Md. Code Regs. 10.64.01.05

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.64.01.05 - Required Transfer of Care

A. Except for §B of this regulation, a licensed direct-entry midwife shall arrange immediate emergency transfer to a hospital if:

(1) The patient requests transfer; or

(2) The patient or newborn is determined to have any of the following conditions during labor, delivery, or the immediate postpartum period:

(a) Unforeseen noncephalic presentation;

(b) Unforeseen multiple gestation;

(c) Nonreassuring fetal heart rate or pattern, including:

(i) Tachycardia

(ii) Bradycardia;

(iii) Significant change in baseline; or

(iv) Persistent late or severe variable decelerations;

(d) Prolapsed cord;

(e) Unresolved maternal hemorrhage;

(f) Retained placenta;

(g) Signs of fetal or maternal infection;

(h) Patient with a third or fourth degree laceration or a laceration beyond the licensed direct-entry midwife's ability to repair;

(i) Apgar of less than seven at 5 minutes;

(j) Obvious congenital anomalies;

(k) Need for chest compressions during neonatal resuscitation;

(I) Newborn with persistent central cyanosis;

(m) Newborn with persistent grunting and retractions;

(n) Newborn with abnormal vital signs;

(o) Gross or thick meconium staining, when discovered; or

(p) Newborn with excessive dehydration due to inability to feed.

B. If transfer is not possible because of imminent delivery, the licensed direct-entry midwife shall consult with a health care provider for guidance on further management of the patient and to determine when transfer may be safely arranged, if required.

C. A licensed direct-entry midwife shall immediately transfer the care of a patient to a health care provider for the treatment of any significant postpartum morbidity, including:

(1) Uncontrolled postpartum hemorrhage;

(2) Preeclampsia;

(3) Thrombo-embolism;

(4) An infection; or

(5) A postpartum mental health disorder.

D. A licensed direct-entry midwife who is required to transfer care of a patient under this regulation may continue other aspects of postpartum care in consultation with the treating health care practitioner.

Md. Code Regs. 10.64.01.05

Regulations .05 adopted effective 43:25 Md. R. 1384, eff. 12/19/2016