In this subtitle the following words have the meanings indicated.
“ACME” means the Accreditation Commission for Midwifery Education, or a successor organization that is an accrediting agency for nurse–midwifery and direct–entry midwifery education programs and is approved by the United States Department of Education.
“AIMM” means the Association of Independent Midwives of Maryland or a successor organization that is a professional organization representing independent midwives in the State.
“Board” means the State Board of Nursing.
“Committee” means the Direct–Entry Midwifery Advisory Committee established under § 8–6C–11 of this subtitle.
“Health care practitioner” means:
An individual certified as a nurse–midwife or a nurse practitioner under this title; or
A physician licensed under Title 14 of this article.
“Health care provider” means a health care practitioner or a hospital.
“Health care provider” includes agents or employees of a health care practitioner or a hospital.
“Hospital” has the meaning stated in § 19–301 of the Health – General Article.
“License” means, unless the context requires otherwise, a license issued by the Board to practice direct–entry midwifery.
“Licensed direct–entry midwife” means an individual who has been granted a license under this subtitle to practice direct–entry midwifery.
“Licensed direct–entry midwife” does not include a licensed nurse certified as a nurse–midwife under this title.
“Low–risk pregnancy” means a pregnancy, labor, and delivery and postpartum, newborn, and interconceptional care that does not include a condition that requires a mandatory transfer under § 8–6C–03.
“MEAC” means the Midwifery Education and Accreditation Council, or a successor organization that is a national accreditation agency for midwifery education approved by the United States Department of Education.
“NARM” means the North American Registry of Midwives, or a successor organization that is an international certification agency that establishes and administers certification for the certified professional midwife credential.
“Patient” means an individual for whom a licensed direct–entry midwife performs services.
“Patient” includes an individual’s newborn for the purpose of perinatal or postpartum care.
“Postpartum period” means the first 6 weeks after delivery.
“Practice direct–entry midwifery” means:
Providing maternity care that is consistent with a midwife’s training, education, and experience; and
Identifying and referring patients who require medical care to an appropriate health care provider.
“Practice direct–entry midwifery” includes the activities described in § 8–6C–02 of this subtitle.
The practice of direct–entry midwifery includes:
Providing the necessary supervision, care, and advice to a patient during a low–risk pregnancy, labor, delivery, and postpartum period; and
Newborn care authorized under this subtitle that is provided in a manner that is:
Consistent with national direct–entry midwifery standards; and
Based on the acquisition of clinical skills necessary for the care of pregnant women and newborns, including antepartum, intrapartum, and postpartum care.
The practice of direct–entry midwifery also includes:
Obtaining informed consent to provide services to the patient;
Discussing:
Any general risk factors associated with the services to be provided;
Any specific risk factors pertaining to the health and circumstances of the individual patient;
Conditions that preclude care by a licensed direct–entry midwife; and
The conditions under which consultation, transfer of care, or transport of the patient must be implemented;
Obtaining a health history of the patient and performing a physical examination;
Developing a written plan of care specific to the patient, to ensure continuity of care throughout the antepartum, intrapartum, and postpartum periods, that includes:
A plan for the management of any specific risk factors pertaining to the individual health and circumstances of the individual patient; and
A plan to be followed in the event of an emergency, including a plan for transportation;
Evaluating the results of patient care;
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;
Referral of all patients, within 72 hours after delivery, to a pediatric health care practitioner for care of the newborn;
As approved by the Board:
Obtaining and administering medications; and
Obtaining and using equipment and devices;
Obtaining appropriate screening and testing, including laboratory tests, urinalysis, and ultrasound;
Providing care during the antepartum period, with consultation or referral as required;
Providing care during the intrapartum period, including:
Monitoring and evaluating the condition of the patient and fetus;
Performing emergency procedures, including:
Administering approved medications;
Administering intravenous fluids for stabilization;
Performing an emergency episiotomy; and
Providing care while on the way to a hospital under circumstances in which emergency medical services have not been activated;
Activating emergency medical services for an emergency; and
Delivering in an out–of–hospital setting;
Participating in peer review as required under § 8–6C–18(e)(2) of this subtitle;
Providing care during the postpartum period, including:
Suturing of first and second degree perineal or labial lacerations, or suturing of an episiotomy with the administration of a local anesthetic; and
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;
Providing routine care for the newborn for up to 72 hours after delivery, exclusive of administering immunizations, including:
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;
Assessing newborn feeding and hydration;
Performing metabolic screening and reporting on the screening in accordance with the regulations related to newborn screenings that are adopted by the Department;
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;
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
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;
Within 24 hours after delivery, notifying a pediatric health care practitioner of the delivery;
Within 72 hours after delivery:
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
Referring the newborn to a pediatric health care practitioner;
Providing the following care of the newborn beyond the first 72 hours after delivery:
Weight checks and general observation of the newborn’s activity, with abnormal findings communicated to the newborn’s pediatric health care practitioner;
Assessment of newborn feeding and hydration; and
Lactation support and counseling; and
Providing limited services to the patient after the postpartum period, including:
Lactation support and counseling; and
Counseling and referral for all family planning methods.
The practice of direct–entry midwifery does not include:
Pharmacological induction or augmentation of labor or artificial rupture of membranes prior to the onset of labor;
Surgical delivery or any surgery except an emergency episiotomy;
Use of forceps or vacuum extractor;
Except for the administration of a local anesthetic, administration of an anesthetic;
Administration of any kind of narcotic analgesic; or
Administration of any prescription medication in a manner that violates this subtitle.
The practice of direct–entry midwifery is independent and does not require oversight by another health care practitioner.
A licensed direct–entry midwife may not assume or continue to take responsibility for a patient’s pregnancy and birth care and shall arrange for the orderly transfer of care to a health care practitioner for a patient who is already under the care of the licensed direct–entry midwife, if any of the following disorders or situations is found to be present at the initial interview or if any of the following disorders or situations occur as prenatal care proceeds:
Diabetes mellitus, including uncontrolled gestational diabetes;
Hyperthyroidism treated with medication;
Uncontrolled hypothyroidism;
Epilepsy with seizures or antiepileptic drug use during the previous 12 months;
Coagulation disorders;
Chronic pulmonary disease;
Heart disease in which there are arrhythmias or murmurs except when, after evaluation, it is the opinion of a physician licensed under Title 14 of this article or a licensed nurse certified as a nurse–midwife or a nurse practitioner under this title that midwifery care may proceed;
Hypertension, including pregnancy–induced hypertension (PIH);
Renal disease;
Previous uterine surgery, including a cesarean section or myomectomy;
Indications that the fetus has died in utero;
Premature labor (gestation less than 37 weeks);
Multiple gestation;
Noncephalic presentation at or after 38 weeks;
Placenta previa or abruption;
Preeclampsia;
Severe anemia, defined as hemoglobin less than 10 g/dL:
That has been measured after treatment; or
Based on blood tests performed at or after 36 weeks;
Uncommon diseases and disorders, including Addison’s disease, Cushing’s disease, systemic lupus erythematosus, antiphospholipid syndrome, scleroderma, rheumatoid arthritis, periarteritis nodosa, and Marfan’s syndrome;
AIDS/HIV;
Hepatitis;
Acute toxoplasmosis infection, if the patient is symptomatic;
Acute Rubella infection during pregnancy;
Acute cytomegalovirus infection, if the patient is symptomatic;
Acute Parvovirus infection, if the patient is symptomatic;
Alcohol abuse, substance abuse, or prescription abuse during pregnancy;
Continued daily tobacco use into the second trimester;
Thrombosis;
Inflammatory bowel disease that is not in remission;
Primary genital herpes simplex virus infection during the third trimester or active genital herpes lesions at the time of labor;
Significant fetal congenital anomaly that directly impacts the birthing process or requires immediate emergency care, as determined by the Board in regulations;
Ectopic pregnancy; or
Post term maturity (gestational age 42 0/7 weeks and beyond).
A licensed direct–entry midwife shall consult with a health care practitioner, and document the consultation, the recommendations of the consultation, and the discussion of the consultation with the client, if any of the following conditions are present during the course of care:
Significant mental disease, including depression, bipolar disorder, schizophrenia, and other conditions that impair the ability of the patient to participate effectively in the patient’s care or that require the use of psychotropic drugs to control the condition;
Second or third trimester bleeding;
Intermittent use of alcohol into the second trimester;
Asthma;
Diet–controlled gestational diabetes;
History of genetic problems, intrauterine death after 20 weeks’ gestation, or stillbirth;
Abnormal pap smear;
Possible ectopic pregnancy;
Tuberculosis;
Controlled hypothyroidism, being treated with thyroid replacement and euthyroid, and with thyroid test numbers in the normal range;
Rh sensitization with positive antibody titer;
Breech presentation between 35 and 38 weeks;
Transverse lie or other abnormal presentation between 35 and 38 weeks;
Premature rupture of membranes at 37 weeks or less;
Small for gestational age or large for gestational age fetus;
Polyhydramnios or oligohydramnios;
Previous LEEP procedure or cone biopsy;
Previous obstetrical problems, including uterine abnormalities, placental abruption, placenta accreta, obstetric hemorrhage, incompetent cervix, or preterm delivery for any reason;
Postterm maturity (41 0/7 to 6/7 weeks gestational age);
Inflammatory bowel disease, in remission;
Active genital herpes lesions during pregnancy except as required by § 8–6C–03(29) of this subtitle;
Prepregnancy body mass index (BMI) of less than 18.5 or 35 or more; or
Significant fetal congenital anomaly.
Subject to subsection (c) of this section, a licensed direct–entry midwife shall arrange immediate emergency transfer to a hospital if:
The patient requests transfer; or
The patient or newborn is determined to have any of the following conditions during labor, delivery, or the immediate postpartum period:
Unforeseen noncephalic presentation;
Unforeseen multiple gestation;
Nonreassuring fetal heart rate or pattern, including tachycardia, bradycardia, significant change in baseline, and persistent late or severe variable decelerations;
Prolapsed cord;
Unresolved maternal hemorrhage;
Retained placenta;
Signs of fetal or maternal infection;
Patient with a third– or fourth–degree laceration or a laceration beyond the licensed direct–entry midwife’s ability to repair;
Apgar of less than seven at 5 minutes;
Significant congenital anomalies that directly affect delivery or immediate postpartum care or require immediate emergency care, as determined by the Board in regulations;
Need for chest compressions during neonatal resuscitation;
Newborn with persistent central cyanosis;
Newborn with persistent grunting and retractions;
Newborn with abnormal vital signs;
Gross or thick meconium staining, when discovered; or
Newborn with excessive dehydration due to inability to feed.
If transfer is not possible because of imminent delivery, the licensed direct–entry midwife shall consult with a health care provider for guidance on further management of the patient and to determine when transfer may be safely arranged, if required.
A licensed direct–entry midwife shall immediately transfer the care of a patient to a health care provider for the treatment of any significant postpartum morbidity, including:
Uncontrolled postpartum hemorrhage;
Preeclampsia;
Thrombo–embolism;
An infection; or
A postpartum mental health disorder.
A licensed direct–entry midwife who is required to transfer care of a patient under paragraph (1) of this subsection may continue other aspects of postpartum care in consultation with the treating health care practitioner.
At the time of delivery, a licensed direct–entry midwife shall be assisted by a second individual who:
Has completed the American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program (NRP) within the previous 2 years; and
Has the skills and equipment necessary to perform a full resuscitation of the newborn in accordance with the principles of NRP.
Except as otherwise provided in this subtitle or §§ 10–14A–03 and 10–14B–03 of the State Government Article, an individual shall be licensed by the Board before the individual may practice direct–entry midwifery in the State.
This section does not apply to:
An individual who assists at a birth in an emergency;
An individual who is licensed as a health care practitioner whose scope of practice allows the individual to practice direct–entry midwifery; or
A student who is practicing direct–entry midwifery while engaged in an approved clinical midwife educational experience under the supervision of a licensed direct–entry midwife.
If a patient chooses to give birth at home in a situation prohibited by this subtitle or in which a licensed direct–entry midwife recommends transfer, the licensed direct–entry midwife shall:
Transfer care of the patient to an appropriate health care practitioner;
Complete the standard form developed under § 8–6C–08(e) of this subtitle and submit the completed form to the accepting health care practitioner; and
Cease to take responsibility for the patient’s pregnancy care within 1 week after the transfer.
If birth is imminent and the patient refuses to be transferred after the licensed direct–entry midwife determines that a transfer is necessary, the licensed direct–entry midwife shall:
Call 9–1–1 and remain with the patient until emergency services personnel arrive; and
Transfer care and give a verbal report of the care provided to the emergency medical services providers.
A licensed direct–entry midwife shall develop a general written plan for their practice for:
Emergency transfer of a patient, newborn, or both;
Transport of a newborn to a newborn nursery or neonatal intensive care nursery; and
Transport of a patient to an appropriate hospital with a labor and delivery unit.
The Committee shall review and recommend approval to the Board of the plan required under subsection (a) of this section.
In addition to the general written plan required under subsection (a) of this section, a licensed direct–entry midwife shall prepare a plan that is specific to each patient and share the plan with the patient.
The plan required under paragraph (1) of this subsection shall:
Include procedures and processes to be undertaken in the event of an emergency for the mother, the newborn, or both;
Identify the hospital closest to the address of the planned home birth that has a labor and delivery unit;
Include a care plan for the newborn; and
Identify the pediatric health care practitioner who will be notified after delivery in accordance with § 8–6C–02(b)(15) of this subtitle to receive the transfer of care of the newborn.
The Board, in consultation with stakeholders, shall develop a standard form for use in all cases in which a transfer occurs during prenatal care, labor, or postpartum.
The form shall include the medical information needed by the health care practitioner receiving the patient.
After a decision to transport a patient has been made, the licensed direct–entry midwife shall:
Call the receiving health care provider;
Inform the health care provider of the incoming patient;
Accompany the patient to the hospital if determined to be appropriate by the licensed direct–entry midwife and the receiving health care provider; and
Provide:
To the staff of the hospital:
The standard form developed under subsection (d) of this section; and
The medical records of the patient or newborn, as determined by the Board in regulations and as requested by the receiving health care provider; and
To the accepting health care practitioner, a verbal summary of the care provided to the patient by the licensed direct–entry midwife.
Before initiating care, a licensed direct–entry midwife shall obtain a signed copy of the Board–approved informed consent agreement in accordance with this section.
The Board, in consultation with stakeholders, shall review and update as necessary the informed consent agreement at least every 4 years.
The agreement reviewed under paragraph (1) of this subsection shall include acknowledgment by the patient of receipt, at a minimum, of the following:
The licensed direct–entry midwife’s training and experience;
Instructions for obtaining a copy of the regulations adopted by the Board under this subtitle;
Instructions for obtaining a copy of the NARM certification requirements;
Instructions for filing a complaint with the Board;
Notice of whether the licensed direct–entry midwife has professional liability insurance coverage;
A description of the procedures, benefits, and risks of home births, including those conditions that may arise during delivery; and
Any other information that the Board requires.
Notwithstanding any other provision of law, a licensed direct–entry midwife shall be subject to reporting requirements adopted by the Board in regulations in consultation with the Committee and any other stakeholders determined appropriate by the Board.
A licensed direct–entry midwife attending an out–of–hospital delivery shall:
For any live birth, complete and submit a birth certificate in accordance with § 4–208 of the Health – General Article; and
For any death, make all medical records available and communicate relevant circumstances of the death to the individual responsible for completing the certificate of death under § 4–212 or § 4–213 of the Health – General Article.
There is a Direct–Entry Midwifery Advisory Committee within the Board.
The Committee consists of seven members appointed by the Board.
Of the seven members:
Subject to paragraph (3) of this subsection and subsection (d) of this section, three shall be licensed direct–entry midwives;
Two shall be licensed nurses certified as nurse–midwives;
One shall be a representative of the Maryland Hospital Association; and
One shall be a consumer member.
The Board shall appoint the licensed direct–entry midwife members of the Committee from a list of qualified individuals submitted to the Board by AIMM.
The Board may request an additional list of qualified individuals from AIMM if the initial list is determined to be inadequate.
Each member of the Committee shall be a citizen of the United States and a resident of the State.
Each licensed direct–entry midwife member of the Committee:
Shall meet the licensure requirements of this subtitle; and
May not be a licensed nurse who is certified as a nurse–midwife.
The consumer member of the Committee:
Shall be a member of the general public;
May not be or ever have been:
A licensed direct–entry midwife;
A licensed nurse certified as a midwife;
A health care practitioner who is directly involved with pregnancy or labor; or
In training to be a licensed direct–entry midwife, a licensed nurse certified as a midwife, or a health care practitioner who is directly involved with pregnancy or labor;
May not have a household member who is:
A licensed direct–entry midwife, a licensed nurse who is certified as a nurse–midwife, or a health care practitioner who is directly involved with pregnancy or labor; or
In training to be a licensed direct–entry midwife, a licensed nurse who is certified as a nurse–midwife, or a health care practitioner who is directly involved with pregnancy or labor;
May not:
Participate or ever have participated in a commercial or professional field related to the practice of direct–entry midwifery;
Have a household member who participates in a commercial or professional field related to the practice of direct–entry midwifery; or
Have, or have had within 2 years before appointment, a substantial financial interest in a person who is regulated by the Board.
The Committee shall elect a chair from among its members to a 2–year term.
The term of a member is 4 years.
The terms of the members are staggered as required by the terms provided for members of the Committee on October 1, 2015.
At the end of a term, a member continues to serve until a successor is appointed and qualifies.
A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.
A member may not serve more than two consecutive full terms.
To the extent practicable, the Board shall fill any vacancy on the Committee within 60 days of the date of the vacancy.
A majority of the full authorized membership of the Committee is a quorum.
In addition to any other meeting requirements of this title, the Committee shall meet:
At the request of the executive director of the Board; and
As necessary to conduct Board or Committee business.
In accordance with the State budget, each member of the Committee is entitled to:
Compensation, at a rate determined by the Board, for each day, or part of a day, on which the member is engaged in the duties of the Committee; and
Reimbursement for expenses under the Standard State Travel Regulations.
The Board may remove a member for incompetence or misconduct.
The Board may remove a member who is absent from two successive Committee meetings without adequate reason.
The Committee shall:
Review applications for licensure as a licensed direct–entry midwife and make recommendations to the Board regarding applicants;
Maintain a list of all licensed direct–entry midwives;
Make recommendations to the Board regarding continuing education requirements for licensed direct–entry midwives;
Review advertising by licensed direct–entry midwives and by institutions that offer a direct–entry midwife program and make recommendations to the Board, as necessary;
Advise the Board on matters relating to the practice of direct–entry midwifery;
Collect the reports required to be submitted by each licensed direct–entry midwife under § 8–6C–10(a) of this subtitle;
Make recommendations to the Board regarding regulations relating to the practice of direct–entry midwifery that are necessary to carry out the provisions of this subtitle;
At the request of the Board, investigate complaints against licensed direct–entry midwives;
Keep a record of the Committee’s proceedings; and
Subject to subsection (b) of this section, beginning November 1, 2016, and on each November 1 thereafter, submit a report to the Board, including:
A summary of the information included in reports submitted to the Committee by licensed direct–entry midwives under § 8–6C–10(a) of this subtitle; and
Any other information identified by the Board.
The Committee may not include any personally identifying information in the report submitted to the Board under subsection (a)(10) of this section.
Beginning December 1, 2016, and on each December 1 thereafter, the Board shall submit to the Senate Education, Health, and Environmental Affairs Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article:
The report submitted to the Board under subsection (a)(10) of this section;
In consultation with the Committee, any recommendations regarding the continuation and improvement of the licensure of licensed direct–entry midwives in the State;
Any recommendations regarding expanding the scope of practice of licensed direct–entry midwives; and
Any recommendations, including recommendations for legislation, regarding the scope of practice of licensed direct–entry midwives to include vaginal birth after cesarean.
In addition to the education and training requirements under subsection (b) of this section, to qualify for a license, an applicant shall:
Submit to a criminal history records check in accordance with § 8–303 of this title;
Be of good moral character;
Be a high school graduate or have completed equivalent education;
Be at least 21 years old;
Hold a current cardiopulmonary resuscitation (CPR) certification issued by the American Red Cross or the American Heart Association; and
Have completed in the past 2 years the American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program (NRP).
An applicant:
Shall hold a current valid Certified Professional Midwife credential granted by NARM; and
Shall have completed a midwifery education program that is accredited by MEAC or ACME;
Shall have completed the NARM Midwifery Bridge Certificate program; or
If the applicant was certified by NARM as a certified professional midwife on or before January 15, 2017, through a non–MEAC accredited program, but otherwise qualifies for licensure, shall provide:
Verification of completion of NARM–approved clinical requirements; and
Evidence of completion, in the past 2 years, of an additional 50 hours of continuing education units approved by the Board and accredited by MEAC, the American College of Nurse Midwives, or the Accrediting Council for Continuing Medical Education, including:
14 hours of obstetric emergency skills training such as a birth emergency skills training (BEST) or an advanced life saving in obstetrics (ALSO) course; and
The remaining 36 hours divided among and including hours in the areas of pharmacology, lab interpretation of pregnancy, antepartum complications, intrapartum complications, postpartum complications, and neonatal care.
To apply for a license, an applicant shall:
Submit to a criminal history records check in accordance with § 8–303 of this title;
Submit to the Board:
An application on the form that the Board requires; and
Written, verified evidence that the requirement of item (1) of this subsection is being met; and
Pay to the Board a fee set by the Board.
The Board shall set reasonable fees for the issuance and renewal of licenses and other services it provides to licensed direct–entry midwives.
The fees charged shall be set so as to produce funds to approximate the cost of maintaining the licensure and other services provided to licensed direct–entry midwives.
The Board shall pay all fees collected under this subtitle to the Comptroller.
The Comptroller shall distribute all fees to the Board.
The fees collected under this section shall be used to cover the actual documented direct and indirect costs of fulfilling the statutory and regulatory duties of the Board as provided by this subtitle.
Subject to subsection (c) of this section, the Board shall issue a license to an applicant who:
Meets the requirements of this subtitle; and
Pays a fee set by the Board.
The Board shall include on each license that the Board issues a designation of licensed direct–entry midwife.
On receipt of the criminal history record information of an applicant for licensure forwarded to the Board in accordance with § 8–303 of this title, in determining whether to grant a license, the Board shall consider:
The age at which the crime was committed;
The circumstances surrounding the crime;
The length of time that has passed since the crime;
Subsequent work history;
Employment and character references; and
Other evidence that demonstrates whether the applicant poses a threat to the public health or safety.
The Board may not issue a license if the criminal history record information required under § 8–303 of this title has not been received.
A license issued under this subtitle authorizes the licensee to practice direct–entry midwifery while the license is active.
A license expires on a date set by the Board, unless the license is renewed for an additional term as provided in this section.
A license may not be renewed for a term longer than 2 years.
At least 3 months before a license expires, the Board shall send to the licensee a renewal notice by:
First–class mail to the last known mailing address of the licensee; or
Electronic means to the last known electronic address of the licensee.
A renewal notice shall state:
The date on which the current license expires;
The date by which the renewal application must be received by the Board for the renewal to be issued and mailed before the license expires; and
The amount of the renewal fee.
Except as otherwise provided in this subtitle, before a license expires, the licensee periodically may renew it for an additional term if the licensee:
Otherwise is entitled to be licensed;
Pays to the Board a renewal fee set by the Board; and
Submits to the Board:
A renewal application on the form that the Board requires; and
Satisfactory evidence of compliance with any continuing education or other competency requirements set under this subtitle for license renewal.
In addition to any other qualifications and requirements established by the Board for license renewal, the Board shall require:
20 accredited and Board–approved continuing education units to be completed every 2 years;
4 hours of peer review in accordance with NARM standards for official peer review to be completed every 2 years; and
Submission of the annual reports required under § 8–6C–10(a) of this subtitle.
Subject to subsection (l) of this section, the Board shall renew the license of each licensee who meets the requirements of this section.
The Board shall place a licensee on inactive status if the licensee:
Fails to provide satisfactory evidence of compliance with any continuing education requirements set under this section for license renewal; or
Fails to submit the annual report required under § 8–6C–10(a) of this subtitle.
The Board shall place a licensee on inactive status if the licensee submits to the Board:
An application for inactive status on the form required by the Board; and
The inactive status fee set by the Board.
The Board shall reactivate the license of an individual who is on inactive status if the individual:
Complies with any continuing education and data reporting requirements established by the Board for this purpose;
Pays to the Board a reactivation fee set by the Board; and
Is otherwise entitled to be licensed.
The Board, in accordance with its regulations, shall reinstate the license of an individual who has failed to renew the license for any reason if the individual:
Is otherwise entitled to be licensed;
Complies with any continuing education and data reporting requirements established by the Board for this purpose;
Pays to the Board a reinstatement fee set by the Board;
For an expired license or lapsed license that has been expired or lapsed for more than 1 year, completes a criminal history records check in accordance with § 8–303 of this title; and
Applies to the Board for reinstatement of the license within 5 years after the license expires.
The Board may not reinstate the license of a licensed direct–entry midwife who fails to apply for reinstatement of the license within 5 years after the license expires.
The individual may become licensed by meeting the current requirements for obtaining a new license under this subtitle.
A licensee shall submit to an additional criminal history records check every 12 years.
On receipt of the criminal history record information of a licensee forwarded to the Board in accordance with § 8–303 of this title, in determining whether to renew a license, the Board shall consider:
The age at which the crime was committed;
The circumstances surrounding the crime;
The length of time that has passed since the crime;
Subsequent work history;
Employment and character references; and
Other evidence that demonstrates whether the applicant poses a threat to the public health or safety.
The Board may not renew a license if the criminal history record information required under § 8–303 of this title has not been received.
Unless the Board agrees to accept the surrender of the license:
A licensed direct–entry midwife may not surrender a license; and
A license may not lapse by operation of law while the licensee is under investigation or while charges are pending against the licensee.
The Board may set conditions on an agreement with the licensed direct–entry midwife under investigation or against whom charges are pending to accept surrender of the license.
Subject to the hearing provisions of § 8–317 of this title, the Board may deny a license or grant a license, including a license subject to a reprimand, probation, or suspension, to an applicant, reprimand a licensee, place a licensee on probation, or suspend or revoke the license of a licensee if the applicant or licensee:
Fraudulently or deceptively obtains or attempts to obtain a license for the applicant or for another;
Fraudulently or deceptively uses a license;
Is disciplined by a licensing or disciplinary authority of any state or country, convicted or disciplined by a court of any state or country, or disciplined by any branch of the uniformed services or the U.S. Department of Veterans Affairs for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes;
Is convicted of or pleads guilty or nolo contendere to a felony or to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside;
Willfully and knowingly:
Files a false report or record of an individual under the licensee’s care;
Gives any false or misleading information about a material matter in an employment application;
Fails to file or record any health record that is required by law;
Obstructs the filing or recording of any health record as required by law; or
Induces another person to fail to file or record any health record as required by law;
Knowingly does any act that has been determined by the Board, in its regulations, to exceed the scope of practice authorized to the individual under this subtitle;
Provides professional services while:
Under the influence of alcohol; or
Using any narcotic or controlled dangerous substance, as defined in § 5–101 of the Criminal Law Article, or other drug that is in excess of therapeutic amounts or without valid medical indication;
Does an act that is inconsistent with generally accepted professional standards in the practice of direct–entry midwifery;
Is grossly negligent in the practice of direct–entry midwifery;
Has violated any provision of this title;
Submits a false statement to collect a fee;
Is physically or mentally incompetent;
Knowingly fails to report suspected child abuse in violation of § 5–704 of the Family Law Article;
Except in an emergency life–threatening situation where it is not feasible or practicable, fails to comply with the Centers for Disease Control and Prevention’s guidelines on universal precautions;
Is in independent practice and fails to display the notice required under § 8–6C–23 of this subtitle;
Is habitually intoxicated;
Is addicted to, or habitually abuses, any narcotic or controlled dangerous substance as defined in § 5–101 of the Criminal Law Article;
Fails to cooperate with a lawful investigation conducted by the Board;
Is expelled from the rehabilitation program established pursuant to § 8–208 of this title for failure to comply with the conditions of the program;
Engages in conduct that violates the professional code of ethics;
Is professionally incompetent;
Practices direct–entry midwifery without a license, before obtaining or renewing a license, including any period when the license has lapsed;
After failing to renew a license or after a license has lapsed, commits any act that would be grounds for disciplinary action under this section;
Violates regulations adopted by the Board or an order from the Board;
Performs an act that is beyond the licensee’s knowledge and skills;
Fails to submit to a criminal history records check in accordance with § 8–303 of this title;
When acting in a supervisory position, directs another licensed direct–entry midwife to perform an act that is beyond the licensed direct–entry midwife’s knowledge and skills; or
Fails to file a report required under this subtitle.
If, after a hearing under § 8–317 of this title, the Board finds that there are grounds under subsection (a) of this section to suspend or revoke a license, to reprimand a licensee, or to place a licensee on probation, the Board may impose a penalty not exceeding $5,000 instead of or in addition to suspending or revoking the license, reprimanding the licensee, or placing the licensee on probation.
Subject to paragraph (2) of this subsection, an individual whose license has been suspended or revoked by the Board shall return the license to the Board.
If a suspended or revoked license has been lost, the individual shall file with the Board a verified statement to that effect.
Unless authorized to practice direct–entry midwifery, an individual may not represent to the public by title, description of service, method, procedure, or otherwise, that the individual is authorized to practice direct–entry midwifery in the State.
A licensee may not advertise in a manner that is unreasonable, misleading, or fraudulent.
Unless authorized to practice direct–entry midwifery under this subtitle, an individual may not use the abbreviation “LDEM” or use the designation “licensed direct–entry midwife”.
Unless authorized to practice direct–entry midwifery under this subtitle or certified as a nurse midwife under this title, an individual may not use the designation “midwife”.
Except for any willful or grossly negligent act, a health care provider or emergency room personnel who work at a hospital, or emergency medical services providers or ambulance personnel, may not be held civilly liable for an action arising solely from an injury resulting from an act or omission of a licensed direct–entry midwife, even if the person has consulted with the licensed direct–entry midwife or accepted a referral from the licensed direct–entry midwife.
A health care practitioner who consults with a licensed direct–entry midwife or receives notification of a delivery under § 8–6C–02(b)(15) of this subtitle or the transfer of records under § 8–6C–02(b)(16) of this subtitle but who does not examine or treat a patient of the licensed direct–entry midwife may not be deemed to have created a physician–patient relationship with the patient.
This section does not apply to a violation of § 8–6C–10(a) of this subtitle.
A person who violates any provision of this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000 or imprisonment not exceeding 1 year or both.
This subtitle may be cited as the Maryland Licensure of Direct–Entry Midwives Act.
Subject to the evaluation and reestablishment provisions of the Maryland Program Evaluation Act, and subject to the termination of this subtitle under § 8–802 of this title, this subtitle and all regulations adopted under this subtitle shall terminate and be of no effect after July 1, 2030.