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<section article="gho" article_name="Health Occupations" number="8-6C-02" title_number="8" title_name="Nurses" subtitle_number="6C" subtitle_name="Licensed Direct-Entry Midwives">
  <level label="a">
    <text>The practice of direct–entry midwifery includes:</text>
    <level label="1">
      <text>Providing the necessary supervision, care, and advice to a patient during a low–risk pregnancy, labor, delivery, and postpartum period; and</text>
    </level>
    <level label="2">
      <text>Newborn care authorized under this subtitle that is provided in a manner that is:</text>
      <level label="i">
        <text>Consistent with national direct–entry midwifery standards; and</text>
      </level>
      <level label="ii">
        <text>Based on the acquisition of clinical skills necessary for the care of pregnant women and newborns, including antepartum, intrapartum, and postpartum care.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>The practice of direct–entry midwifery also includes:</text>
    <level label="1">
      <text>Obtaining informed consent to provide services to the patient;</text>
    </level>
    <level label="2">
      <text>Discussing:</text>
      <level label="i">
        <text>Any general risk factors associated with the services to be provided;</text>
      </level>
      <level label="ii">
        <text>Any specific risk factors pertaining to the health and circumstances of the individual patient;</text>
      </level>
      <level label="iii">
        <text>Conditions that preclude care by a licensed direct–entry midwife; and</text>
      </level>
      <level label="iv">
        <text>The conditions under which consultation, transfer of care, or transport of the patient must be implemented;</text>
      </level>
    </level>
    <level label="3">
      <text>Obtaining a health history of the patient and performing a physical examination;</text>
    </level>
    <level label="4">
      <text>Developing a written plan of care specific to the patient, to ensure continuity of care throughout the antepartum, intrapartum, and postpartum periods, that includes:</text>
      <level label="i">
        <text>A plan for the management of any specific risk factors pertaining to the individual health and circumstances of the individual patient; and</text>
      </level>
      <level label="ii">
        <text>A plan to be followed in the event of an emergency, including a plan for transportation;</text>
      </level>
    </level>
    <level label="5">
      <text>Evaluating the results of patient care;</text>
    </level>
    <level label="6">
      <text>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;</text>
    </level>
    <level label="7">
      <text>Referral of all patients, within 72 hours after delivery, to a pediatric health care practitioner for care of the newborn;</text>
    </level>
    <level label="8">
      <text>As approved by the Board:</text>
      <level label="i">
        <text>Obtaining and administering medications; and</text>
      </level>
      <level label="ii">
        <text>Obtaining and using equipment and devices;</text>
      </level>
    </level>
    <level label="9">
      <text>Obtaining appropriate screening and testing, including laboratory tests, urinalysis, and ultrasound;</text>
    </level>
    <level label="10">
      <text>Providing care during the antepartum period, with consultation or referral as required;</text>
    </level>
    <level label="11">
      <text>Providing care during the intrapartum period, including:</text>
      <level label="i">
        <text>Monitoring and evaluating the condition of the patient and fetus;</text>
      </level>
      <level label="ii">
        <text>Performing emergency procedures, including:</text>
        <level label="1">
          <text>Administering approved medications;</text>
        </level>
        <level label="2">
          <text>Administering intravenous fluids for stabilization;</text>
        </level>
        <level label="3">
          <text>Performing an emergency episiotomy; and</text>
        </level>
        <level label="4">
          <text>Providing care while on the way to a hospital under circumstances in which emergency medical services have not been activated;</text>
        </level>
      </level>
      <level label="iii">
        <text>Activating emergency medical services for an emergency; and</text>
      </level>
      <level label="iv">
        <text>Delivering in an out–of–hospital setting;</text>
      </level>
    </level>
    <level label="12">
      <text>Participating in peer review as required under § 8–6C–18(e)(2) of this subtitle;</text>
    </level>
    <level label="13">
      <text>Providing care during the postpartum period, including:</text>
      <level label="i">
        <text>Suturing of first and second degree perineal or labial lacerations, or suturing of an episiotomy with the administration of a local anesthetic; and</text>
      </level>
      <level label="ii">
        <text>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;</text>
      </level>
    </level>
    <level label="14">
      <text>Providing routine care for the newborn for up to 72 hours after delivery, exclusive of administering immunizations, including:</text>
      <level label="i">
        <text>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;</text>
      </level>
      <level label="ii">
        <text>Assessing newborn feeding and hydration;</text>
      </level>
      <level label="iii">
        <text>Performing metabolic screening and reporting on the screening in accordance with the regulations related to newborn screenings that are adopted by the Department;</text>
      </level>
      <level label="iv">
        <text>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;</text>
      </level>
      <level label="v">
        <text>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</text>
      </level>
      <level label="vi">
        <text>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;</text>
      </level>
    </level>
    <level label="15">
      <text>Within 24 hours after delivery, notifying a pediatric health care practitioner of the delivery;</text>
    </level>
    <level label="16">
      <text>Within 72 hours after delivery:</text>
      <level label="i">
        <text>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</text>
      </level>
      <level label="ii">
        <text>Referring the newborn to a pediatric health care practitioner;</text>
      </level>
    </level>
    <level label="17">
      <text>Providing the following care of the newborn beyond the first 72 hours after delivery:</text>
      <level label="i">
        <text>Weight checks and general observation of the newborn’s activity, with abnormal findings communicated to the newborn’s pediatric health care practitioner;</text>
      </level>
      <level label="ii">
        <text>Assessment of newborn feeding and hydration; and</text>
      </level>
      <level label="iii">
        <text>Lactation support and counseling; and</text>
      </level>
    </level>
    <level label="18">
      <text>Providing limited services to the patient after the postpartum period, including:</text>
      <level label="i">
        <text>Lactation support and counseling; and</text>
      </level>
      <level label="ii">
        <text>Counseling and referral for all family planning methods.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>The practice of direct–entry midwifery does not include:</text>
    <level label="1">
      <text>Pharmacological induction or augmentation of labor or artificial rupture of membranes prior to the onset of labor;</text>
    </level>
    <level label="2">
      <text>Surgical delivery or any surgery except an emergency episiotomy;</text>
    </level>
    <level label="3">
      <text>Use of forceps or vacuum extractor;</text>
    </level>
    <level label="4">
      <text>Except for the administration of a local anesthetic, administration of an anesthetic;</text>
    </level>
    <level label="5">
      <text>Administration of any kind of narcotic analgesic; or</text>
    </level>
    <level label="6">
      <text>Administration of any prescription medication in a manner that violates this subtitle.</text>
    </level>
  </level>
  <level label="d">
    <text>The practice of direct–entry midwifery is independent and does not require oversight by another health care practitioner.</text>
  </level>
</section>
