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Author: Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Council of Licensed Midwifery

Midwifery is governed by the Council of Licensed Midwifery. The members are appointed by the State Surgeon General. The Council assists and advises in developing rules related to training, competency, licensure exam, fees, midwives’ responsibilities, records and reports. They also educate the public, collect and review data, recommend changes to the practice act, and address concerns.¹

The Midwifery Practice Act is very specific and restrictive in actions allowable by midwives.

Licensure

To be licensed to practice midwifery, applicants must have graduated from an approved program, passed the exam and pay licensure fees. Licenses are renewed every two years and require completion of continuing education. A license can be obtained by endorsement for midwives licensed or trained elsewhere if the council determines that the applicant has met training and examination standards.^1,2

There is also a mechanism to inactivate and reactive a license.

Informed Consent Plan

A licensed midwife shall include in the informed consent plan presented to the parents the status of the midwife’s malpractice insurance, including the amount of malpractice insurance, if any.^1,3

The required form to be used for every patient is Informed Consent for Licensed Midwifery Services, Form DH-MQA 1047, revised 3/01, which is hereby adopted and incorporated by reference and can be obtained from the Council of Licensed Midwifery, 4052 Bald Cypress Way, BIN #C06, Tallahassee, Florida 32399-3256.₂

Emergency care plan; immunity

Every licensed midwife shall develop a written plan for the appropriate delivery of emergency care. A copy of the plan shall accompany any application for license issuance or renewal. The plan includes¹:

Consultation with other health care providers
Emergency transfer
Access to neonatal intensive care units and obstetrical units or other patient care areas

467.017 (2) Any physician licensed under chapter 458 or chapter 459, or any certified nurse midwife, or any hospital licensed under chapter 395, or any osteopathic hospital, providing medical care or treatment to a woman or infant due to an emergency arising during delivery or birth as a consequence of the care received by a midwife licensed under chapter 467 shall not be held liable for any civil damages as a result of such medical care or treatment unless such damages result from providing, or failing to provide, medical care or treatment under circumstances demonstrating a reckless disregard for the consequences so as to affect the life or health of another.¹

Continuing Education

The council approves companies that can provide continuing education, like CEUFast.com.

Subject Area⁴	Required Hours	Important Information
General Hours	16	Must have clinical relevance to the practice of midwifery.
Prevention of Medical Errors	2	This course is required for all licensed health care practitioners per section 456.013(7), Florida Statues.
Laws and Rules	1	Course covering the Medical Practice Act (345, F.S.), the Midwifery Practice Act (467, F.S.), and Rule Title 64B24, Florida Administrative Code.
HIV/AIDS	1	Course should include information on current Florida law on acquired immune deficiency syndrome and its impact on testing, confidentiality of test results, treatment of patients, and any protocols and procedures applicable to human immunodeficiency virus counseling and testing, reporting, the offering of HIV testing to pregnant women, and partner notification issues pursuant to ss. 381.004, F.S., and 384.25, F.S.
Total Hours	20

Two hours of Domestic Violence is required every third biennium (every six years) in addition to the 20 required hours above.

Five hours of continuing education credit can be earned by providing pro bono services for indigent persons or underserved populations in areas of critical need within the state.^{1, 2}

A presenter of a continuing education program may receive the same credit as a participant on a one-time basis. To receive this credit, the presenter must have developed the program, been in attendance for the entire program, and received documentation of completion from the approved provider. Only three hours of continuing education credit per biennium can be earned this way.¹

Risk Assessment

A risk assessment must be done by the licensed midwife before accepting a patient and during care.

If the risk factor score reaches 3 points, the midwife shall consult with a physician who has obstetrical hospital privileges and if there is a joint determination that the patient can be expected to have a normal pregnancy, labor and delivery the midwife may provide services to the patient. When a client has a risk score of 3 or higher and has previously had a physician consultation for the identified risk factors in a prior pregnancy with no current changes in health or risk factors another consultation is not required.

The licensed midwife shall continue to evaluate a patient during the antepartum, intrapartum and postpartum. If the cumulative risk score reaches three points or higher and the patient is not expected to have a normal pregnancy, labor and delivery, the midwife shall transfer such patient out of his or her care. The midwife may provide collaborative care to the patient.¹

The following is the required risk assessment tool.

The risk factors shall be scored as follows²:		Score
(a) Socio-Demographic Factors
1. Chronological age under 16, or older than 40.		1
2. Residence of anticipate birth more than 30 minutes from emergency care.		3
(b) Documented Problems in Maternal Medical History
1. Cardiovascular System.
a. Chronic hypertension		3
b. Heart disease		3
c. Heart disease assessed by a cardiologist which places the mother or fetus at no risk		1
d. Pulmonary embolus		3
e. Congenital heart defects		3
I. Congenital heart defects assessed by a cardiologist which places the mother or fetus at no risk		1
2. Urinary System
a. Renal disease		3
b. History of pyelonephritis		1
3. Psycho-Neurological
a. History of psychotic episode adjudged by psychiatric evaluation and which required use of drugs related to its management, but not currently on medication		1
b. Current mental health problems requiring drug therapy		3
c. Epilepsy or seizures in the last two years		3
d. Required use of anticonvulsant drugs		3
e. During the current pregnancy, drug or alcohol addiction, use of addictive drugs		3
f. Severe undiagnosed headache		3
4. Endocrine System
a. Diabetes mellitus		3
b. History of gestational diabetes		1
c. Current thyroid disease
I. Euthyroid		1
II. Non-Euthyroid		3
5. Respiratory System
a. Chronic bronchitis		1
I. Current or chronic or with medication		3
II. Without medication or current problems		1
b. Smoking
I. 10 or less cigarettes per day		1
II. More than 10 cigarettes per day		3
6. Other Systems
a. Bleeding disorder or hemolytic disease		3
b. Cancer of the breast in the past five years		3
7. Documented Problems in Obstetrical History
a. Expected Date of Delivery (EDD) less than 12 months from date of previous delivery		1
b. Previous Rh sensitization		3
c. 5 or more term pregnancies		3
d. Previous abortions
I. 3 or more consecutive spontaneous abortions		3
II. Two consecutive spontaneous abortions or more than three spontaneous abortions		1
III. Septic abortion		3
e. Uterus
I. Incompetent cervix, with related medical treatment		3
II. Prior uterine surgery		3
III. Prior uterine surgery followed by an uncomplicated vaginal birth		2
f. Previous placenta abruptio		3
g. Previous placenta previa		1
h. Severe pregnancy-induced hypertension during last pregnancy		2
i. Postpartum hemorrhage apparently unrelated to management		3
8. Physical Findings of Previous Births
a. Stillbirth occurring at more than 20 weeks gestation or neonatal loss (other than cord accident)		3
b. Birthweight
I. Less than 2500 grams or two or more previous premature labors without a subsequent low-risk pregnancy and full-term appropriate for gestational age (AGA) infant		3
II. Less than 2500 grams or two or more previous premature labors with one or more full-term AGA infant(s) subsequently delivered, after a low-risk pregnancy		1
III. More than 4000 grams		1
c. Major congenital malformations, genetic, or metabolic disorder		3
9. Maternal Physical Findings
a. Gestation
I. Of more than 22 weeks in the patient’s first pregnancy (nullipara), unless the patient provides a copy of a medical record documenting a prenatal physical examination and prenatal care by a licensed physician, advanced registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who regularly provides maternity care		3
II. Of more than 28 weeks if the patient has had at least one previous viable birth (multipara), unless the patient provides a copy of a medical record documenting a prenatal physical examination and prenatal care by a licensed physician, advanced registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who regularly provides maternity care		3
b. Prepregnant weight is not within the range of the following weights by height:		2
Weight in inches without shoes	Prepregnant minimum weight in pounds	Prepregnant maximum weight in pounds
56	83	143
57	85	146
58	86	150
59	89	153
60	92	157
61	95	161
62	97	166
63	100	170
64	103	175
65	106	180
66	110	185
67	113	190
68	117	196
69	121	202
70	124	208
71	128	212
72	131	217
73	135	222
c. Evidence of clinically diagnosed pathological uterine myoma or malformations, abdominal or adnexal masses		3
d. Polyhydramnios or oligohydramnios
I. Prior pregnancy		2
II. Current pregnancy		3
e. Cardiac diastolic murmur, systolic murmur grade III or above, or cardiac enlargement		3
10. Current Laboratory Findings
a. Hematocrit/Hemoglobin
I. Less than 31% or 10.3 gm/100 ml		1
II. Less than 28% or 9.3 gm/100 ml		3
b. Sickle cell anemia		3
c. Pap smear suggestive of dysplasia		3
d. Evidence of active tuberculosis		3
e. Positive serologic test for syphilis confirmed active		3
f. HIV positive		3

Responsibilities

A midwife accepts and provides care for only those mothers who are expected to have a normal pregnancy, labor, and delivery. The midwife may provide collaborative prenatal and postnatal care to pregnant women not at low risk in their pregnancy, labor, and delivery, within a written protocol of a physician currently licensed when the physician maintains supervision for directing the specific course of medical treatment.¹

Antepartum

The midwife must prepare a written plan of action with the family to ensure continuity of medical care throughout labor and delivery and to provide for immediate medical care if an emergency arises. The family should have specific plans for medical care throughout the prenatal, intrapartum, and postpartum periods. The patient and family must be educated regarding the preparation of the environment and ensure availability of equipment and supplies needed for delivery and infant care, if a home birth is planned. Education should also include the hygiene of pregnancy and nutrition as it relates to prenatal care.¹

The midwife must maintain equipment and supplies. He/she determines the progress of labor. When birth is imminent, the midwife must be immediately available until delivery is accomplished. During labor and delivery, the midwife shall comply with rules that govern¹:

Maintaining a safe and hygienic environment;
Monitoring the progress of labor and the status of the fetus;
Recognizing early signs of distress or complications; and
Enacting the written emergency plan when indicated.

To prepare for a home birth, the licensed midwife must²:

Encourage each patient to have medical care available by a health care practitioner experienced in obstetrics throughout the prenatal, intrapartal and postpartal periods
Make a home visit by 36 weeks of pregnancy. The licensed midwife shall ensure that the setting in which the infant is to be delivered is safe, clean and conducive to the establishment and maintenance of health.
Prepare or arrange for the following facilities to be used for delivery:
1. The area used for labor shall be cleaned, well lighted, well ventilated and close to the toilet.
2. The delivery area should be large enough to allow ample workspace and provide privacy.
3. The delivery area must be organized, well lighted, clean, free from drafts and insects, near handwashing facilities and clear of unnecessary furnishings.
4. A safe, clean sleeping arrangement for the infant.
Educate the expectant parents and ensure that appropriate supplies are on hand for use by the mother and infant at the time of delivery and early postpartum.
Have the following equipment and supplies clean and ready for use at delivery:
1. Sterile obstetrical pack.
2. Bulb syringe.
3. Oxygen.
4. Eye prophylaxis

During the Antepartum Period, the licensed midwife is responsible to²:

Require each patient to have a complete history and physical examination which includes:
1. Pap smear.
2. Serological screen for syphilis.
3. Gonorrhea and chlamydia screening.
4. Blood group including Rh factor and antibody screen.
5. Complete blood count (CBC).
6. Rubella titer.
7. Urinalysis with culture.
8. Sickle cell screening for at-risk population.
9. Screen for hepatitis B surface antigen (HBsAg).
10. Screen for HIV/AIDS.
Conduct the Healthy Start Prenatal Screen interview or assure that each patient has been previously screened.
Provide counseling and offer screening related to the following:
1. Neural tube defects.
2. Group B Streptococcus.
3. CVS or genetic amniocentesis for women 35 years of age or older at the time of delivery.
4. Nutritional counseling.
5. Childbirth preparation.
6. Risk Factors.
7. Common discomforts of pregnancy.
8. Danger signs of pregnancy.
Follow-up screening:
1. Hematocrit or hemoglobin levels at 28 and 36 weeks gestation.
2. Diabetic screening between 24 and 28 weeks gestation.
3. Antibody screen for Rh-negative mothers, at 28 weeks gestation. Counsel and encourage RhoGAM prophylaxis. In those clients declining RhoGAM prophylaxis repeat antibody screen at 36 weeks.
Require prenatal visits every four weeks until 28 weeks gestation, every two weeks from 28 to 36 weeks gestation and weekly from 36 weeks until delivery.

During each prenatal visit, complete and record the following procedures and examinations²:

Weight.
Blood pressure.
Urine dip stick for protein and glucose each visit with leukocytes, ketones, and nitrites as indicated.
Fundal height measurements.
Fetal heart tones and rate.
Assessment of edema and patellar reflexes, when indicated.
Indication of weeks’ gestation and size correlation.
Determination of fetal presentation after 28 weeks of gestation.
Nutritional assessment.
Assessment of subjective symptoms of PIH, UTI and preterm labor.

Assess the Expected Date of Delivery (EDD) and gestational age by 20 weeks, according to²:

Last normal menstrual period.
Reference to the statement of uterine size recorded during the initial exam.
Hearing fetal heart tones at eleven weeks with a Doppler unit, if one is available, and patient gives consent.
Recording of quickening date.
Recording weeks of gestation by dates and measuring in centimeters the height of the uterine fundus.
Hearing the fetal heart tones at twenty weeks with a fetoscope.

If a reliable EDD cannot be established by the above criteria, then the licensed midwife shall encourage the patient to have an ultrasound for EDD.

A consultation with a physician with hospital obstetrical privileges if any of the following conditions occur during the pregnancy2:

Hematocrit of less than 33% at the 37th week of gestation or hemoglobin less than 11 gms/100 ml.
Unexplained vaginal bleeding.
Abnormal weight change defined as less than 12 or more than 50 pounds at term.
Non-vertex presentation persisting past the 37th week of gestation.
Gestational age between 41 and 42 weeks.
Genital herpes confirmed clinically or by culture at term.
Documented asthma attack.
Hyperemesis is not responsive to supportive care.
Any other severe obstetrical, medical or surgical problem.

Transfer a patient to a physician if any of the following conditions occur during the pregnancy²:

Genetic or congenital abnormalities or fetal chromosomal disorder.
Multiple gestations.
Pre-eclampsia.
Intrauterine growth retardation.
Thrombophlebitis.
Pyelonephritis.
Gestational diabetes confirmed by abnormal glucose tolerance test.
Laboratory evidence of Rh sensitization.

If these conditions resolve satisfactorily and the physician and midwife deem that the patient is expected to have a normal pregnancy, labor and delivery, then the care of the patient shall continue with the licensed midwife.

Intrapartum

During the Intrapartum Period, the licensed midwife is responsible to²:

Determine onset of labor.
Review patient’s prenatal records.
Assess condition of the mother and fetus.
Assess delivery environment.
Perform sterile vaginal examinations to initially assess cervical dilation and effacement, presentation, position and station of the fetus, and the status of the membranes.

During active labor, the midwife must²:

Maintain a safe and hygienic environment.
Provide nourishment, rest and support as indicated by the patient’s condition.
Monitor, assess and record the status of labor and the maternal and fetal condition.
Measure the blood pressure every hour unless significant changes or symptoms require more frequent assessments.
Take the patient’s pulse every 2 hours while membranes are intact and temperature is normal, then every hour after the rupture of membranes.
Take the temperature every 4 hours, or more frequently if maternal condition warrants, and every hour if elevated to 100º F or above.
Estimate fluid intake and urinary output at least every 2 hours.
Assess for hydration and edema

Assessment and recording the status of labor includes²:

Measure the frequency, duration and intensity of the contractions every half hour and more frequently if indicated.
Observe and record vaginal discharge.
Monitor fetal heart tones during and following contractions to assess fetal condition according to the following schedule after admission to care for labor:
1. Every hour during the latent phase.
2. Every 30 minutes during the active phase of the first stage.
3. Every 15 minutes during transition.
4. Every five minutes during the second stage.

Immediately after the appearance of amniotic fluid in the vaginal discharge.²

Palpate the abdomen for the position and level of the presenting part.
Perform sterile vaginal examinations to assess cervical dilation and effacement, presentation, position and station of the fetus, and the status of the membranes.

Risk factors must be assessed throughout labor to determine the need for physician consultation or emergency transport. Consult, refer or transfer to a physician with hospital obstetrical privileges if the following occur during labor, delivery or immediately thereafter²:

Premature labor, meaning labor occurring at less than 37 weeks of gestation.
Premature rupture of membranes, meaning rupture occurring more than 12 hours before onset of regular active labor.
Non-vertex presentation.
Evidence of fetal distress.
Abnormal heart tones.
Moderate or severe meconium staining.
Estimated fetal weight less than 2,500 grams or greater than 4,000 grams.
Pregnancy-induced hypertension which is defined as 140/90, or an increase of 30 mm Hg systolic or 15 mm Hg diastolic above baseline.
Failure to progress in active labor:
1. First stage: lack of steady progress in dilation and descent after 24 hours in primipara and 18 hours in multipara.
2. Second stage: more than 2 hours without progress in descent.
3. Third stage: more than 1 hour.
Severe vulvar varicosities.
Marked edema of cervix.
Active bleeding.
Prolapse of the cord.
Active infectious process.
Other medical or surgical problems.

The midwives can only perform the following operative procedure²:

Artificial rupture of the membranes when the fetal head is engaged and well applied to the cervix in active labor and four or more centimeters dilated.
Clamping and cutting the umbilical cord.
Episiotomy when indicated.
Suture to repair first and second-degree lacerations.

The following are prohibited actions by midwives²:

Attempts to correct fetal presentations by external or internal version.
Use of artificial, forcible or mechanical means to assist the birth.

A licensed midwife may only administer¹:

Prophylactic ophthalmic medication
Oxygen
Postpartum oxytocin
Vitamin K
Rho immune globulin (human)
Local anesthetic pursuant to a prescription issued by a practitioner
Other medicinal drugs as prescribed by such practitioner

Any such prescription for medicinal drugs must be dispensed in a pharmacy, by a licensed pharmacist.¹

The midwife must instill into each eye of the newborn infant a prophylactic and must remain with the postpartal mother until the conditions of the mother and the neonate are stabilized.¹

Records and Reports

The midwife will¹:

Completed birth certificate for each birth within five days
Instruct the parents regarding the requirement for an infant screening blood test for metabolic diseases and notify the county health department within 48 hours, unless other arrangements for the test have been made by the parents
Immediately report maternal death, newborn death, and stillbirth to the medical examiner
Keep a record of for five years for each patient served including:
1. Consultation
2. Referral
3. Transport
4. Transfer of care
5. Emergency care
6. All subsequent updates

The midwife must report any adverse events, along with a medical summary of events, to the department within 15 days after the adverse incident occurs that occurring during an attempted or completed planned out-of-hospital birth, and results in one or more of the following injuries or conditions³:

A maternal death that occurs during delivery or within 42 days after delivery;
The transfer of a maternal patient to a hospital intensive care unit;
A maternal patient experiencing hemorrhagic shock or requiring a transfusion of more than four units of blood or blood products;
A fetal or newborn death, including a stillbirth, associated with an obstetrical delivery;
A transfer of a newborn to a neonatal intensive care unit due to a traumatic physical or neurological birth injury, including any degree of a brachial plexus injury;
A transfer of a newborn to a neonatal intensive care unit within the first 72 hours after birth if the newborn remains in such unit for more than 72 hours; or
Any other injury as determined by department rule.

The department reviews each incident report and determines whether the incident involves conduct by a health care practitioner which is subject to disciplinary action.³

467.019 Records and reports.

(5) Within 90 days after the death of a midwife, the estate or agent shall place all patient records of the deceased midwife in the care of another midwife licensed in this state who shall ensure that each patient of the deceased midwife is notified in writing. A midwife who terminates or relocates to private practice outside the local telephone directory service area of the midwife’s current practice shall provide notice to all patients as prescribed by department rule.

(6) Patient records of a deceased midwife or a midwife who terminates or relocates a private practice shall be maintained pursuant to department requirements.

(7) A licensed midwife who is or has been employed by a practice or facility, such as a birth center, which maintains patient records as records belonging to the facility may review patient records on the premises of the practice or facility as necessary for statistical purposes.¹

Violations, Disciplinary Actions, and Penalties

Each of the following acts constitutes a felony of the third degree¹:

Practicing midwifery, unless holding an active license to do so.
Using or attempting to use a license which has been suspended or revoked.
The willful practice of midwifery by a student midwife without a preceptor present, except in an emergency.
Knowingly allowing a student midwife to practice midwifery without a preceptor present, except in an emergency.
Obtaining or attempting to obtain a license under this chapter through bribery or fraudulent misrepresentation.
Using the name or title “midwife” or “licensed midwife” or any other name or title which implies that a person is licensed to practice midwifery, unless such person is duly licensed as provided in this chapter.
Knowingly concealing information relating to the enforcement

The following acts constitute grounds for denial of a license or disciplinary action¹:

Procuring, attempting to procure, or renewing a license to practice midwifery by bribery, by fraudulent misrepresentation, or through an error of the department.
Having a license to practice midwifery revoked, suspended, or otherwise acted against, including being denied licensure, by the licensing authority of another state, territory, or country.
Being convicted or found guilty, regardless of adjudication, in any jurisdiction of a crime which directly relates to the practice of midwifery or to the ability to practice midwifery.
Advertising falsely, misleadingly, or deceptively.
Engaging in unprofessional conduct
Being unable to practice midwifery with reasonable skill and safety to patients by reason of illness; drunkenness; or use of drugs, narcotics, chemicals, or other materials or because of any mental or physical condition.
Failing to report to the department any person whom the licensee knows is in violation of this chapter or of the rules of the department.

The department may enter an order denying licensure or imposing any of the penalties for licensure or licensee who is found guilty.

A health care provider shall not refer a patient to an entity in which the provider is an investor unless, prior to the referral, the provider furnishes the patient with a written disclosure form, informing the patient of³:

The existence of the investment interest.
The name and address of each applicable entity in which the referring health care provider is an investor.
The patient’s right to obtain the items or services for which the patient has been referred at the location or from the provider or supplier of the patient’s choice, including the entity in which the referring provider is an investor.
The names and addresses of at least two alternative sources of such items or services available to the patient.

The health care provider must post a copy of the disclosure forms in a conspicuous public place in his or her office. A violation of this section shall constitute a misdemeanor of the first degree.³

A health care provider may not refer a patient for the provision of designated health services to an entity in which the health care provider is an investor or has an investment interest. There are exceptions that should be closely evaluated before a provider makes such a referral.³

Kickbacks are prohibited. Kickback means a remuneration or payment, by or on behalf of a provider of health care services or items, to any person as an incentive or inducement to refer patients for past or future services or items, when the payment is not tax deductible as an ordinary and necessary expense. Violations are considered patient brokering and is punishable.³

456.0575 Duty to notify patients.—³

(1) Every licensed health care practitioner shall inform each patient, or an individual identified… in person about adverse incidents that result in serious harm to the patient. Notification of outcomes of care that result in harm to the patient under this section does not constitute an acknowledgment of admission of liability, nor can such notifications be introduced as evidence.

(2) Upon request by a patient, before providing nonemergency medical services in a facility licensed… a health care practitioner shall provide, in writing or by electronic means, a good faith estimate of reasonably anticipated charges to treat the patient’s condition at the facility. The health care practitioner shall provide the estimate to the patient within 7 business days after receiving the request and is not required to adjust the estimate for any potential insurance coverage. The health care practitioner shall inform the patient that the patient may contact his or her health insurer or health maintenance organization for additional information concerning cost-sharing responsibilities. The health care practitioner shall provide information to uninsured patients and insured patients for whom the practitioner is not a network provider or preferred provider which discloses the practitioner’s financial assistance policy, including the application process, payment plans, discounts, or other available assistance, and the practitioner’s charity care policy and collection procedures. Such estimate does not preclude the actual charges from exceeding the estimate. Failure to provide the estimate in accordance with this subsection, without good cause, shall result in disciplinary action against the health care practitioner and a daily fine of $500 until the estimate is provided to the patient. The total fine may not exceed $5,000.

456.061 Practitioner disclosure of confidential information; immunity from civil or criminal liability.—³

(1) A practitioner regulated through the Division of Medical Quality Assurance of the department shall not be civilly or criminally liable for the disclosure of otherwise confidential information to a sexual partner or a needle-sharing partner under the following circumstances:

(a) If a patient of the practitioner who has tested positive for human immunodeficiency virus discloses to the practitioner the identity of a sexual partner or a needle-sharing partner;

(b) The practitioner recommends the patient notify the sexual partner or the needle-sharing partner of the positive test and refrain from engaging in sexual or drug activity in a manner likely to transmit the virus and the patient refuses, and the practitioner informs the patient of his or her intent to inform the sexual partner or needle-sharing partner; and

(c) If pursuant to a perceived civil duty or the ethical guidelines of the profession, the practitioner reasonably and in good faith advises the sexual partner or the needle-sharing partner of the patient of the positive test and facts concerning the transmission of the virus.

Sexual misconduct in the practice of a health care profession is prohibited.³

Health care fraud in the practice of a health care profession is prohibited.³

Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

References

CHAPTER 467, MIDWIFERY,. Online Sunshine. Accessed August 14, 2018.
64B24: Council of Licensed Midwifery. Florida Department of State. Accessed August 14, 2018.
CHAPTER 456, HEALTH PROFESSIONS AND OCCUPATIONS: GENERAL PROVISIONS. Online Sunshine. Accessed August 14, 2018.
Continuing Education. Florida Health, Midwifery. Updated March 28, 2018. Accessed August 19, 2018.

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