DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS  
DIRECTOR’S OFFICE  
BOARD OF MIDWIFERY  
Filed with the secretary of state on March 21, 2023  
These rules take effect immediately upon filing with the secretary of state unless  
adopted under section 33, 44, or 45a(9) of the administrative procedures act of 1969,  
1969 PA 306, MCL 24.233, 24.244, or 24.245a. Rules adopted under these sections  
become effective 7 days after filing with the secretary of state.  
(By authority conferred on the director of the department of licensing and regulatory affairs by  
sections 16145, 16148, 16174, 16186, 16201, 16204, 16205, 17105, 17107, 17111, 17112, and  
17117 of the public health code, 1978 PA 368, MCL 333.16145, 333.16148, 333.16174,  
333.16186, 333.16201, 333.16204, 333.16205, 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)  
R 338.17101, R 338.17111, R 338.17115, R 338.17121, R 338.17123, R 338.17125, R 338.17134,  
R 338.17137, and R 338.17141 of the Michigan Administrative Code are amended and  
R 338.17127 is rescinded as follows:  
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 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.  
(c) “Code” means the public health code, 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.  
July 6, 2022  
2
(e) “Department” means the 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) Unless otherwise defined in these rules, the terms defined in the code have the same  
meaning when used in these rules.  
PART 2. PRELICENSURE LICENSED MIDWIFERY EDUCATION  
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 who is licensed 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  
acceptable proof of completion of training, including either of the following:  
(a) Proof of completion certificate issued by the training provider that includes the date,  
provider name, name of training, and individual’s name.  
(b) A self-certification statement by an individual. The certification statement must 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.  
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(3) Pursuant to section 16148 of the code, MCL 333.16148, the requirements specified in  
subrule (1) of this rule apply for license renewals beginning with the first renewal cycle after  
August 1, 2019, and for initial licenses issued after August 1, 2024.  
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 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 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.  
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 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 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:  
(A) Submits proof to the department that the applicant holds a midwifery bridge certificate  
awarded by 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 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.  
(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.  
(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.  
4
(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.  
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 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 the applicant meets the requirements of section 16174 of the code, MCL  
333.16174, 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 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 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 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, which includes  
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 MEAC approved, 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 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.  
R 338.17125 Relicensure requirements.  
Rule 125. (1) An applicant for relicensure who has let his or her license from this state lapse,  
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 (√):  
5
(a) For a midwife who has let his or her license from thisLapsed lessLapsed more Lapsed 7  
state lapse and who does not hold a license in another than 3  
state: years  
than 3 years, or more  
but less than 7 years  
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 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 hours of  
continuing education 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 was 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 from 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, which include verification from  
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the issuing entity showing that disciplinary proceedings  
are not pending against the applicant and sanctions are  
not in force at the time of application.  
(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 his or her credential of  
CPM from NARM, or equivalent credential approved by  
the board, during the license cycle.  
(b) For a midwife who has let his or her license from Michigan Michigan  
Michigan  
this state lapse, but who holds a current midwife  
license in good standing in another state:  
license  
license lapsed license  
lapsed Less more than 3 lapsed  
than 3  
years  
years,  
but less than 7 years  
years  
7 or more  
(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 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 hours of  
continuing education 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 was 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 from 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.  
7
(vi) Meet the English language requirement under R  
338.7002b and the implicit bias training required in R √  
338.7004.  
(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, which include 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 his or her  
credential of CPM from 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.  
R 338.17127 Rescinded.  
PART 4. PRACTICE, CONDUCT, AND CLASSIFICATION OF CONDITIONS  
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.  
(iv) Significant vaginal bleeding before the onset of labor not associated with uncomplicated  
spontaneous abortion.  
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(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.  
(xlv) Chronic pulmonary disease.  
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(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.  
(i) Signs of clinically significant dehydration.  
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(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.  
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 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 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  
Duration of  
Treatment  
Contraindications Comments  
Oxygen  
Maternal distress or fetal  
distress.  
10-12 L/minute. Free-flow, nasal  
cannula, mask.  
Until stabilized None, with  
or transfer of  
care.  
indications  
present.  
Pitocin 10  
units/ml  
Pitocin 10  
units/ml  
Prevention and treatment of 10 units/ml.  
postpartum hemorrhage.  
Prevention and treatment of 20 units in 1000 Intravenous.  
Intramuscular.  
1-2 doses, PRN.  
4 hours.  
postpartum hemorrhage.  
ml IV fluids,  
initial bolus rate  
1000 ml/hour  
bolus for 30  
minutes (equals  
10 units) followed  
by a maintenance  
rate 125 ml/hour  
over 3.5 hours  
(equals remaining  
10 units).  
Methyl-  
Prevention and treatment of 0.2 mg/ml.  
Intramuscular.  
0.2 mg IM q2- Contraindicated IM preferred for acute postpartum  
ergonovine postpartum hemorrhage.  
(Methergine)  
4hr PRN; not to for patient with  
exceed 5 doses. hypertension or  
use. Oral methergine can help to  
lessen continued bleeding after  
0.2 mg/ml  
Reynaud's disease. hemorrhage.  
Can be used in  
conjunction with  
Pitocin after  
delivery of the  
placenta.  
Methyl-  
0.2 mg tab.  
Oral.  
0.2-0.4 mg PO Contraindicated IM preferred for acute postpartum  
ergonovine  
(Methergine)  
0.2 mg  
q6-8hr  
PRN for 2-7  
days .  
for patient with  
hypertension or  
Reynaud's disease. hemorrhage.  
use. Oral methergine can help to  
lessen continued bleeding after  
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Medication Indication  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindications Comments  
Misoprostol Treatment of postpartum  
600 mcg oral or Oral, buccal, rectal. 1 dose.  
(Cytotec)  
hemorrhage.  
800 mcg buccal or  
rectal.  
Hemabate  
(Carboprost) hemorrhage.  
Treatment of postpartum  
0.25mg IM.  
Every 15-90  
Asthma.  
Relative counterindications:  
hypertension.  
minutes; not to  
exceed 8 doses.  
Use within 3  
hours and as  
early as possibledeep vein  
after onset of thrombosis,  
Tranexamic Treatment of postpartum  
Acid (TXA hemorrhage.  
or Lystdea)  
1g in 10 ml IV at Intravenous.  
1 ml/min,  
administered over  
10 minutes.  
Contraindicated TXA should be administered slowly  
for patient with  
as an IV injection over 10 minutes  
because bolus injection carries a  
potential risk of hypotension.  
postpartum  
hemorrhage.  
history of  
coagulopathy, or Should not be mixed with blood or  
active solutions containing penicillin or  
hypersensitivity tomannitol.  
TXA.  
RHo (D)  
Immune  
Globulin  
(Rhogam)  
Prophylactic dose: RH-  
patient at 28-30 weeks  
gestation; RH- patient after  
a miscarriage; postpartum  
RH- patient with an RH+  
baby. A prenatal dose can  
also be given after an injury  
under advisement of a  
physician.  
300 mcg pre-filledIntramuscular.  
syringe.  
Administer  
within 72 hours deficiency.  
of birth or  
RH positive; IgA  
antenatal event.  
Penicillin G Group Beta Strep (GBS)  
prophylaxis in labor.  
Initial loading  
dose: 5 million  
units IV.  
Administer via IV Until delivery. Allergy to  
No saline limitation when  
administering antibiotics.  
with prepared  
minibag.  
penicillin.  
Subsequent doses:  
2.5–3.0 million  
units IV  
every 4 hours.  
Initial loading  
dose: 2 g IV.  
Ampicillin Group Beta Strep  
prophylaxis in labor.  
Administer via IV Until delivery. Allergy to  
with prepared penicillin.  
No saline limitation when  
administering antibiotics.  
Subsequent doses: minibag.  
1 g IV every 4  
hours.  
14  
Medication Indication  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindications Comments  
Cefazolin  
Group Beta Strep  
prophylaxis in labor.  
Initial loading  
dose: 2g IV.  
Subsequent  
doses: 1g IV  
every 8 hours.  
Administer via IV Until delivery. Allergy to  
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.  
with prepared  
minibag.  
cefazolin.  
No saline limitation when  
administering antibiotics.  
Clindamycin Group Beta Strep  
prophylaxis in labor.  
900 mg IV every Administer via IV Until delivery. Allergy to  
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  
8
hours until  
with prepared  
minibag.  
clindamycin.  
delivery.  
limitation when administering  
antibiotics.  
Vancomycin Group Beta Strep  
prophylaxis in labor.  
1 g IV every 12 Administer via IV Until delivery. Allergy to  
Use only with patient with history  
of anaphylactic reaction to  
hours.  
with prepared  
minibag.  
vancomycin.  
penicillin and the GBS isolate is  
laboratory proven to be resistant to  
Clindamycin. No saline limitation  
when administering antibiotics.  
Discontinue medication that is  
causing reaction; place patient  
supine and elevate lower  
extremities. Protect the airway.  
Transport to hospital should follow.  
Most patients respond to  
Epinephrine Severe allergic reaction.  
Single dose of 0.3  
mg, USP,  
1:1000 (0.3 ml) in  
a sterile solution.  
5-15 minutes.  
Transport to  
hospital should  
be initiated.  
Lactated  
Ringers  
solution  
Dehydration during labor. Up to 2L.  
Intravenous.  
Over the course  
of 3-5 hours.  
intravenous hydration and a short  
period of gut rest, followed by  
reintroduction of oral intake.  
Preferred over normal saline.  
15  
Medication Indication  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindications Comments  
Intrapartum: the addition of 5%  
0.9% Normal Dehydration during labor, 1L- 2L bolus.  
Intravenous.  
During course of  
infusion.  
Saline  
solution  
when LR not available.  
Postpartum hemorrhage.  
Allergic reactions.  
Dextrose to solution can increase  
success rate with nausea or  
vomiting.  
Lidocaine  
Lidocaine  
Postpartum repair of vulvo- Injectable: up to Injection.  
2 hours.  
Known allergy or Do not use lidocaine with  
vaginal lacerations.  
20 ml 2%, up to  
30 ml 1%, or up  
to 60 ml 0.5%.  
signs or  
epinephrine, max dose 4.5 mg/kg  
infiltration.  
symptoms of  
allergic reaction.  
Known allergy or  
signs or  
Postpartum repair of vulvo-  
vaginal lacerations.  
Topical cream,  
spray, or gel.  
symptoms of  
allergic reaction.  
Diphenhydra To reduce vomiting during 25 to 50 mg every Oral; intravenous.  
mine  
(Benadryl)  
labor.  
4 to 6 hours / 10-  
50 mg every 4-  
6 hours.  
Ondansetron To reduce vomiting during 4-8 mg IVP / 4  
Oral; intravenous.  
May produce headache as side  
effect.  
(Zofran)  
labor.  
mg (up to twice  
PRN).  
16  
Table 2  
Neonatal - Administration of Prescription Drugs and Medications  
Medication Indication  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindications Comments  
Oxygen  
Neonatal resuscitation, if  
indicated; abnormal pulse indicated.  
oximetry readings.  
10L/minute, or as Bag and mask,  
free-flow.  
Until pulse-  
oximetry  
None, with  
indications  
present.  
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 radical and oxidative  
stress damage in the neonate.  
readings are  
within target  
range of infant  
age, or transfer  
of care.  
0.5%  
Prophylaxis of neonatal  
1 cm ribbon of  
Ocular, in lower  
1 dose.  
1 dose.  
Hypersensitivity May cause ocular irritation or  
to drug class or blurred vision.  
component.  
Erythromycinophthalmia neonatorum due 0.5% ointment in eyelid.  
Ophthalmic to N. gonorrhoeae or  
ointment chlamydia trachomatis.  
Vitamin K Prophylaxis and therapy of 0.5-1.0 mg.  
1.0 mg/0.5 hemorrhagic disease of the  
each eye within  
24 hours of birth.  
Intramuscular.  
Family history of Vitamin K 1.0 mg/0.5 ml  
hypoprothrombine  
ml  
newborn.  
mia;  
hypersensitivity  
to drug class or  
component.  
Epinephrine Neonatal resuscitation.  
Epinephrine Neonatal resuscitation.  
0.1 - 0.3ml/kg  
(0.01 - 0.03  
mg/kg) of body catheter followed bpm with chest  
weight in a  
1:10,000  
concentration.  
Administered in theRepeat every 3-5  
umbilical venous min if HR <60  
EMS services should be en route.  
by 1 – 3 ml flush ofcompressions.  
sterile normal  
saline.  
1 ml/kg 1:10,000 Endotracheal.  
concentration.  
Repeat every 3-5  
min if HR <60  
bpm with chest  
compressions.  
Max 3 ml/dose, EMS services  
should be en route.  
17  
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 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 before renewal shall accumulate all of  
the following, during the prior 2 years by the end of the license cycle:  
(a) Not less than 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. 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:  
(i) Behavior management.  
(ii) Psychology of pain.  
(iii) Behavior modification.  
(iv) Stress management.  
(v) 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-reviewed journal, health care journal, or professional or scientific journal.  
(d) Two 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 hour of continuing education in pharmacology applicable to the practice of midwifery.  
(f) Submit proof to the department of meeting the human trafficking training required in R  
338.17111.  
(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.  
(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  
18  
reading an article that is published in a peer-reviewed 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.  
(9) 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 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.  
;