<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.05.02.07" title_num="10" subtitle_num="05" chapter_num="02" heading="Clinical Practice Guidelines.">
  <paragraph num="A.">
    <text>The clinical director and director of midwifery shall develop clinical practice guidelines for the management of routine and emergency care of the patient and the fetus or newborn during pregnancy, birth, and postpartum through discharge, whether through completion of the pregnancy or referral or transfer to other levels of care.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The clinical practice guidelines shall include, at a minimum, procedures for the:</text>
    <paragraph num="(1)">
      <text>Transfer of patients or newborns for appropriate hospital obstetric and newborn care;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Monitoring of fetal heart tones consistent with the current standards of care; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Use of ultrasound imaging that is:</text>
      <paragraph num="(a)">
        <text>Consistent with the current standards of care; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Within the scope of practice for a:</text>
        <paragraph num="(i)">
          <text>Physician;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Certified nurse midwife; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Licensed certified midwife.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The administrator shall:</text>
    <paragraph num="(1)">
      <text>Ensure that all clinical practice guidelines are fully implemented by the clinical staff;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Periodically review the non-clinical policies and revise them when necessary; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Make the [protocols] clinical practice guidelines available to staff for reference on site at all times.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A licensed direct-entry midwife, certified nurse midwife, and licensed certified midwife practicing in a birthing center shall remain in compliance with applicable practice guidelines including but not limited to:</text>
    <paragraph num="(1)">
      <text>Health Occupations Article, §8-6C-08, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>COMAR 10.64.01.10;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>COMAR 10.27.05.04; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>COMAR 10.27.05.01(a)(8).</text>
    </paragraph>
  </paragraph>
</regulation>