.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, §8-6C-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).