The purpose of this course is to prepare midwives to practice within the parameters of the Florida Midwifery Practice Act.
After completing this course, the learner will be able to:
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.
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.
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
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:
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
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.|
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.
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
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.
2. Residence of anticipate birth more than 30 minutes from emergency care.
(b) Documented Problems in Maternal Medical History
1. Cardiovascular System.
a. Chronic hypertension
b. Heart disease
c. Heart disease assessed by a cardiologist which places the mother or fetus at no risk
d. Pulmonary embolus
e. Congenital heart defects
I. Congenital heart defects assessed by a cardiologist which places the mother or fetus at no risk
2. Urinary System
a. Renal disease
b. History of pyelonephritis
a. History of psychotic episode adjudged by psychiatric evaluation and which required use of drugs related to its management, but not currently on medication
b. Current mental health problems requiring drug therapy
c. Epilepsy or seizures in the last two years
d. Required use of anticonvulsant drugs
e. During the current pregnancy, drug or alcohol addiction, use of addictive drugs
f. Severe undiagnosed headache
4. Endocrine System
a. Diabetes mellitus
b. History of gestational diabetes
c. Current thyroid disease
5. Respiratory System
a. Chronic bronchitis
I. Current or chronic or with medication
II. Without medication or current problems
I. 10 or less cigarettes per day
II. More than 10 cigarettes per day
6. Other Systems
a. Bleeding disorder or hemolytic disease
b. Cancer of the breast in the past five years
7. Documented Problems in Obstetrical History
a. Expected Date of Delivery (EDD) less than 12 months from date of previous delivery
b. Previous Rh sensitization
c. 5 or more term pregnancies
d. Previous abortions
I. 3 or more consecutive spontaneous abortions
II. Two consecutive spontaneous abortions or more than three spontaneous abortions
III. Septic abortion
I. Incompetent cervix, with related medical treatment
II. Prior uterine surgery
III. Prior uterine surgery followed by an uncomplicated vaginal birth
f. Previous placenta abruptio
g. Previous placenta previa
h. Severe pregnancy-induced hypertension during last pregnancy
i. Postpartum hemorrhage apparently unrelated to management
8. Physical Findings of Previous Births
a. Stillbirth occurring at more than 20 weeks gestation or neonatal loss (other than cord accident)
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
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
III. More than 4000 grams
c. Major congenital malformations, genetic, or metabolic disorder
9. Maternal Physical Findings
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
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
b. Prepregnant weight is not within the range of the following weights by height:
|Weight in inches without shoes||Prepregnant minimum weight in pounds||Prepregnant maximum weight in pounds|
c. Evidence of clinically diagnosed pathological uterine myoma or malformations, abdominal or adnexal masses
d. Polyhydramnios or oligohydramnios
I. Prior pregnancy
II. Current pregnancy
e. Cardiac diastolic murmur, systolic murmur grade III or above, or cardiac enlargement
10. Current Laboratory Findings
I. Less than 31% or 10.3 gm/100 ml
II. Less than 28% or 9.3 gm/100 ml
b. Sickle cell anemia
c. Pap smear suggestive of dysplasia
d. Evidence of active tuberculosis
e. Positive serologic test for syphilis confirmed active
f. HIV positive
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
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:
To prepare for a home birth, the licensed midwife must2:
During the Antepartum Period, the licensed midwife is responsible to2:
During each prenatal visit, complete and record the following procedures and examinations2:
Assess the Expected Date of Delivery (EDD) and gestational age by 20 weeks, according to2:
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:
Transfer a patient to a physician if any of the following conditions occur during the pregnancy2:
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.
During the Intrapartum Period, the licensed midwife is responsible to2:
During active labor, the midwife must2:
Assessment and recording the status of labor includes2:
Immediately after the appearance of amniotic fluid in the vaginal discharge.2
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:
The midwives can only perform the following operative procedure2:
The following are prohibited actions by midwives2:
A licensed midwife may only administer1:
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
The midwife will1:
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:
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
Each of the following acts constitutes a felony of the third degree1:
The following acts constitute grounds for denial of a license or disciplinary action1:
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 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