1. A. The clinical director and director of midwifery shall develop clinical practice guidelines for the management of routine and emergency care of the patient and the fetus or newborn during pregnancy, birth, and postpartum through discharge, whether through completion of the pregnancy or referral or transfer to other levels of care.

2. B. The clinical practice guidelines shall include, at a minimum, procedures for the:

   1. (1) Transfer of patients or newborns for appropriate hospital obstetric and newborn care;
   2. (2) Monitoring of fetal heart tones consistent with the current standards of care; and

   3. (3) Use of ultrasound imaging that is:

      1. (a) Consistent with the current standards of care; and

      2. (b) Within the scope of practice for a:

         1. (i) Physician;
         2. (ii) Certified nurse midwife; or
         3. (iii) Licensed certified midwife.

3. C. The administrator shall:

   1. (1) Ensure that all clinical practice guidelines are fully implemented by the clinical staff;
   2. (2) Periodically review the non-clinical policies and revise them when necessary; and
   3. (3) Make the [protocols] clinical practice guidelines available to staff for reference on site at all times.

4. D. A licensed direct-entry midwife, certified nurse midwife, and licensed certified midwife practicing in a birthing center shall remain in compliance with applicable practice guidelines including but not limited to:

   1. (1) Health Occupations Article, §8-6C-08, Annotated Code of Maryland;
   2. (2) COMAR 10.64.01.10;
   3. (3) COMAR 10.27.05.04; and
   4. (4) COMAR 10.27.05.01(a)(8).

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)