10.64.01.02

.02 Scope of Practice.

The practice of direct-entry midwifery includes:

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

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

(1) Consistent with national direct-entry midwifery standards; and

(2) Based on the acquisition of clinical skills necessary for the care of pregnant women and newborns, including antepartum, intrapartum, and postpartum care;

C. Obtaining informed consent to provide services to the patient;

D. Discussing:

(1) Any general risk factors associated with the services to be provided;

(2) Any specific risk factors pertaining to the health and circumstances of the individual patient;

(3) Conditions that preclude care by a licensed direct-entry midwife; and

(4) The conditions under which consultation, transfer of care, or transport of the patient must be implemented;

E. Obtaining a health history of the patient, including a travel history, and performing a physical examination;

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) A plan for the management of any specific risk factors pertaining to the individual health and circumstances of the individual patient; and

(2) A plan to be followed in the event of an emergency, including a plan for transportation;

G. Evaluating the results of patient care;

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;

I. Referral of all patients, within 72 hours after delivery, to a pediatric health care practitioner for care of the newborn;

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

(1) Obtaining and administering medications; and

(2) Obtaining and using equipment and devices;

K. Obtaining appropriate screening and testing, including laboratory tests, urinalysis, and ultrasound;

L. Providing prenatal care during the antepartum period, with consultation or referral as required;

M. Providing care during the intrapartum period, including:

(1) Monitoring and evaluating the condition of the patient and fetus;

(2) At the onset of active labor notifying the pediatric health care practitioner, by any electronic device, that delivery is imminent;

(3) Performing emergency procedures, including:

(a) Administering approved medications;

(b) Administering intravenous fluids for stabilization;

(c) Performing an emergency episiotomy; and

(d) Providing care while on the way to a hospital under circumstances in which emergency medical services have not been activated;

(4) Activating emergency medical services for an emergency; and

(5) Delivering in an out-of-hospital setting;

N. Participating in peer review as required under Regulation .16 of this chapter;

O. Providing care during the postpartum period, including:

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

(a) Hemorrhage;

(b) Preeclampsia;

(c) Thrombo-embolism;

(d) Infection; and

(e) Emotional well-being;

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

(1) Immediate care at birth, including:

(a) Resuscitating as needed;

(b) Performing a newborn examination; and

(c) Administering intramuscular vitamin K and eye ointment for prevention of ophthalmia neonatorum;

(2) Assessing newborn feeding and hydration;

(3) Performing metabolic screening and reporting on the screening in accordance with COMAR 10.52.12;

(4) Performing critical congenital heart disease screening and reporting on the screening in accordance with COMAR 10.52.12;

(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) 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) Referring the infant to an audiologist for a hearing screening in accordance with COMAR 10.52.12;

Q. Within 24 hours after delivery, notifying a pediatric health care practitioner, by any electronic device, of the delivery;

R. Within 72 hours after delivery:

(1) Referring the newborn to a pediatric health care practitioner; and

(2) Transferring health records to the pediatric health care practitioner, including documentation of the performance of the screenings required under this regulation;

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

(1) Weight checks and general observation of the newborn’s activity, with abnormal findings communicated to the newborn’s pediatric health care practitioner;

(2) Assessment of newborn feeding and hydration; and

(3) Breastfeeding support and counseling; and

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

(1) Breastfeeding support and counseling; and

(2) Counseling and referral for all family planning methods.