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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
midwives; medication administration; advisory committee
Purpose
Outlines prescription administration authority and disclosure and reporting requirements for licensed midwives. Establishes the Arizona Midwifery Advisory Committee (Advisory Committee) in the Department of Health Services (DHS).
Background
DHS licenses and regulates midwives in Arizona. The DHS Director must, by
rule: 1) define and describe, consistent with statute, the duties and limits of
the practice of midwifery; 2) adopt standards with respect to the practice of
midwifery designed to safeguard the health and safety of the mother and child;
3) establish criteria for granting, denying, suspending and revoking a license
in order to protect the health and safety of the mother and child; and
4) describe and define reasonable and necessary minimum qualification for
midwives (A.R.S. Title 36,
Chapter 6, Article 7).
A
person applying for midwife licensure must: 1) disclose whether the applicant
has ever been convicted of a felony or a misdemeanor in Arizona or another
state or jurisdiction;
2) demonstrate that the applicant is at least 21 years of age; 3) document
completion of training in adult basic cardiopulmonary resuscitation through a
course recognized by the American Heart Association and neonatal resuscitation
through a course recognized by the American Academy of Pediatrics or American
Heart Association; 4) document a high school diploma, a high school equivalency
diploma, an associate degree or a higher degree; and 5) document certification
by the North American Registry of Midwives as a Certified Professional Midwife
(A.A.C.
R9-16-102).
A midwife must not administer drugs or medications except: 1) Rh
immunoglobulin to an unsensitized Rh negative client under a physician’s
written orders; or 2) vitamin K under a physician's written order to a newborn.
In an emergency, a midwife may also administer: 1) oxygen at up to eight liters
per minute via mask for the client and five liters per minute for the newborn
via neonatal mask; 2) local anesthetic for suturing of episiotomy or tearing of
the perineum to stop active bleeding, contingent upon consultation with a
physician or certified nurse midwife or physician’s written orders; and 3) pitocin
intramuscularly at a maximum dose of 20 units, in
10-unit dosages each, 30 minutes apart, to a client for the control of
postpartum hemorrhage, contingent upon physician or certified nurse midwife
consultation and written orders by a physician, and arrangements for immediate
transport of the client to a hospital (A.A.C. R9-16-108
and R9-16-113).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Clarifies that the DHS Director must adopt rules to describe and define reasonable and necessary minimum qualifications for licensed midwives.
2. Requires the DHS Director to consider the most recent midwifery job analysis issued by the North American Registry of Midwives when adopting or amending rules related to the midwifery scope of practice.
Prescription Dispensing and Administration Authority
3. Allows a licensed midwife who, in addition to the requirements for initial licensure, 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 the following medications, therapies and devices with the following limitations:
a) antibiotics related to Group B Streptococcus Prophylaxis consistent with the U.S. Centers for Disease Control and Prevention guidelines or other current evidence-based guidelines;
b) the following antihemorrhagic medications for preventing and treating postpartum hemorrhage as defined by the American College of Obstetricians and Gynecologists:
i. oxytocin for preventing uterine atony during or immediately following the third stage of labor according to current evidence-based standards of care;
ii. methylergonovine;
iii. carboprost tromethamine;
iv. misoprostol; and
v. tranexamic acid;
c) prophylactic ophthalmic medications for newborn eye care;
d) intravenous fluids for the following:
i. medication administration;
ii. routine fluid administration; and
iii. treating hypovolemic shock while awaiting emergency medical service;
e) vitamin K prophylaxis for newborns;
f) rho immune globulin;
g) topical, intramuscular or subcutaneous local anesthetics for postpartum repair of first and second degree tears, lacerations or episiotomies, excluding any Schedule I controlled substance;
h) oxygen and compressed air for fetal or maternal distress and infant resuscitation;
i) epinephrine for neonatal resuscitation consistent with the neonatal resuscitation program guidelines and to treat maternal allergic reactions;
j) glucose gel administered orally for neonatal hypoglycemia;
k) 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;
l) resuscitation supplies and equipment according to the current neonatal resuscitation program algorithm;
m) medical supplies and equipment needed to administer authorized medications; and
n) electronic breast pumps, glucose monitors, compression stockings and pregnancy support belts or devices.
4. Prohibits a licensed midwife from using the antihemorrhagic medications to induce or augment labor.
5. Requires the licensed midwife to initiate a transfer of care if an antihemorrhagic medication is administered for managing hemorrhage.
6. Allows a licensed midwife to administer other prescription medications as prescribed by a licensed allopathic, naturopathic or osteopathic physician, a registered nurse practitioner or a licensed physician assistant.
7. States that a pharmacist who dispenses prescription medications in compliance with statute to a licensed midwife is not liable for any adverse reaction that is caused by the licensed midwife's method of use.
8. Allows a licensed midwife to lawfully obtain, transport, administer and possess adequate quantities of authorized medications and the equipment normally required to administer those medications.
9. Requires the licensed midwife to:
a) store the authorized medications as directed by the manufacturer; and
b) record in the patient's chart each use of medication and the medication's lot number and expiration date.
10. Prohibits a licensed midwife from administering a medication to any person after the listed expiration date.
Advisory Committee
11. Establishes the Advisory Committee in DHS to:
a) assist in examining applicants for a midwifery license, if requested;
b) collaborate with and assist the DHS Director in disciplinary matters, if requested; and
c) perform any other required duties.
12. Requires the DHS Director to appoint the members of the Advisory Committee, which must be composed of no more than 11 of the following members:
a) at least five licensed midwives;
b) two licensed certified nurse midwives; and
c) two physicians who are licensed to practice allopathic, naturopathic or osteopathic medicine and are board certified in obstetrics, pediatrics or family medicine; and
d) one consumer of midwifery care.
13. Requires the DHS Director to solicit physician applications from state medical societies and associations for the two physician members of the Advisory Committee.
14. States that the Advisory Committee members are not eligible for compensation or reimbursement of expenses.
15. Requires the Advisory Committee to meet at least four times each year, once per quarter.
16. Requires the Advisory Committee to make recommendations to the DHS Director when adopting or amending rules relating to the midwifery scope of practice.
17. Requires a licensed midwife who is interested in modifying the midwifery scope of practice to submit a report to the Advisory Committee that contains at least the following:
a) a description of the issue and why an addition to the midwifery scope of practice is necessary, including the extent to which consumers need and will benefit from a licensed midwife's ability to provide this additional health care service;
b) the available evidence-based research that demonstrates that licensed midwives are competent to perform the proposed health care service; and
c) the extent to which a change in the midwifery scope of practice may harm the public, including the extent to which a change in the scope of practice will restrict entry into the practice of midwifery.
18. Requires the Advisory Committee, if a majority of a quorum of the Advisory Committee members votes to approve a change in the midwifery scope of practice, to provide the DHS Director with its recommendations for a possible rule change.
19. Requires the Advisory Committee to conduct a review of sentinel events occurring during the course of prenatal, intrapartum or postpartum care provided by licensed midwives in Arizona.
20. Allows the Advisory Committee to convene emergency meetings when a case or sentinel event requires timely review or action to protect the public health and safety.
21. Requires the Advisory Committee, following the review of a sentinel event, to make recommendations to DHS regarding whether the care provided was:
a) consistent with community standards;
b) consistent with community standards but outside the scope of practice as defined by DHS in rule; or
c) outside of community standards and requiring corrective action.
22. Allows the Advisory Committee, for care determined to be outside of community standards, to recommend one or more of the following to DHS:
a) additional continuing education requirements;
b) mentoring or supervised practice;
c) administrative civil penalties;
d) restriction or suspension of a license; or
e) revocation of a license.
23. Requires the Advisory Committee to review midwife care disclosure reports submitted in accordance with statute.
24. Allows the Advisory Committee to recommend modifications to the disclosure reporting requirements to DHS to support quality improvement and patient safety.
Disclosure and Reporting Requirements
25. Requires each licensed midwife, at the initiation of care, to disclose to each patient whether the licensed midwife maintains professional liability insurance.
26. Requires the disclosure to be included in the informed consent document and acknowledged by the patient's signature.
27. Requires each licensed midwife, by January 31 of each year, to file a report with DHS, in a format prescribed by DHS, the following information, not including any individually identifiable health information of a patient, for the preceding calendar year:
a) the number of women for whom the licensed midwife provided care;
b) the number of deliveries the licensed midwife attended as primary midwife;
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 licensed midwife's full name, license number and county.
28. Requires a licensed midwife to additionally report to DHS:
a) a perinatal mortality within 72 hours after the death; and
b) a sentinel event within 14 days after the event.
29. Allows the information reported to DHS by a licensed midwife to be inspected, copied, obtained or provided to the Advisory Committee for research and evidence.
30. Requires the annual report to DHS to replace the report required by each licensed midwife following termination of care for each patient.
Miscellaneous
31. Defines individually identifiable health information as having the same meaning prescribed in the federal Health Insurance Portability and Accountability Act privacy standards.
32. Defines licensed midwife as a midwife licensed in accordance with statute.
33. Defines sentinel event as an unexpected, serious patient safety incident resulting in death, permanent harm or a significant risk of harm.
34. Includes, in the definition of sentinel event, both of the following:
a) maternal sentinel events, including:
i. maternal death;
ii. maternal intensive care unit admission;
iii. uterine rupture;
iv. postpartum hemorrhage requiring a blood transfusion; and
v. shoulder dystocia with brachial plexus injury; and
b) neonatal sentinel events, including:
i. neonatal intensive care unit admission within 72 hours after birth, not including observation-only admissions or admissions for congenital anomalies;
ii. a birth weight of less than 2,500 grams;
iii. an Apgar score of less than seven at five minutes; and
iv. respiratory distress requiring prolonged ventilation.
35. Designates this legislation as the Jordan and Mack Terry Act.
36. Makes technical and conforming changes.
37. Becomes effective on the general effective date.
House Action
HHS 2/16/26 DPA 11-1-0-0
3rd Read 3/5/26 42-8-9-0-1
Prepared by Senate Research
March 16, 2026
JT/ci