(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.
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