1. A. In this chapter, the following terms have the meanings indicated.

2. B. Terms Defined.

   1. (1) “Board” means the Board of Nursing.
   2. (2) “Certified nurse midwife” has the meaning stated in COMAR 10.27.05.01.

   3. (3) Freestanding Birthing Center.

      1. (a) “Freestanding birthing center” means a facility that provides nurse midwife services through individuals licensed to practice under Health Occupations Article, Title 8, Subtitle 6, Annotated Code of Maryland.

      2. (b) “Freestanding birthing center” does not include:

         1. (i) Birthing services that are licensed or accredited as a unit of a hospital; or
         2. (ii) The private residence of the patient.
   4. (4) “Immediate action” means all actions the freestanding birthing center has taken or will take to immediately address the noncompliance that resulted in or made serious injury, serious harm, serious impairment, or death likely.

   5. (5) Immediate Jeopardy.

      1. (a) “Immediate jeopardy” means a situation in which immediate corrective action is necessary because the freestanding birthing center's noncompliance with one or more licensure requirements has already caused, is causing, or is likely to cause, at any time, serious injury or harm, or death, to individuals served by the freestanding birthing center or to the health or safety of the general public.

      2. (b) “Immediate jeopardy” consists of three components:

         1. (i) Noncompliance with this chapter;
         2. (ii) Serious injury, harm, or death; and
         3. (iii) The need for immediate action.
   6. (6) “Informal dispute resolution (IDR)” means an informal process that provides a freestanding birthing center the opportunity to dispute one or more deficiencies cited in a written Statement of Deficiencies issued by the Department or the Department’s designee related to a recent survey.
   7. (7) “Licensed certified midwife” has the meaning stated in Health Occupations Article, §8-6D-01, Annotated Code of Maryland.
   8. (8) “Licensed direct-entry midwife” has the meaning stated in COMAR 10.64.01.01.
   9. (9) “Midwifery” means the antepartum, intrapartum, and postpartum management and care of birthing persons and their newborns.
   10. (10) “Need for immediate action” means that immediate corrective action is necessary to remove the jeopardy.
   11. (11) “Newborn” means an infant in the first 28 days of life.
   12. (12) “Noncompliance” means the freestanding birthing center is non-compliant with one or more licensure requirements of this chapter.

   13. (13) Normal Maternity.

       1. (a) “Normal maternity” means a low risk, uncomplicated prenatal course as determined by adequate prenatal care and prospects for a normal, uncomplicated birth as defined by reasonable and generally accepted criteria of maternal and fetal health.
       2. (b) “Normal maternity” does not include the use of drugs for induction or augmentation of labor, general and regional anesthesia, vacuum extractors, forceps, recorded electronic fetal monitors, cesarean section, surgical procedures other than episiotomy or perineal repair, intrapartum care provided prior to 36 weeks gestation, or intrapartum care provided after 42 weeks gestation.
   14. (14) “Office of Health Care Quality (OHCQ)” means the Office of Healthcare Quality of the Maryland Department of Health.
   15. (15) “Plan of Correction” means a written plan submitted by the freestanding birthing center to the OHCQ which documents steps the freestanding birthing center will take to come into compliance with the licensure requirements.
   16. (16) “Removal of the immediate jeopardy” means that the freestanding birthing center has implemented the removal plan, and the OHCQ has verified that all actions the freestanding birthing center took were effective in removing the likelihood that serious injury, serious harm, serious impairment, or death would occur or recur.
   17. (17) “Serious injury, harm, or death” means a situation which has already caused, is causing, or is likely to cause, at any time, serious injury or harm, or death, to individuals served by the freestanding birthing center or to the health or safety of the general public.
   18. (18) “Statement of Deficiencies” means the written notification that the OHCQ issues to the free standing birthing center that contains a listing of deficiencies cited that require correction.

Authority: Health-General Article, §19-3B-01 et seq., Annotated Code of Maryland

Effective date: August 23, 1999 (26:17 Md. R. 1322)

Chapter revised effective February 15, 2016 (43:3 Md. R. 272)

Regulation .01B amended effective December 8, 2016 (43:24 Md. R. 1350)

Regulation .06A amended effective December 8, 2016 (43:24 Md. R. 1350)

Chapter revised effective October 13, 2025 (52:20 Md. R. 1000)