Midwife Licensure Exam The Midwife's Public Health Service Delivery Reviewer 2026

Answer: A. MNCHN (Maternal, Newborn, Child Health and Nutrition)

Step 1 – Identify the question: It asks for the overall DOH strategy for reducing maternal and neonatal deaths. Step 2 – Recall the definition: MNCHN (formalized under A.O. 2008-0029) is the umbrella strategy that defines service packages across the reproductive continuum AND organizes facilities into a network. Step 3 – Eliminate distractors: EINC is a specific newborn care protocol; BEmONC is a facility-level service standard; FHSIS is the recording and reporting system. Step 4 – Conclusion: MNCHN is the correct answer because it is the overarching strategy, while the others are components within it.

Answer: C. 7

Step 1 – Recall the BEmONC standard: The current WHO/DOH standard lists 7 signal functions for a BEmONC facility. Step 2 – List the 7: (1) parenteral antibiotics, (2) parenteral oxytocics, (3) parenteral anticonvulsants (MgSO4), (4) manual removal of placenta, (5) removal of retained products (MVA), (6) assisted vaginal delivery (vacuum extraction), (7) basic newborn resuscitation. Step 3 – Note the common trap: Older Philippine references list only 6, excluding newborn resuscitation, but the current standard includes it as the 7th. Step 4 – Distinguish from CEmONC: CEmONC performs all 7 PLUS cesarean section and blood transfusion = 9 total. Answer is 7.

Answer: B. Cesarean section and blood transfusion

Step 1 – Recall the formula: CEmONC = BEmONC 7 functions + 2 additional = 9 total. Step 2 – Identify the two additions: These are cesarean section (a surgical procedure) and blood transfusion. Step 3 – Eliminate distractors: Manual vacuum aspiration is already a BEmONC function; oxytocin administration is also a BEmONC function; vacuum extraction is a BEmONC function. Step 4 – Key rule: Anything requiring surgery or blood transfusion belongs only to CEmONC, which is why these cases must be referred up the chain.

Answer: B. Within one minute of the baby's birth, after ruling out a second baby

Step 1 – Define AMTSL: It is the set of three steps that prevent postpartum hemorrhage (PPH), the leading cause of maternal death. Step 2 – First step of AMTSL: Give oxytocin 10 IU IM within ONE minute of the baby's birth. The qualifier 'after ruling out a second baby' is critical – giving oxytocin before checking could trap a second twin inside. Step 3 – Why not after delivery of placenta: Giving the uterotonic BEFORE placental delivery causes the uterus to contract, which helps expel the placenta and prevents hemorrhage. Step 4 – Common mistakes: Option A (after placenta) is too late; Option C (second stage) is too early; Option D (only when bleeding) makes it a treatment, not prevention.

Answer: B. Immediate and thorough drying of the newborn for the first 30 seconds

Step 1 – Recall the 4 EINC/Unang Yakap steps in order: (1) Immediate and thorough drying for 30 seconds, (2) Skin-to-skin contact, (3) Delayed cord clamping after pulsations stop (1-3 minutes), (4) Non-separation and early breastfeeding within 90 minutes. Step 2 – Why drying is first: Drying stimulates the baby to breathe and prevents hypothermia – two immediate life-threatening risks. It must happen in the very first 30 seconds. Step 3 – All the other options are correct EINC steps but come AFTER drying. Step 4 – Memory tip: 'Dry first, then hug, then cut, then feed' captures the correct sequence.

Answer: B. After cord pulsations stop, usually 1 to 3 minutes after birth

Step 1 – Define delayed cord clamping: It means waiting until cord pulsations stop before clamping and cutting. Step 2 – Why delay: While the cord is still pulsating, it transfers oxygen-rich blood and iron from the placenta to the newborn, improving iron stores and reducing the risk of anemia. Step 3 – Timeframe: This typically takes 1 to 3 minutes. The key indicator is cessation of pulsations, not a fixed clock time. Step 4 – Eliminate distractors: Immediate clamping (Option A) deprives the baby of this extra blood; waiting until after placental delivery (Option C) may be too long; a fixed 5-minute rule (Option D) does not reflect the current standard.

Answer: B. BHS → RHU/BEmONC → CEmONC hospital

Step 1 – Recall the three-level referral chain: The SDN (Service Delivery Network) under MNCHN creates a clear escalation pathway. Step 2 – Level 1: The BHS (Barangay Health Station) is where the midwife identifies risk, provides prenatal care, and detects danger signs. Step 3 – Level 2: The RHU (Rural Health Unit) functions as the BEmONC facility with 7 signal functions and skilled birth attendance. Step 4 – Level 3: The CEmONC hospital provides the two additional functions (cesarean section and blood transfusion). The path always goes upward through these levels; skipping levels can cause delay but in true emergencies, bypassing to CEmONC directly may be necessary.

Answer: B. Magnesium sulfate (MgSO4)

Step 1 – Identify the context: A convulsing woman most likely has eclampsia (seizures from severe pre-eclampsia). Step 2 – Drug of choice: Magnesium sulfate (MgSO4) is the anticonvulsant of choice for severe pre-eclampsia and eclampsia according to DOH BEmONC protocols. Step 3 – Midwife's authority: RA 7392 authorizes a trained midwife to administer the MgSO4 LOADING DOSE as a life-saving stabilizing action before and during referral to CEmONC. This is one of the BEmONC signal functions. Step 4 – Eliminate distractors: Diazepam, phenytoin, and hydralazine are NOT the recommended first-line drugs under current DOH BEmONC guidelines for this situation.

Answer: A. Delay in deciding to seek care, delay in reaching care, delay in receiving care at the facility

Step 1 – Recall the 'Three Delays Model': This is an internationally recognized framework explaining why women die from obstetric complications. Step 2 – The three delays are: (1) Delay in DECIDING to seek care – due to not recognizing danger signs or cultural barriers; (2) Delay in REACHING care – due to distance, transport problems, or cost; (3) Delay in RECEIVING care – due to facility unreadiness or understaffing. Step 3 – How the midwife fights each: (1) Teaches danger signs at prenatal visits; (2) Ensures a birth plan with named facility and transport; (3) Stabilizes the patient and communicates ahead to the receiving facility. Step 4 – The other options describe specific clinical events, not the public health framework.

Answer: C. Folic acid supplementation and healthy timing and spacing of pregnancy

Step 1 – Recall MNCHN service packages by phase: Pre-pregnancy, Pregnancy, Childbirth, Postpartum/Newborn, Child care. Step 2 – Pre-pregnancy package includes: family planning, folic acid supplementation, nutrition and iron counseling, anemia management, reproductive tract infection management, and healthy timing and spacing of pregnancy (HTSP). Step 3 – Eliminate distractors: Tetanus toxoid immunization is part of the PREGNANCY (antenatal) package; Newborn screening is part of the POSTPARTUM/NEWBORN package; AMTSL is part of the CHILDBIRTH (intrapartum) package. Step 4 – Key concept: The continuum begins BEFORE pregnancy to optimize health before conception.

Answer: B. RA 10354 – Responsible Parenthood and Reproductive Health Act of 2012

Step 1 – Identify the law being asked: the question asks about universal access to modern FP and informed choice. Step 2 – Recall that RA 10354 is the Responsible Parenthood and Reproductive Health Act of 2012, also called the RH Law. It guarantees universal access to medically safe, effective, legal, and affordable reproductive health care, including the full range of modern family planning methods. Step 3 – Rule out the distractors: RA 7392 governs midwifery practice in general; RA 9173 governs nursing; RA 11223 is the Universal Health Care Act, which covers broader health-system financing. None of these specifically mandate modern FP access and informed choice the way RA 10354 does. Step 4 – Confirm: RA 10354 is the cornerstone FP law in the Philippines and is always the correct answer when the question mentions the RH Law, informed choice, voluntarism, or the full method mix.

Answer: C. DMPA injectable (Depo-Medroxyprogesterone Acetate)

Step 1 – Recall the two categories of midwife FP scope: methods she can provide independently after basic DOH FP training, and methods that need additional certification or referral. Step 2 – DMPA injectable is included in the standard FP service package a trained midwife delivers independently. She administers 150 mg IM every 3 months (13 weeks) herself. Step 3 – IUD insertion and implant insertion both require additional DOH competency-based certification beyond basic training. Without that certification, the midwife counsels and refers. Step 4 – Bilateral tubal ligation is a surgical procedure entirely outside the midwife's scope; she counsels and refers. Step 5 – Therefore, DMPA is the only option here that falls within the midwife's independent scope.