Regulation .02 Scope of Practice.
Regulation .02 Scope of Practice.LinkCopy Citation
The practice of direct-entry midwifery includes:
A.
Providing the necessary supervision, care, and advice to a patient during a low-risk pregnancy, labor, delivery, and postpartum period;
B.
Newborn care authorized under Health Occupations Article, §8-6C-02, Annotated Code of Maryland, provided in a manner that is:
(1)
Consistent with national direct-entry midwifery standards; and
(2)
Based on the acquisition of clinical skills necessary for the care of pregnant women and newborns, including antepartum, intrapartum, and postpartum care;
C.
Obtaining informed consent to provide services to the patient;
D.
Discussing:
(1)
Any general risk factors associated with the services to be provided;
(2)
Any specific risk factors pertaining to the health and circumstances of the individual patient;
(3)
Conditions that preclude care by a licensed direct-entry midwife; and
(4)
The conditions under which consultation, transfer of care, or transport of the patient must be implemented;
E.
Obtaining a health history of the patient, including a travel history, and performing a physical examination;
F.
Developing a written plan of care specific to the patient, to ensure continuity of care throughout the antepartum, intrapartum, and postpartum periods that includes:
(1)
A plan for the management of any specific risk factors pertaining to the individual health and circumstances of the individual patient; and
(2)
A plan to be followed in the event of an emergency, including a plan for transportation;
G.
Evaluating the results of patient care;
H.
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;
I.
Referral of all patients, within 72 hours after delivery, to a pediatric health care practitioner for care of the newborn;
J.
As approved by the Board, in accordance with Regulation .08 of this chapter:
(1)
Obtaining and administering medications; and
(2)
Obtaining and using equipment and devices;
K.
Obtaining appropriate screening and testing, including laboratory tests, urinalysis, and ultrasound;
L.
Providing prenatal care during the antepartum period, with consultation or referral as required;
M.
Providing care during the intrapartum period, including:
(1)
Monitoring and evaluating the condition of the patient and fetus;
(2)
At the onset of active labor notifying the pediatric health care practitioner, by any electronic device, that delivery is imminent;
(3)
Performing emergency procedures, including:
(a)
Administering approved medications;
(b)
Administering intravenous fluids for stabilization;
(c)
Performing an emergency episiotomy; and
(d)
Providing care while on the way to a hospital under circumstances in which emergency medical services have not been activated;
(4)
Activating emergency medical services for an emergency; and
(5)
Delivering in an out-of-hospital setting;
N.
Participating in peer review as required under Regulation .16 of this chapter;
O.
Providing care during the postpartum period, including:
(1)
Suturing of first and second degree perineal or labial lacerations or suturing of an episiotomy with the administration of a local anesthetic; and
(2)
Making further contact with the patient within 48 hours, within 2 weeks, and at 6 weeks after the delivery to assess for:
(a)
Hemorrhage;
(b)
Preeclampsia;
(c)
Thrombo-embolism;
(d)
Infection; and
(e)
Emotional well-being;
P.
Providing routine care for the newborn for up to 72 hours after delivery, exclusive of administering immunizations, including:
(1)
Immediate care at birth, including:
(a)
Resuscitating as needed;
(b)
Performing a newborn examination; and
(c)
Administering intramuscular vitamin K and eye ointment for prevention of ophthalmia neonatorum;
(2)
Assessing newborn feeding and hydration;
(3)
Performing metabolic screening and reporting on the screening in accordance with COMAR 10.52.12;
(4)
Performing critical congenital heart disease screening and reporting on the screening in accordance with COMAR 10.52.12;
(5)
If unable to perform the screening required under §P(3) or (4) of this regulation, referring the newborn to a pediatric health care practitioner to perform the screening within 24 to 48 hours after delivery;
(6)
Administering any other required newborn test, medication, or treatment required by the Department if authorized by the formulary in Regulation .07 of this chapter; and
(7)
Referring the infant to an audiologist for a hearing screening in accordance with COMAR 10.52.12;
Q.
Within 24 hours after delivery, notifying a pediatric health care practitioner, by any electronic device, of the delivery;
R.
Within 72 hours after delivery:
(1)
Referring the newborn to a pediatric health care practitioner; and
(2)
Transferring health records to the pediatric health care practitioner, including documentation of the performance of the screenings required under this regulation;
S.
Providing the following care of the newborn beyond the first 72 hours after delivery:
(1)
Weight checks and general observation of the newborn’s activity, with abnormal findings communicated to the newborn’s pediatric health care practitioner;
(2)
Assessment of newborn feeding and hydration; and
(3)
Breastfeeding support and counseling; and
T.
Providing limited services to the patient after the postpartum period, including:
(1)
Breastfeeding support and counseling; and
(2)
Counseling and referral for all family planning methods.