SB 854 — Health Occupations: Licensed Direct‑Entry Midwives — Revisions (Chapter 644, 2025)
Status & key dates
- Enacted as Chapter 644 (2025). Approved by the Governor: October 1, 2025.
- Effective date reported in the fiscal analysis: June 1, 2025.
- Companion/related: HB 3172 / HB 838.
Purpose
- To update and clarify the statutory scope of practice, regulatory responsibilities, and oversight/discipline provisions for licensed direct‑entry midwives (DEMs) in Maryland, and to extend the statutory sunset for the licensure program.
Main changes and provisions
- Independent practice: The statute explicitly states that the practice of direct‑entry midwifery is independent and does not require oversight by another health care practitioner.
- Scope of practice: Revises and reorganizes the statutory list of activities that constitute “practice of direct‑entry midwifery,” including antepartum, intrapartum, postpartum and newborn care consistent with national DEM standards. Removes the requirement that a DEM notify a pediatric practitioner “at onset of active labor.”
- Patient definition: Changes “patient” language to use gender‑neutral “individual” and clarifies inclusion of the newborn for perinatal/postpartum care.
- Transfer vs. consultation thresholds:
- Prescribes more specific measures for certain conditions (for example, “severe anemia” defined as hemoglobin < 10 g/dL measured after treatment or based on testing at/after 36 weeks).
- Removes some conditions from the mandatory transfer list (e.g., Rh sensitization with positive titer, certain systemic/rare diseases, and specified BMI thresholds) and instead requires consultation in some cases.
- Adds conditions requiring consultation (e.g., prepregnancy BMI <18.5 or ≥35; significant fetal congenital anomaly that affects delivery or immediate care as defined by Board regulation).
- Emergency hospital transfer: Clarifies that emergency transfer is required for newborns or patients with significant congenital anomalies that directly affect delivery or require immediate emergency care (as determined by Board regulation).
- Written plans and transfers: Modifies required written plans and timing for newborn/pediatric follow‑up — e.g., routine newborn care and required screenings, transfer of records and referral to a pediatric practitioner within 72 hours after delivery.
- Reporting requirement repealed: Eliminates a statutory reporting obligation to the Direct‑Entry Midwifery Advisory Committee.
- Discipline and licensing: Clarifies the disciplinary actions the State Board of Nursing (MBON) may take against applicants or licensed DEMs for statutory violations.
- Sunset extension: Extends the termination date for the Maryland Licensure of Direct‑Entry Midwives Act by five years to July 1, 2030.
- Technical and conforming edits: Various stylistic and conforming statutory changes.
Who is affected
- Licensed direct‑entry midwives and DEM applicants (practice autonomy, clinical responsibilities, and regulatory compliance).
- The State Board of Nursing (regulatory authority, rulemaking discretion to define certain conditions).
- Patients/clients and newborns receiving out‑of‑hospital and perinatal care.
- Hospitals, pediatric practitioners, and emergency transport systems (transfer protocols and coordination).
- Direct‑Entry Midwifery Advisory Committee (reduced reporting obligations).
Fiscal and practical impact
- Fiscal note: Changes are primarily technical and are not expected to materially affect State or local government finances. Small business impact is minimal.
- Regulatory impact: MBON will implement regulatory clarifications (e.g., defining “significant fetal congenital anomaly”) and adjust required written policies/procedures and peer‑review processes as needed.
Bottom line
SB 854 modernizes and clarifies Maryland’s statutory framework for licensed direct‑entry midwives by affirming independent practice, adjusting clinical thresholds for consultation vs. transfer, removing a reporting duty, refining newborn care/transfer timing, clarifying disciplinary authority, and extending the licensing program’s sunset for continued oversight and evaluation.
