(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.