SB 854 revises Maryland’s licensing framework for direct-entry midwives. The bill expands and clarifies the scope of practice for licensed direct-entry midwives, including updated definitions that use gender-neutral language for patients and newborns, and it expressly states that direct-entry midwifery is an independent practice that does not require oversight by another health care practitioner except when consultation or transfer of care is required by law. It also updates the services midwives may provide, including antepartum, intrapartum, postpartum, and limited newborn care, while preserving prohibitions on higher-risk or more invasive procedures such as surgical delivery, forceps or vacuum use, narcotic analgesics, and most anesthesia.
The bill also revises the conditions that require transfer of care or consultation, including pregnancy-related medical risks, severe anemia, significant fetal congenital anomalies, and other specified maternal or fetal conditions. It changes transfer and documentation requirements, including how records are shared with receiving providers and how emergency transport plans are handled. In addition, it removes the prior annual reporting mandate to the Direct-Entry Midwifery Advisory Committee and instead subjects licensed midwives to reporting requirements adopted by the Board in regulation, in consultation with stakeholders.
SB 854 further modifies disciplinary authority by allowing the Board to deny, grant with conditions, reprimand, place on probation, suspend, or revoke a license, and it adds or clarifies grounds for discipline tied to reporting failures, scope-of-practice violations, incompetence, and other professional misconduct. The bill also extends the sunset date for the Maryland Licensure of Direct-Entry Midwives Act from July 1, 2025 to July 1, 2030, continuing the statutory framework for the profession for another five years.
The overall sentiment appears strongly favorable. The bill passed the Senate unanimously and the House by a substantial margin, indicating broad legislative support for modernizing and continuing the direct-entry midwifery licensing system. No committee transcript excerpts were provided, so the available record suggests little visible opposition in the recorded votes.
The main points of contention, based on the statutory changes themselves, are likely the bill’s move toward greater professional independence for direct-entry midwives and the reduction of prescriptive reporting requirements to the advisory committee. At the same time, the bill preserves and in some cases sharpens safety-related transfer, consultation, and disciplinary provisions, suggesting an effort to balance midwifery autonomy with oversight and patient safety. Any disagreement would most likely center on how much independence midwives should have, what conditions should trigger mandatory transfer of care, and how much reporting the Board should require.
SB 854 amends Title 8, Subtitle 6C of the Health Occupations Article governing licensed direct-entry midwives. It updates definitions, scope-of-practice provisions, consultation and transfer rules, emergency planning requirements, reporting obligations, and disciplinary standards, while extending the subtitle’s sunset date to July 1, 2030. The bill affects licensed direct-entry midwives, the State Board of Nursing, the Direct-Entry Midwifery Advisory Committee, hospitals, pediatric providers, and patients receiving out-of-hospital maternity care.
The bill’s recorded legislative history shows strong support: it passed the Senate 44-0 and the House 110-27. That voting pattern suggests broad bipartisan acceptance of the revisions and of continuing the licensure program. With no committee transcript excerpts available, the public record here reflects a generally favorable and relatively low-conflict bill, though the House vote indicates some dissent remained.
The most notable policy tension is between expanding midwives’ independent practice and maintaining safeguards through consultation, transfer, and emergency referral requirements. Supporters appear to favor modernizing the profession, reducing outdated reporting burdens, and clarifying authority for direct-entry midwives. Potential critics would likely focus on patient safety, the adequacy of oversight, and whether the bill gives midwives too much autonomy in managing low-risk births and responding to complications. The revised discipline and reporting provisions suggest lawmakers tried to address those concerns by preserving Board oversight and enforcement authority.