Midwife Licensure Exam Midwifery Pharmacology & Newborn Procedures Reviewer 2026

Answer: B. 60 mg elemental iron + 400 mcg folic acid once daily

Step 1: The DOH standard prenatal supplement combines iron and folic acid in one tablet. Step 2: The correct dose is 60 mg ELEMENTAL iron (not total iron salt) plus 400 micrograms (0.4 mg) of folic acid. Step 3: It is given ONCE daily, starting at the first prenatal visit and continued throughout pregnancy and for 3 months postpartum. Step 4: Option A is too low (30 mg / 200 mcg) — this is not the Philippine standard. Step 5: Option C doubles the folic acid and the frequency unnecessarily; Option D doubles the iron — this higher dose is only used for diagnosed severe anemia under protocol, not routine supplementation.

Answer: C. Before conception and during the first trimester

Step 1: Neural tube defects (NTDs) such as spina bifida and anencephaly occur very early — the neural tube closes around days 24–28 after conception, often before a woman even knows she is pregnant. Step 2: Folic acid must be present BEFORE conception and in the FIRST TRIMESTER to provide protective benefit during this critical window. Step 3: Starting folic acid only in the second or third trimester is too late to prevent NTDs, because the neural tube has already formed (or failed to form properly) by that point. Step 4: The midwife should counsel all women of reproductive age planning pregnancy to take folic acid early — this is a key counseling point on the MLE.

Answer: B. 200,000 IU — given within the early postpartum period

Step 1: High-dose Vitamin A is CONTRAINDICATED during pregnancy because of its teratogenic risk, but postpartum supplementation is safe and beneficial. Step 2: The DOH postpartum dose is 200,000 IU, given within the early postpartum period (within the first 4 weeks / while still lactating-amenorrheic) to build the mother's stores and enrich her breast milk. Step 3: 100,000 IU is the dose for infants 6–11 months — not for postpartum mothers. Step 4: 400,000 IU exceeds the recommended dose and is not the DOH protocol. Step 5: Waiting until 6 weeks is incorrect; the supplementation should be given early while she is still lactating and amenorrheic to maximize benefit to the nursing infant.

Answer: B. 100,000 IU

Step 1: The DOH uses age-based dosing for child Vitamin A supplementation. Step 2: For infants aged 6–11 months, the dose is 100,000 IU — a single dose. Step 3: The higher dose of 200,000 IU is reserved for children aged 12–59 months (1–5 years), given every 6 months. Step 4: An 8-month-old child falls in the 6–11-month category, so 100,000 IU is correct. Step 5: Vitamin A is NOT routinely given below 6 months to exclusively breastfed infants — they receive sufficient Vitamin A through breast milk, especially if the mother received her postpartum dose. Giving it earlier than 6 months is incorrect.

Answer: C. RA 10028 (Expanded Breastfeeding Promotion Act of 2009)

Step 1: There are several Philippine laws related to breastfeeding — it is important to know what each one covers. Step 2: RA 10028 (Expanded Breastfeeding Promotion Act, 2009) is the law that specifically requires lactation stations in workplaces and public places, and grants lactation breaks to working mothers. Step 3: EO 51 (the Milk Code) regulates the marketing and promotion of breast-milk substitutes, feeding bottles, and teats — it does not cover workplace lactation stations. Step 4: RA 7600 (Rooming-In and Breastfeeding Act) requires hospitals to practice rooming-in and promote breastfeeding at the facility level — not workplace lactation stations. Step 5: RA 8172 (ASIN Law) is about iodized salt — unrelated to breastfeeding workplaces.

Answer: C. The baby's lower lip is turned outward and the chin is touching the breast

Step 1: A good latch is critical to prevent sore nipples and ensure the baby gets enough milk. Step 2: The four signs of a GOOD latch are: (a) more areola visible ABOVE than below the mouth, (b) mouth WIDE open, (c) lower lip EVERTED (turned outward), and (d) CHIN touching the breast. Step 3: Option A (nipple only inside the mouth) is a POOR latch — the baby must take in most of the areola, not just the nipple. Step 4: Option B (equal areola above and below) is not the correct description — there should be MORE areola visible ABOVE. Step 5: Option D (head turned away) is wrong positioning. The baby should face the breast with nose-to-nipple alignment.

Answer: B. Breast milk alone provides all the water the baby needs — no water is needed even in hot weather

Step 1: Exclusive breastfeeding means breast milk ONLY for the first 6 months — no other food, drink, or liquid, NOT EVEN WATER, regardless of the climate or temperature. Step 2: Breast milk is approximately 88% water and fully meets the baby's hydration needs even in hot weather. Step 3: Giving water (even clean or boiled water) to an exclusively breastfed infant under 6 months violates exclusive breastfeeding, reduces breast-milk intake, and increases the risk of diarrhea and undernutrition. Step 4: This is a very common concern Filipino mothers raise. The midwife must confidently and kindly dispel this myth with accurate information. Step 5: If the baby seems thirsty in hot weather, the correct advice is to INCREASE breastfeeding frequency — not to add water.

Answer: B. 6 completed months

Step 1: The WHO and DOH recommend exclusive breastfeeding for the first 6 COMPLETED months. Step 2: After 6 completed months, breast milk alone can no longer meet all of the baby's energy and nutrient needs — this is when complementary foods are introduced. Step 3: Starting too early (e.g., 4 months) increases the risk of choking, infection, and obesity, and reduces breast-milk intake. Step 4: Starting too late (e.g., 8 or 12 months) leads to growth faltering and micronutrient deficiencies. Step 5: The key message: start complementary foods AT 6 MONTHS, not before, not significantly after — and always CONTINUE BREASTFEEDING alongside complementary foods up to 2 years and beyond.

Answer: B. A flat or falling growth curve over two consecutive weighings

Step 1: Growth monitoring is not just about a single number — it is about the DIRECTION of the growth curve over time. Step 2: A flat line (no weight gain) or a falling line (weight loss) over consecutive monthly weighings signals a nutrition problem EARLIER than a single low weight measurement does. Step 3: A child can have a low weight for age but be growing steadily — this is less alarming than a child whose weight is not increasing or is decreasing. Step 4: Option A (single low weight) may indicate underweight, but it is a less sensitive early warning compared to trend. Step 5: A MUAC of 13.5 cm is actually within normal range — MUAC below 11.5 cm in a child 6–59 months signals severe acute malnutrition and needs referral. The midwife must plot and interpret the curve at every visit.

Answer: B. Refer the child immediately to a physician or therapeutic feeding program

Step 1: The midwife must recognize the signs of SEVERE ACUTE MALNUTRITION (SAM) as a detect-and-refer situation. Step 2: SAM is indicated by: MUAC less than 11.5 cm in a child 6–59 months, OR bilateral pedal (foot) edema (sign of kwashiorkor), OR severe visible wasting. Step 3: This child has TWO danger signs — MUAC of 11.0 cm (below the 11.5 cm cut-off) AND bilateral edema, confirming SAM. Step 4: SAM requires specialized therapeutic feeding and medical management BEYOND the midwife's scope — the priority action is IMMEDIATE REFERRAL to a physician, hospital, or community-based therapeutic feeding program. Step 5: Continuing monitoring, giving Vitamin A only, or starting iron alone are all insufficient responses to SAM — they would delay life-saving care.

Answer: B. The midwife who attended the birth

Step 1 — Identify the rule: Under Philippine law and PSA regulations, the attendant at birth is legally responsible for accomplishing and filing the Certificate of Live Birth. Step 2 — Apply to scenario: The midwife attended the home delivery, so she is the birth attendant in this case. Step 3 — Why not the mother? The mother is the subject of care immediately after delivery and is not the registering party. Step 4 — Why not the barangay captain or father? These parties step in only when there is no birth attendant or when the attendant fails to register. Step 5 — Key rule: The midwife must file the COLB at the Office of the Local Civil Registrar (LCR) of the city or municipality where the birth occurred, and the LCR then transmits records to the PSA.

Answer: C. March 31 (within 30 days)

Step 1 — Recall the rule: A live birth must be registered within 30 days of birth. Step 2 — Calculate: 30 days from March 1 = March 31. Step 3 — Why not 7 or 15 days? Those are common distractors; the legal window is 30 days, not 7 or 15. Step 4 — Why not 90 days? 90 days is not the standard window; registration after 30 days is already classified as delayed or late registration. Step 5 — Consequence of late registration: It requires additional affidavits and a more complex LCR process, and the child is left without legal identity in the meantime.