2023 Maryland Statutes › Health Occupations › Title 8 - Nurses › Subtitle 6C - Licensed Direct-Entry Midwives › Section 8-6C-02 - Practice of Direct-Entry Midwifery

(a)    The practice of direct–entry midwifery includes:
(1)    Providing the necessary supervision, care, and advice to a patient during a low–risk pregnancy, labor, delivery, and postpartum period; and
(2)    Newborn care authorized under this subtitle that is provided in a manner that is:
(i)    Consistent with national direct–entry midwifery standards; and
(ii)    Based on the acquisition of clinical skills necessary for the care of pregnant women and newborns, including antepartum, intrapartum, and postpartum care.
(b)    The practice of direct–entry midwifery also includes:
(1)    Obtaining informed consent to provide services to the patient;
(2)    Discussing:
(i)    Any general risk factors associated with the services to be provided;
(ii)    Any specific risk factors pertaining to the health and circumstances of the individual patient;
(iii)    Conditions that preclude care by a licensed direct–entry midwife; and
(iv)    The conditions under which consultation, transfer of care, or transport of the patient must be implemented;
(3)    Obtaining a health history of the patient and performing a physical examination;
(4)    Developing a written plan of care specific to the patient, to ensure continuity of care throughout the antepartum, intrapartum, and postpartum periods, that includes:
(i)    A plan for the management of any specific risk factors pertaining to the individual health and circumstances of the individual patient; and
(ii)    A plan to be followed in the event of an emergency, including a plan for transportation;
(5)    Evaluating the results of patient care;
(6)    Consulting and collaborating with a health care practitioner regarding the care of a patient, and referring and transferring care to a health care provider, as required;
(7)    Referral of all patients, within 72 hours after delivery, to a pediatric health care practitioner for care of the newborn;
(8)    As approved by the Board:
(i)    Obtaining and administering medications; and
(ii)    Obtaining and using equipment and devices;
(9)    Obtaining appropriate screening and testing, including laboratory tests, urinalysis, and ultrasound;
(10)    Providing prenatal care during the antepartum period, with consultation or referral as required;
(11)    Providing care during the intrapartum period, including:
(i)    Monitoring and evaluating the condition of the patient and fetus;
(ii)    At the onset of active labor notifying the pediatric health care practitioner that delivery is imminent;
(iii)    Performing emergency procedures, including:
1.    Administering approved medications;
2.    Administering intravenous fluids for stabilization;
3.    Performing an emergency episiotomy; and
4.    Providing care while on the way to a hospital under circumstances in which emergency medical services have not been activated;
(iv)    Activating emergency medical services for an emergency; and
(v)    Delivering in an out–of–hospital setting;
(12)    Participating in peer review as required under § 8–6C–18(e)(2) of this subtitle;
(13)    Providing care during the postpartum period, including:
(i)    Suturing of first and second degree perineal or labial lacerations, or suturing of an episiotomy with the administration of a local anesthetic; and
(ii)    Making further contact with the patient within 48 hours, within 2 weeks, and at 6 weeks after the delivery to assess for hemorrhage, preeclampsia, thrombo–embolism, infection, and emotional well–being;
(14)    Providing routine care for the newborn for up to 72 hours after delivery, exclusive of administering immunizations, including:
(i)    Immediate care at birth, including resuscitating as needed, performing a newborn examination, and administering intramuscular vitamin K and eye ointment for prevention of ophthalmia neonatorum;
(ii)    Assessing newborn feeding and hydration;
(iii)    Performing metabolic screening and reporting on the screening in accordance with the regulations related to newborn screenings that are adopted by the Department;
(iv)    Performing critical congenital heart disease screening and reporting on the screening in accordance with the regulations related to newborn screenings that are adopted by the Department;
(v)    If unable to perform the screening required under item (iii) or (iv) of this item, referring the newborn to a pediatric health care practitioner to perform the screening within 24 to 48 hours after delivery; and
(vi)    Referring the infant to an audiologist for a hearing screening in accordance with the regulations related to newborn screenings that are adopted by the Department;
(15)    Within 24 hours after delivery, notifying a pediatric health care practitioner of the delivery;
(16)    Within 72 hours after delivery:
(i)    Transferring health records to the pediatric health care practitioner, including documentation of the performance of the screenings required under item (14)(iii) and (iv) of this subsection; and
(ii)    Referring the newborn to a pediatric health care practitioner;
(17)    Providing the following care of the newborn beyond the first 72 hours after delivery:
(i)    Weight checks and general observation of the newborn’s activity, with abnormal findings communicated to the newborn’s pediatric health care practitioner;
(ii)    Assessment of newborn feeding and hydration; and
(iii)    Breastfeeding support and counseling; and
(18)    Providing limited services to the patient after the postpartum period, including:
(i)    Breastfeeding support and counseling; and
(ii)    Counseling and referral for all family planning methods.
(c)    The practice of direct–entry midwifery does not include:
(1)    Pharmacological induction or augmentation of labor or artificial rupture of membranes prior to the onset of labor;
(2)    Surgical delivery or any surgery except an emergency episiotomy;
(3)    Use of forceps or vacuum extractor;
(4)    Except for the administration of a local anesthetic, administration of an anesthetic;
(5)    Administration of any kind of narcotic analgesic; or
(6)    Administration of any prescription medication in a manner that violates this subtitle.