Family Planning Provision by Midwives - Concept Map
Family Planning Service Delivery by Philippine Midwives
Related concepts
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
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
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
Methods Outside Midwife Scope
Sub concepts
- Bilateral Tubal Ligation
- Vasectomy
- Referral Protocols
Relationship to central
Surgical procedures requiring physician referral
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
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
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
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
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
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
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
Concept connections
- RA 10354 RH LawInformed Choice and VoluntarismLegal mandate requires informed choice; voluntarism is core principle preventing coercion
- Informed Choice and VoluntarismGATHER FrameworkCounseling framework operationalizes informed choice principle in practice
- WHO Medical Eligibility CriteriaSafe Provision and MonitoringMEC categories (1-4) guide screening decisions and determine method safety for each client
- Methods Midwife ProvidesScreening ProcessScreening must precede provision of any method to ensure safety and appropriateness
- POPsBreastfeedingPOPs are preferred choice for breastfeeding mothers; progestin-only does not reduce milk supply
- COCsBreastfeedingCOCs containing estrogen should be avoided in first 6 months postpartum due to milk supply reduction
- DMPA InjectableFollow-UpDMPA requires scheduled re-injection every 13 weeks; missed appointments need active follow-up
- LAMPostpartum CareLAM is natural postpartum FP method; requires all three conditions and bridge method planning
- IUD and ImplantCertification RequiredBoth long-acting methods require DOH competency-based training before midwife can insert/remove
- Side Effects and ManagementClient RetentionProper counseling on expected side effects prevents dropouts; reassurance reduces discontinuation
- CondomsSTI ProtectionCondoms are only method protecting against HIV/STI; promote dual protection with other methods
- SDMRegular CyclesSDM only suitable for cycles 26-32 days; requires cycle tracking and partner cooperation
- Family Planning ProvisionHealthy Timing and SpacingFP prevents high-risk pregnancies; spacing 24 months between births improves maternal/child health
- Target Client ListFollow-UpTCL enables systematic tracking of clients for resupply, re-injection, or follow-up visits
- Blood Pressure MonitoringCOCs and DMPAElevated BP is contraindication for COCs/DMPA; must be checked before provision
- Pregnancy AssessmentHormonal MethodsMust rule out pregnancy before starting COCs, POPs, or DMPA to avoid teratogenic effects
- Counsel and ReferIUD and ImplantMidwife counsels on long-acting methods but refers for insertion unless additionally certified
- RHU and BHSFamily Planning ProvisionMidwife is primary FP provider in rural/community settings; often sole trained provider
- Non-Discrimination PrincipleService AccessServices provided regardless of age, marital status, or number of children
- FHSIS RecordingPublic Health TrackingFP records feed FHSIS, enabling monitoring of contraceptive prevalence and service quality
Diagrams
Family Planning Provision by Midwives - Comprehensive Concept Map
Comprehensive mind map showing the full hierarchy of family planning provision by midwives, including legal framework, method categories, screening requirements, counseling approaches, and public health integration within the MNCHN continuum.
Family Planning Method Selection and Provision Flowchart
Decision tree flowchart guiding midwife through the FP provision process from client intake through screening, method selection, counseling, and follow-up. Shows how clinical decision-making incorporates eligibility criteria and client preferences.
Contraceptive Methods: Scope of Midwife Practice
Classification flowchart organizing all modern contraceptive methods by the midwife's scope of practice: independent provision, certification-required, and referral-only. Color-coding shows different practice categories.
Screening Checklist Before FP Method Provision
Step-by-step screening protocol midwife follows before providing any FP method, including history, vital signs, pregnancy assessment, infection screening, and WHO MEC classification. Highlights decision points and referral pathways.
DMPA Injectable: Administration and Follow-Up Protocol
Detailed protocol for DMPA administration, counseling on expected effects and warning signs, injection technique, and follow-up scheduling with emphasis on client retention and tracking within 13-week cycles and grace periods.
LAM (Lactational Amenorrhea Method) Assessment and Use
Assessment flowchart for LAM eligibility emphasizing the three non-negotiable conditions: baby under 6 months, exclusive/near-exclusive breastfeeding, and amenorrhea. Shows how failure of any one condition requires immediate method switching and planning for bridge method.
Modern Contraceptive Methods by Midwife Provision Category
Distribution showing that the majority of modern methods (7 out of 11 commonly discussed) are within the independent scope of a trained midwife, while 2 require additional certification and 2 require surgical referral.
Informed Counseling: GATHER and REDI Frameworks
Two complementary counseling frameworks (GATHER and REDI) used by midwives to facilitate informed choice. Both emphasize rapport, accurate information, client exploration, and voluntary decision-making without coercion.