Regulation .03 Scope of Practice — Prohibitions.
Regulation .03 Scope of Practice — Prohibitions.LinkCopy Citation
A.
The practice of direct-entry midwifery does not include:
(1)
Pharmacological induction or augmentation of labor or artificial rupture of membranes before the onset of labor;
(2)
Surgical delivery or any surgery except an emergency episiotomy;
(3)
Use of forceps or vacuum extractor;
(4)
Except for the administration of a local anesthetic, administration of an anesthetic;
(5)
Administration of any kind of narcotic analgesic; or
(6)
Administration of any prescription medication not authorized in accordance with Regulation .07 of this chapter.
B.
A licensed direct-entry midwife may not assume care or continue to take responsibility for a patient’s pregnancy and birth care if a finding of any of the disorders or situations listed under §C of this regulation is found to be present:
(1)
At the initial interview;
(2)
During an examination of the patient;
(3)
While obtaining a patient history or at subsequent prenatal visits;
(4)
As a result of a laboratory or other test; or
(5)
After consultation with another health care practitioner.
C.
If any of the following disorders or situations exist, the licensed direct-entry midwife shall arrange for the orderly transfer of care to a health care practitioner:
(1)
Diabetes mellitus, including uncontrolled gestational diabetes;
(2)
Hyperthyroidism treated with medication;
(3)
Uncontrolled hypothyroidism;
(4)
Epilepsy with seizures or antiepileptic drug use during the previous 12 months;
(5)
Coagulation disorders;
(6)
Chronic pulmonary disease;
(7)
Heart disease in which there are arrhythmias or murmurs except when, after evaluation, it is the opinion of a physician licensed under Health Occupations Article, Title 14, Annotated Code of Maryland, or a licensed nurse certified as a nurse-midwife or a nurse practitioner under Health Occupations Article, Title 8, Annotated Code of Maryland, that midwifery care may proceed;
(8)
Hypertension, including pregnancy-induced hypertension (PIH);
(9)
Renal disease;
(10)
Except as otherwise provided in Health Occupations Article, §8-6C-04(a)(11), Annotated Code of Maryland, Rh sensitization with positive antibody titer;
(11)
Previous uterine surgery, including a cesarean section or myomectomy;
(12)
Indications that the fetus has died in utero;
(13)
Premature labor (gestation less than 37 weeks);
(14)
Multiple gestation;
(15)
Noncephalic presentation at or after 38 weeks;
(16)
Placenta previa or abruption;
(17)
Preeclampsia;
(18)
Severe anemia, defined as hemoglobin less than 10 g/dL;
(19)
Uncommon diseases and disorders, including:
(a)
Addison’s disease;
(b)
Cushing’s disease;
(c)
Systemic lupus erythematosus;
(d)
Antiphospholipid syndrome;
(e)
Scleroderma;
(f)
Rheumatoid arthritis;
(g)
Periarteritis nodosa;
(h)
Marfan’s syndrome; and
(i)
Other systemic and rare diseases and disorders, as determined by the Department;
(20)
AIDS/HIV;
(21)
Hepatitis A through G and non-A through G;
(22)
Acute toxoplasmosis infection, if the patient is symptomatic;
(23)
Acute Rubella infection during pregnancy;
(24)
Acute cytomegalovirus infection, if the patient is symptomatic;
(25)
Acute Parvovirus infection, if the patient is symptomatic;
(26)
Alcohol abuse, substance abuse, or prescription abuse during pregnancy;
(27)
Continued daily tobacco use into the second trimester;
(28)
Thrombosis;
(29)
Inflammatory bowel disease that is not in remission;
(30)
Primary herpes simplex virus, genital infection during pregnancy, or any active genital lesions at the time of delivery;
(31)
Significant fetal congenital anomaly;
(32)
Ectopic pregnancy;
(33)
Prepregnancy body mass index (BMI) of less than 18.5 or 35 or more; or
(34)
Post term maturity (gestational age 42 0/7 weeks and beyond).