§ 8-6C-02
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/md/health-occupations/8-6c-02·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§8–6C–02.
(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 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)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;
(iii)Activating emergency medical services for an emergency; and
(iv)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)Lactation support and counseling; and
(18)Providing limited services to the patient after the postpartum period, including:
(i)Lactation 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.
(d)The practice of direct–entry midwifery is independent and does not require oversight by another health care practitioner.