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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
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HB 2251: midwives; medication administration; advisory committee
Sponsor: Representative Bliss, LD 1
Committee on Health & Human Services
Overview
Authorizes licensed midwives with specific pharmacology training to dispense and administer certain medications, therapies and devices. Requires licensed midwives to disclose their professional liability insurance status to patients and establishes annual reporting of care statistics to the Department of Health Services. Establishes the Arizona Midwifery Advisory Committee to assist in licensing and disciplinary matters related to midwifery.
History
The Arizona Department of Health Services (DHS) regulates licensed midwives (LM) and certified professional midwives (CPM) who provide health care related to pregnancy, delivery and postpartum care. They often attend births in homes and birthing centers but not births in hospitals (A.R.S. §§ 36-755 and 36-751).
To qualify for midwife licensure in Arizona, an applicant must: 1) disclose any felony or misdemeanor conviction in Arizona or another state; 2) be at least 21 years of age; 3) present documentation of completion of training in adult basic cardiopulmonary resuscitation through a course recognized by the American Heart Association and training in neonatal resuscitation through a course recognize by the American Academy of Pediatrics or American Heart Association; 4) have a high school diploma, equivalent diploma or higher education diploma; 5) possess certification by the North American Registry of Midwives (NARM) as a CPM; and 6) pay all associated fees (A.A.C. R9-16-108).
The CPM credential, issued by NARM, is accredited by the National Commission for Certifying Agencies, the accrediting body of the Institute for Credentialing Excellence (NARM).
A midwife is prohibited from administering drugs or medications except in the following situations: 1) Rh immunoglobulin under a physician's written order to an unsensitized Rh negative client; and 2) Vitamin K under a physician's written order to a newborn. In an emergency situation in which the health or safety of a client or newborn are determined to be at risk, a midwife may perform the following procedures as necessary: 1) cardiopulmonary resuscitation; 2) administer oxygen at no more than eight liters per minute for a client and five liters per minute for the newborn; 3) episiotomy; 4) suturing of episiotomy or tearing of the perineum to stop active bleeding, following administration of local anesthetic upon consultation with a physician or certified nurse midwife; 5) release of shoulder dystocia, hyperflexion, application of external pressure suprapubic-cally, rotation of the nonimpacted shoulder, delivery of the posterior shoulder, application of posterior pressure on the anterior shoulder and positioning of the client on all fours with the back arched; 6) manual exploration of the uterus for control of severe bleeding; or 7) manual removal of placenta (A.A.C. R9-16-108 and R9-16-113).
Provisions
Midwifery Dispensing and Administration Authority
1. Permits a LM who has proof of completion of a pharmacology course of at least eight continuing education units from a midwifery education accreditation council-accredited institution or a regionally accredited institution to dispense and administer certain medications, therapies and devices, as outlined. (Sec. 3)
2. Allows an LM to dispense and administer antibiotics related to:
a. treating breast infections, urinary tract infections and vulvar infections; and
b. group B streptococcus prophylaxis consistent with the U.S. Centers for Disease Control and Prevention guidelines. (Sec. 3)
3. Permits an LM to dispense and administer the following antiviral medications for treating the herpes simplex virus consistent with the American College of Obstetricians and Gynecologists guidelines:
a. Acyclovir; and
b. Valacylovir. (Sec. 3)
4. Allows an LM to dispense and administer the following antifungal medications for treating breast and vulvar infections or conditions consistent with the American College of Obstetricians and Gynecologists guidelines:
a. Fluconazole;
b. Metronidazole; and
c. Miconazole. (Sec. 3)
5. Permits an LM to administer intravenous fluids for:
a. medication administration;
b. dehydration; and
c. treating hypovolemic shock while awaiting emergency medical service. (Sec. 3)
6. Allows an LM to dispense and administer the following low-potency topical steroids antipruritic medications and therapies related to treating breasts and vulvar infections or conditions consistent with the American College of Obstetricians and Gynecologists guidelines:
a. Hydrocortisone 2.5%; and
b. Triamcinolone 1%. (Sec. 3)
7. Permits an LM to dispense and administer antiemetics only for treating nausea and vomiting. (Sec. 3)
8. Permits an LM to dispense and administer the following antihemorrhagic medications for preventing and treating postpartum hemorrhage as defined by the American College of Obstetricians and Gynecologists:
a. Oxytocin;
b. Methylergonovine
c. Misoprostol; and
d. Tranexamic acid. (Sec. 3)
9. Prohibits an LM from using the antihemorrhagic medications to induce or augment labor. (Sec. 3)
10. Requires a LM to initiate a transfer of care if the patient's condition does not improve after the use of an antihemorrhagic medication. (Sec. 3)
11. Allows an LM to administer and dispense the following medications, therapies and devices:
a. vitamin K prophylaxis for newborns;
b. RHO immune globin;
c. topical, intramuscular or subcutaneous local anesthetics for postpartum repair of tears, lacerations or episiotomies;
d. oxygen and compressed air for fetal or maternal distress and infant resuscitation;
e. Epinephrine for neonatal resuscitation consistent with the Neonatal Resuscitation Program guidelines and to treat maternal allergic;
f. glucose gel administered orally for neonatal hypoglycemia;
g. vitamins and minerals for correcting electrolyte imbalances, including B vitamins, calcium, magnesium, dietary supplements, homeopathic remedies, plant substances that are not designated as prescription drugs or controlled substances and over-the-counter medications;
h. resuscitation supplies and equipment according to the current Neonatal Resuscitation Program algorithm;
i. medical supplies and equipment needed to administer the prescribed medications; and
j. electronic breast pumps, glucose monitors, compression stockings and pregnancy support belts or devises. (Sec. 3)
12. Specifies the topical, intramuscular or subcutaneous local anesthetics does not include any schedule I controlled substance. (Sec. 3)
13. Authorizes an LM to lawfully obtain, transport, administer and possess adequate quantities of the medications and the equipment normally required to administer those medications. (Sec. 3)
14. Requires an LM to store the medications as directed by the manufacturer. (Sec. 3)
15. Prohibits an LM to administer a medication to any person after the listed expiration date. (Sec. 3)
16. Requires an LM to record in the patient's chart each use of medication and its lot number and expiration date. (Sec. 3)
Arizona Midwifery Advisory Committee (Advisory Committee)
17. Establishes the 9-member Advisory Committee under DHS to assist in examining applicants for a midwifery license, if requested, to collaborate and assist the DHS Director in disciplinary matters and to perform any other duties, as outlined. (Sec. 3)
18. Requires the DHS Director to appoint the members of the Advisory Committee and outlines its membership. (Sec. 3)
19. Specifies that Advisory Committees members are ineligible for compensation or reimbursement of expenses. (Sec. 3)
20. Requires the Advisory Committee to meet at least four times each year, once per quarter. (Sec. 3)
21. Requires the Advisory Committee to make recommendations to the DHS Director when adopting or amending rules relating to the midwifery scope of practice. (Sec. 3)
22. Instructs an LM who is interested in modifying the midwifery scope of practice to submit a report to the Advisory Committee that contains the following:
a. a description of the issue and why an addition to the midwifery scope of practice is necessary, is including the extent to which consumers need and will benefit from an LM ability to provide this additional health care service;
b. the available evidence-based research that demonstrated that LMs are competent to perform the proposed health care service; and
c. the extent to which a change in the midwifery scope of practice may hard the public, including the extent to which a change in the scope of practice will restrict entry into the practice of midwifery. (Sec. 3)
23. Requires the Advisory Committee, if a majority of a quorum of the Advisory Committee votes to approve a change in the midwifery scope of practice, to provide the DHS Director with its recommendation for the possible change. (Sec. 3)
Reporting Requirements
24. Requires an LM, at the initiation of care, to disclose to each patient whether the LM maintains professional liability insurance. (Sec. 3)
25. Requires this disclosure to be included in the informed consent document and acknowledged by the patient's signature. (Sec. 3)
26. Requires, annually by January 31, each LM to file a report with DHS in a formal prescribed by DHS rule the following information for the preceding calendar year:
a. the number of women for whom the LM provided care;
b. the number of deliveries the LM performed;
c. the number, reason for and outcome of each transfer or transport of a patient in the antepartum, intrapartum or immediate postpartum periods;
d. the number of perinatal deaths, including the cause of death and a description of the circumstance;
e. the number and outcome of breech births and vaginal births after cesarean;
f. the number of births that occurred more than 25 miles from a hospital that provides obstetrics services;
g. the number of fetal deaths after 20 weeks gestation; and
h. the LM's full name, license number and county. (Sec. 3)
27. Specifies the reported information must not include any individually identifiable patient information. (Sec. 3)
28. States that the reported information may be inspected, copied, obtained or provided to the Advisory Committee for research and evidence. (Sec. 3)
29. Specifies that the reported information replaced the report required by each licensed LM following the termination of care for each patient. (Sec. 3)
Miscellaneous
30. Defines terms. (Sec. 1 and 3)
31. Requires the DHS Director to consider the most recent midwifery job analysis issued by NARM when adopting or amending rules relating to the midwifery scope of practice. (Sec. 2)
32. Makes technical and conforming changes. (Sec. 1 and 2)
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Initials AG HB 2251
1/21/2026 Page 0 Health & Human Services
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