<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.64.01.04" title_num="10" subtitle_num="64" chapter_num="01" heading="Required Consultation.">
  <paragraph num="A.">
    <text>A licensed direct-entry midwife shall consult with a health care practitioner and document:</text>
    <paragraph num="(1)">
      <text>The consultation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The recommendations of the consultation; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The discussion of the consultation with the client if any of the following conditions are present during prenatal care:</text>
      <paragraph num="(a)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Second or third trimester bleeding;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Intermittent use of alcohol into the second trimester;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Asthma;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Diet-controlled gestational diabetes;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>History of genetic problems, intrauterine death after 20 weeks’ gestation, or stillbirth;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Abnormal Pap smear;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Possible ectopic pregnancy;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Tuberculosis;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Controlled hypothyroidism, being treated with thyroid replacement and euthyroid, and with thyroid test numbers in the normal range;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Rh sensitization with positive antibody titer;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Breech presentation between 35 and 38 weeks;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Transverse lie or other abnormal presentation between 35 and 38 weeks;</text>
      </paragraph>
      <paragraph num="(n)">
        <text>Premature rupture of membranes at 37 weeks or less;</text>
      </paragraph>
      <paragraph num="(o)">
        <text>Small for gestational age or large for gestational age fetus;</text>
      </paragraph>
      <paragraph num="(p)">
        <text>Polyhydramnios or oligohydramnios;</text>
      </paragraph>
      <paragraph num="(q)">
        <text>Previous LEEP procedure or cone biopsy;</text>
      </paragraph>
      <paragraph num="(r)">
        <text>Previous obstetrical problems, including uterine abnormalities, placental abruption, placenta accreta, obstetric hemorrhage, incompetent cervix, or preterm delivery for any reason;</text>
      </paragraph>
      <paragraph num="(s)">
        <text>Post-term maturity (41 0/7 to 6/7 weeks gestational age);</text>
      </paragraph>
      <paragraph num="(t)">
        <text>Inflammatory bowel disease, in remission; or</text>
      </paragraph>
      <paragraph num="(u)">
        <text>Primary herpes simplex virus, infection or any active infection at time of delivery.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Any changes in the plan of care following a consultation in accordance with §A of this regulation shall be documented in the patient’s plan of care.</text>
  </paragraph>
</regulation>