Midwife Licensure Exam The Midwife's Public Health Service Delivery — BEmONC and MNCHN from the Midwife's RoleConcept Map

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

To

BEmONC Signal Functions

From

MNCHN Strategy

Strength

strong

Relationship

MNCHN provides the overall DOH framework; BEmONC signal functions are the concrete facility-level deliverables of MNCHN at the primary level

To

Midwife's Direct Interventions in BEmONC

From

BEmONC Signal Functions

Strength

strong

Relationship

Midwife performs or activates signal functions 1-7 as a core BEmONC team member under RA 7392 and DOH protocols

To

Postpartum Hemorrhage Prevention

From

Active Management of Third Stage of Labor (AMTSL)

Strength

strong

Relationship

AMTSL is the single most important midwife intervention against postpartum hemorrhage, the leading cause of maternal death

To

Newborn Survival and Early Bonding

From

Essential Intrapartum and Newborn Care (EINC / Unang Yakap)

Strength

strong

Relationship

EINC four steps prevent hypothermia, establish breastfeeding, and ensure early detection of newborn complications

To

Referral Competency and Three Delays Model

From

Service Delivery Network (SDN) and Continuum of Care

Strength

strong

Relationship

SDN structures the facilities and pathways; Three Delays model guides midwife's actions to overcome barriers within the SDN

To

Midwife's Direct Interventions in BEmONC

From

Referral Competency and Three Delays Model

Strength

strong

Relationship

Midwife's stabilizing interventions (oxytocin, MgSO4, antibiotics) occur before and during referral to address the third delay (receiving care)

To

MNCHN Strategy

From

Policy Emphasis: Facility-Based Delivery

Strength

strong

Relationship

Facility-based delivery with skilled attendant is a central MNCHN policy to prevent home delivery complications

To

MNCHN Strategy

From

Recording and Reporting (FHSIS)

Strength

moderate

Relationship

FHSIS data (births attended, referrals, postpartum visits) are the evidence that MNCHN strategy is being implemented and is effective

To

Service Delivery Network (SDN) and Continuum of Care

From

Facility Standards and Population Coverage

Strength

moderate

Relationship

Facility ratios (1 BEmONC per 125,000, 1 CEmONC per 500,000) ensure geographic access and function of the SDN

To

Comprehensive EmONC (CEmONC)

From

BEmONC Signal Functions

Strength

strong

Relationship

CEmONC includes all 7 BEmONC functions plus cesarean surgery and blood transfusion; midwife refers when the additional functions are needed

To

High-Risk Content: Detect and Refer

From

Midwife's Direct Interventions in BEmONC

Strength

strong

Relationship

Midwife's stabilizing drugs (oxytocin, MgSO4, antibiotics) are first-line interventions for complications that must then be referred to higher level

To

AMTSL

From

EINC / Unang Yakap

Strength

moderate

Relationship

Both EINC and AMTSL occur in the immediate perinatal period; AMTSL prevents postpartum hemorrhage while EINC ensures newborn survival and bonding

To

High-Risk Content: Detect and Refer

From

Three Delays Model

Strength

strong

Relationship

Three Delays model is the framework for overcoming barriers to emergency care for complications the midwife detects and refers

To

Continuum of Care Across Time

From

MNCHN Strategy

Strength

strong

Relationship

MNCHN service packages (pre-pregnancy, prenatal, intrapartum, postpartum, child care) define the continuum across the woman and child's lifespan

To

Magnesium Sulfate (MgSO4) Loading Dose

From

Midwife's Direct Interventions in BEmONC

Strength

strong

Relationship

MgSO4 is the anticonvulsant of choice for severe pre-eclampsia and eclampsia; midwife gives loading dose to stabilize before referral