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, 16186, 16201, 16204, 16287, 17105, 17107, 17111, 17112, and 17117 of

the public health code, 1978 PA 368, MCL 333.16145, 333.16148, 333.16186, 333.16201,

333.16204, 333.16287, 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 an individual licensed, registered, or otherwise

authorized to engage in a health profession under article 15 of the code, MCL 333.16101 to

333.18838, who is referred to, consulted with, or collaborates with a licensed midwife.

(b) "Board" means the Michigan board of licensed midwifery created in section 17113 of the

code, MCL 333.17113.

(c) “Code” means the public health code, 1978 PA 368, MCL 333.1101 to 333.25211.

(d) "Continuing education hour" means the cumulative number of program minutes divided by

60. If 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 not be counted. Breaks are not counted.

(e) “CPM” means a certified professional midwife who meets the standards for certification set

by the North American Registry of Midwives.

(f) “Department” means the department of licensing and regulatory affairs.

(g) “MEAC” means the Midwifery Education Accreditation Council.

(h) “NARM” means the North American Registry of Midwives.

(i) “NCCA” means the National Commission for Certifying Agencies.

(j) “Peer-review” means the process utilized by midwives to confidentially discuss patient cases

in a professional forum, including support, feedback, follow-up, and learning objectives.

(2) Unless otherwise defined in these rules, the terms defined in the code have the same meaning

when used in these rules.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

PART 2. PRELICENSURE LICENSED MIDWIFERY EDUCATION

R 338.17111 Training standards for identifying victims of human trafficking: requirements.

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Rule 111. (1) Under section 16148 of the code, MCL 333.16148, an individual seeking licensure

shall complete training in identifying victims of human trafficking that meets all the following

standards:

(a) Training content must 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 healthcare settings.

(iii) Identifying the warning signs of human trafficking in healthcare settings for adults and

minors.

(iv) Identifying 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 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-reviewed journal,

healthcare 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 an individual and request documentation of proof of

completion of training. If audited by the department, the individual shall provide acceptable proof

of completion of training, including 1 of the following:

(a) Proof of completion certificate issued by the training provider including the date, provider

name, name of training, and individual’s name.

(b) A self-certification statement by the individual. The self-certification statement must include

the individual’s name and 1 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 the peer-reviewed journal, healthcare journal, or professional or

scientific journal, and the 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 apply for initial licenses issued after August 1, 2024.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

R 338.17113 Licensed midwifery accrediting organizations.

Rule 113. (1) The board approves the MEAC, or its successor entity, as an accrediting organization

for an educational program or pathway.

(2) A petition may be filed with the board for approval of a midwifery accrediting organization

for an educational program or pathway, which is evaluated to determine the organization’s

equivalence to the standards of other board approved accrediting organizations. The board may

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approve a petition only if the standards and evaluative criteria of the organization are determined

to be equivalent to the standards of the MEAC, or its successor entity.

History: 2019 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

R 338.17114 CPM credential.

Rule 114. The CPM credential is accredited by the NCCA. The CPM credential with the NARM

requires a midwife to do all of the following:

(a) Validate education.

(b) Pass an examination.

(c) Complete a workshop, module, or course on cultural awareness.

(d) Meet general education requirements.

(e) Maintain current adult cardiopulmonary resuscitation (CPR) certification and current neonatal

resuscitation program certification with a hands-on component.

History: 2025 MR 18, Eff. Oct. 2, 2025.

R 338.17115 Licensed midwifery credentialing program.

Rule 115. The board may approve a licensed midwifery credentialing program if the program

meets all of the following:

(a) It satisfies the standards and evaluative criteria are equivalent to the credential of a CPM from

the 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 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 the NCCA, or its successor entity.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

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, and R 338.7001 to R 338.7005, an applicant for licensure 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 the MEAC, or its successor entity, or by another accrediting organization approved

by the board under R 333.17113.

(ii) If before January 1, 2020, the applicant holds a current credential of CPM from the NARM,

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:

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(A) Submits proof to the department that the applicant holds a midwifery bridge certificate

awarded by the NARM, 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, 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 the NCCA, or its

successor entity.

(b) Submit proof to the department of holding a current credential of CPM from the NARM, or

its successor entity, or an equivalent credential from another midwifery credentialing program,

that is approved by the board under R 383.17115.

(c) Submit proof to the department of successfully passing the examination developed and

scored by theNARM or another exam approved by the board under subrule (3) of this rule.

(d) Submit proof to the department of completing the human trafficking training required in R

338.17111.

(2) The board approves and adopts the examination developed and scored by the 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.

(4) A licensed midwife shall have obtained the recredential or maintain the CPM credential from

the NARM, or equivalent credential approved by the board, pursuant to R 338.17115, during the

license cycle.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

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 accredited by the MEAC or accredited by an accrediting organization approved by the

board under R 338.17113 the applicant may apply for a nonrenewable temporary license if the

applicant 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 shall hold a midwifery bridge certificate from

the NARM or an equivalent credential approved by the board pursuant to R 338.17115, to qualify

for a license when the individual’s 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; 2025 MR 18, Eff. Oct. 2, 2025.

R 338.17123 Licensure by endorsement from another state.

Rule 123. (1) An applicant who currently holds an active midwifery license in good standing in

another state and 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 the applicant meets the requirements of section 16174 of the code, MCL 333.16174,

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and R 338.7001 to R 338.7005; submits a completed application, on a form provided by the

department, together with the requisite fee; and complies with all of the following:

(a) Submits proof to the department of completion of an educational program or pathway

accredited by the MEAC, or its successor entity, or by another accrediting organization approved

by the board under R 333.17113.

(b) Submits proof to the department of holding a current credential of CPM from the NARM or

another midwifery credentialing program approved by the board under R 333.17115.

(c) Submits proof of successfully passing the examination developed and scored by the NARM

or another exam approved by the board under R 338.17121(3).

(d) Discloses each license, registration, or certification in a health profession or specialty issued

by another state, the United States military, the federal government, or another country on the

application form.

(e) Satisfies the requirements of section 16174(2) of the code, MCL 333.16174, including

verification from the issuing entity showing that disciplinary proceedings are not pending against

the applicant and sanctions are not in force at the time of application.

(f) Submits proof to the department of meeting the human trafficking training required in R

338.17111.

(2) An applicant who is licensed as a midwife in a state that does not require completion of an

educational program or pathway that is approved by the MEAC, may apply to the department for

a determination that the applicant has met the requirements of subrule (1)(a) of this rule if the

applicant 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 the 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 the 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 the NCCA or its successor entity.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

R 338.17125 Relicensure requirements.

Rule 125. (1) An applicant for relicensure whose license from this state has lapsed, under the

provisions of section 16201(3) or (4) of the code, MCL 333.16201, as applicable, may be

relicensed by complying with the following requirements as noted by (√):

(a) For a midwife whose license from this state has lapsedLapsed lessLapsed moreLapsed 7

and who does not hold a license in another state:

than

years

3than 3 years,or more

but less than 7years

years

(i) Submit a completed application on a form provided by√

√

the department, together with the requisite fee.

(ii) Establish that the applicant is of good moral character

as defined in, and determined under, 1974 PA 381, MCL√

338.41 to 338.47.

√

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(iii) Submit fingerprints as required under section

16174(3) of the code, MCL 333.16174.

√

(iv) Submit proof of having completed 30 continuing

education hours in courses and programs and not less than

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 that the continuing education hours were

earned within the 3-year period immediately before the

application for relicensure. However, if the continuing

education hours submitted with the application are

deficient, the applicant has 2 years after the date of the

application to complete the deficient hours. The

application must be held, and the license may not be

issued until the continuing education requirements are

met.

(v) Complete a 1-time training in identifying victims of

human trafficking that meets the standards in R

338.17111.

√

(vi) Meet the English language requirement under R

338.7002b and the implicit bias training required in R

338.7004.

√

(vii) Within the 3-year period immediately before the

application for relicensure, retake and pass the

examination approved by the board pursuant to R

338.17121.

(viii) An applicant who is or has been licensed, registered,

or certified in a health profession or specialty by another

state, the United States military, the federal government,√

or another country, shall do both of the following:

(A) Disclose each license, registration, or certification on

the application form.

√

(B) Satisfy the requirements of section 16174(2) of the

code, MCL 333.16174, including verification from the

issuing entity showing that disciplinary proceedings are

not pending against the applicant and sanctions are not in

force at the time of application.

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(ix) 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 the credential of CPM from the NARM, or

equivalent credential approved by the board, during the

license cycle.

√

(b) For a midwife whose license from this state hasMichigan Michigan

lapsed, but who holds a current midwife license inlicense

good standing in another state:

Michigan

license lapsedlicense

lapsed lessmore than 3lapsed

than 3 yearsyears,

7 or more

but less than 7years

years

(i) Submit a completed application on a form provided

by the department, together with the requisite fee.

√

(ii) Establish that the applicant is of good moral

character as defined in, and determined under, 1974 PA√

381, MCL 338.41 to 338.47.

√

(iii) Submit fingerprints as required under section

16174(3) of the code, MCL 333.16174.

√

(iv) Submit proof of having completed 30 continuing

education hours in courses and programs and not less

than 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 the continuing education hours were

earned within the 3-year period immediately before the

application for relicensure. However, if the continuing

education hours submitted with the application are

deficient, the applicant has 2 years after the date of the

application to complete the deficient hours. The

application must be held, and the license must not be

issued until the continuing education requirements are

met.

(v) Complete a 1-time training in identifying victims of

human trafficking that meets the standards in R

338.17111.

√

(vi) Meet the English language requirement under R

338.7002b and the implicit bias training required in R√

338.7004.

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(vii) An applicant who is or has been licensed,

registered, or certified in a health profession or√

specialty by another state, the United States military,

the federal government, or another country, shall do

both of the following:

√

(A) Disclose each license, registration, or certification

on the application form.

(B) Satisfy the requirements of section 16174(2) of the

code, MCL 333.16174, including verification from the

issuing entity showing that disciplinary proceedings

are not pending against the applicant and sanctions are

not in force at the time of application.

(viii) 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 the credential of CPM

from the NARM, or equivalent credential approved by

the board, during the license cycle.

√

(2) If relicensure is granted and it is determined that a sanction has been imposed by another state,

the United States military, the federal government, or another country, the disciplinary

subcommittee of the board may impose appropriate sanctions under section 16174(5) of the code,

MCL 333.16174.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

R 338.17127 Rescinded.

History: 2019 AACS; 2023 AACS.

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 the 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 healthcare team.

(c) “DOR” means the Division of Research for the Midwives Alliance of North America.

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(d) “Emergency medical services personnel” means a medical first responder, emergency medical

technician, emergency medical technician specialist, or paramedic.

(e) “Futility” means care offered that would not mitigate a patient’s lethal diagnosis or prognosis

of imminent death.

(f) “HIPAA” means the health insurance portability and accountability act of 1996, Public Law

104-191.

(g) “MANA” means the Midwives Alliance of North America.

(h) “Refer” means to suggest a patient seek discussion, information, aid, or treatment from a

particular appropriate health professional.

(i) “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.

(j) “Transport” means the physical movement of a patient from 1 location to another.

History: 2019 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

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 the NARM and this state, and relevant HIPAA

disclosures.

(b) Access to the midwife’s practice guidelines.

(c) Whether the licensed midwife is allowed 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.

(e) Whether the licensed midwife has malpractice liability insurance coverage, and if so, the

policy limitations of the coverage. The patient shall 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 that includes 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.

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(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; 2025 MR 18, Eff. Oct. 2, 2025.

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.

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, MCL

333.16101 to 333.18838, 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 2 separate occasions more than 4

hours apart.

(ii) Persistent, severe headaches, epigastric pain, or visual disturbances.

(iii) Persistent symptoms of urinary tract infection.

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(iv) Significant vaginal bleeding before the onset of labor not associated with uncomplicated

spontaneous abortion.

(v) Rupture of membranes before 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 before 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.

(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.

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(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.

(ix) Systolic blood pressure greater than 140 mm Hg and diastolic blood pressure greater than

90 mm Hg measured on 2 separate occasions more than 4 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, MCL 333.16101 to

333.18838, 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 blood spot infant screening.

(b) Failed hearing screening.

(c) Failed critical congenital heart defect screening (CCHD).

(d) Jaundice occurring outside of normal range.

(e) Failure to urinate within 36 hours of birth.

(f) Failure to pass meconium within 48 hours of birth.

(g) Medically significant nonlethal congenital anomalies.

(h) Suspected birth injury.

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(i) Signs of clinically significant dehydration.

(j) Signs and symptoms of neonatal abstinence syndrome.

(k) Weight less than 2500 grams or 5 pounds, 8 ounces, singleton.

(l) 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, MCL 333.16101 to 333.18838, 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 do the following:

(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; 2023 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.

(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.

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(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.

(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:

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(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 professional with prescriptive authority, is allowed 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 comply 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 and Table 2:

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Table 1

Maternal - Administration of Prescription Drugs and Medications

Medication Indication

Dose

Route of

Administration Treatment

Duration of

Contraindications Comments

None, with

Oxygen

Maternal distress or fetal 10-12 liters per Free-flow, nasal Until

distress. minute.

cannula, mask. stabilized or indications

transfer of

care.

present.

Pitocin 10 Prevention and treatment 10 units per

Intramuscular.

1-2 doses,

PRN.

units per

milliliter

of postpartum

hemorrhage.

milliliter.

Pitocin 10 Prevention and treatment 20 units in 1000 Intravenous.

4 hours.

units per

milliliter

of postpartum

hemorrhage.

milliliters IV

fluids, initial

bolus rate 1000

milliliters per

hour bolus for

30 minutes

(equals 10 units)

followed by a

maintenance rate

125 milliliters

per hour over

3.5 hours (equals

remaining 10

units).

Methyl-

Prevention and treatment 0.2 milligram Intramuscular.

0.2 milligram Contraindicated IM preferred for acute

IM q2-4 hours for patient with postpartum use. Oral

PRN; not to hypertension or methergine can help to lessen

ergonovine of postpartum

(Methergine hemorrhage.

) 0.2

per milliliter.

exceed 5

doses.

Reynaud's

disease. Can be hemorrhage.

continued bleeding after

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milligram

used in

per milliliter

conjunction with

Pitocin after

delivery of the

placenta.

Methyl-

0.2 milligram Oral.

tab.

0.2-0.4

Contraindicated IM preferred for acute

ergonovine

(Methergine

) 0.2

milligram PO for patient with postpartum use. Oral

q6-8 hours hypertension or methergine can help to lessen

PRN for 2-7 Reynaud's

continued bleeding after

hemorrhage.

milligram

days.

disease.

Medication Indication

Dose

Route of

Duration of

Contraindications Comments

Administration Treatment

Misoprostol Treatment of postpartum 600 micrograms Oral, buccal,

1 dose.

(Cytotec) hemorrhage.

oral or

800 micrograms

rectal.

buccal or rectal.

Hemabate

(Carboprost)

Treatment of postpartum 0.25 milligram

Every 15-90 Asthma.

minutes; not to

exceed 8

Relative counterindications:

hypertension.

hemorrhage.

IM.

doses.

Tranexamic Treatment of postpartum 1000 milligrams Intravenous piggyUse within 3 Contraindicated TXA should be administered

Acid (TXA hemorrhage.

or Lysteda)

in 50 milliliters back (IVPB) or hours and as for patient with slowly as an IVPB or IV push

0.9 normal

saline

administered

over 15 minutes.

intravenous push early as

(IV push). possible after thrombosis,

deep vein

over 15 minutes or longer

because bolus injection carries

a potential risk of hypotension.

onset of

history of

postpartum

coagulopathy, or

hemorrhage. active

Should not be mixed with blood

hypersensitivity toor solutions containing

TXA.

penicillin or mannitol.

RHo (D)

Immune

Prophylactic dose: RH- 300 micrograms Intramuscular.

Administer

within 72

hours of birth

RH positive; IgA

deficiency.

patient at 28-30 weeks

gestation; RH- patient

pre-filled

syringe.

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Globulin

after a miscarriage;

or antenatal

event.

(Rhogam) postpartum RH- patient

with an RH+ baby. A

prenatal dose can also be

given after an injury

under advisement of a

physician.

Penicillin G Group Beta Strep (GBS) Initial loading Administer via IVUntil delivery. Allergy to

No saline limitation when

administering antibiotics.

prophylaxis in labor.

dose: 5 million with prepared

penicillin.

units IV.

minibag.

Subsequent

doses: 2.5–3.0

million units IV

every 4 hours.

Ampicillin Group Beta Strep

prophylaxis in labor.

Initial loading Administer via IVUntil delivery. Allergy to

dose: 2 grams with prepared penicillin.

No saline limitation when

administering antibiotics.

IV.

minibag.

Subsequent

doses: 1 gram IV

every 4 hours.

Medication Indication

Dose

Route of

Duration of

ContraindicationsComments

Administration Treatment

Cefazolin Group Beta Strep

prophylaxis in labor.

Initial loading Administer via IVUntil delivery. Allergy to

dose: 2 grams with prepared cefazolin.

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 anaphylactic

penicillin allergy.

IV.

minibag.

Subsequent

doses: 1gramIV

every 8 hours.

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No saline limitation when

administering antibiotics.

Clindamyci Group Beta Strep

prophylaxis in labor.

900 milligrams Administer via IVUntil delivery. Allergy to

IV every 8 hours with prepared clindamycin.

Use only with patient with

history of anaphylactic reaction

to penicillin and the GBS

isolate is laboratory proven to

be susceptible to Clindamycin.

No saline limitation when

administering antibiotics.

Use only with patient with

history of anaphylactic reaction

to penicillin and the GBS

isolate is laboratory proven to

be resistant to Clindamycin. No

saline limitation when

n

until delivery.

minibag.

VancomycinGroup Beta Strep

prophylaxis in labor.

1 gram IV

Administer via IVUntil delivery. Allergy to

every 12 hours. with prepared

minibag.

vancomycin.

administering antibiotics.

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. Single dose of

5-15 minutes.

Transport to

hospital should

be initiated.

0.3 milligram,

USP,

1:1000 (0.3

milliliters) in a

sterile solution.

Lactated

Ringers

solution

Dehydration during labor. Up to 2 liters. Intravenous.

Over the course

of 3-5 hours.

Most patients respond to

intravenous hydration and a

short period of gut rest,

followed by reintroduction of

oral intake. Preferred over

normal saline.

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Medication Indication

Dose

Route of

Administration Treatment

Duration of

ContraindicationsComments

Intrapartum: the addition of 5%

0.9%

Dehydration during labor, 1- 2 liters bolus. Intravenous.

when LR not available.

During course

of infusion.

Normal

Saline

solution

Dextrose to solution can

increase success rate with

nausea or vomiting.

Postpartum hemorrhage.

Allergic reactions.

Lidocaine Postpartum repair of

Injectable: up to Injection.

2 hours.

Known allergy or Do not use lidocaine with

vulvo-vaginal lacerations. 20 milliliters

signs or

symptoms of

allergic reaction. infiltration.

epinephrine, max dose 4.5

milligrams per kilogram

2%, up to 30

milliliters 1%, or

up to 60

milliliters 0.5%.

Lidocaine Postpartum repair of

vulvo-vaginal lacerations.

Topical cream,

spray, or gel.

Known allergy or

signs or

symptoms of

allergic reaction.

Diphenhydr To reduce vomiting

25 to 50

Oral; intravenous.

amine

(Benadryl)

during labor.

milligrams every

4 to 6 hours / 10-

50 milligrams

every 4-

6 hours.

OndansetronTo reduce vomiting

(Zofran) during labor.

4-8 milligrams Oral; intravenous.

IVP / 4

May produce headache as side

effect.

milligrams (up

to twice PRN).

Ibuprofen To reduce post-partum

discomfort.

200 milligrams Oral.

up to 4 tablets

Until

postpartum

History of

gastritis; history

every 6-8 hours.

pain resolves. of gastrointestinal

bleed.

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Table 2

Neonatal – Administration of Prescription Drugs and Medications

Medication Indication

Dose

Route of

Administration Treatment

Duration of

ContraindicationComments

s

Oxygen

Neonatal resuscitation, if 10 liters per

indicated; abnormal pulse minute, or as

Bag and mask, Until pulse-

None, with

indications

present.

Administration of oxygen to a

free-flow.

oximetry

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 radical and oxidative

stress damage in the neonate.

oximetry readings.

indicated.

readings are

within target

range of infant

age, or transfer

of care.

0.5%

Erythromyci ophthalmia neonatorum ribbon of 0.5% eyelid.

due to N. gonorrhoeae or ointment in each

Ophthalmic chlamydia trachomatis. eye within

Prophylaxis of neonatal 1 centimeter

Ocular, in lower 1 dose.

Hypersensitivity May cause ocular irritation or

to drug class or blurred vision.

component.

n

ointment

24 hours of

birth.

Vitamin K Prophylaxis and therapy 1.0 milligram forIntramuscular.

1.0 of hemorrhagic disease of a newborn above

1 dose.

Family history Vitamin K 1.0 milligram per 0.5

of

milliliter.

milligram the newborn.

per 0.5

1500 grams.

hypoprothrombin

emia;

milliliter

hypersensitivity

to drug class or

component.

Epinephrine Neonatal resuscitation.

0.2 milliliter per Administered in Repeat every 3-

kilogram (0.02 the umbilical 5 minutes if

milligram per venous catheter HR <60 beats

kilogram) of or interosseous per minute with

body weight in a route followed by chest

3 milliliter flush compressions.

EMS services should be en

route.

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1:10,000

of sterile normal

concentration. saline.

1 milliliter per Endotracheal.

kilogram

1:10,000

concentration.

Epinephrine Neonatal resuscitation.

If heart rate

remains less

than 60 beats

per minute,

move on to

Epinephrine

administered

by IV or

Max 3 milliliters per dose, EMS

services should be en route.

interosseous

route.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

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 Michigan Register, 2025 MR 18. The memorandum requesting the correction was published in Michigan

Register, 2025 MR 18.

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R 338.17138 Report patient’s data.

Rule 138. (1) A licensed midwife shall report patient data to the statistics registry maintained by

the MANA’s DOR, or its successor organization, pursuant to the MANA’s policies and

procedures, or a similar registry maintained by a successor organization approved by the board,

unless the patient refuses.

(2) A licensed midwife shall register with the MANA’s DOR.

(3) A licensed midwife shall submit patient data on all completed courses of care in the licensed

midwife’s practice during the previous 12 months by the date determined by the MANA, annually.

(4) A licensed midwife shall submit data from the date of licensure to the date determined by the

MANA, during the first year of licensure.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

R 338.17139 Telehealth.

Rule 139. (1) A licensed midwife shall obtain consent for treatment before providing a telehealth

service under section 16284 of the code, MCL 333.16284.

(2) A licensed midwife shall keep proof of consent for telehealth treatment in the patient’s up-to-

date medical record and satisfy section 16213 of the code, MCL 333.16213.

(3) A licensed midwife providing telehealth services shall do both of the following:

(a) Act within the scope of the licensed midwife’s practice.

(b) Exercise the same standard of care applicable to a traditional, in-person health

care service.

History: 2025 MR 18, Eff. Oct. 2, 2025.

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, before renewal, shall hold the credential of

CPM from the 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 3-year period immediately before the expiration date on the license, shall

accumulate not less than 30 continuing education hours. The continuing education hours must

include all of the following, during the prior 3 years by the end of the license cycle:

(a) Obtain or maintain the credential of CPM from the NARM, or an equivalent credential

approved by the board.

(b) One continuing education hour in pain and symptom management pursuant to section

16204(2) of the code, MCL 333.16204. Acceptable methods of continuing education in pain and

symptom management include online and in-person presentations, courses, or programs and may

include, but are not limited to, the following subject areas:

(i) Behavior management.

(ii) Psychology of pain.

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(iii) Behavior modification.

(iv) Stress management.

(v) Clinical applications as they relate to professional practice.

(c) Two continuing education hours on cultural awareness that include examination of disparate

maternal infant mortality and morbidity experienced by the African American, Indigenous

populations, the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community, and other

vulnerable and marginalized 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-reviewed journal, healthcare journal, or professional or scientific journal.

(d) Three hours of implicit bias training required in R 338.7004. The implicit bias training

required in R 338.7004 may also be used for credit for the cultural awareness training in

subdivision (c) of this subrule if the training meets all of the requirements in subdivision (c) of this

subrule.

(e) One continuing education hour in pharmacology applicable to the practice of midwifery.

(3) Submission of an application for renewal constitutes the applicant’s certification of

compliance with the requirements of this rule.

(4) A licensed midwife shall retain documentation of meeting the requirements of this rule for a

period of 6 years after the date of applying for license renewal.

(5) The board may require an applicant or licensed midwife to submit evidence to demonstrate

compliance with this rule.

(6) A self-certification statement by the individual that includes the title of the article, author,

publication name, and the date, volume, and issue of publication, as applicable, is acceptable

evidence of reading an article that is published in a peer-reviewed journal, healthcare journal, or

professional or scientific journal.

(7) Failure to comply with this rule is a violation of section 16221(h) of the code, MCL

333.16221.

(8) A request for a waiver under section 16205 of the code, MCL 333.16205, must be received

by the department before the expiration date of the license. A CPM credential from the NARM, or

equivalent credential approved by the board, may not be waived.

History: 2019 AACS; 2023 AACS; 2025 MR 18, Eff. Oct. 2, 2025.

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