  
(a) “Appropriate pharmacology training” means 8 hours of training related to pharmacology  
applicable to midwifery practice, approved by MEAC or the board.  
(b) “Consultation” means the process by which a licensed midwife, who maintains primary  
management responsibility for the patient’s care, seeks the advice of another appropriate health  
professional or member of the health care team.  
(c) “Emergency medical services personnel” means a medical first responder, emergency medical  
technician, emergency medical technician specialist, or paramedic.  
(d) “Futility” means care offered that would not mitigate a patient’s lethal diagnosis or prognosis  
of imminent death.  
(e) “Refer” means to suggest a patient seek discussion, information, aid, or treatment from a  
particular appropriate health professional.  
(f) “Transfer” means to convey the responsibility for the care of a patient to a hospital, emergency  
medical services personnel, or another appropriate health professional. Transfer may occur at any  
point during care, during the prenatal, intrapartum, postpartum, or neonatal period, and may be  
either of an emergent or non-emergent nature.  
(g) “Transport” means the physical movement of a patient from 1 location to another.  
History: 2019 AACS.  
R 338.17132 Informed disclosure and consent.  
Rule 132. (1) At the inception of care for a patient, a licensed midwife shall provide an informed  
disclosure in writing to the patient that includes all the following:  
(a) A description of the licensed midwife’s training, philosophy of practice, information  
regarding the care team, transfer of care plan, credentials and legal status, services to be provided,  
availability of a complaint process both with NARM and the state, and relevant Health Insurance  
Portability and Accountability Act (HIPAA) disclosures.  
(b) Access to the midwife’s practice guidelines.  
(c) Whether the licensed midwife is permitted to administer drugs and medications pursuant to  
R 338.17137, which medications the licensed midwife carries for potential use, if a medication is  
required by law, and if certain standard medications are not available from the midwife, how and  
where the medications can be obtained.  
(d) Access to the board of licensed midwifery rules.  
Page 8  
(e) Whether the licensed midwife has malpractice liability insurance coverage, and if so, the  
policy limitations of the coverage. The patient must be informed of the coverage and policy  
limitations both verbally and in writing.  
(2) If during care and shared decision making, a patient chooses to deviate from a licensed  
midwife’s recommendation, the licensed midwife shall provide the patient with an informed  
consent process which must include all the following:  
(a) Explanation of the available treatments and procedures.  
(b) Explanation of both the risks and expected benefits of the available treatments and  
procedures.  
(c) Discussion of alternative procedures, including delaying or declining of testing or treatment,  
and the risks and benefits associated with each choice.  
(d) Documentation of any initial refusal by the patient of any action, procedure, test, or screening  
that is recommended by the licensed midwife.  
(3) A licensed midwife shall obtain the patient’s signature acknowledging that the patient has  
been informed, verbally and in writing, of the disclosures.  
(4) A licensed midwife shall provide an abbreviated informed consent appropriate to the emergent  
situation with documentation to follow once the situation has stabilized.  
History: 2019 AACS.  
R 338.17133 Additional informed consent requirements.  
Rule 133. (1) Additional informed consent processes are required when a patient presents to a  
licensed midwife under any of the following circumstances:  
(a) Previous cesarean birth – at the inception of care.  
(b) Fetus in a breech presentation – when it is likely in the midwife’s judgment the fetus will  
present in breech presentation at the onset of labor.  
(c) Twin or multiple gestation – at the time of discovery by the midwife.  
(2) A licensed midwife shall disclose to the patient his or her practice guidelines surrounding the  
management of the pregnancies listed in subrule (1) of this rule, which must include the licensed  
midwife’s level of experience, type of special training, care philosophy, and outcome history  
relative to such circumstances.  
(3) The disclosure must contain information regarding the licensed midwife’s care team and style  
of management to be expected under such circumstances, including a description of conditions  
under which the licensed midwife shall recommend transfer or transport.  
(4) The licensed midwife shall practice within the limits of his or her practice guidelines described  
in this rule.  
(5) The licensed midwife shall provide the patient with an informed choice document and written  
informed consent, specific to the conditions listed in subrule (1) of this rule, which includes the  
potential increased risks and benefits of the following:  
(a) The circumstances listed in subrule (1) of this rule.  
(b) Birth outside a hospital setting associated with the circumstances listed in subrule (1) of this  
rule.  
(c) Medical care options associated with the circumstances listed in subrule (1) of this rule,  
including the risks of cesarean section, both in the current pregnancy and any future pregnancies.  
(6) A licensed midwife shall provide an abbreviated informed consent appropriate to the emergent  
situation with documentation to follow once the situation has stabilized.  
Page 9  
History: 2019 AACS.  
R 338.17134 Consultation and referral.  
Rule 134. (1) A licensed midwife shall consult with or refer a patient to a physician, physician’s  
assistant, or advanced practice registered nurse licensed under article 15 of the code, document the  
consultation or referral, and follow up with the patient regarding the consultation or referral, if the  
patient presents with any of the following conditions:  
(a) Antepartum:  
(i) Hypertension in pregnancy as defined as systolic blood pressure greater than 140 mm Hg  
and diastolic blood pressure greater than 90 mm Hg measured on two separate occasions more  
than four hours apart.  
(ii) Persistent, severe headaches, epigastric pain, or visual disturbances.  
(iii) Persistent symptoms of urinary tract infection.  
(iv) Significant vaginal bleeding before the onset of labor not associated with uncomplicated  
spontaneous abortion.  
(v) Rupture of membranes prior to the 36.6 weeks of gestation without active labor.  
(vi) Noted abnormal decrease in or cessation of fetal movement.  
(vii) Hemoglobin level less than 9 and resistant to supplemental therapy.  
(viii) A temperature of 100.4 degrees Fahrenheit or 38.0 degrees Celsius or greater for more  
than 24 hours.  
(ix) Isoimmunization, Rh-negative sensitization, or any other positive antibody titer, which  
would have a detrimental effect on the mother or fetus.  
(x) Abnormally elevated blood glucose levels unresponsive to dietary management.  
(xi) Positive HIV antibody test.  
(xii) TORCH (Toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex infections.)  
(xiii) Symptoms of severe malnutrition, severe persistent dehydration, or protracted weight  
loss.  
(xiv) Symptoms of deep vein thrombosis.  
(xv) Documented placenta previa.  
(xvi) Documented placenta overlying the site of a previous uterine scar.  
(xvii) Active labor prior to 36.0 weeks of gestation.  
(xviii) Fetus with diagnosed congenital abnormalities that will require immediate medical  
intervention at birth.  
(xix) History of myomectomy.  
(xx) Prior history of early preterm birth, 32 weeks or less.  
(xxi) Pelvic or uterine abnormalities affecting normal vaginal births, including tumors and  
malformations.  
(xxii) Marked abnormal fetal heart tones.  
(xxiii) Abnormal non-stress test or abnormal biophysical profile.  
(xxiv) Marked or severe hydramnios or oligohydramnios.  
(xxv) Suspected intrauterine growth restriction.  
(xxvi) Gestation beyond 42.0 weeks.  
(xxvii) Suspected perinatal mood disorder or uncontrolled current serious psychiatric illness.  
(xxviii) Suspected active alcohol use disorder.  
(xxix) Suspected active substance use disorder.  
Page 10  
(xxx) Receiving opioid replacement therapy.  
(xxxi) Sexually transmitted infection.  
(xxxii) Symptoms of ectopic pregnancy  
(xxxiii) Second or third trimester fetal demise.  
(xxxiv) Symptoms or evidence of hydatidiform mole.  
(xxxv) Thrombocytopenia with a count less than 100,000 platelets per microliter.  
(xxxvi) Vaginal infection unresponsive to treatment.  
(xxxvii) Symptoms or clinical evidence of hepatitis.  
(xxxviii) Abnormal liver or metabolic panel.  
(xxxix) Significant proteinuria.  
(xl) Abnormal PAP test results.  
(xli) Significant hematological disorders or coagulopathies, or pulmonary embolism.  
(xlii) Hyperreflexia.  
(xliii) Clonus.  
(xliv) Rheumatoid arthritis.  
(xlv) Chronic pulmonary disease.  
(xlvi) Uncontrolled gestational diabetes.  
(xlvii) Hyperthyroidism treated with medication.  
(xlviii) Suspected coagulation disorder.  
(xlix) Inflammatory bowel disease.  
(l) Addison’s disease.  
(li) Scleroderma.  
(lii) Any other condition or symptom that could threaten the health of the mother or fetus, as  
assessed by a licensed midwife exercising reasonable skill and judgment.  
(b) Intrapartum:  
(i) Persistent, severe headaches, epigastric pain or visual disturbances.  
(ii) Temperature over 100.4 degrees Fahrenheit or 38.0 degrees Celsius in absence of  
environmental factors.  
(iii) Signs or symptoms of maternal infection.  
(iv) Confirmed ruptured membranes without onset of labor after 24 hours.  
(v) Excessive vomiting, dehydration, acidosis, or exhaustion unresponsive to treatment.  
(vi) Uncontrolled current serious psychiatric illness.  
(vii) Fetal heart rate abnormalities of severe bradycardia, fetal tachycardia, or sustained  
deceleration of fetal heart rate.  
(viii) Any other condition or symptom that could threaten the health of the mother or fetus, as  
assessed by a licensed midwife exercising reasonable skill and judgment.  
(c) Postpartum:  
(i) Failure to void bladder within 6 hours of birth or catheterization.  
(ii) Temperature of 101.0 degrees Fahrenheit or 39 degrees Celsius for more than 12 hours.  
(iii) Signs or symptoms of uterine sepsis.  
(iv) Symptoms of deep vein thrombosis.  
(v) Suspected perinatal mood disorder or uncontrolled current serious psychiatric illness.  
(vi) Suspected active alcohol use disorder.  
(vii) Suspected active substance use disorder.  
(viii) Lacerations requiring repair beyond the scope of practice of the licensed midwife.  
Page 11  
(ix) Systolic blood pressure greater than 140 mm Hg and diastolic blood pressure greater than 90  
mm Hg measured on two separate occasions more than four hours apart after delivery of the baby.  
(x) Any other condition or symptom that could threaten the health of the mother, as assessed by a  
licensed midwife exercising reasonable skill and judgment.  
(2) A licensed midwife shall consult with or refer a patient to a physician, physician’s assistant,  
or advanced practice registered nurse licensed under article 15 of the code, document the  
consultation or referral, and follow up with the patient regarding the consultation or referral, if the  
infant presents with any of the following conditions:  
(a) Abnormal metabolic infant screening.  
(b) Failed hearing screening.  
(c) Jaundice occurring outside of normal range.  
(d) Failure to urinate within 36 hours of birth.  
(e) Failure to pass meconium within 48 hours of birth.  
(f) Medically significant nonlethal congenital anomalies.  
(g) Suspected birth injury.  
(h) Signs of clinically significant dehydration.  
(i) Signs and symptoms of neonatal abstinence syndrome.  
(j) Weight less than 2500 grams or 5 pounds, 8 ounces, singleton.  
(k) Any other abnormal infant behavior or appearance that could adversely affect the health of the  
infant, as assessed by a licensed midwife exercising reasonable skill and judgment.  
(3) When a referral to a physician, physician’s assistant, or advanced practice registered nurse  
licensed under article 15 of the code is made, after referral the licensed midwife may, if possible,  
remain in communication with the physician, physician’s assistant, or advanced practice registered  
nurse until resolution of the concern.  
(4) If the patient elects not to accept a referral or the physician, physician’s assistant, or advanced  
practice registered nurse’s advice, the licensed midwife shall:  
(a) Obtain full informed consent from the patient and document the refusal in writing.  
(b) Discuss with the patient what the continuing role of the licensed midwife will be and whether  
the licensed midwife will continue or discontinue care of the patient.  
(5) Neither consultation nor referral preclude the possibility of continued care by a licensed  
midwife or the possibility of an out-of-hospital birth. The licensed midwife may maintain care of  
the patient to the greatest degree possible.  
History: 2019 AACS.  
R 338.17135 Emergent transfer of care.  
Rule 135. (1) In the following emergent circumstances, a licensed midwife shall immediately  
arrange for transport of the patient to a hospital and notify hospital staff of the transfer of care of  
the patient:  
(a) Mother:  
(i) Seizures.  
(ii) Unconsciousness.  
(iii) Respiratory distress or arrest.  
(iv) Maternal shock unresponsive to treatment.  
(v) Symptoms of maternal stroke.  
(vi) Symptoms of suspected psychosis.  
Page 12  
(vii) Symptomatic cardiac arrhythmias or chest pain.  
(viii) Prolapsed umbilical cord.  
(ix) Symptoms of uterine rupture.  
(x) Symptoms of placental abruption.  
(xi) Symptoms of preeclampsia or eclampsia.  
(xii) Severe abdominal pain inconsistent with normal labor.  
(xiii) Symptoms of pulmonary or amniotic fluid embolism.  
(xiv) Symptoms of chorioamnionitis that include the presence of a fever greater than 100.4 degrees  
Fahrenheit or 38.0 degrees Celsius and 2 of the following 3 signs: uterine tenderness, maternal or  
fetal tachycardia, or foul/purulent amniotic fluid.  
(xv) Unresolved fetal malpresentation not compatible with spontaneous vaginal delivery.  
(xvi) Hemorrhage non-responsive to therapy.  
(xvii) Uterine inversion.  
(xviii) Persistent uterine atony.  
(xix) Symptoms of anaphylaxis.  
(xx) Failure to deliver placenta within 2 hours in the third stage.  
(xxi) Persistent abnormal vital signs.  
(xxii) Significant abnormal bleeding prior to delivery, with or without abdominal pain.  
(xxiii) Fetal distress evidenced by abnormal fetal heart tones when birth is not imminent.  
(xxiv) A single blood pressure reading of greater than or equal to 160/110.  
(xxv) Genital herpes lesions at the time of delivery if the lesions cannot be covered by an  
occlusive dressing.  
(b) Infant:  
(i) Persistent cardiac irregularities.  
(ii) Persistent central cyanosis, pallor, or abnormal perfusion.  
(iii) Persistent lethargy or poor muscle tone.  
(iv) Seizures.  
(v) Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes.  
(vi) Non-transient respiratory distress.  
(vii) Significant signs or symptoms of infection.  
(viii) Evidence of unresolved hypoglycemia.  
(ix) Abnormal, bulging, or depressed fontanel.  
(x) Significant evidence of prematurity.  
(xi) Clinically significant abnormalities in vital signs, muscle tone, or behavior.  
(xii) Failed critical congenital heart defect screening.  
(xiii) Persistent inability to suck.  
(xiv) Clinically significant abdominal distension.  
(xv) Clinically significant projectile vomiting.  
(xvi) Contact with genital herpes lesions at birth.  
(2) As required under subrule (1) of this rule, a licensed midwife shall initiate immediate transport  
according to the licensed midwife's emergency care plan; provide necessary emergency  
stabilization until transfer to a hospital or emergency medical services personnel is completed;  
provide pertinent information to the provider assuming care of the patient or patients; and is  
encouraged to fill out a patient transfer form provided by the department.  
(3) Transport via private vehicle is an acceptable method of transport if it is the most expedient  
method for accessing medical services.  
Page 13  
(4) A licensed midwife if present, is allowed to provide care to a patient with any of the  
complications or conditions set forth in this rule under any of the following circumstances:  
(a) If no emergency medical services personnel are available.  
(b) If delivery occurs during transport.  
(c) If the patient refuses to be transported to the hospital.  
(d) If the transfer or transport entails futility, or extraordinary and unnecessary human suffering.  
(5) The licensed midwife may remain in consultation with the appropriate health professional  
after a transfer is made.  
(6) If authorized by the patient, a licensed midwife may be able to be present during the labor and  
childbirth, and care may return to the midwife upon discharge.  
History: 2019 AACS.  
R 338.17136 Prohibited conduct.  
Rule 136. An individual covered by these rules shall not perform the following acts:  
(a) Except as provided in R 338.17137, administer prescription drugs or medications.  
(b) Use vacuum extractors or forceps.  
(c) Prescribe medications.  
(d) Perform surgical procedures other than episiotomies, repairs of perineal lacerations, and  
clamping and cutting the umbilical cord.  
(e) Knowingly accept sole responsibility for prenatal or intrapartum care of a patient with any of  
the following risk factors:  
(i) Chronic significant maternal cardiac, pulmonary, renal, or hepatic disease.  
(ii) Malignant disease in an active phase.  
(iii) Insulin dependent diabetes mellitus.  
(iv) Active tuberculosis.  
(v) Active syphilis.  
(vi) Confirmed AIDS status.  
(vii) Current seizure disorder requiring medication.  
(viii) History of previous uterine rupture.  
(ix) Monoamniotic twins.  
(x) Opioid use disorder.  
(xi) Known uncontrolled hypothyroidism.  
(xii) Cushing’s disease.  
(xiii) Systemic lupus erythematosus.  
(xiv) Antiphospholipid syndrome.  
(xv) Polyarteritis nodosa.  
(xvi) Primary genital herpes infection in pregnancy.  
History: 2019 AACS.  
R 338.17137 Administration of prescription drugs or medications.  
Rule 137. (1) Pursuant to section 17111 of the code, MCL 333.17111, a licensed midwife who has  
appropriate pharmacology training and holds a standing prescription from an appropriate health  
Page 14  
professional with prescriptive authority, is permitted to administer the following prescription drugs  
and medications:  
(a) Prophylactic vitamin K to an infant, either orally or through intramuscular injection.  
(b) Antihemorrhagic agents to a postpartum mother after the birth of the infant.  
(c) Local anesthetic for the repair of lacerations to a mother.  
(d) Oxygen to a mother or infant.  
(e) Prophylactic eye agent to an infant.  
(f) Prophylactic Rho(D) immunoglobulin to a mother.  
(g) Agents for group B streptococcus prophylaxis, recommended by the federal centers for  
disease control and prevention, to a mother.  
(h) Intravenous fluids, excluding blood products, to a mother.  
(i) Antiemetics to the mother.  
(j) Epinephrine.  
(2) Administration of any of the drugs included in subrule (1) of this rule must be in accordance  
with this rule. The indications, dose, route of administration, duration of treatment, and  
contraindications relating to the administration of drugs or medications identified under subrule  
(1) of this rule are shown in Table 1:  
Page 15  
Table 1  
Administration of Prescription Drugs and Medications  
Medication Indication  
Maternal  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindicatio Comments  
ns  
Administration of oxygen to a  
neonate should be in accordance with  
NRP standards. When an oxygen  
blender is not accessible, free-flow  
oxygen may be used combined with  
pulse oximetry. Current research  
cautions that inappropriate use of  
oxygen can cause free  
Maternal: free-  
flow, nasal  
cannula, mask.  
Oxygen  
Maternal: fetal distress,  
Maternal:  
maternal shock, stroke-like 12L/minute.  
symptoms.  
Maternal: until None, with  
stabilized or  
indications  
transfer of care. present.  
radical and oxidative stress damage in  
the neonate.  
Prevention and treatment of  
Pitocin 10 postpartum hemorrhage.  
units/ml  
10 units/ml.  
Intramuscular.  
1-2 doses, PRN.  
20 units in 1000  
ml IV fluids,  
Initial bolus rate  
1000 ml/hour  
bolus for 30  
minutes (equals  
10 units) followed  
Pitocin 10 Prevention and treatment of by a maintenance Intravenous.  
4 hours.  
units/ml  
postpartum hemorrhage.  
rate 125 ml/hour  
over 3.5 hours  
(equals remaining  
10 units).  
Contraindicated  
for patient with  
hypertension or  
Reynaud's  
disease. Can be  
Methyl-  
used in  
ergonovine Prevention and treatment of 0.2 mg/ml.  
(Methergine postpartum hemorrhage.  
) 0.2 mg/ml  
Intramuscular.  
0.2 mg IM q2- conjunction  
4hr PRN; not to with Pitocin  
exceed 5 doses. after delivery of lessen continued bleeding after  
IM preferred for acute postpartum  
use. Oral methergine can help to  
Page 16  
the placenta.  
hemorrhage.  
Contraindicated  
for patient with  
Methyl-  
ergonovine  
(Methergine  
) 0.2 mg  
0.2-0.4 mg PO hypertension or IM preferred for acute postpartum  
0.2 mg tab.  
Oral.  
q6-8hr  
Reynaud's  
disease.  
use. Oral methergine can help to  
lessen continued bleeding after  
hemorrhage.  
PRN for 2-7  
days .  
Misoprostol  
600 mcg oral or  
(Cytotec) Postpartum hemorrhage.  
800 mcg buccal orOral, buccal, rectal. Single dose.  
rectal.  
Prophylactic dose: RH-  
patient at 28-30 weeks  
gestation; RH- patient after a  
RHo (D)  
Immune  
Globulin  
miscarriage; postpartum RH-  
patient with an RH+ baby. A  
prenatal dose can also be  
Administer  
within 72 hours RH positive;  
of birth or  
Intramuscular.  
300 mcg pre-filled  
IgA deficiency.  
(Rhogam) given after an injury under syringe.  
advisement of a physician.  
antenatal event.  
Initial loading  
dose: 5 million  
units IV.  
Group Beta Strep (GBS)  
Administer via  
Penicillin G prophylaxis in labor.  
Subsequent doses: IVPB with  
2.5–3.0 million prepared minibag.  
units IV  
Until delivery. Allergy to  
penicillin.  
every 4 hours.  
Initial loading  
dose: 2 g IV.  
Administer via  
Ampicillin Group Beta Strep prophylaxisSubsequent doses: IVPB with  
Until delivery. Allergy to  
prepared minibag. penicillin.  
in labor.  
1 g IV every 4  
hours.  
Page 17  
Administration of Prescription Drugs and Medications  
Maternal  
Initial loading  
dose: 2g IV.  
Subsequent  
doses: 1g IV  
Cefazolin is the first choice for  
patients who have a history of allergy  
to penicillin but no history of  
anaphylactic reaction to penicillin.  
Use clindamycin or vancomycin for  
patients who have a history of  
Administer via  
IVPB with  
prepared minibag.  
Cefazolin  
Group Beta Strep  
every 8 hours.  
Until delivery. Allergy to  
cefazolin.  
prophylaxis in labor.  
anaphylactic penicillin allergy.  
Use only with history of anaphylactic  
reaction to penicillin. Clindamycin  
and Vancomycin are the drugs  
900 mg IV every  
Clindamycin Group Beta Strep  
prophylaxis in labor.  
8
hours until  
Administer via  
IVPB with  
prepared minibag.  
Until delivery. Allergy to  
delivery.  
clindamycin. of choice for GBS prophylaxis for  
patients who have a history of  
anaphylactic reactions to penicillin.  
Use only with history of anaphylactic  
reaction to penicillin. Clindamycin  
and Vancomycin are the drugs  
1 g IV every 12 Administer via  
Vancomycin Group Beta Strep  
prophylaxis in labor.  
hours.  
IVPB with  
prepared minibag.  
Until delivery. Allergy to  
vancomycin.  
of choice for GBS prophylaxis for  
patients who have a history of  
anaphylactic reactions to penicillin.  
Single dose of 0.3  
mg, USP,  
1:1000 (0.3 mL)  
in a sterile  
5-15 minutes.  
Transport to  
hospital should  
be initiated.  
Discontinue medication that is  
causing reaction; place patient supine  
and elevate lower extremities. Protect  
the airway. Transport to hospital  
should follow.  
Epinephrine Severe allergic reaction.  
Lactated  
solution.  
Most patients respond to intravenous  
hydration and a  
short period of gut rest, followed by  
reintroduction of oral intake.  
Preferred over normal saline.  
Over the course  
of 3-5 hours.  
Ringers  
Solution  
Dehydration during labor. Up to 2L.  
Intravenous.  
Intravenous.  
Dehydration during labor,  
when LR not available.  
Postpartum hemorrhage.  
0.9% Normal Allergic reactions.  
1L- 2L bolus.  
During course of  
Intrapartum: the addition of 5%  
Page 18  
Saline  
solution  
infusion.  
2 hours.  
Dextrose to solution can increase  
success rate with nausea or vomiting.  
Injectable: up to 5  
ml 2%,  
Postpartum repair of vulvo- 10 ml 1%, or 20  
Known allergy  
or signs  
Do not use lidocaine with,  
or symptoms of epinephrine, max dose 3 mg/kg.  
Lidocaine  
vaginal lacerations.  
ml 0.5%. Topical Injection.  
cream, spray, or  
gel.  
allergic  
reaction.  
Antiemetic  
ranitidine  
zantac  
Treat until  
symptoms  
subside.  
To reduce vomiting during 150 mg every 6 Oral.  
labor.  
hours.  
25 to 50 mg every  
4 to 6  
Diphenhydra To reduce vomiting during hours / 10-50 mg Oral; intravenous.  
mine  
labor.  
every 4-  
6 hours.  
4-8 mg IVP / 4  
Ondansetron To reduce vomiting during mg (up to twice Oral; intravenous.  
May produce headache as side effect.  
labor.  
PRN).  
Neonatal  
Oxygen  
Administration of oxygen to a  
neonate should be in accordance with  
NRP standards. When an oxygen  
blender is not accessible, free-flow  
oxygen may be used combined with  
pulse oximetry. Current research  
cautions that inappropriate use of  
oxygen can cause free  
Neonatal: until  
pulse- oximetry  
readings are  
Neonatal: neonatal  
resuscitation, if indicated;  
abnormal pulse oximetry  
readings.  
Neonatal:  
Neonatal: bag and within target  
10L/minute, or as mask, free-flow. range of  
None, with  
indications  
present.  
indicated.  
infant age, or  
transfer of care.  
radical and oxidative stress damage in  
the neonate.  
Prophylaxis of neonatal  
1 cm ribbon of  
0.5%  
ophthalmia neonatorum due 0.5% ointment in  
Hypersensitivit  
y to drug class  
or component. May cause ocular irritation or blurred  
vision.  
Family history  
of  
Erythromycinto N. gonorrhoeae or  
Ophthalmic chlamydia trachomatis.  
ointment  
each eye within  
24 hours of birth. Ocular, in lower  
eyelid.  
1 dose.  
Prophylaxis and therapy of  
Vitamin K hemorrhagic disease of the 0.5-1.0 mg.  
hypoprothrombi  
nemia;  
Intramuscular.  
Single dose.  
Page 19  
1.0 mg/0.5 newborn.  
ml  
hypersensitivity Vitamin K 1.0 mg/0.5 ml  
to drug  
class or  
component.  
Administered in theRepeat every 3-5  
umbilical venous min if HR <60  
0.1 - 0.3 mL/kg catheter followed bpm with chest  
Epinephrine Neonatal resuscitation.  
(0.01 - 0.03  
by  
compressions.  
EMS services should be en route.  
mg/kg) of body 1 - 3 mL flush of  
weight in a  
1:10,000  
sterile normal  
saline.  
concentration.  
Repeat every 3-5  
min  
if HR <60 bpm  
with chest  
1 ml/kg 1:10,000  
concentration.  
Epinephrine Neonatal resuscitation.  
History: 2019 AACS.  
Endotracheal.  
Max 3 ml/dose, EMS services should  
be en route.  
compressions.  
Editor's Note: An obvious error in R 338.17137 was corrected at the request of the promulgating agency, pursuant to Section 56 of 1969 PA 306,  
as amended by 2000 PA 262, MCL 24.256. The rule containing the error was published in Annual Administrative Code Supplement, 2019. The  
memorandum requesting the correction was published in Michigan Register, 2020 MR 3.  
Page 20  
R 338.17138 Report patient’s data.  
Rule 138. (1) Unless the patient refuses, a licensed midwife shall report patient data to the statistics  
registry maintained by midwives alliance of North America’s (MANA) division of research  
(DOR), pursuant to MANA’s policies and procedures, or a similar registry maintained by a  
successor organization approved by the board.  
(2) A licensee shall register with MANA’s DOR.  
(3) Annually, by the date determined by MANA, a licensee shall submit patient data on all  
completed courses of care in the licensee’s practice during the previous 12 months.  
(4) During the first year of licensure, a licensee shall submit data from the date of licensure to the  
date determined by MANA.  
PART 5. LICENSE RENEWAL AND CONTINUING EDUCATION  
R 338.17141 License renewals; requirements; applicability.  
Rule 141. (1) In addition to meeting the requirements of section 16201 of the code, MCL  
333.16201, an applicant for renewal shall submit a completed application on a form provided by  
the department, together with the requisite fee and, prior to renewal, shall hold the credential of  
CPM from NARM, or equivalent credential approved by the board.  
(2) Pursuant to section 16201 of the code, MCL 333.16201, an applicant for license renewal who  
has been licensed for the 2-year period immediately prior to renewal shall accumulate all of the  
following, during the prior 2 years by the end of the license cycle:  
(a) At least 30 hours of continuing education that is met by obtaining or maintaining, the  
credential of CPM from NARM, or an equivalent credential approved by the board.  
(b) One hour of continuing education in pain and symptom management pursuant to section  
16204(2) of the code, MCL 333.16204(2). Acceptable methods of continuing education in pain  
and symptom management includes online and in person presentations, courses or programs and  
may include, but is not limited to, the following subject areas: behavior management, psychology  
of pain, behavior modification, stress management, and clinical applications as they relate to  
professional practice.  
(c) Two hours of continuing education on cultural awareness that include examination of  
disparate maternal infant mortality and morbidity experienced by the African American and  
indigenous populations. Acceptable methods of continuing education in cultural awareness include  
online and in person presentations, courses, programs, or reading an article that is published in a  
peer review journal, health care journal, or professional or scientific journal.  
(d) One hour of continuing education in pharmacology applicable to the practice of midwifery.  
(3) "Continuing education hour" as used in these rules means the cumulative number of program  
minutes divided by 60. When the fractional part of an hour is 55 minutes or more, it counts as 1  
hour. Any portion of an hour between 30 and 54 minutes counts as half of an hour. Any part of an  
hour less than 30 minutes will be discarded. Breaks are not counted.  
(4) Submission of an application for renewal constitutes the applicant’s certification of compliance  
with the requirements of this rule.  
(5) A licensee shall retain documentation of meeting the requirements of this rule for a period of  
4 years from the date of applying for license renewal.  
Page 21  
(6) The board may require an applicant or licensee to submit evidence to demonstrate compliance  
with this rule.  
(7) A self-certification statement by an individual that includes the title of the article, author,  
publication name, date, volume, and issue of publication, as applicable, is acceptable evidence of  
reading an article that is published in a peer review journal, health care journal, or professional or  
scientific journal.  
(8) Failure to comply with this rule is a violation of section 16221(h) of the code, MCL  
333.16221(h).  
(9) A request for a waiver under section 16205 of the code, MCL 333.16205, must be received by  
the department prior to the expiration date of the license. A CPM credential from NARM, or  
equivalent credential approved by the board, may not be waived.  
(10) The requirements of this part do not apply to an applicant during an initial 1-year licensure  
cycle.  
History: 2019 AACS.  
Page 22