The practice of direct-entry midwifery includes:

1. A. Providing the necessary supervision, care, and advice to a patient during a low-risk pregnancy, labor, delivery, and postpartum period;

2. B. Newborn care authorized under Health Occupations Article, §8-6C-02, Annotated Code of Maryland, provided in a manner that is:

   1. (1) Consistent with national direct-entry midwifery standards; and
   2. (2) Based on the acquisition of clinical skills necessary for the care of pregnant women and newborns, including antepartum, intrapartum, and postpartum care;
3. C. Obtaining informed consent to provide services to the patient;

4. D. Discussing:

   1. (1) Any general risk factors associated with the services to be provided;
   2. (2) Any specific risk factors pertaining to the health and circumstances of the individual patient;
   3. (3) Conditions that preclude care by a licensed direct-entry midwife; and
   4. (4) The conditions under which consultation, transfer of care, or transport of the patient must be implemented;
5. E. Obtaining a health history of the patient, including a travel history, and performing a physical examination;

6. F. Developing a written plan of care specific to the patient, to ensure continuity of care throughout the antepartum, intrapartum, and postpartum periods that includes:

   1. (1) A plan for the management of any specific risk factors pertaining to the individual health and circumstances of the individual patient; and
   2. (2) A plan to be followed in the event of an emergency, including a plan for transportation;
7. G. Evaluating the results of patient care;
8. H. 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;
9. I. Referral of all patients, within 72 hours after delivery, to a pediatric health care practitioner for care of the newborn;

10. J. As approved by the Board, in accordance with Regulation .08 of this chapter:

    1. (1) Obtaining and administering medications; and
    2. (2) Obtaining and using equipment and devices;
11. K. Obtaining appropriate screening and testing, including laboratory tests, urinalysis, and ultrasound;
12. L. Providing prenatal care during the antepartum period, with consultation or referral as required;

13. M. Providing care during the intrapartum period, including:

    1. (1) Monitoring and evaluating the condition of the patient and fetus;
    2. (2) At the onset of active labor notifying the pediatric health care practitioner, by any electronic device, that delivery is imminent;

    3. (3) Performing emergency procedures, including:

       1. (a) Administering approved medications;
       2. (b) Administering intravenous fluids for stabilization;
       3. (c) Performing an emergency episiotomy; and
       4. (d) Providing care while on the way to a hospital under circumstances in which emergency medical services have not been activated;
    4. (4) Activating emergency medical services for an emergency; and
    5. (5) Delivering in an out-of-hospital setting;
14. N. Participating in peer review as required under Regulation .16 of this chapter;

15. O. Providing care during the postpartum period, including:

    1. (1) Suturing of first and second degree perineal or labial lacerations or suturing of an episiotomy with the administration of a local anesthetic; and

    2. (2) Making further contact with the patient within 48 hours, within 2 weeks, and at 6 weeks after the delivery to assess for:

       1. (a) Hemorrhage;
       2. (b) Preeclampsia;
       3. (c) Thrombo-embolism;
       4. (d) Infection; and
       5. (e) Emotional well-being;

16. P. Providing routine care for the newborn for up to 72 hours after delivery, exclusive of administering immunizations, including:

    1. (1) Immediate care at birth, including:

       1. (a) Resuscitating as needed;
       2. (b) Performing a newborn examination; and
       3. (c) Administering intramuscular vitamin K and eye ointment for prevention of ophthalmia neonatorum;
    2. (2) Assessing newborn feeding and hydration;
    3. (3) Performing metabolic screening and reporting on the screening in accordance with COMAR 10.52.12;
    4. (4) Performing critical congenital heart disease screening and reporting on the screening in accordance with COMAR 10.52.12;
    5. (5) If unable to perform the screening required under §P(3) or (4) of this regulation, referring the newborn to a pediatric health care practitioner to perform the screening within 24 to 48 hours after delivery;
    6. (6) Administering any other required newborn test, medication, or treatment required by the Department if authorized by the formulary in Regulation .07 of this chapter; and
    7. (7) Referring the infant to an audiologist for a hearing screening in accordance with COMAR 10.52.12;
17. Q. Within 24 hours after delivery, notifying a pediatric health care practitioner, by any electronic device, of the delivery;

18. R. Within 72 hours after delivery:

    1. (1) Referring the newborn to a pediatric health care practitioner; and
    2. (2) Transferring health records to the pediatric health care practitioner, including documentation of the performance of the screenings required under this regulation;

19. S. Providing the following care of the newborn beyond the first 72 hours after delivery:

    1. (1) Weight checks and general observation of the newborn’s activity, with abnormal findings communicated to the newborn’s pediatric health care practitioner;
    2. (2) Assessment of newborn feeding and hydration; and
    3. (3) Breastfeeding support and counseling; and

20. T. Providing limited services to the patient after the postpartum period, including:

    1. (1) Breastfeeding support and counseling; and
    2. (2) Counseling and referral for all family planning methods.

Authority: Health-General Article, §§8-205 and Title 8, Subtitle 6C, Annotated Code of Maryland;
Ch. 383, Acts of 2015

Effective date: December 19, 2016 (43:25 Md. R. 1385)

Regulation .15B amended as an emergency provision effective July 11, 2023 (50:15 Md. R. 680); adopted permanently effective October 16, 2023 (50:20 Md. R. 887)