Md. Code Regs. 10.64.01.03

Current through Register Vol. 51, No. 25, December 13, 2024
Section 10.64.01.03 - Scope of Practice - Prohibitions
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, § 8-6 C-04(a)(ll), 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).

Md. Code Regs. 10.64.01.03

Regulations .03 adopted effective 43:25 Md. R. 1384, eff. 12/19/2016