Chapter 05. Practice of Nurse Midwifery
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“ACME” means the Accreditation Commission for Midwifery Education.
(2)
“ACNM” means the American College of Nurse Midwives.
(3)
“Advanced practice registered nurse (APRN)” means a registered nurse who is certified by the Board as:
(a)
A certified nurse midwife (CNM);
(b)
A certified registered nurse anesthetist (CRNA);
(c)
A certified nurse practitioner (CRNP); or
(d)
A clinical nurse specialist (CNS).
(4)
“AMCB” means the American Midwifery Certification Board.
(5)
“Board” means the Board of Nursing.
(6)
“Certification” means the permission to practice nurse midwifery granted by the Board to a registered nurse who has:
(a)
Met all the specified requirements of a national certifying body recognized by the Board; and
(b)
Complied with the requirements of this chapter.
(7)
“Certified nurse midwife” means an advanced practice registered nurse who is certified by the Board to practice nurse midwifery in this State.
(8)
“Clinical practice guidelines” standards for practice of midwifery using current guidelines established by ACNM in Standards for the Practice of Midwifery.
(9)
“Delegated medical functions” means those functions that come within the definition of “practice medicine” in the Health Occupations Article, §14-101, Annotated Code of Maryland, that have been delegated to a certified nurse midwife to perform.
(10)
“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.
(11)
“Newborn” means an infant in the first 28 days after birth.
(12)
“Nurse midwifery” means the health care management of newborns and clients throughout their reproductive life cycle.
(13)
“Physician” means an individual licensed to practice medicine in this State.
(14)
“Registered nurse (RN)” means an individual who:
(a)
Is licensed by the Board to practice registered nursing; or
(b)
Has a multistate licensure privilege to practice registered nursing.
Regulation .02 Certification.LinkCopy Citation
A.
An applicant for certification as a nurse midwife shall:
(1)
Hold a current Maryland license in good standing to practice registered nursing or a multistate licensure privilege to practice registered nursing;
(2)
Have graduated from a Board-approved graduate level program for nurse midwives at the Masters’ level or higher that is accredited by:
(a)
The National League for Nursing Accreditation Commission (NLNAC);
(b)
The Commission on Nursing Education (CCNE);
(c)
ACME; or
(d)
Any other accrediting body recognized by the Board;
(3)
Hold a current national certification as a nurse midwife from the AMCB or any other national certifying body recognized by the Board;
(4)
Submit to the Board a completed application for certification as a nurse midwife;
(5)
Submit an affidavit that the applicant agrees to comply at all times with the clinical practice guidelines in accordance with Regulation .01B(8) of this chapter when providing clinical midwifery services;
(6)
Comply with all the requirement set forth in COMAR 10.27.01.04;
(7)
Demonstrate written and oral competency in the English language; and
(8)
Pay all fees.
B.
If the applicant’s nurse midwifery program was completed before July 1, 2014, and was not at a Master’s degree or higher level, but the applicant otherwise qualifies for certification, the applicant shall provide the Board with:
(1)
Verification of completion of a nurse midwifery program recognized by AMCB; and
(2)
Current national certification by AMCB or any other national certifying body recognized by the Board.
Regulation .03 Duties of the Board.LinkCopy Citation
The Board shall:
A.
Maintain an up-to-date list of all certified nurse midwives in this State; and
B.
Include on the nurse midwife's registered nursing license an indication that the licensee is certified as a nurse midwife.
Regulation .04 Required Documentation.LinkCopy Citation
A.
A certified nurse midwife who provides clinical midwifery services across the reproductive lifespan shall:
(1)
Maintain a medical record for each client; and
(2)
In the case of a transfer of care to another provider or a facility, transfer the client’s medical records with the client.
B.
A certified nurse midwife who provides clinical midwifery services shall have available at all times for examination by the Board, written clinical practice guidelines that cover all aspects of care, practice, and quality assurance, including but not limited to:
(1)
A plan for emergency consultation;
(2)
A plan for transfer of care; and
(3)
If needed, a plan for admission of the client or newborn to a hospital within the client’s geographic area.
Regulation .05 Practice Before Certification.LinkCopy Citation
A.
A registered nurse who meets the qualifications to sit for the AMCB national certifying examination or any other certifying examination approved by the Board who has taken that examination and is waiting for the results of it may practice as a nurse midwife graduate before certification if the:
(1)
Practice is under the supervision of a certified nurse midwife who shall be physically available to the nurse midwife graduate;
(2)
Supervising certified nurse midwife signs a written supervision agreement on the required form to provide the supervision; and
(3)
Nurse midwife graduate files with the Board a copy of the admission slip to the Board-approved certifying examination and a copy of the signed supervision agreement.
B.
A nurse midwife graduate who has entered into a supervision agreement under this regulation shall immediately notify the Board and the supervising certified nurse midwife of the results of the Board-approved certifying examination.
C.
A nurse midwife graduate may not continue to practice under a supervision agreement under this regulation for more than 1 year from the filing of all documents required under §A of this regulation, or after the denial of AMCB or other Board-approved certification, whichever occurs first.
Regulation .06 Scope of Practice.LinkCopy Citation
A.
A certified nurse midwife who meets the requirements of Regulation .02 of this chapter may perform the following functions:
(1)
Independent management of clients appropriate to the skill and educational preparation of the certified nurse midwife and the nurse midwife's clinical practice guidelines;
(2)
Consult or collaborate with a physician or other health care provider as needed; and
(3)
Refer clients with complications beyond the scope of practice of the certified nurse midwife to a licensed physician.
B.
A certified nurse midwife shall keep a record of all cases attended and maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.
C.
A certified nurse midwife has the right and obligation to refuse to perform any delegated medical act, oral or written, if, in the certified nurse midwife’s judgment, it is unsafe or an invalidly prescribed medical act or beyond the competence of the certified nurse midwife, in which case the nurse midwife shall notify the delegating physician at once.
D.
A certified nurse midwife shall comply with applicable State and federal law.
Regulation .07 Nurse Midwife Peer Review Advisory Committee. — Repealed.LinkCopy Citation
Regulation .08 Renewal of Certification.LinkCopy Citation
A.
Certification as a nurse midwife expires at the same time as the nurse midwife's registered nursing license unless the certification is renewed.
B.
Before a nurse midwife’s certification expires, the nurse midwife may renew the certification biennially if the nurse midwife:
(1)
Is otherwise entitled to be certified;
(2)
Submits to the Board:
(a)
Documentation of a current national certification as a nurse midwife from AMCB or another national certifying body recognized by the Board; and
(b)
A completed renewal application on the form that the Board requires; and
(3)
Pays all fees.
C.
Certified nurse midwife renewal applicants who are authorized to practice registered nursing in this State under a multistate licensure privilege shall be periodically required to submit to a criminal history records check in accordance with the schedule and requirements set forth in COMAR 10.27.01.13J — N.
D.
The certified nurse midwife shall ensure that the Board has a record of the renewed national certification if the national certification expires before the registered nurse license renewal date.
E.
Certification as a nurse midwife shall be deemed to have lapsed if the Board does not have a record of a current active national certification.
F.
Practicing on an expired national certification is prohibited and subject to discipline under Health Occupations Article, §8-316(a), Annotated Code of Maryland.
Regulation .09 Compliance.LinkCopy Citation
The certified nurse midwife shall develop and comply with clinical practice guidelines as defined in Regulation .01B of this chapter.
Regulation .10 Unlawful Practices.LinkCopy Citation
Pursuant to Health Occupations Article, Title 8, Subtitle 7, Annotated Code of Maryland, an individual may not:
A.
Practice nurse midwifery unless certified under these regulations or otherwise permitted by law to engage in those activities;
B.
Use the title nurse midwife, certified nurse midwife, or any other similar designation unless certified by the AMCB, or other certifying body approved by the Board; or
C.
Use the title certified nurse midwife unless certified by the Board.
Regulation .11 Prescribing of Substances by a Certified Nurse Midwife.LinkCopy Citation
Pursuant to Health Occupations Article, §8-601, Annotated Code of Maryland, a certified nurse midwife may prescribe:
A.
Substances commonly used in the practice of nurse midwifery; and
B.
Controlled substances on Schedules II-V under Criminal Law Article, §§5-403 — 5-406, Annotated Code of Maryland, commonly used in the practice of nurse midwifery; and
C.
Dispense substances prescribed in accordance with §§A and B of this regulation in the course of treating a client at a:
(1)
Nonprofit medical facility or clinic;
(2)
Health center operating on the campus of an institution of higher learning;
(3)
Public health facility;
(4)
Medical facility under contract with a State or local health department; or
(5)
Facility funded with public funds.
Chapter annotations
Authority: Health Occupations Article, §§8-101, 8-205, and 8-601—8-603, Annotated Code of Maryland
History: Effective date:
History: Regulations .01—.10 adopted as an emergency provision effective March 14, 1983 (10:11 Md. R. 970); emergency status expired July 13, 1983; adopted permanently effective October 10, 1983 (10:20 Md. R. 1787)
History: Regulation .01 amended effective September 2, 1991 (18:17 Md. R. 1919); April 10, 1995 (22:7 Md. R. 536); June 26, 2000 (27:12 Md. R. 1140)
History: Regulation .01B amended effective March 1, 2004 (31:4 Md. R. 316)
History: Regulation .02 amended effective April 10, 1995 (22:7 Md. R. 536); June 26, 2000 (27:12 Md. R. 1140)
History: Regulation .02B amended effective September 2, 1991 (18:17 Md. R. 1919)
History: Regulation .02 repealed and new Regulation .02 adopted effective March 1, 2004 (31:4 Md. R. 316)
History: Regulation .03 repealed effective February 15, 1993 (20:3 Md. R. 259)
History: Regulation .04 repealed effective April 10, 1995 (22:7 Md. R. 536)
History: Regulation .05 amended effective February 15, 1993 (20:3 Md. R. 259); April 10, 1995 (22:7 Md. R. 536); June 26, 2000 (27:12 Md. R. 1140)
History: Regulation .06 amended effective April 10, 1995 (22:7 Md. R. 536)
History: Regulation .06C amended effective March 1, 2004 (31:4 Md. R. 316)
History: Regulation .07 amended effective April 10, 1995 (22:7 Md. R. 536); March 1, 2004 (31:4 Md. R. 316)
History: Regulation .07B amended effective February 15, 1993 (20:3 Md. R. 259)
History: Regulation .08 amended effective February 15, 1993 (20:3 Md. R. 259); April 10, 1995 (22:7 Md. R. 536)
History: Regulation .09 amended effective February 15, 1993 (20:3 Md. R. 259); April 10, 1995 (22:7 Md. R. 536); June 26, 2000 (27:12 Md. R. 1140)
History: Regulation .10 amended effective April 10, 1995 (22:7 Md. R. 536)
History: Regulation .11 adopted effective September 2, 1991 (18:17 Md. R. 1919)
History: Regulation .11 amended effective April 10, 1995 (22:7 Md. R. 536); March 1, 2004 (31:4 Md. R. 316)
History: Chapter revised as an emergency provision effective January 1, 2010 (37:6 Md. R. 474); revised permanently effective June 28, 2010 (37:13 Md. R. 852)
History: Chapter revised effective September 29, 2014 (41:19 Md. R. 1079)
History: Regulation .01B amended effective July 2, 2018 (45:13 Md. R. 667); October 13, 2025 (Md. R. 1001)
History: Regulation .02 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .06B amended effective October 13, 2025 (Md. R. 1001)
History: Regulation .06D adopted effective October 13, 2025 (Md. R. 1001)
History: Regulation .07 repealed effective February 22, 2026 (52:17 Md. R. 875)
History: Regulation .08 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .09 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .10 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .11 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Annotation: COMAR 10.11 Midwifery was replaced by COMAR 10.27.05 Practice of Nurse Midwifery
History: Annotation: COMAR 10.11 Midwifery adopted effective February 1, 1957; repealed effective July 12, 1987 (14:14 Md. R. 1572)