DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS  
DIRECTOR’S OFFICE  
LICENSED MIDWIFERY  
Filed with the secretary of state on October 2, 2025  
These rules become effective immediately after 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, 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)  
R 338.17101, R 338.17111, R 338.17113, R 338.17115, R 338.17121, R 338.17122, R  
338.17123, R 338.17125, R 338.17131, R 338.17132, R 338.17137, R 338.17138, and R  
338.17141 of the Michigan Administrative Code are amended, and R 338.17114 and R  
338.17139 are added, as follows:  
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.  
October 2, 2024  
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(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.  
PART 2. PRELICENSURE LICENSED MIDWIFERY EDUCATION  
R 338.17111 Training standards for identifying victims of human trafficking: requirements.  
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.  
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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 initial licenses issued after August 1, 2024.  
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  
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.  
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.  
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.  
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:  
4
(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:  
(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.  
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.  
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  
5
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 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 theNARM  
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.  
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  
Lapsed lessLapsed more Lapsed 7  
lapsed and who does not hold a license in another state: than 3  
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.  
6
(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 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 has Michigan Michigan  
Michigan  
lapsed, but who holds a current midwife license in  
good standing in another state:  
license  
lapsed  
license lapsed license  
more than 3 lapsed  
less than 3 years,  
7 or more  
years  
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 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.  
8
(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.  
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.  
(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.  
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(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.  
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.  
(4) A licensed midwife shall provide an abbreviated informed consent appropriate to the  
emergent situation with documentation to follow once the situation has stabilized.  
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:  
10  
(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:  
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 liters per Free-flow, nasal  
Until stabilized None, with  
minute.  
cannula, mask.  
Intramuscular.  
or transfer of  
care.  
indications  
present.  
Pitocin 10  
units per  
milliliter  
Pitocin 10  
units per  
milliliter  
Prevention and treatment of 10 units per  
postpartum hemorrhage. milliliter.  
1-2 doses, PRN.  
4 hours.  
Prevention and treatment of 20 units in 1000 Intravenous.  
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 of 0.2 milligram per Intramuscular.  
0.2 lligram IM Contraindicated IM preferred for acute postpartum  
ergonovine postpartum hemorrhage.  
(Methergine)  
milliliter.  
q2-4 hours  
PRN; not to  
for patient with  
hypertension or lessen continued bleeding after  
use. Oral methergine can help to  
0.2 milligram  
exceed 5 doses. Reynaud's disease. hemorrhage.  
per milliliter  
Can be used in  
conjunction with  
Pitocin after  
delivery of the  
placenta.  
Methyl-  
0.2 milligram tab. Oral.  
0.2-0.4  
Contraindicated IM preferred for acute postpartum  
ergonovine  
(Methergine)  
0.2 milligram  
milligram PO for patient with  
use. Oral methergine can help to  
q6-8 hours  
hypertension or lessen continued bleeding after  
Reynaud's disease. hemorrhage.  
PRN for 2-7  
October 2, 2024  
12  
days.  
Medication Indication  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindications Comments  
Misoprostol Treatment of postpartum  
600 micrograms Oral, buccal, rectal. 1 dose.  
(Cytotec)  
Hemabate  
hemorrhage.  
oral or  
800 micrograms  
buccal or rectal.  
0.25 milligram  
IM.  
Treatment of postpartum  
Every 15-90  
minutes; not to  
exceed 8 doses.  
Asthma.  
Relative counterindications:  
hypertension.  
(Carboprost) hemorrhage.  
Tranexamic Treatment of postpartum  
Acid (TXA hemorrhage.  
or Lysteda)  
1000 milligrams Intravenous piggy Use within 3  
in 50 milliliters back (IVPB) or hours and as  
0.9 normal saline intravenous push early as possibledeep vein  
Contraindicated TXA should be administered slowly  
for patient with  
as an IVPB or IV push over 15  
minutes or longer because bolus  
injection carries a potential risk of  
hypotension.  
administered over (IV push).  
15 minutes.  
after onset of thrombosis,  
postpartum  
history of  
hemorrhage.  
coagulopathy, or  
active  
Should not be mixed with blood or  
hypersensitivity to solutions containing penicillin or  
TXA.  
mannitol.  
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 micrograms Intramuscular.  
pre-filled 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.  
Ampicillin Group Beta Strep  
prophylaxis in labor.  
Initial loading  
Administer via IV Until delivery. Allergy to  
No saline limitation when  
administering antibiotics.  
dose: 2 grams IV. with prepared  
Subsequent doses: minibag.  
1 gram IV every 4  
penicillin.  
hours.  
13  
Medication Indication  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindications Comments  
Cefazolin  
Group Beta Strep  
prophylaxis in labor.  
Initial loading  
dose: 2 grams IV. with prepared  
Subsequent  
doses: 1gramIV  
every 8 hours.  
Administer via IV Until delivery. Allergy to  
cefazolin.  
minibag.  
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.  
No saline limitation when  
administering antibiotics.  
Clindamycin Group Beta Strep  
prophylaxis in labor.  
900 milligrams IV Administer via IV Until delivery. Allergy to  
every 8 hours until with prepared clindamycin.  
delivery. minibag.  
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.  
Vancomycin Group Beta Strep  
prophylaxis in labor.  
1 gram IV every Administer via IV Until delivery. Allergy to  
Use only with patient with history  
of anaphylactic reaction to  
12 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  
milligram, USP,  
1:1000 (0.3  
milliliters) in a  
sterile solution.  
5-15 minutes.  
Transport to  
hospital should  
be initiated.  
Lactated  
Ringers  
solution  
Dehydration during labor. Up to 2 liters.  
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.  
14  
Medication Indication  
Dose  
Route of  
Administration  
Duration of  
Treatment  
Contraindications Comments  
Intrapartum: the addition of 5%  
0.9% Normal Dehydration during labor, 1- 2 liters 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 milliliters 2%,  
up to 30 milliliters  
1%, or up to 60  
milliliters 0.5%.  
signs or  
epinephrine, max dose 4.5  
symptoms of  
allergic reaction.  
milligrams per kilogram infiltration.  
Postpartum repair of vulvo-  
vaginal lacerations.  
Topical cream,  
spray, or gel.  
Known allergy or  
signs or  
symptoms of  
allergic reaction.  
Diphenhydra To reduce vomiting during 25 to 50  
Oral; intravenous.  
mine  
(Benadryl)  
labor.  
milligrams every  
4 to 6 hours / 10-  
50 milligrams  
every 4-  
6 hours.  
Ondansetron To reduce vomiting during 4-8 IVP / 4  
Oral; intravenous.  
May produce headache as side  
effect.  
(Zofran)  
labor.  
milligrams (up to  
twice PRN).  
Ibuprofen  
To reduce post-partum  
discomfort.  
200 milligrams up Oral.  
to 4 tablets every  
6-8 hours.  
Until postpartum History of  
pain resolves. gastritis; history  
of gastrointestinal  
bleed.  
15  
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 minute, or as  
oximetry readings.  
10 liters per  
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.  
indicated.  
readings are  
within target  
range of infant  
age, or transfer  
of care.  
0.5%  
Prophylaxis of neonatal  
1 centimeter  
Ocular, in lower 1 dose.  
eyelid.  
Hypersensitivity May cause ocular irritation or  
to drug class or blurred vision.  
component.  
Erythromycinophthalmia neonatorum due ribbon of 0.5%  
Ophthalmic to N. gonorrhoeae or  
ointment chlamydia trachomatis.  
ointment in each  
eye within  
24 hours of birth.  
Vitamin K Prophylaxis and therapy of 1.0 milligram for Intramuscular.  
1.0 milligram hemorrhagic disease of the a newborn above  
1 dose.  
Family history of Vitamin K 1.0 milligram per 0.5  
hypoprothrombine milliliter.  
mia;  
per 0.5  
newborn.  
1500 grams.  
milliliter  
hypersensitivity  
to drug class or  
component.  
Epinephrine Neonatal resuscitation.  
0.2 milliliter per Administered in theRepeat every 3-5  
EMS services should be en route.  
kilogram (0.02  
milliliter per  
umbilical venous minutes if HR  
catheter or <60 beats per  
kilogram) of body interosseous route minute with  
weight in a  
1:10,000  
concentration.  
followed by 3  
milliliter flush of compressions.  
sterile normal  
chest  
saline.  
Epinephrine Neonatal resuscitation.  
1 milliliter per  
kilogram 1:10,000  
concentration.  
Endotracheal.  
If heart rate  
remains less than  
60 beats per  
Max 3 milliliters per dose, EMS  
services should be en route.  
minute, move on  
to Epinephrine  
administered by  
IV or  
16  
interosseous  
route.  
17  
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.  
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.  
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.  
(iii) Behavior modification.  
(iv) Stress management.  
18  
(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.  
;