Midwife Licensure Exam The Midwife's Public Health Service Delivery — Prenatal Home-Based and Postnatal Home CareRevision Notes

Exam Tips

• MLE frequently asks: 'What is the PRIMARY principle of bag technique?' — Answer: To minimize/prevent the spread of infection.
• MLE frequently asks: 'What is the FIRST thing the midwife does upon arriving at a home visit?' — Answer: Place the bag on a clean, flat surface (using the paper lining if needed).
• Remember the handwashing rule: You wash hands TWICE — once before starting care and once after finishing.
• The inside of the bag is ALWAYS clean — this phrase appears in MLE options; it is always correct.
• Think of the bag technique sequence as: SURFACE → LINING → HANDWASHING ARTICLES → WASH HANDS → CARE → REPLACE → WASH HANDS → RECORD.

Key Points

• A home visit is a planned, purposeful, family-centered contact conducted in the client's own home environment.
• It allows the midwife to assess real living conditions: water source, sanitation, available transport, and household support — all of which affect maternal risk.
• The PUBLIC HEALTH BAG is the midwife's mobile clinic. It contains all equipment and supplies needed to provide safe care in a non-sterile home setting.
• BAG TECHNIQUE is the standardized, systematic method of using the public health bag to prevent infection and ensure efficient, professional care.
• The four guiding principles of bag technique: (1) Keep the bag clean and well-arranged; (2) Minimize the spread of infection; (3) Save time and effort through orderly movements; (4) Reflect professionalism and the value of good technique.
• The INSIDE of the bag is always treated as CLEAN — dirty hands or used supplies must never contaminate the bag's interior.
• The classic bag technique sequence: Place bag on clean surface → Take out paper lining to create a clean field → Remove soap dish and handwashing articles → Wash hands thoroughly → Remove only articles needed for the procedure (close bag in between) → Perform care → Clean and replace used articles → Wash hands again → Record and give instructions.
• If no clean surface is available, use the bag's own lining or a clean paper as a barrier before placing the bag.
• The midwife washes hands both BEFORE starting care AND AFTER completing the procedure.
• The bag is closed between each removal of articles to maintain cleanliness.

Definitions

Section Title

The Home Visit and the Public Health Bag

Common Mistakes

• Forgetting that the FIRST action after placing the bag is to wash hands — not to open the bag and immediately take out supplies.
• Confusing the principle of bag technique as 'sterilizing' the home — it is about MINIMIZING infection spread, not full sterilization.
• Leaving the bag open while performing procedures — the bag must be CLOSED between removals to protect its cleanliness.
• Placing the bag directly on a dirty or wet surface without using the paper lining as a barrier.
• Returning used or contaminated articles into the bag without proper cleaning first.

Exam Tips

• Memorize the danger signs of pregnancy as a list: VAGINAL BLEEDING, SEVERE HEADACHE, BLURRED VISION, FACIAL/HAND SWELLING, CONVULSIONS, HIGH FEVER, SEVERE ABDOMINAL/EPIGASTRIC PAIN, SEVERE VOMITING, DECREASED FETAL MOVEMENT, WATERY/FOUL DISCHARGE, DIFFICULTY BREATHING.
• The birth plan must include: PLACE, SKILLED BIRTH ATTENDANT, TRANSPORT, FUNDS, COMPANION, and BLOOD DONOR — six key components.
• MLE question trigger: 'What should the midwife do when a pregnant woman reports blurred vision and severe headache?' — Answer: Refer immediately to a BEmONC/CEmONC facility (signs of pre-eclampsia).
• Remember: TT/Td = 5 doses for lifetime protection; given during pregnancy.
• ANC visit timing mnemonic: 1st trimester (ASAP), 2nd trimester (once), 3rd trimester (TWICE) = 4 visits total.
• Deworming timing: NOT in the 1st trimester — only 2nd or 3rd trimester.

Key Points

• DOH standard: Minimum of FOUR (4) antenatal care (ANC) visits during pregnancy.
• ANC visit schedule: (1) First visit — as early as possible in the FIRST trimester; (2) Second visit — SECOND trimester; (3) Third visit — early THIRD trimester; (4) Fourth visit — late THIRD trimester.
• WHO now recommends EIGHT (8) ANC contacts — Philippine services are moving in this direction.
• The PRENATAL PACKAGE delivered at home visits includes: history and risk assessment, physical examination, TT/Td immunization, micronutrient supplementation, laboratory screening, and health teaching.
• BLOOD PRESSURE is checked at EVERY prenatal visit — it is the single most important vital sign for detecting hypertensive disorders of pregnancy.
• Fundal height and fetal heart tones (FHT) are assessed at each visit; Leopold's maneuvers are done in later (third trimester) pregnancy to assess fetal position.
• TT/Td (Tetanus Toxoid/Tetanus-diphtheria) immunization follows a 5-dose schedule that confers long-term protection for mother and newborn.
• Micronutrients: IRON WITH FOLIC ACID (daily throughout pregnancy), CALCIUM supplementation, and IODINE.
• DEWORMING is given in the SECOND or THIRD trimester only — NEVER in the first trimester.
• Laboratory screening (where available): blood typing, hemoglobin/hematocrit, urinalysis, syphilis screening.
• Health teaching at every visit: nutrition, rest, breastfeeding preparation, and DANGER SIGNS OF PREGNANCY.
• Any danger sign = IMMEDIATE REFERRAL to a BEmONC or CEmONC facility.

Definitions

Section Title

Prenatal Home-Based Care

Common Mistakes

• Stating that the DOH standard is 8 ANC visits — the WHO now recommends 8 CONTACTS, but the current DOH minimum standard is 4 VISITS.
• Forgetting that deworming is CONTRAINDICATED in the first trimester — given only in 2nd or 3rd trimester.
• Omitting blood pressure from the list of assessments at every visit — it is the MOST critical vital sign in prenatal care.
• Confusing the birth plan's purpose as simply choosing a hospital — it actively defeats the Three Delays by pre-arranging transport, funds, companion, and blood donor.
• Thinking Leopold's maneuvers are done at every visit — they are primarily a third trimester procedure for assessing fetal position/presentation.
• Saying the midwife MANAGES pre-eclampsia or other complications — the midwife DETECTS danger signs and REFERS immediately.

Exam Tips

• Use the mnemonic BVSCAFVFDWB for danger signs: Bleeding, Vision changes, Severe headache, Convulsions, Abdominal pain, Fever, Vomiting (severe), Fetal movement decreased, Watery discharge, Breathing difficulty.
• If an MLE scenario describes ANY of the 11 danger signs — the correct action is ALWAYS 'refer immediately to a BEmONC/CEmONC facility.'
• Distinguish: ankle edema (possibly normal) vs. facial/hand edema (DANGER SIGN, refer immediately).
• Distinguish: normal fetal movement (reassuring) vs. decreased or absent fetal movement (DANGER SIGN, refer immediately).

Key Points

• Teaching danger signs is a REQUIRED task at EVERY prenatal contact — not just the first visit.
• Each danger sign is a REFERRAL TRIGGER — the midwife does not manage these at home. She arranges immediate transfer to a BEmONC or CEmONC facility.
• VAGINAL BLEEDING at any stage of pregnancy is always a danger sign.
• SEVERE HEADACHE and BLURRING OF VISION suggest hypertensive disorders (pre-eclampsia) — an obstetric emergency.
• SWELLING OF THE FACE AND HANDS (pathological edema) is a sign of pre-eclampsia.
• CONVULSIONS or FITS indicate eclampsia — a life-threatening emergency requiring immediate referral.
• HIGH FEVER may indicate infection (chorioamnionitis, UTI, malaria in endemic areas).
• SEVERE ABDOMINAL or EPIGASTRIC PAIN may indicate placental abruption, ruptured ectopic pregnancy, or HELLP syndrome.
• PERSISTENT, SEVERE VOMITING can lead to dehydration and nutritional deficiency (hyperemesis gravidarum).
• DECREASED OR ABSENT FETAL MOVEMENT suggests fetal distress or intrauterine fetal death.
• WATERY VAGINAL DISCHARGE (gushing or continuous leaking) indicates rupture of membranes — risk of infection and cord prolapse.
• FOUL-SMELLING VAGINAL DISCHARGE indicates infection.
• FAST OR DIFFICULT BREATHING may indicate cardiac or respiratory complications.
• Teach the family using simple language (Filipino/local dialect) and repeat at every visit to ensure retention and prompt action.

Definitions

Section Title

Danger Signs of Pregnancy

Common Mistakes

• Teaching danger signs only at the first prenatal visit — they must be reinforced at EVERY contact.
• Underestimating decreased fetal movement — students sometimes think this is not as urgent as bleeding or convulsions, but it is always a referral trigger.
• Confusing normal leg edema (ankles, feet) with pathological edema (face and hands) — facial and hand swelling is a DANGER SIGN; mild ankle edema at the end of the day may be normal.
• Failing to include the family in danger sign education — in the Philippine context, the husband, mother-in-law, or companion at home is often the one who acts first.

Exam Tips

• MLE scenario: 'What should the midwife include in a birth plan?' — List all 6-7 components. Any answer that omits blood donor or transport is incomplete.
• The birth plan DEFEATS the Three Delays — connect this concept in application questions.
• Keyword: 'Written and family-endorsed' — the birth plan is not just a verbal conversation, it is documented.
• The place of delivery in the birth plan is always a FACILITY (RHU, lying-in, hospital with BEmONC capability) — never a home with a TBA.

Key Points

• The birth plan is a REQUIRED component of prenatal care and a key strategy of the MNCHN program.
• Purpose: To turn a potential emergency into a rehearsed response by making decisions in advance — directly defeating the THREE DELAYS.
• The six to seven key components of a birth plan: (1) PLACE OF DELIVERY — a BEmONC-capable facility; (2) SKILLED BIRTH ATTENDANT — a midwife, nurse, or physician; (3) TRANSPORT — vehicle/boat/plan and a backup; (4) COMPANION — who goes with the mother and who stays with other children; (5) FUNDS/SAVINGS — money prepared in advance for delivery and emergencies; (6) BLOOD DONOR — identified in advance in case transfusion is needed; (7) Knowledge of LABOR SIGNS and DANGER SIGNS.
• The birth plan must be WRITTEN and FAMILY-ENDORSED — not just verbally discussed.
• Facility delivery with a SKILLED BIRTH ATTENDANT is mandatory — traditional birth attendant (TBA/hilot) home births are NOT safe and are NOT recommended.
• The midwife is the health worker primarily responsible for facilitating birth planning during prenatal home visits.
• Birth planning is one of the most effective interventions for reducing Delay 1 (decision) and Delay 2 (transport) in the Three Delays model.

Definitions

Section Title

The Birth Plan

Common Mistakes

• Listing only 3-4 components of the birth plan — always include all 6-7: place, SBA, transport, companion, funds, blood donor, and danger/labor sign recognition.
• Thinking the birth plan is optional or secondary to other prenatal care components — it is a REQUIRED part of every prenatal package.
• Assuming a TBA/hilot-assisted home delivery is acceptable if no facility is available — the midwife must counsel for FACILITY DELIVERY only and address barriers through the birth plan.
• Forgetting that the blood donor must be IDENTIFIED IN ADVANCE — not just 'we will find one if needed.'

Exam Tips

• Memorize: DOH postpartum standard = At least 2 check-ups: FIRST within 24 HOURS, SECOND at 7th DAY, PLUS 6-WEEK visit.
• Postpartum danger signs mnemonic: HEAVY BLEEDING, FOUL LOCHIA, FEVER, SEVERE HEADACHE, CONVULSIONS, BREAST INFECTION (mastitis), CALF PAIN/SWELLING (DVT), DIFFICULTY BREATHING, SEVERE DEPRESSION.
• For lochia: Remember the color progression — Rubra (red), Serosa (pink-brown), Alba (white-yellow). Any deviation in amount or smell = referral.
• The midwife assesses BOTH the mother AND the newborn at every postnatal home visit — do not focus on only one.

Key Points

• The first 24-48 hours and the first week postpartum carry the HIGHEST RISK of death for both mother and newborn.
• DOH STANDARD: At least TWO (2) postpartum check-ups: (1) FIRST within 24 HOURS of delivery; (2) SECOND on about the 7th DAY (one week) postpartum; PLUS an additional visit at around 6 WEEKS.
• WHO postnatal contact model adds contacts at Day 3 and Days 7-14, reflecting the same principle of frequent early follow-up.
• At each postnatal home visit, the midwife assesses the mother for: VITAL SIGNS (especially temperature for fever/infection), UTERINE INVOLUTION (fundus firm and descending), LOCHIA (amount, color, odor), PERINEUM/WOUND (healing, signs of infection), BREASTS (for engorgement, cracked nipples, mastitis, breastfeeding support), BLADDER AND BOWEL FUNCTION, and SIGNS OF POSTPARTUM DEPRESSION.
• LOCHIA timeline: Rubra (red, Days 1-3) → Serosa (pinkish-brown, Days 4-10) → Alba (yellowish-white, Days 11 to 6 weeks). Heavy or foul-smelling lochia at any stage is ABNORMAL.
• The midwife provides FAMILY PLANNING counseling at postnatal visits and ensures CONTINUED IRON SUPPLEMENTATION.
• EXCLUSIVE BREASTFEEDING is supported and reinforced at every postnatal contact.
• POSTPARTUM DANGER SIGNS are referral triggers — the midwife does not manage these independently.

Definitions

Section Title

Postnatal Home Care — The Mother

Common Mistakes

• Stating that the FIRST postnatal check-up is at Day 3 — DOH standard is WITHIN 24 HOURS of delivery.
• Confusing normal ankle edema postpartum with postpartum danger sign — severe headache, visual changes, and swelling of face/hands postpartum ARE danger signs.
• Forgetting to include family planning counseling at postnatal visits — it is a required component.
• Thinking lochia must always be red — normal progression is Rubra → Serosa → Alba; persistent heavy red lochia beyond Day 3-4 is abnormal.
• Overlooking postpartum depression assessment — students may focus only on physical danger signs and miss the mental health component.

Exam Tips

• NEWBORN SCREENING timing: 24-72 HOURS — never before 24 hours. This exact timeframe is tested frequently.
• Fast breathing in a newborn = 60 breaths per minute or MORE = REFERRAL TRIGGER.
• Jaundice of PALMS AND SOLES = DANGER SIGN, refer immediately. Jaundice that stays only on the face and is present after Day 2-3 needs monitoring but jaundice extending to palms and soles is always urgent.
• CORD CARE = CLEAN AND DRY ONLY. No alcohol, no traditional herbs, no binding. Redness or pus = refer.
• Birth doses to confirm: BCG (right deltoid, intradermal) + Hepatitis B (given within 12-24 hours of birth).
• Mnemonic for newborn danger signs: PUFF-JCFH — Poor feeding, Unconscious/no movement, Fast breathing, Fever/hypothermia, Jaundice (palms/soles), Convulsions, Chest indrawing (severe), Hard/red cord or eye pus.

Key Points

• The newborn is assessed at EVERY postnatal home visit alongside the mother.
• EXCLUSIVE BREASTFEEDING on demand is reinforced at every contact — check for good latch and adequate output (wet diapers, weight gain).
• CORD CARE: Keep the cord stump CLEAN AND DRY. Do NOT apply anything to the cord (no alcohol, herbal preparations, or bindings). Watch for redness, swelling, foul smell, or discharge — these are referral triggers.
• WARMTH: Prevent hypothermia. Teach skin-to-skin/kangaroo care, especially for small babies. Room temperature should be warm enough for the baby.
• WEIGHT AND GROWTH MONITORING: Weigh the newborn at each visit; expected to regain birth weight by 10-14 days.
• NEWBORN SCREENING (Expanded NBS, heel-prick blood sample): Ideally taken between 24 AND 72 HOURS OF LIFE — NEVER before 24 hours. The midwife ensures this was done or arranges it.
• NEWBORN HEARING SCREENING: Also confirmed or arranged by the midwife.
• IMMUNIZATION: Confirm BCG and HEPATITIS B BIRTH DOSES were given at the facility before discharge. Set the EPI schedule for subsequent vaccines.
• NEWBORN DANGER SIGNS are all referral triggers — the midwife detects these and immediately refers to a BEmONC or higher facility.
• Key newborn danger signs: POOR FEEDING or NOT FEEDING, CONVULSIONS, FAST BREATHING (60 breaths per minute or more), SEVERE CHEST INDRAWING, FEVER or HYPOTHERMIA (too hot or too cold to touch), NO MOVEMENT even when stimulated, JAUNDICE OF PALMS AND SOLES, and REDNESS/SWELLING/PUS around cord or eyes.
• EINC (Essential Intrapartum and Newborn Care) / Unang Yakap principles are continued in postnatal home care: warmth, breastfeeding, cord care.

Definitions

Section Title

Postnatal Home Care — The Newborn

Common Mistakes

• Stating that newborn screening can be done BEFORE 24 hours — it must be done at 24-72 hours of life. Before 24 hours gives inaccurate results.
• Recommending alcohol or herbal applications on the cord stump — CLEAN AND DRY ONLY; no substances applied.
• Accepting a respiratory rate of 50-59 breaths per minute in a newborn as a danger sign — 60/min or MORE is the threshold for fast breathing as a danger sign. (Normal newborn RR is 30-60/min; concern is ≥60).
• Forgetting that jaundice of PALMS AND SOLES (not just the face) is the danger-sign-level jaundice — mild facial jaundice in the first few days may be physiologic.
• Thinking the midwife gives all EPI vaccines during home visits — she CONFIRMS birth doses were given and SCHEDULES future visits; vaccines are typically given at the BHS or RHU.

Exam Tips

• MLE may ask: 'What tool does the midwife use to track defaulters in the community?' — Answer: Target Client List (TCL).
• MLE may ask: 'Where is community health data compiled for national reporting?' — Answer: Field Health Services Information System (FHSIS).
• Documentation is a legal obligation under RA 7392 — this may appear in ethics/law questions in the MLE.
• Home-based care + proper documentation = unbroken continuum of care — this is the philosophical answer to 'why home visits matter.'

Key Points

• EVERY home visit, prenatal contact, immunization, and postnatal check must be RECORDED on mother-and-child records and the TARGET CLIENT LIST (TCL).
• The TCL feeds into the FIELD HEALTH SERVICES INFORMATION SYSTEM (FHSIS) — the national community health data system.
• The FHSIS generates maternal and neonatal indicators used to evaluate the MNCHN strategy and DOH programs.
• Proper documentation allows the midwife to: TRACK who is due for the next visit, IDENTIFY defaulters (those who missed visits), and PLAN follow-up actions.
• Home-based care, done and documented well, keeps the CONTINUUM OF CARE unbroken from the household to the facility and back.
• The midwife uses TCL/FHSIS data to generate monthly reports submitted to the RHU, which roll up to district, provincial, and national levels.
• Documentation is a professional and legal obligation under RA 7392 (The Midwifery Act).

Definitions

Section Title

Recording, Documentation, and the Public Health Frame

Common Mistakes

• Treating documentation as less important than clinical care — in the MLE and in practice, unrecorded care is considered undelivered care.
• Confusing TCL with FHSIS — the TCL is the individual client register; the FHSIS is the information system that compiles and uses data from the TCL.
• Failing to update the TCL after each home visit — the TCL must be updated immediately after every contact to ensure accurate tracking.