BEmONC and MNCHN from the Midwife's Role - Concept Map
Midwife's Public Health Service Delivery: BEmONC and MNCHN Strategy
Related concepts
MNCHN Strategy
Sub concepts
- Pre-pregnancy care (family planning, nutrition, anemia management)
- Prenatal care (4+ ANC visits, danger sign screening, birth planning)
- Intrapartum care (skilled birth attendance, facility-based delivery)
- Postpartum and newborn care (monitoring, immunization, breastfeeding)
- Child care (immunization, growth monitoring)
- Administrative Order 2008-0029 (legal foundation)
Relationship to central
DOH's flagship framework that organizes the midwife's entire service delivery across the reproductive continuum
Basic EmONC (BEmONC)
Sub concepts
- Signal Function 1: Parenteral antibiotics
- Signal Function 2: Parenteral oxytocics
- Signal Function 3: Parenteral anticonvulsants (MgSO4)
- Signal Function 4: Manual removal of placenta
- Signal Function 5: Removal of retained products (MVA)
- Signal Function 6: Assisted vaginal delivery (vacuum)
- Signal Function 7: Basic newborn resuscitation
Relationship to central
Core facility-level capacity that the midwife works within and activates at every birth
Comprehensive EmONC (CEmONC)
Sub concepts
- All 7 BEmONC signal functions plus:
- Signal Function 8: Cesarean section
- Signal Function 9: Blood transfusion
- Typically a provincial or tertiary hospital
Relationship to central
Higher-level facility with surgical and transfusion capacity; midwife refers complications upward
Midwife's Direct Interventions in BEmONC
Sub concepts
- First-dose oxytocin 10 IU IM for postpartum hemorrhage prevention
- Loading dose magnesium sulfate for severe pre-eclampsia/eclampsia
- Initial parenteral antibiotics for sepsis or PROM
- Newborn resuscitation with bag and mask
- Active Management of Third Stage of Labor (AMTSL)
- Manual removal of placenta (when trained, no physician present)
- Bimanual uterine compression (stabilizing measure)
Relationship to central
Skilled procedures and medications the midwife is authorized to perform under RA 7392 and DOH protocols
Essential Intrapartum and Newborn Care (EINC / Unang Yakap)
Sub concepts
- Step 1: Immediate and thorough drying (first 30 seconds)
- Step 2: Early skin-to-skin contact (prone on mother's abdomen)
- Step 3: Delayed cord clamping (1-3 minutes, after pulsations stop)
- Step 4: Early breastfeeding within 90 minutes with non-separation
Relationship to central
Four time-bound newborn interventions the midwife performs at every birth to ensure survival and bonding
Active Management of Third Stage of Labor (AMTSL)
Sub concepts
- Step 1: Give oxytocin 10 IU IM within 1 minute of baby's birth
- Step 2: Controlled cord traction with counter-traction on uterus
- Step 3: Immediate uterine massage after placenta delivery and continued monitoring
Relationship to central
Single most important midwife intervention against postpartum hemorrhage, the leading cause of maternal death
Service Delivery Network (SDN) and Continuum of Care
Sub concepts
- Community level: BHS midwife provides prenatal care and recognizes danger signs
- Primary facility: RHU/BEmONC for skilled birth attendance
- Secondary/tertiary facility: CEmONC hospital for complications
- Continuum across time: pre-pregnancy through child care
- No gaps in escalation pathway
Relationship to central
Linked system of facilities ensuring unbroken service from community through pregnancy, birth, postpartum, and childhood
Referral Competency and Three Delays Model
Sub concepts
- Delay 1 (Decision): Teach danger signs at prenatal visits
- Delay 2 (Reaching): Ensure birth plan names facility and transport
- Delay 3 (Receiving): Stabilize patient before and during transfer
- Recognize danger signs early
- Stabilize with first-line drugs (oxytocin, MgSO4, antibiotics)
- Communicate ahead to receiving facility
- Accompany with written referral note including history and interventions
- Follow up on outcome and document
Relationship to central
Midwife's systematic approach to overcome barriers to emergency care and prevent maternal/neonatal deaths
Recording and Reporting (FHSIS)
Sub concepts
- Field Health Services Information System (FHSIS)
- Target Client List (TCL)
- Prenatal visits recorded
- Tetanus immunization tracked
- Births attended documented
- Postpartum visits monitored
- Referrals documented
- Data rolls up to MMR and NMR indicators
Relationship to central
Midwife's data capture system that tracks program performance and informs MNCHN strategy effectiveness
Facility Standards and Population Coverage
Sub concepts
- One BEmONC facility per ~125,000 population
- One CEmONC facility per ~500,000 population
- RHU/BEmONC operates 24/7 with doctor, nurse, midwife minimum
- Birthing home upgrades with BEmONC capability
Relationship to central
DOH targets for geographic access and capacity planning to support midwife-centered care delivery
High-Risk Content: Detect and Refer (Midwife's Scope)
Sub concepts
- Postpartum hemorrhage (detect, give oxytocin, refer)
- Eclampsia/severe pre-eclampsia (detect, give MgSO4 loading dose, refer)
- Sepsis/chorioamnionitis (detect, give antibiotics, refer)
- Obstructed labor (detect, refer)
- Retained placenta (detect, attempt manual removal if trained, refer)
- Non-breathing newborn (resuscitate, refer if unresponsive)
Relationship to central
Complications that midwife recognizes early but refers to higher level; NOT the midwife's independent management
Policy Emphasis: Facility-Based Delivery
Sub concepts
- Life-threatening complications can occur suddenly
- Home has no drugs, equipment, or escalation option
- Postpartum hemorrhage kills within hours
- Every mother steered toward BEmONC-capable facility
Relationship to central
Central MNCHN policy that directs midwife's counseling and service planning; discourages home birth with hilots
Concept connections
- MNCHN StrategyBEmONC Signal FunctionsMNCHN provides the overall DOH framework; BEmONC signal functions are the concrete facility-level deliverables of MNCHN at the primary level
- BEmONC Signal FunctionsMidwife's Direct Interventions in BEmONCMidwife performs or activates signal functions 1-7 as a core BEmONC team member under RA 7392 and DOH protocols
- Active Management of Third Stage of Labor (AMTSL)Postpartum Hemorrhage PreventionAMTSL is the single most important midwife intervention against postpartum hemorrhage, the leading cause of maternal death
- Essential Intrapartum and Newborn Care (EINC / Unang Yakap)Newborn Survival and Early BondingEINC four steps prevent hypothermia, establish breastfeeding, and ensure early detection of newborn complications
- Service Delivery Network (SDN) and Continuum of CareReferral Competency and Three Delays ModelSDN structures the facilities and pathways; Three Delays model guides midwife's actions to overcome barriers within the SDN
- Referral Competency and Three Delays ModelMidwife's Direct Interventions in BEmONCMidwife's stabilizing interventions (oxytocin, MgSO4, antibiotics) occur before and during referral to address the third delay (receiving care)
- Policy Emphasis: Facility-Based DeliveryMNCHN StrategyFacility-based delivery with skilled attendant is a central MNCHN policy to prevent home delivery complications
- Recording and Reporting (FHSIS)MNCHN StrategyFHSIS data (births attended, referrals, postpartum visits) are the evidence that MNCHN strategy is being implemented and is effective
- Facility Standards and Population CoverageService Delivery Network (SDN) and Continuum of CareFacility ratios (1 BEmONC per 125,000, 1 CEmONC per 500,000) ensure geographic access and function of the SDN
- BEmONC Signal FunctionsComprehensive EmONC (CEmONC)CEmONC includes all 7 BEmONC functions plus cesarean surgery and blood transfusion; midwife refers when the additional functions are needed
- Midwife's Direct Interventions in BEmONCHigh-Risk Content: Detect and ReferMidwife's stabilizing drugs (oxytocin, MgSO4, antibiotics) are first-line interventions for complications that must then be referred to higher level
- EINC / Unang YakapAMTSLBoth EINC and AMTSL occur in the immediate perinatal period; AMTSL prevents postpartum hemorrhage while EINC ensures newborn survival and bonding
- Three Delays ModelHigh-Risk Content: Detect and ReferThree Delays model is the framework for overcoming barriers to emergency care for complications the midwife detects and refers
- MNCHN StrategyContinuum of Care Across TimeMNCHN service packages (pre-pregnancy, prenatal, intrapartum, postpartum, child care) define the continuum across the woman and child's lifespan
- Midwife's Direct Interventions in BEmONCMagnesium Sulfate (MgSO4) Loading DoseMgSO4 is the anticonvulsant of choice for severe pre-eclampsia and eclampsia; midwife gives loading dose to stabilize before referral
Diagrams
BEmONC and MNCHN: Complete Concept Hierarchy for Midwife's Public Health Role
Comprehensive mind map showing all major concepts in the BEmONC and MNCHN chapter, organized hierarchically from the central role of the midwife in public health service delivery, through MNCHN strategy phases, BEmONC signal functions, midwife interventions (AMTSL and Unang Yakap), the service delivery network, referral pathways, and documentation systems. This is the primary concept organizer for the chapter and emphasizes the midwife's frontline role in detecting and referring complications within the MNCHN framework.
AMTSL (Active Management of Third Stage of Labor): Step-by-Step Midwife Protocol
Detailed flowchart of AMTSL (Active Management of Third Stage of Labor), the single most important midwife intervention against postpartum hemorrhage. Shows the three critical steps: (1) oxytocin 10 IU IM within 1 minute after baby delivery, (2) controlled cord traction with counter-traction, and (3) immediate uterine massage. Includes decision points for checking for a second baby and waiting for signs of placental separation. This is high-yield examination content.
Essential Intrapartum and Newborn Care (EINC / Unang Yakap): Four Sequential Steps
Step-by-step illustration of Essential Intrapartum and Newborn Care (EINC), known in the Philippines as Unang Yakap (First Embrace). Shows the four time-bound interventions midwives perform at every birth: immediate drying (first 30 seconds), skin-to-skin contact, delayed cord clamping (1-3 minutes after pulsations stop), and early breastfeeding within 90 minutes with non-separation. Each step has clear timing and rationale for examination and clinical practice.
Referral Competency: Midwife's Systematic Approach to Overcome Three Delays
Flowchart illustrating the Three Delays model and the midwife's systematic approach to overcome barriers to emergency obstetric care. Shows how midwife interventions at each delay stage—teaching at ANC, birth planning, and stabilization with referral—work together to prevent maternal deaths. Emphasizes the recognize-stabilize-communicate-accompany-follow-up framework that is central to midwife competency and heavily tested on the MLE.
Service Delivery Network (SDN) Continuum: Community to CEmONC
Horizontal flowchart showing the Service Delivery Network (SDN) continuum of care from community (BHS) through primary (RHU/BEmONC) to tertiary (CEmONC) facility levels. Also shows the continuum across time from pre-pregnancy through child care. Emphasizes that the midwife's role is to work within and facilitate this unbroken chain, steering every mother toward facility-based delivery with a skilled attendant and ensuring no gaps in the escalation pathway.
BEmONC Signal Functions: Midwife's Direct Role vs. Refer to Higher Cadre
Sequence diagram showing the midwife's direct responsibility for BEmONC signal functions 1-7 at the RHU/BEmONC level, and the escalation pathway when complications exceed BEmONC capacity. When cesarean section (SF8) or blood transfusion (SF9) is needed, the midwife recognizes the limitation, stabilizes the patient with first-line interventions, communicates ahead, and escorts the referral to the CEmONC hospital. This illustrates the key principle: midwife is skilled birth attendant for NORMAL birth and recognizes/REFERS complications.
Midwife's Danger Sign Recognition and Referral Decision Tree
Decision tree showing how midwives systematically recognize major danger signs (postpartum hemorrhage, eclampsia, sepsis, obstructed labor, non-breathing newborn), stabilize with appropriate first-line interventions, and refer to CEmONC. Each branch demonstrates the recognize-stabilize-refer workflow and emphasizes that midwife does NOT manage these complications independently but acts as the critical link to higher-level care. Color-coded: red for recognition, orange for stabilization, dark red for referral, and green for documentation.
Signal Functions Distribution: BEmONC vs CEmONC Capacity
Pie chart illustrating that BEmONC facilities perform 7 out of 9 total signal functions (parenteral drugs, manual placental removal, retained products removal, assisted delivery, newborn resuscitation), while CEmONC adds cesarean surgery and blood transfusion. This visual emphasizes that most emergency obstetric care is provided at the BEmONC level under midwife leadership, with only the most complex surgical and transfusion cases requiring CEmONC.