Midwife Licensure Exam The Midwife's Public Health Service Delivery — Family Planning Provision by MidwivesConcept Map

Concept

Legal and Policy Framework

Sub Concepts

• RA 10354 (RH Law 2012)
• Informed Choice and Voluntarism
• Universal Access to Modern Methods
• Non-Discrimination Principle
• DOH Competency-Based Training

Relationship To Central

Establishes the midwife's mandate and scope for FP provision

Concept

Methods a Midwife Can Independently Provide

Sub Concepts

• Combined Oral Contraceptives (COCs)
• Progestin-Only Pills (POPs)
• DMPA Injectable
• Condoms (Male and Female)
• Lactational Amenorrhea Method (LAM)
• Standard Days Method (SDM)
• Family Planning Counseling

Relationship To Central

Core clinical competencies within scope of practice

Concept

Methods Requiring Certification

Sub Concepts

• Intrauterine Device (IUD)
• Subdermal Contraceptive Implant
• Competency-Based Certification Process
• Counsel and Refer Pathway

Relationship To Central

Beyond entry-level scope; requires additional DOH training

Concept

Methods Outside Midwife Scope

Sub Concepts

• Bilateral Tubal Ligation
• Vasectomy
• Referral Protocols

Relationship To Central

Surgical procedures requiring physician referral

Concept

Screening and Assessment

Sub Concepts

• WHO Medical Eligibility Criteria (MEC)
• Focused Health History
• Blood Pressure Measurement
• Pregnancy Status Assessment
• Contraindication Identification
• Category 1-4 Classification

Relationship To Central

Critical safety step before method provision

Concept

Informed Choice Process

Sub Concepts

• GATHER Counseling Framework
• REDI Counseling Framework
• Method Explanation (Benefits, Side Effects, Effectiveness)
• Client Questions and Concerns
• Voluntary Method Selection
• Confidentiality and Privacy

Relationship To Central

Ethical foundation ensuring client autonomy and safety

Concept

Method-Specific Details and Counseling

Sub Concepts

• COCs: Timing, Missed Pill Rules, STI Protection Gap
• POPs: Strict Daily Timing, Breastfeeding Suitability
• DMPA: 150 mg IM every 13 weeks, Delayed Return to Fertility
• Condoms: Dual Protection, STI/HIV Protection
• LAM: Three Conditions, Bridge Method
• SDM: Cycle Length Requirements, Fertile Window (Days 8-19)
• Side Effect Management and Reassurance

Relationship To Central

Specific information midwife must provide for each method

Concept

Safe Provision and Monitoring

Sub Concepts

• Pre-Provision Screening Checklist
• Blood Pressure Monitoring (COCs/DMPA)
• Pregnancy Rule-Out Protocol
• Infection Screening and Referral
• Documentation and Recording
• Follow-Up and Return Dates
• Dropout Prevention

Relationship To Central

Quality assurance steps ensuring effective, safe FP service

Concept

Side Effects and Management

Sub Concepts

• Common Expected Effects (Spotting, Amenorrhea, Breast Tenderness)
• Warning Signs Requiring Prompt Review
• Reassurance and Normalization
• Method Switching Options
• Client Counseling on Expectations

Relationship To Central

Expected vs. warning signs; client retention strategy

Concept

Public Health Integration

Sub Concepts

• Healthy Timing and Spacing of Pregnancies (HTSP)
• Prevention of High-Risk Pregnancies
• FHSIS Recording and Reporting
• Target Client List (TCL)
• Contraceptive Prevalence Rate Tracking
• RHU/BHS Service Delivery

Relationship To Central

FP provision embedded within MNCHN continuum

Concept

Service Delivery Context

Sub Concepts

• Barangay Health Station (BHS)
• Rural Health Unit (RHU)
• Lying-In Clinic
• Postpartum and Post-Abortion Contacts
• Prenatal and Well-Woman Visits
• Community FP Outreach

Relationship To Central

Real-world settings where midwives provide FP

To

Informed Choice and Voluntarism

From

RA 10354 RH Law

Strength

strong

Relationship

Legal mandate requires informed choice; voluntarism is core principle preventing coercion

To

GATHER Framework

From

Informed Choice and Voluntarism

Strength

strong

Relationship

Counseling framework operationalizes informed choice principle in practice

To

Safe Provision and Monitoring

From

WHO Medical Eligibility Criteria

Strength

strong

Relationship

MEC categories (1-4) guide screening decisions and determine method safety for each client

To

Screening Process

From

Methods Midwife Provides

Strength

strong

Relationship

Screening must precede provision of any method to ensure safety and appropriateness

To

Breastfeeding

From

POPs

Strength

strong

Relationship

POPs are preferred choice for breastfeeding mothers; progestin-only does not reduce milk supply

To

Breastfeeding

From

COCs

Strength

strong

Relationship

COCs containing estrogen should be avoided in first 6 months postpartum due to milk supply reduction

To

Follow-Up

From

DMPA Injectable

Strength

strong

Relationship

DMPA requires scheduled re-injection every 13 weeks; missed appointments need active follow-up

To

Postpartum Care

From

LAM

Strength

strong

Relationship

LAM is natural postpartum FP method; requires all three conditions and bridge method planning

To

Certification Required

From

IUD and Implant

Strength

strong

Relationship

Both long-acting methods require DOH competency-based training before midwife can insert/remove

To

Client Retention

From

Side Effects and Management

Strength

strong

Relationship

Proper counseling on expected side effects prevents dropouts; reassurance reduces discontinuation

To

STI Protection

From

Condoms

Strength

strong

Relationship

Condoms are only method protecting against HIV/STI; promote dual protection with other methods

To

Regular Cycles

From

SDM

Strength

strong

Relationship

SDM only suitable for cycles 26-32 days; requires cycle tracking and partner cooperation

To

Healthy Timing and Spacing

From

Family Planning Provision

Strength

strong

Relationship

FP prevents high-risk pregnancies; spacing 24 months between births improves maternal/child health

To

Follow-Up

From

Target Client List

Strength

moderate

Relationship

TCL enables systematic tracking of clients for resupply, re-injection, or follow-up visits

To

COCs and DMPA

From

Blood Pressure Monitoring

Strength

strong

Relationship

Elevated BP is contraindication for COCs/DMPA; must be checked before provision

To

Hormonal Methods

From

Pregnancy Assessment

Strength

strong

Relationship

Must rule out pregnancy before starting COCs, POPs, or DMPA to avoid teratogenic effects

To

IUD and Implant

From

Counsel and Refer

Strength

strong

Relationship

Midwife counsels on long-acting methods but refers for insertion unless additionally certified

To

Family Planning Provision

From

RHU and BHS

Strength

strong

Relationship

Midwife is primary FP provider in rural/community settings; often sole trained provider

To

Service Access

From

Non-Discrimination Principle

Strength

moderate

Relationship

Services provided regardless of age, marital status, or number of children

To

Public Health Tracking

From

FHSIS Recording

Strength

moderate

Relationship

FP records feed FHSIS, enabling monitoring of contraceptive prevalence and service quality