The Midwife's Role in Primary & Community Midwifery - Cheat Sheet
Your last-minute revision companion for RA 7392 scope of practice, Philippine health-system ladder, and community midwifery role. Review these key facts, definitions, and system structures in the final 30 minutes before the exam.
RA 7392: The Midwifery Law & Legal Scope
Important facts
- RA 7392 (Midwifery Law) passed in 1992; defines midwife as an INDEPENDENT primary care provider, not subordinate to physician.
- Midwife is legally authorized to conduct normal, uncomplicated pregnancies, deliveries, and postpartum care WITHIN her competence and scope.
- Midwife MUST refer: obstetric emergencies, medical complications, abnormal presentations, prolonged labor, hemorrhage, preeclampsia, eclampsia, uterine rupture, amniotic fluid embolism, and any unresolved complications.
- Midwife works WITHIN the Philippine health system hierarchy but retains independent clinical judgment for normal care.
- Registration and annual renewal of midwife license is mandatory; practicing without a current PRC license is illegal (RA 7392 violation).
- Midwife may NOT administer anesthesia, perform cesarean section, or manage obstetric emergencies — these require physician/specialist intervention.
- A registered midwife may work in RHU, BHS, private birthing home, private clinic, or institutional setting, PROVIDED she stays within legal scope.
Key definitions
Midwife (RA 7392)
Example
A registered midwife conducts a prenatal visit, identifies pre-eclampsia signs, and immediately refers the client to the RHU physician or hospital.
An independent primary provider of NORMAL maternal, newborn, family-planning, and community care who recognizes complications and REFERS them appropriately.
Scope of Practice
Example
Midwife attends a normal vertex delivery at the BHS lying-in clinic; refers placental abruption and preeclampsia upward to hospital.
Midwife provides care for NORMAL pregnancy, labor, delivery, postpartum, newborn, family planning, and community health — NOT obstetric emergencies or high-risk complications.
Recognize & Refer (Core Principle)
Example
On postpartum day 2, midwife detects fever, foul-smelling lochia, and lower abdominal tenderness → immediate referral for suspected postpartum infection.
Midwife must accurately DETECT signs/symptoms of complications and REFER (not manage) them to appropriate higher-level facility in time.
Diagrams to know
- RA 7392 scope-of-practice box: what IS and IS NOT within the midwife's independent authority.
- Decision tree: 'Is this normal care, complication, or emergency?' → determines whether midwife manages, consults, or refers.
Philippine Health System Ladder & Settings
Common values
Value
~5,000 persons
Symbol
Standard planning norm
Quantity
Typical BHS catchment population
Value
1–3 barangays
Symbol
Typical range
Quantity
Number of barangays served by one BHS
Important facts
- Health system is hierarchical: BHS (barangay) → RHU (municipal) → district/provincial/city hospital (referral).
- BHS is often MIDWIFE-RUN — the midwife is frequently the sole skilled health professional at the smallest government facility.
- RHU is led by the MUNICIPAL HEALTH OFFICER (MHO, physician); the PUBLIC HEALTH NURSE (PHN) often oversees programme implementation across the municipality.
- Planning norm: approximately ONE midwife per BHS serving ~5,000 population (this is the accepted staffing standard, not a rigid legal figure).
- Most rural midwives are LGU EMPLOYEES (hired and paid by the municipality/city), not DOH civil servants; DOH provides technical supervision and programme direction.
- Midwife at BHS is supported by BARANGAY HEALTH WORKERS (BHWs) — trained volunteers who extend her reach into households.
- Lying-in homes/birthing homes must be PhilHealth-accredited to receive reimbursement through the Maternity Care Package (MCP) and Newborn Care Package.
- Private practice midwives may run clinics or attend home births, but must comply with all licensing, accreditation, and scope-of-practice requirements.
Key definitions
Barangay Health Station (BHS)
Example
In Barangay San Jose, the midwife is the sole health worker at the BHS, assisted by 3 BHWs; she conducts all prenatal, delivery, postnatal, and immunization services.
Smallest, most peripheral government health facility serving 1–3 barangays; often staffed and run by a midwife as primary health provider.
Rural Health Unit (RHU) / Municipal Health Centre
Example
The RHU in Poblacion serves 15 barangays; 5 rural-health midwives are assigned one per cluster, but report to the MHO for technical oversight and emergency backup.
Municipal-level facility led by the Municipal Health Officer (MHO, a physician); team includes RHU midwives, public health nurse, and support staff; serves entire municipality.
District / Provincial / City Hospital
Example
A woman with eclampsia is referred from the BHS → RHU → Provincial Hospital for ICU care, emergency delivery, and specialist management.
Tertiary facility providing comprehensive emergency obstetric and newborn care (CEmONC); where complicated pregnancies, high-risk births, and obstetric emergencies are managed.
Lying-In Clinic / Birthing Home
Example
Midwife Rosa owns a 10-bed birthing home in the municipality; it is PhilHealth-accredited and part of the BEmONC referral network.
Facility (public or private) dedicated to NORMAL, low-risk deliveries and immediate postpartum/newborn care; often owned/managed by midwife; PhilHealth-accredited for reimbursement.
Local Government Code (RA 7160, 1991)
Example
A midwife is hired by the Municipal Government of San Pedro; she is an LGU employee but must follow DOH programme guidelines and standards.
Devolved basic health services to LGUs; most rural midwives are LGU employees hired and paid by the municipality, while DOH sets national standards and technical direction.
Diagrams to know
- Philippine health-system pyramid: BHS at base, RHU in middle, hospital at top; showing referral flow and each level's role.
- Organizational structure of RHU: MHO (head) → PHN, rural midwives, BHWs, barangay officials.
Community Midwifery Functions & Care Continuum
Common values
Value
4 or more
Symbol
4+ ANC visits
Quantity
Minimum prenatal visits (WHO standard)
Value
30 mg iron + 400 mcg folic acid daily
Symbol
IFA
Quantity
Iron-folate supplementation (pregnancy)
Value
2 doses (or booster if previously vaccinated)
Symbol
TT
Quantity
Tetanus toxoid doses (pregnancy)
Value
Within 24 hours, 3–5 days, 6 weeks
Symbol
Timing milestones
Quantity
Postpartum home visits (recommended)
Value
Collected 24–48 hours of life
Symbol
Timing per RA 9288
Quantity
Newborn screening blood spot
Important facts
- Midwife OWNS and DRIVES the maternal care continuum: pregnancy registration, prenatal screening, facility-delivery planning, skilled attendance at birth, postpartum follow-up, newborn care, and family planning.
- Prenatal care includes: blood pressure, urine test, hemoglobin check, tetanus toxoid (TT) vaccination, iron-folate supplementation, BP & weight monitoring, risk screening, and birth-plan discussion.
- Facility-based delivery by skilled birth attendant is the DOH priority; midwife ensures low-risk women deliver at BHS/lying-in home, not at home.
- Postpartum care (within 24 hours, 3–5 days, 6 weeks): monitor for bleeding, infection, blood pressure, mood; assess infant feeding and newborn health; counsel on family planning.
- EINC (Unang Yakap) includes: rooming-in, exclusive breastfeeding, thermal care, eye prophylaxis (tetracycline or silver nitrate), vitamin K, newborn screening (RA 9288), and initial immunizations.
- Newborn screening (RA 9288) mandatory: blood spot on filter paper at 24–48 hours of life for congenital hypothyroidism, phenylketonuria (PKU), and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
- RA 7600 (Rooming-in Law): mother and newborn must room together; RA 10028 (Expanded Breastfeeding Promotion Act) mandates workplace and institutional support for breastfeeding.
- Immunization: BCG and HepB at birth; routine childhood vaccines per DOH schedule delivered by midwife at barangay level.
- Micronutrient supplementation: iron-folate during pregnancy (30 mg iron + 400 mcg folic acid daily); vitamin A for women postpartum and children 6–59 months.
- Health promotion: nutrition education, sanitation, hand hygiene, birth spacing, and disease prevention delivered in clinic visits and community meetings.
- Surveillance: midwife is a routine reporter on maternal deaths, neonatal deaths, acute flaccid paralysis, diarrheal disease, and other notifiable illnesses.
- TCL and FHSIS are THE documentation backbone: accurate, timely data entry allows LGU/provincial planners to identify gaps, target high-risk populations, and measure programme effectiveness.
Key definitions
Maternal Care Continuum
Example
Midwife identifies Ms. Santos at 8 weeks pregnant, conducts 4+ prenatal visits with risk screening, arranges facility delivery, attends labor, provides rooming-in/breastfeeding support, and offers family planning at 6-week postpartum check.
Complete pathway from pregnancy identification → prenatal care → facility-based skilled delivery → immediate postpartum/newborn care → family planning.
Essential Newborn Care (EINC / 'Unang Yakap')
Example
Immediately after vaginal delivery, baby is placed skin-to-skin with mother; cord is clamped at 2–3 minutes; colostrum is encouraged; newborn screening is arranged within 48 hours.
Critical immediate care for every newborn: skin-to-skin contact (rooming-in), delayed cord clamping, exclusive breastfeeding, thermal protection, eye prophylaxis, vitamin K, BCG, and hepatitis B vaccination.
Target Client List (TCL)
Example
Midwife's TCL shows 42 currently pregnant women, 156 active family-planning acceptors, and 89 children due for DPT booster this month.
Community midwife's master list of pregnant women, family-planning clients, children due for immunization, and other registered programme participants for tracking and recall.
Field Health Services Information System (FHSIS)
Example
Midwife submits FHSIS report on: deliveries attended, postpartum visits, live births, newborn complications detected, family-planning clients, immunizations given.
DOH's standard routine reporting system by which BHS/RHU midwives submit monthly/quarterly data on maternal, child health, and programme activities; aggregates from barangay to national level.
Barangay Health Worker (BHW)
Example
BHW Aling Nena visits pregnant women monthly to check compliance with prenatal appointments and iron-folate supplementation.
Trained volunteer health worker supervised by the midwife; conducts household visits, reminds clients of appointments, reports illnesses, and extends midwife's reach into community.
Trained Traditional Birth Attendant (TBA)
Example
Hilot Mang Jose, a respected traditional birth attendant, refers high-risk women to the midwife and assists in community education.
Traditional or empirical birth attendant trained in hygienic birth practices, danger-sign recognition, and referral; works alongside midwife as community mobilizer, NOT as primary birth attendant.
Diagrams to know
- Maternal care continuum flowchart: pregnancy detection → prenatal visits (4+ visits, risk screening) → facility-birth plan → skilled delivery → postpartum visit → family planning.
- Child-health milestones from birth: EINC → newborn screening → 1st immunization → growth monitoring → monthly OPV/DPT → vitamin A supplementation.
- BHS team structure: midwife (center) with BHWs radiating outward, representing household-level reach.
Midwife's Team Role & Supervision
Important facts
- Midwife's chain of command: BHS midwife reports to RHU (via MHO and/or RHU midwife supervisor); RHU midwives report to MHO.
- MHO is the midwife's TECHNICAL SUPERVISOR and final decision-maker on clinical and administrative matters at the municipal level.
- PHN often coordinates PROGRAMME IMPLEMENTATION (maternal health clinics, immunization campaigns, disease surveillance); midwife executes at barangay level.
- BHWs are VOLUNTEERS supervised by the midwife; they extend the midwife's reach but are NOT paid government employees.
- Trained TBAs are MOBILIZERS and ADVOCATES, not primary care providers; the midwife trains them on danger signs and referral pathways.
- Barangay officials (captain, health officer) are administrative partners; they approve health budgets, mobilize community, and facilitate facility construction.
- Team meetings (monthly or quarterly) between midwife, BHWs, barangay officials, and TBAs strengthen coordination, planning, and accountability.
- Midwife participates in RHU team meetings, district health board, and provincial health planning forums.
- Documentation of supervision (e.g., supervisory notes, mentoring records) is part of quality assurance in community midwifery.
Key definitions
Municipal Health Officer (MHO)
Example
Dr. Santos, the MHO of San Juan, reviews the monthly FHSIS reports submitted by the 6 rural midwives under her supervision and provides technical guidance on high-risk cases.
Physician appointed to head the RHU; responsible for technical oversight, supervision of rural midwives, and overall municipal health performance; midwife's immediate technical supervisor.
Public Health Nurse (PHN)
Example
RN Maria, the PHN, ensures the Maternal Health Programme is implemented in all 15 barangays and conducts quarterly reviews with the BHS midwives.
Senior nurse at the RHU who often coordinates programme implementation (maternal health, immunization, disease surveillance) across the municipality and supervises PHN activities.
Supervision & Collaboration
Example
Midwife conducts monthly performance review with BHWs, quarterly reporting to RHU PHN, and works with barangay captain to mobilize transport for referrals.
Midwife reports to MHO, collaborates with PHN on programmes, directs and mentors BHWs, coordinates with barangay officials, and interfaces with TBAs as community mobilisers.
Diagrams to know
- Organizational chart: RHU (headed by MHO with PHN) → BHS (midwife) → BHWs and trained TBAs.
- Accountability flow: midwife reports to MHO/RHU; supervises BHWs; coordinates with barangay officials.
Referral, Linkage & Health System Connector Role
Important facts
- Midwife MUST recognize and REFER obstetric complications EARLY and in TIME — delay kills.
- Complications that ALWAYS require referral: antepartum hemorrhage, preeclampsia/eclampsia, prolonged labor, obstructed labor, postpartum hemorrhage, uterine rupture, amniotic fluid embolism, sepsis, retained placenta, and ALL neonatal emergencies.
- Referral includes: clinical documentation (partograph, vitals, findings), verbal handover to receiving provider, safe transport, and escort (BHW or family member) with vital information.
- Midwife has a DUTY TO REFER even if she is unsure of diagnosis; better to transfer early than wait for certainty.
- RHU and lying-in homes part of BEmONC network; Provincial/City Hospitals part of CEmONC network; midwife knows which level her client needs.
- Emergency transport (ambulance, motorcycle taxi, tricycle) is arranged by barangay officials or BHWs; cost is often borne by barangay emergency medical fund or client.
- Midwife maintains referral communication log and documents client outcomes; this feedback improves her recognition of complications.
- BEmONC/CEmONC facilities audit their outcomes and may provide midwife feedback on referred cases (maternal deaths, complications, near-misses).
- Blood bank access, emergency cesarean availability, and ICU capacity vary by facility; midwife KNOWS the capabilities and limitations of her referral hospitals.
Key definitions
Referral (Core Midwifery Function)
Example
Midwife detects retained placenta at 2 hours postpartum; calls RHU physician, arranges immediate transport, and hand-carries client records to hospital.
Midwife identifies complications, documents findings, communicates with receiving facility/provider, and ensures timely transport of client for higher-level care.
Back-Referral / Counter-Referral
Example
Woman treated for preeclampsia at hospital is discharged with follow-up instructions; midwife continues postpartum monitoring and family-planning counseling at BHS.
After complication is stabilized or resolved at higher level, client returns to midwife for follow-up and community reintegration.
BEmONC (Basic Emergency Obstetric and Newborn Care)
Example
The RHU or a private birthing home certified as BEmONC facility can manage postpartum hemorrhage with IV fluids, oxytocin, and manual vacuum extraction before transfer if needed.
Package of signal functions (parenteral antibiotics, oxytocin, anticonvulsants, manual removal of placenta, assisted delivery, resuscitation) provided at district/rural hospital level for obstetric emergencies.
CEmONC (Comprehensive Emergency Obstetric and Newborn Care)
Example
Uterine rupture, placental abruption with massive hemorrhage, and eclampsia with pulmonary edema are managed at the CEmONC-capable Provincial Hospital.
BEmONC functions PLUS cesarean section, blood transfusion, and intensive care provided at provincial/city hospital for life-threatening obstetric complications.
Midwife as System Connector
Example
Midwife identifies a malnourished pregnant woman, refers her to the health worker for nutrition support, coordinates with barangay nutrition officer, and ensures prenatal visits are kept.
Midwife links households to health services DOWNWARD (BHWs), UPWARD (RHU/hospital referral), and LATERALLY (nutrition, water/sanitation, education, barangay governance).
Diagrams to know
- Referral pyramid: BHS (normal care) → RHU (BEmONC) → Provincial Hospital (CEmONC) with midwife at the BASE making the critical first decision.
- Referral pathway flowchart: Complication detected → Risk assessment → Decision to refer → Documentation → Transport → Handover → Follow-up.
- System linkages: midwife connected downward (BHWs, trained TBAs), upward (RHU, hospital), and laterally (nutrition, sanitation, education, barangay).
DOH Programs & Legal Framework for Community Midwifery
Common values
Value
Blood spot collected at 24–48 hours of life
Symbol
Critical window
Quantity
Newborn-screening timeframe (RA 9288)
Value
First 6 months of life
Symbol
DOH recommendation
Quantity
Exclusive breastfeeding duration (RA 10028)
Value
Mother and newborn together continuously (except emergency)
Symbol
Legal mandate
Quantity
Rooming-in requirement (RA 7600)
Important facts
- MNCHN is the overarching DOH framework; midwife operationalizes it at BHS and barangay level through prenatal, delivery, postpartum, newborn, and child-health activities.
- PhilHealth MCP and Newborn Care Package are the financial mechanism by which facility-based delivery is made accessible and affordable; accreditation is prerequisite for reimbursement.
- RA 9288: Newborn screening is MANDATORY, not optional; midwife is responsible for blood-spot collection and transmission to laboratory within specified timeframe.
- Congenital hypothyroidism, PKU, and G6PD deficiency must be detected early; treatment in first weeks of life prevents intellectual disability or hemolytic anemia.
- RA 7600 (Rooming-In): Separation of mother and newborn is NOT permitted except for emergency treatment; rooming-in is a quality indicator and a legal right.
- RA 10028 (Breastfeeding): Exclusive breastfeeding for first 6 months; midwife counsels, assists with latching, and monitors for difficulties.
- Micronutrient supplementation: Iron-folate in pregnancy, vitamin A postpartum and for children, iodized salt, and fortified foods are part of MNCHN nutrition component.
- DOH supplies vaccines (under the Expanded Program on Immunization, EPI) at no charge to BHS; midwife administers and records in immunization card.
- DOH provides guidelines, standards, and training on safe delivery practices, active management of third stage of labor, EINC, and danger-sign recognition.
- Disease surveillance (maternal deaths, neonatal deaths, acute flaccid paralysis, diarrhea) is a midwife's responsibility; regular reporting feeds DOH epidemiological monitoring.
Key definitions
MNCHN (Maternal, Newborn and Child Health and Nutrition)
Example
A province's MNCHN target: 90% facility-based delivery attendance, 95% postpartum visit within 48 hours, 100% newborn screening, 100% child immunization coverage.
DOH's integrated strategy to reduce maternal and child mortality through comprehensive prenatal, delivery, postpartum, newborn, child health, and nutrition services operationalized at community level by midwife.
Maternity Care Package (MCP) — PhilHealth
Example
Ms. Santos delivers at a PhilHealth-accredited lying-in home run by a midwife; the package covers 4 prenatal visits, facility delivery, and 2 postpartum home visits.
Insurance package covering prenatal visits, facility-based normal delivery, postpartum care, and immediate newborn care at PhilHealth-accredited facilities (RHU, BHS, lying-in homes); reimburses accredited providers.
Newborn Care Package (PhilHealth)
Example
Baby Juan's newborn screening (RA 9288) and initial vaccines (BCG, HepB) are covered under the Newborn Care Package.
Insurance coverage for normal newborn care, including EINC, newborn screening, initial immunizations, and complications detected within the first 28 days of life.
RA 9288 (Newborn Screening Law)
Example
Midwife collects blood spot from all newborns on day 2 of life and sends to accredited newborn-screening laboratory; results guide early intervention.
Mandatory blood-spot screening of all newborns within 24–48 hours for congenital hypothyroidism, phenylketonuria (PKU), and glucose-6-phosphate dehydrogenase (G6PD) deficiency; coordinated by DOH.
RA 7600 (Rooming-In Law)
Example
At the BHS lying-in clinic, mothers and newborns are never separated after vaginal delivery; skin-to-skin contact is immediate, rooming-in is continuous.
Mandates that mother and newborn room together in all birthing facilities to promote bonding, breastfeeding, and maternal observation; health workers facilitate rooming-in practices.
RA 10028 (Expanded Breastfeeding Promotion Act)
Example
Midwife counsels postpartum mothers on exclusive breastfeeding for 6 months; refers working mothers to employers for RA 10028 lactation rights.
Mandates workplace and institutional support for breastfeeding: lactation breaks, designated spaces, protection from discrimination; health workers counsel and support mothers.
Diagrams to know
- MNCHN strategy flowchart: Pregnancy detection → Prenatal care → Facility delivery → Postpartum care → Newborn screening → Child health → Nutrition support.
- PhilHealth reimbursement cycle: Accreditation → Service delivery → Documentation → Claim submission → Reimbursement.
- RA 9288 screening timeline: Birth → Blood spot at 24–48 hours → Submission to laboratory → Results reporting → Referral if abnormal.
Primary Health Care (PHC) & Community-Based Approach
Important facts
- PHC philosophy underpins the Philippine health system; midwife is the practical embodiment of PHC at the barangay level.
- Accessibility: BHS is located close to residents' homes; midwife conducts prenatal clinics at fixed times and does household visits for follow-up.
- Affordability: Most services at BHS are free or heavily subsidized; PhilHealth MCP and Newborn Care Package further reduce cost of facility delivery.
- Acceptability: BHS and midwife are known and trusted in the community; cultural sensitivity and health education help residents understand and use services.
- Prevention & Health Promotion: Midwife educates on nutrition, sanitation, breastfeeding, birth spacing, and early warning signs — reducing disease burden.
- Community Resources: BHWs are paid volunteers (small honorarium or none); barangay officials provide budget for transport, facility maintenance; health committee mobilizes labor.
- Alma-Ata Declaration (1978): 'Health is a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity'; midwife contributes to this holistic view.
- Monitoring & Evaluation: TCL, FHSIS, community feedback, and outcome indicators (MMR, facility-delivery rate, immunization coverage) drive continuous improvement.
- Barangay Health Committee: Formalized participatory body (barangay officials, BHWs, youth, women's groups) that assists midwife in planning and monitoring health services.
Key definitions
Primary Health Care (PHC)
Example
A midwife stationed in Barangay San Jose provides prenatal clinics, deliveries, immunizations, and health education to all families within walking distance; cost is minimal or free.
Essential health care made ACCESSIBLE, AFFORDABLE, and ACCEPTABLE to all people through prevention, health promotion, and community participation; delivered at the most peripheral level possible (Alma-Ata, 1978).
Midwife as PHC Provider
Example
Midwife Rosa holds weekly prenatal clinics, conducts household visits, teaches nutrition, assists with safe deliveries, and refers complications — all within one barangay.
The community midwife embodies PHC philosophy: stationed in the barangay, supported by volunteers (BHWs), prevention-focused, and accountable to the community she serves.
Community Participation & Mobilization
Example
Midwife meets monthly with barangay captain, BHW coordinator, and health committee to discuss maternal deaths, immunization gaps, and budget for birth transport.
Active involvement of barangay residents, officials, BHWs, and community organizations in planning, implementing, and monitoring health programs; midwife is the catalyst.
Equity (in PHC)
Example
Even the poorest families in the remote barangay receive prenatal care at the BHS for free; delivery cost is subsidized by the barangay emergency fund.
Equal access to health care regardless of income, geography, or social status; midwife ensures poor families access prenatal care, safe delivery, and family planning.
Diagrams to know
- PHC pillars diagram: Accessibility + Affordability + Acceptability + Prevention + Community Participation = Effective community midwifery.
- Alma-Ata framework: Applied to midwifery — midwife stations at barangay, uses BHWs, emphasizes prevention, links to referral system, involves community.
Outcome Indicators & Programme Measurement
Common values
Value
≤70 per 100,000 live births
Symbol
National goal
Quantity
Philippines MMR target (SDG 2030)
Value
≤10 per 100,000 live births
Symbol
Aspirational
Quantity
WHO recommended MMR to consider maternal mortality eliminated
Value
95% or higher
Symbol
Herd immunity threshold
Quantity
Immunization coverage target
Value
35–45% (varies by region)
Symbol
CPR benchmark
Quantity
Contraceptive prevalence (Philippines national estimate)
Value
≈8–10 per 1,000 live births
Symbol
NMR baseline
Quantity
Neonatal mortality (Philippines national average)
Important facts
- Outcome indicators (MMR, facility-delivery rate, CPR, immunization coverage, NMR) directly reflect midwife's work and are used to evaluate programme performance.
- Facility-based delivery with skilled attendant is the SINGLE MOST POWERFUL intervention to reduce maternal mortality; midwife's job is to ensure every low-risk woman delivers at a facility.
- Maternal deaths in hospital reflect complications not prevented/detected early at community level; midwife's role is EARLY DETECTION and TIMELY REFERRAL.
- Postpartum family planning increases birth spacing, reduces high-risk pregnancies, and improves child survival; midwife counsels at 6-week postpartum visit.
- Immunization coverage is a quality marker for BHS/RHU; gaps indicate supply problems, BHW performance, or community barriers that midwife must address.
- Neonatal screening (RA 9288) follow-up ensures early diagnosis and treatment; midwife tracks results and refers abnormal newborns for specialist care.
- Data quality is critical: accurate FHSIS reporting, complete immunization cards, and TCL tracking allow LGU planners to identify gaps and target interventions.
- Provincial Health Board uses these indicators for performance monitoring; barangay health committee uses them for local accountability and resource allocation.
Key definitions
Maternal Mortality Ratio (MMR)
Example
A province with 10,000 live births and 8 maternal deaths = MMR of 80 per 100,000 live births.
Number of maternal deaths per 100,000 live births; primary indicator of midwifery and maternal health programme effectiveness; target: Philippines MMR ≤70 by 2030.
Facility-Based Delivery Rate (Skilled Birth Attendance)
Example
In 2023, 85% of pregnant women in municipality delivered at a health facility with skilled attendant; 15% delivered at home (mostly with TBA).
Percentage of all pregnancies delivered at a health facility (BHS, RHU, hospital, accredited private clinic) attended by a skilled birth attendant (midwife, nurse, physician); target: 100%.
Contraceptive Prevalence Rate (CPR)
Example
CPR in the barangay is 42%; midwife counsels postpartum and postabortion women on family-planning options to increase uptake.
Percentage of eligible women (married or in union, 15–49 years) using any modern contraceptive method; indicator of family-planning programme reach.
Immunization Coverage
Example
In Barangay San Jose, 92% of 1-year-olds have completed infant vaccination series; midwife's next target is to reach the remaining 8%.
Percentage of children fully immunized with all vaccines per DOH schedule; target: 95%+ for each vaccine; measured via immunization card review.
Neonatal Mortality Rate (NMR)
Example
A municipality with 5,000 live births and 45 neonatal deaths = NMR of 9 per 1,000 live births.
Number of neonatal deaths (0–28 days) per 1,000 live births; indicator of quality of newborn care and early referral for complications.
Diagrams to know
- Key outcome-indicator dashboard: MMR ↓, Facility-delivery rate ↑, CPR ↑, Immunization coverage ↑, NMR ↓ = Successful community midwifery programme.
- Midwife's influence on outcomes: Early pregnancy detection → Prenatal screening → Facility-delivery planning → Skilled attendance → Normal postpartum → Family planning → Reduced MMR & NMR.
Must remember
- RA 7392: Midwife is an INDEPENDENT primary provider of NORMAL maternal, newborn, family-planning, and community care; she RECOGNIZES complications and REFERS them — this is her core legal scope.
- Health System Ladder: BHS (barangay, midwife-led) → RHU (municipal, MHO-led) → Hospital (referral care). Midwife sits at the BASE and is the hinge between household and formal system.
- Midwife is often the FIRST and ONLY skilled health professional in rural communities; she is stationed at the Barangay Health Station (BHS) and is usually an LGU employee under the Municipal Health Officer's supervision.
- Maternal Care Continuum = Pregnancy identification → Prenatal screening (4+ visits, risk assessment) → Facility-based skilled delivery → Postpartum care (within 24h, 3–5d, 6 weeks) → Family planning. This is the midwife's OWNERSHIP pathway.
- Essential Newborn Care (EINC / 'Unang Yakap') MUST include: rooming-in (RA 7600), exclusive breastfeeding (RA 10028), skin-to-skin contact, delayed cord clamping, eye prophylaxis, vitamin K, newborn screening at 24–48 hours (RA 9288), and initial immunizations (BCG, HepB).
- DETECT & REFER: Midwife must recognize danger signs (preeclampsia, hemorrhage, prolonged labor, infection, fetal distress, neonatal emergency) and refer IMMEDIATELY with documentation, vital signs, and client records. Delay in referral kills.
- PhilHealth MCP (Maternity Care Package) and Newborn Care Package reimburse facility-based normal deliveries and newborn care at PhilHealth-accredited facilities; lying-in homes must be accredited to receive reimbursement.
- BHWs (Barangay Health Workers) are VOLUNTEERS supervised by the midwife; they extend her reach into households, reminding clients of appointments, reporting illnesses, and extending surveillance. Midwife trains, mentors, and monitors BHW performance.
- Target Client List (TCL) and Field Health Services Information System (FHSIS) are the documentation backbone: accurate, timely data entry allows LGU/provincial planners to identify gaps, measure programme progress (MMR, facility-delivery rate, CPR, immunization coverage), and allocate resources.
- Primary Health Care (PHC) philosophy: Midwife brings essential care CLOSE TO HOME, prevention-focused, AFFORDABLE, ACCESSIBLE, and with COMMUNITY PARTICIPATION; she embodies equity and is the practical foundation of the Philippine health system in rural communities.
Last minute tips
- On the MLE, if a question asks 'What is the midwife's role in [scenario]?' — always think: (1) Is this NORMAL care? → Midwife provides independently. (2) Is this a COMPLICATION? → Midwife DETECTS and REFERS immediately. Never say 'midwife manages' obstetric emergencies — she refers them.
- Health System Ladder questions: Remember the hierarchy is BHS (midwife, barangay) → RHU (MHO, municipal) → Hospital (physician, referral). Midwife reports to MHO; she supervises BHWs. If confused about who does what, visualize the organizational chart.
- For questions on PhilHealth, lying-in homes, or facility accreditation: Lying-in homes (midwife-owned or managed) MUST be accredited by PhilHealth to receive Maternity Care Package (MCP) and Newborn Care Package reimbursement. Non-accredited facilities cannot bill PhilHealth.
- When reviewing RA 9288 (Newborn Screening), RA 7600 (Rooming-In), and RA 10028 (Breastfeeding): These are MANDATORY laws. Blood spot at 24–48 hours is NOT optional; rooming-in is NOT negotiable; exclusive breastfeeding is the norm. Know the exact diseases screened (hypothyroidism, PKU, G6PD) and remember vitamin A supplementation is postpartum and for children.
- High-yield exam patterns: Questions often test (a) When does midwife refer? (recognizing danger signs), (b) What is midwife's team role? (supervisor of BHWs, report to MHO), (c) What is the maternal care continuum? (4+ prenatal, facility delivery, postpartum 24h/3–5d/6w), and (d) Outcome indicators? (MMR, facility-delivery rate, CPR, immunization coverage, NMR). Study these patterns and you will recognize most questions.
Comparison tables
BHS vs RHU vs Hospital: Roles, Staffing, and Capabilities
| Feature | Barangay Health Station (BHS) | Rural Health Unit (RHU) | District/Provincial Hospital |
|---|---|---|---|
| Location & Catchment | 1–3 barangays, ~5,000 population | Entire municipality, ~50,000–100,000 population | District/province, ~500,000+ population |
| Head/Leader | Usually a midwife (solo or with nurse) | Municipal Health Officer (MHO, physician) | Hospital Director (physician); specialty departments |
| Core Team | Midwife + BHWs (volunteers) | MHO + PHN + rural midwives + health workers | Physicians, nurses, specialists, support staff |
| Services Provided | Prenatal, normal delivery (if accredited), postnatal, child health, family planning, immunization, health education | Maternal clinics, physician services, limited obstetric care, immunization, disease surveillance, programme coordination | Comprehensive obstetric & emergency care, surgery, blood transfusion, ICU, specialties |
| Delivery Capability | Normal, low-risk delivery (BHS lying-in clinic) | Normal & some complicated cases (BEmONC if accredited) | All deliveries, including emergencies (CEmONC if accredited) |
| Referral Responsibility | Recognizes & REFERS complications upward | Manages BEmONC cases; refers severe complications further up | Manages CEmONC cases; may refer to specialty centers |
| PhilHealth Accreditation | Yes (if lying-in facility) → reimburses MCP | Yes → reimburses services | Yes → reimburses services |
| Midwife Role in Setting | PRIMARY PROVIDER, independent; solo practice in many BHS | Team member; reports to MHO; provides community-outreach services | Employee; works within department; limited community interface |
Normal Care (Midwife-Led) vs Complications (Refer Immediately)
| Situation | Midwife's Role | Setting | Decision & Action |
|---|---|---|---|
| Healthy 28-week pregnant woman, no risk factors, BP normal, urine negative | Conduct routine prenatal visit; screen for danger signs | BHS clinic | NORMAL → Continue prenatal care; deliver at BHS/lying-in home |
| Woman at 33 weeks with BP 150/95 mmHg, proteinuria 2+, headache, visual disturbances | DETECT preeclampsia; document findings | BHS or home visit | COMPLICATION → Refer IMMEDIATELY to RHU/hospital for specialist care |
| Woman in active labor, regular contractions, dilated 6 cm, bag of waters intact, normal fetal heart rate | Attend labor; monitor progress with partograph; provide support | BHS lying-in clinic or birthing home | NORMAL → Continue labor support; manage normal vaginal delivery |
| Woman in labor 24+ hours, cervix not progressing, tired, fetal heart rate irregular | DETECT prolonged/obstructed labor; document vital signs, contraction pattern, fetal status | Current setting | COMPLICATION → Refer immediately to hospital for assessment & possible cesarean |
| Woman 2 days postpartum, lochia normal, uterus firm, vitals stable, breastfeeding well | Conduct postpartum assessment; counsel on self-care & danger signs | BHS or home visit | NORMAL → Continue postpartum follow-up; plan 6-week visit & family planning |
| Woman 1 day postpartum, fever 39°C, foul-smelling lochia, lower abdominal tenderness, chills | DETECT postpartum infection/sepsis; document vitals & findings | Current setting | COMPLICATION → Refer immediately to RHU/hospital for antibiotic therapy & investigation |
| Healthy newborn, active, skin pink, feeding well, no visible abnormality | Provide EINC (rooming-in, breastfeeding support, vitamin K, eye prophylaxis, vaccines) | BHS/birthing home | NORMAL → Continue newborn care; arrange newborn screening; follow-up visits |
| Newborn with respiratory distress, cyanosis, or severe jaundice at day 2 of life | DETECT neonatal emergency; document signs, vitals | Current setting | COMPLICATION → Refer immediately to RHU/hospital NICU for respiratory support, phototherapy, investigation |
Key DOH Laws & Programmes Relevant to Community Midwifery
| Law/Programme Code | Title | Key Mandate for Midwife | Example |
|---|---|---|---|
| RA 7392 | Midwifery Law (1992) | Defines scope: normal maternity, newborn, family planning, community care; midwife recognizes & refers complications | Conduct prenatal visit, attend normal delivery, screen for preeclampsia, refer immediately |
| RA 7160 | Local Government Code (1991) | Devolved health services to LGUs; midwife is LGU employee; DOH provides technical direction | Report to Municipal Health Officer; follow DOH programme guidelines; use FHSIS reporting |
| RA 9288 | Newborn Screening Law | Mandatory blood-spot screening at 24–48 hours for hypothyroidism, PKU, G6PD deficiency | Collect blood spot from all newborns; submit to laboratory; ensure treatment of abnormal cases |
| RA 7600 | Rooming-In Law | Mother & newborn must room together continuously; promote breastfeeding & bonding | Facilitate rooming-in in BHS/birthing home; no separation except emergency; counsel on breastfeeding |
| RA 10028 | Expanded Breastfeeding Promotion Act | Workplace lactation support; institutional breastfeeding protection; exclusive breastfeeding 6 months | Counsel postpartum women; refer working mothers to employers for lactation rights; promote exclusive breastfeeding |
| DOH MNCHN Strategy | Maternal, Newborn, Child Health and Nutrition | Integrated strategy: prenatal → facility delivery → postpartum → newborn screening → child health → nutrition | Implement all components at BHS: prenatal clinics, facility-delivery planning, immunization, growth monitoring |
| PhilHealth MCP | Maternity Care Package | Insurance coverage for normal prenatal, facility delivery, postpartum care at accredited facilities | Accredit BHS/lying-in home; deliver services per MCP standards; submit claims to PhilHealth |
Diagrams
Philippine Health System Hierarchy & Midwife's Position
Flowchart showing the three-tier health system with BHS (barangay level midwife-led) → RHU (municipal physician-led) → Hospital (referral). Shows referral decision point, back-referral, and midwife's connector role (downward to BHWs/TBAs, upward to RHU/hospital, lateral to barangay officials).
Maternal Care Continuum: Midwife's Ownership Pathway
Mind map showing the complete maternal care continuum from pregnancy detection through postpartum and family planning. Illustrates the sequential, holistic nature of midwife-led care and highlights EINC and newborn screening as integral components.
Complication Detection & Referral Pathway (Recognize & Refer)
Flowchart illustrating the RECOGNIZE & REFER principle: midwife detects complications through assessment, documents findings, makes a risk/emergency determination, arranges appropriate referral (RHU for high-risk, hospital for emergencies), and resumes follow-up care after back-referral. This is the core midwife responsibility.
Essential Newborn Care (EINC / Unang Yakap) Checklist
Flowchart detailing all components of Essential Newborn Care (EINC / Unang Yakap): immediate actions (rooming-in, cord clamping, eye care, vitamin K), initial vaccines, newborn screening (RA 9288), and post-discharge follow-up. Emphasizes the integration of RA 7600 (rooming-in) and RA 10028 (breastfeeding).
Midwife's Team Role & Supervision Structure
Mind map showing the midwife's position in the health team: upward accountability to MHO and PHN, downward supervision of BHWs and TBAs, lateral coordination with barangay officials and complementary health programs. Illustrates the midwife's central connector role.
PhilHealth Maternity & Newborn Care Package (MCP/NCP) Pathway
Flowchart showing the PhilHealth Maternity Care Package (MCP) and Newborn Care Package (NCP) pathway: accreditation requirement, covered services (prenatal, facility delivery, postpartum, EINC, newborn screening), service delivery by midwife, documentation, claim submission, and reimbursement. Emphasizes that accreditation is prerequisite for PhilHealth reimbursement.