$5201 

FLORIDA DEPARTMENT OF HEALTH
Council of Licensed Midwifery

ANNUAL REPORT OF PRACTICE

Report data from July 1 through June 30 of each year. Reports are due no later than July 31.

 

I SECTION I: PRACTICE INFORMATION

Midwife Name: Harmony A. Miller License MW195

 

Practice Name: Birth Harmony, Inc. dba Rosemary Birthing Home

Address: 800 Central Ave Sarasota, FL 34236

 

Phone Number: 941-330-9966 Email: harmonv@rosemarybirthing.com

 

SECTION II. CLIENT CARE SERVICES FOR THE (include data for the report year only) I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section Total(s)
number
2 A Total number of initial OB clients seen by you (include those accepted into care and
not accepted into care): 193
Total number of maternity clients you accepted for care in the reporting period: 48
Total number of deliveries you performed during reporting period: 18
Total number of licensed midwife students assigned to you during the reporting
period: 1
How many delivered at: Home: 13 Birthing Ctr: 5 Hospital: 0 18
Twins I
Number of unplanned. Breech. 1 Multiples 0 1
. . of subsequent

Number of planned VBAC. of primary VBAC. 0 VBAC: 1 1
Number of water births: 12
I Number of mothers requiring sutures:

3 A Number of mothers transferred antepartum (for medical reasons): 8
Number of mothers transferred intrapartum: 1
Number of mothers transferred postpartum: (medical reasons) 0
Number of newborn transfers: 1

4 A Number of fetal deaths I stillborn: (midwife delivery only) 0
Number of fetal deaths I neonatal: (within 7 days of life) 0
Number of maternal deaths: (please submit separate report) 0

 

 

 

 

 

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Rule 64824-7014, F.A.C. I

 

 

 

 

1 SECTION TRANSFER INFORMATION

 

 

 

 

 

 

 

 

 

 

 

(3-A) ANTEPARTUM TRANSFER (Medical Reasons): List each transfer separately. Do not list names. Attach separate
sheet as needed
Planned or . .

Date Reason For Transfer ngigpeed Tg?si; 
8/3/16 Breech presentation unplanned 4o 
12/6/16 unplanned 41 NSVD
12/28/16 Breech presentation unplanned 38 0/5

10/19/15 Breech presentation unplanned 33 0/8
6/12/17 Breech presentation unplanned 39 0/5
6/30/17 Elevated pre-eclampsia unplanned 32 

3/3/17 Cervical cancer dx unplanned 16 unknown
4/27/17 Prenatal care only d/t hx 3 prior planned 31 0/8

 

 

 

 

 

 

 

 

 

Total Number of Antepartum Transfers from

 

 

 

 

 

 

 

 

all sheet 8
(3-3) INTRAPARTUM TRANSFERS: List each transfer separately. Do not list names. If needed, attach separate sheets as needed.
MOTHER INFANT
Delivery . . 9 BIRTH Admitted to Neonatal
DATE REASON FOR TRANSFER Method WEIGHT If yes, reason and of days Death?
10/14/16 Failure to progress/ pain management None 8-7 No No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Rule 64824-7014, F.A.C.

Total lntrapartum Transfers from all sheets (3-B)



 

 

 

 

 

 

(3-C) MATERNAL POSTPARTUM TRANSFERS: (List each transfer separately. Do not list names.)

 

 

of Days in

Hospital Outcome/Condition on Discharge

Date Reason For Transfer

 

 

 

 

 

 

 

 

 

 

 

Total Number of Postpartum Transfers from all

 

 

 

 

 

 

sheets (3-C) 0
(3-D) NEWBORN TRANSFERS: (List each transfer separately. Do not list names.)
Birth Admission to
Date Reason For Transfer . APGARS Outcome
Walght lfjes, of days
3 Stable:i WNL. Ongomg routine follow up
3/6/17 unresponsuve newborn. full resuscntatlon 1o_o 4 14 and OT to ensure milestones met.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Newborn Transfers from all sheets(3-D) I 1

SECTION IV - DEATHS 

 

 

(4-A) STILLBIRTH (midwife delivered only)

 

 

 

DeathWas: Birth Gestational
Date Cause ofDeath Before During During Weight Age

Labor Labor Delivery

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Number of Fetal Death/Stillborn (4-A) 0

 

DH-MQA 5011. 08/2015
Rule 64824-7014, F.A.C. 3

 

(4-B) FETAL NEONATAL DEATH (Deaths within seven days of life following midwife delivery of a live

 

infant)

 

 

Date

Cause of Death

Site of Death Birth Weight Age at death

 

 

 

 

 

 

 

 

 

 

Total Number of FetalINeonatal Deaths (4-B) 0

 

 

 

(4-C) MATERNAL DEATH (PLEASE SUBMIT A SEPARATE REPORT FOR EACH INCIDENT)

 

 

Number of Reports Attached

 

Total Number of Maternal Deaths (4-C) 0

 

 

 

have participated in giving information for the purpose of gathering statistics of
Licensed Midwives in the State of Florida. The information have given is accurate

and true.

Print Name: #ft 1 3/121 L12

Signature: 

Date: 7/27? 7

DH-MQA 5011. 08/2015
Rule 64824-7014, F.A.C.

7K-.- ,1

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