Midwife Licensure Exam Midwifery Pharmacology & Newborn Procedures — Maternal & Child Nutrition Counseling (Midwife-led)Concept Map

Concept

Maternal Micronutrient Supplementation

Sub Concepts

• Iron-Folic Acid (60 mg + 400 mcg daily)
• Timing: First visit through 3 months postpartum
• Neural tube defect prevention
• Anemia prevention and PPH reduction
• Vitamin A contraindication in pregnancy
• Postpartum Vitamin A 200,000 IU dosing
• Iodine promotion via iodized salt (RA 8172)
• Calcium supplementation for pre-eclampsia risk

Relationship To Central

Core intervention during pregnancy to prevent deficiency-related complications

Concept

Infant & Child Vitamin A Supplementation

Sub Concepts

• 6-11 months: 100,000 IU single dose
• 12-59 months: 200,000 IU every 6 months
• Not routine below 6 months (breastfed)
• Paired with deworming campaigns
• Recording to avoid accumulation toxicity
• Adjunct in measles and severe illness

Relationship To Central

Prevents child blindness, xerophthalmia, and mortality; scheduled twice-yearly program

Concept

Exclusive Breastfeeding (6 Months)

Sub Concepts

• Initiate within first hour (EINC standard)
• Breast milk only—no water, food, formula
• Colostrum—rich in antibodies, never discard
• Benefits: nutrition, immunity, bonding, LAM
• Continue to 2 years with complementary food
• Good positioning & latch technique
• Signs of effective feeding
• Breast engorgement & sore nipple solutions
• Working mother support & lactation breaks (RA 10028)

Relationship To Central

Foundation of infant nutrition and immune protection; mandated by RA 10028 and Milk Code

Concept

Complementary Feeding (6 Months Onwards)

Sub Concepts

• Timely start at 6 completed months
• Adequate: 2-3 meals at 6-8 mo, 3-4 meals + snacks at 9-23 mo
• Safe: strict food hygiene, avoid contamination
• Properly fed: responsive feeding, no bottles
• Iron-rich & animal-source foods priority
• Include fruits, vegetables, added fat for energy
• Avoid sugary drinks, tea, low-nutrient junk
• Gradual progression to family foods

Relationship To Central

Transition from breast milk to family foods while maintaining breastfeeding

Concept

Growth Monitoring & Promotion (GMP)

Sub Concepts

• Monthly weighing for infants and children
• Plot on Growth Monitoring Chart or WHO standards
• Interpret growth curve direction (flat/falling = early warning)
• Classify nutritional status (normal, underweight, severe)
• MUAC measurement (< 11.5 cm = severe acute malnutrition)
• Detect bilateral pedal edema (kwashiorkor)
• Provide feeding advice at each visit
• Refer severe faltering or SAM cases
• Teaching moment with mother at each weighing

Relationship To Central

Regular surveillance tool to detect faltering early and guide feeding intervention

Concept

Deworming & Adjunct Programs

Sub Concepts

• Twice-yearly deworming schedule
• Albendazole 400 mg (children 12-23 mo: 200 mg)
• Paired with Vitamin A twice-yearly rounds
• Pregnant women dewormed after first trimester
• Food fortification promotion (RA 8976, RA 8172)
• Link to therapeutic feeding programs for malnourished

Relationship To Central

Complement nutrition care to reduce worm-related anemia and undernutrition

Concept

Legislative & Policy Framework

Sub Concepts

• RA 10028: Expanded Breastfeeding Promotion Act
• EO 51 / Milk Code: prohibition on formula advertising
• RA 7600: Rooming-In & Breastfeeding Act
• RA 8172 (ASIN Law): iodized salt mandate
• RA 8976: Food Fortification Law
• RA 7392: Midwife scope (independent NORMAL care, refer complications)
• Workplace lactation stations & lactation breaks
• DOH micronutrient schedules & growth monitoring protocols

Relationship To Central

Mandates and protections that guide midwife practice and ensure program uptake

To

Neural Tube Defect Prevention

From

Iron-Folic Acid Supplementation

Strength

strong

Relationship

Folic acid taken before conception and first trimester directly prevents neural tube defects (spina bifida, anencephaly); iron prevents anemia-related complications in pregnancy

To

Postpartum Hemorrhage Reduction

From

Iron-Folic Acid Supplementation

Strength

strong

Relationship

Iron supplementation throughout pregnancy builds maternal iron stores, reducing risk of severe PPH and PPH-related death

To

Colostrum & Immunity

From

Exclusive Breastfeeding

Strength

strong

Relationship

Colostrum, the first milk, is rich in antibodies and immune factors; never discarding it is critical for establishing passive immunity in the newborn

To

LAM Contraceptive Effectiveness

From

Exclusive Breastfeeding

Strength

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Relationship

LAM (Lactational Amenorrhea Method) requires exclusive breastfeeding, baby under 6 months, and no menses return; ~98% effective when all criteria met

To

Exclusive Breastfeeding to 6 Months

From

Complementary Feeding Start at 6 Months

Strength

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Relationship

At exactly 6 months, exclusive breastfeeding ends and complementary foods are introduced while continuing to breastfeed; timing is critical for nutrient adequacy

To

Iron-Rich & Animal-Source Foods

From

Complementary Feeding

Strength

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Relationship

Complementary foods must include meat, liver, fish, egg, and legumes to provide bioavailable iron and prevent anemia as breast milk iron becomes limited after 6 months

To

Faltering Detection

From

Growth Monitoring

Strength

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Relationship

A flat or falling growth curve detected on the Growth Monitoring Chart signals nutritional problem earlier than a single low weight; this early warning enables intervention before severe malnutrition

To

MUAC & Severe Acute Malnutrition

From

Growth Monitoring

Strength

strong

Relationship

Mid-Upper Arm Circumference < 11.5 cm in a child 6-59 months indicates severe acute malnutrition requiring immediate referral to physician or therapeutic feeding program

To

Complementary Feeding Success

From

Deworming

Strength

moderate

Relationship

Intestinal worm infection reduces appetite, nutrient absorption, and causes anemia; deworming improves the efficacy of nutrition counseling and complementary feeding

To

Xerophthalmia & Blindness Prevention

From

Infant Vitamin A Supplementation

Strength

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Relationship

Vitamin A deficiency causes night blindness, xerophthalmia, and corneal scarring leading to preventable blindness; twice-yearly Vitamin A (100,000 IU at 6-11 mo, 200,000 IU at 12-59 mo) prevents this

To

Increased Infection & Childhood Mortality

From

Infant Vitamin A Supplementation

Strength

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Relationship

Vitamin A deficiency impairs immune function, increasing risk of infections and childhood death; supplementation reduces all-cause mortality by ~12% in deficient populations

To

Workplace Lactation Support

From

RA 10028 Breastfeeding Promotion Act

Strength

strong

Relationship

RA 10028 mandates workplace lactation stations and lactation breaks, enabling working mothers to sustain exclusive breastfeeding and express milk safely

To

Prohibition of Formula Promotion

From

EO 51 Milk Code

Strength

strong

Relationship

The Milk Code (EO 51) forbids advertising and promotion of breast-milk substitutes and free samples; protects exclusive breastfeeding by preventing commercial undermining

To

Iodine-Deficiency Disorder Prevention

From

RA 8172 ASIN Law

Strength

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Relationship

Mandatory iodization of salt (RA 8172) ensures population iodine intake, preventing goiter and iodine-deficiency disorders in mother and child

To

First 1000 Days Concept

From

Maternal Micronutrient Care

Strength

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Relationship

Maternal nutrition in pregnancy and lactation sets the foundation for child growth, immunity, and long-term health outcomes in the critical first 1,000 days

To

EINC Guidelines

From

Breastfeeding Initiation Within First Hour

Strength

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Relationship

EINC (Essential Intrapartum & Newborn Care) mandates first-hour breastfeeding initiation with skin-to-skin contact, optimizing latch and colostrum transfer

To

Prevention of Sore & Cracked Nipples

From

Good Latch Technique

Strength

strong

Relationship

Most sore nipples result from poor attachment; correct positioning (head/body straight, close to mother, facing breast) and proper latch signs prevent nipple trauma

To

Complementary Feeding Adequacy

From

Responsive Feeding

Strength

moderate

Relationship

Responsive feeding (following the child's hunger and satiety cues) ensures adequate intake and prevents both under- and over-feeding during complementary feeding

To

Diarrhea Prevention

From

Food Safety in Complementary Feeding

Strength

strong

Relationship

Strict food hygiene (clean hands, boiled water, no contamination) during complementary feeding preparation prevents infectious diarrhea, which worsens nutritional status

To

Breast Milk Enrichment

From

Vitamin A Postpartum Dose

Strength

moderate

Relationship

A postpartum dose of Vitamin A 200,000 IU enriches the mother's breast milk with Vitamin A, providing passive supplementation to the breastfed infant

To

Teratogenicity Prevention

From

Vitamin A Contraindication in Pregnancy

Strength

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Relationship

High-dose Vitamin A is teratogenic and causes birth defects; the midwife must never give this to a woman who could be pregnant, only postpartum

To

Nutrition Referral & BEmONC Linkage

From

Midwife Role in Growth Monitoring

Strength

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Relationship

The midwife identifies severe malnutrition (MUAC < 11.5 cm, edema, severe wasting) at the BHS and refers to physician or BEmONC facility; she does not manage, but detects and refers

To

Midwife Counseling & Teaching Moments

From

Monthly Growth Monitoring Visits

Strength

moderate

Relationship

Each monthly growth-monitoring visit is an opportunity for the midwife to counsel on feeding, provide nutrition education, and reinforce best practices with the mother

To

RA 7392 Midwife Scope of Practice

From

Micronutrient Supplementation Schedule

Strength

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Relationship

RA 7392 (Midwifery Law) defines the midwife as an independent primary provider of normal maternal-child care, including micronutrient supplementation, counseling, and monitoring—not medication management

To

BHS & Lying-in Service

From

Breastfeeding Support in Community

Strength

strong

Relationship

The BHS (Barangay Health Station) is the frontline site where the midwife provides breastfeeding initiation, counseling, and problem-solving; lying-in services extend postpartum support

To

Garantisadong Pambata Synchronization

From

Deworming & Vitamin A Programs

Strength

moderate

Relationship

Vitamin A supplementation and deworming are synchronized twice yearly with immunization and health campaigns under DOH programs for efficiency and coverage