State Board of Pharmacy - Prescriber-Pharmacist Agreements
HB0838 revises Maryland’s licensure and practice rules for direct-entry midwives. The bill makes the practice of direct-entry midwifery expressly independent, meaning it does not require oversight by another health care practitioner except when a transfer or consultation is required under the subtitle. It also updates terminology throughout the law to use gender-neutral references such as “individual” instead of “woman,” and it expands and clarifies the scope of care midwives may provide, including antepartum, intrapartum, postpartum, and limited newborn services, lactation support, and family planning counseling.
The bill also modifies the clinical and administrative framework governing midwives. It revises when a midwife must transfer care or consult with a health care practitioner, updates lists of conditions that require transfer or consultation, and changes how emergency transport and handoff to hospitals are handled. It removes the prior annual reporting requirement to the Direct-Entry Midwifery Advisory Committee and instead subjects licensed direct-entry midwives to reporting requirements adopted by the Board in regulation, in consultation with stakeholders. The bill also broadens disciplinary authority by allowing the Board to grant licenses subject to reprimand, probation, or suspension, and it adds or clarifies grounds for discipline tied to scope-of-practice violations, failure to report, and other professional misconduct.
In state law, HB0838 amends multiple sections of the Health Occupations Article governing the Maryland Licensure of Direct-Entry Midwives Act. It changes statutory definitions, practice standards, transfer-of-care procedures, reporting obligations, and disciplinary provisions, and it extends the sunset date for the subtitle from July 1, 2025 to July 1, 2030. As a result, the direct-entry midwifery licensing program remains in effect for an additional five years under the Maryland Program Evaluation Act.
The general sentiment reflected by the bill text is supportive of expanding and modernizing the direct-entry midwifery framework while preserving safety-related safeguards. The bill appears designed to recognize independent midwifery practice and reduce unnecessary oversight, while still maintaining consultation, transfer, and emergency referral requirements for higher-risk situations. No committee transcripts or recorded votes were provided, so there is no additional evidence of floor or committee opposition or support beyond the enacted changes themselves.
The main points of contention suggested by the legislation are the balance between professional autonomy and medical oversight, and the extent to which midwives may manage higher-risk pregnancies or newborn complications. The bill narrows or clarifies some transfer triggers, removes some mandatory reporting to the advisory committee, and shifts reporting authority to the Board, which may be viewed as either streamlining regulation or reducing transparency depending on perspective. Stakeholders likely include licensed direct-entry midwives, the State Board of Nursing, physicians, nurse-midwives, pediatric providers, hospitals, and families seeking out-of-hospital births.
HB0838 amends the Health Occupations Article provisions governing licensed direct-entry midwives, changing practice standards, consultation and transfer requirements, reporting obligations, and disciplinary authority. It also extends the sunset date for the Maryland Licensure of Direct-Entry Midwives Act to July 1, 2030, thereby continuing the licensing program and associated regulations for another five years. The bill affects licensed direct-entry midwives, the State Board of Nursing, the Direct-Entry Midwifery Advisory Committee, and related health care practitioners involved in consultation, transfer, and newborn follow-up care.
The bill’s overall tone is reform-oriented and permissive toward independent direct-entry midwifery practice, while still retaining safety and referral requirements. The statutory changes suggest a policy preference for clearer scope of practice, less prescriptive oversight, and updated terminology. Because no committee testimony or vote record was provided, there is no documented public debate in the supplied materials, but the text itself indicates a generally supportive posture toward the profession with continued regulatory guardrails.
The most likely areas of contention are whether direct-entry midwives should practice independently without oversight, how broad their scope of practice should be, and how much reporting should be required to state regulators. Another possible point of disagreement is the bill’s handling of higher-risk conditions and emergency transfer triggers, including congenital anomalies, anemia, BMI thresholds, and other medical complications. Supporters would likely emphasize autonomy, access to out-of-hospital birth care, and modernization of the statute, while critics may focus on patient safety, hospital coordination, and the adequacy of oversight and reporting.