Making Motherhood Safer

							       Training and Monitoring
of Midwives for their Expanded Role
    in Maternal and Child Health

                   Alejandro R. San Pedro
                         Board of Midwifery
                 Professional Regulation Commission
               Department of Obstetrics and Gynecology
                       Bulacan Medical Center




           The Women Deliver - Philippines Conference
    September 17, 2010 The Crowne Plaza Hotel, City of Mandaluyong
       Presentation content

• Midwifery in the Philippines
• Scope of midwives’ expanded
  functions
• Undergraduate & In-Service training
• Monitoring facilities & practitioners
• Challenges in training & monitoring
          Midwifery in the Philippines
• Direct entry course
• 248 Midwifery Schools*
• Training on expanded role
    begins in Midwifery school
    (new curriculum)
•   Entry into practice requires
    passing the MLEx (PRC)*
•   Ladderized curriculum in
    selected schools
•   BSc in Midwifery
     * CHED data
    ** Professional Regulation Commission
Expanded role added skills
     (Midwifery Act of 1992)

        Internal examination
        Suturing perineal
          lacerations
        Intravenous fluid
          insertion
        Dispensing oxytocics
        Vitamin K for newborn
  Midwives in the Philippines

157,501 RMs up to Jan. 8, 2010




 17,000 RMs work in the public sector
Midwifery Act of 1992 (R.A.7392)
             primary health care
                 services in community,
                 including nutrition and
                 family planning
             •    to giving motivation and counseling to
                 married couples who wish to avail of
                 family planning services.
             •   midwives who have undergone a special
                 training given a certificate by the
                 Certifying Board jointly undertaken by
                 the DOH and the Board of Midwifery will
                 be allowed to provide FP interventions
                 that are medical or surgical in nature, i.e.
                 pills and intrauterine devices.
            82,000 Filipino children die annually,
              most could have been prevented




                                           Source: CHERG estimates of under-five deaths, 2000-03

       The Philippines is one of the 42 countries that account for 90% of
                           global under-five mortality
Source: H. Sobel Unang Yakap – Essential Newborn Care Presentation
        Training for midwives’
 on expanded role (mainly In-Service)
1. Life Savings Skills and
   MDG Countdown (POGS)
2. Basic and Comprehensive
   Family Planning (DOH, IMCH)
3. BeMONC (Fabella Hosp)
4. EPI/IMCI (DOH)
5. Newborn Screening
6. Essential Newborn Care
   (PSNbM)
  * DrJFMH began training in 1994 on
   expanded midwifery functions
    CPE Council for Midwifery

 Composition:                 • Accreditation &
                                monitoring CPE
• Board of Midwifery            Providers and
• APO (accredited               Programs
 professional organization)    (Competency-based training,
                                interactive learning, workshop,
• APSOM (academe)               standards of care and best
                                practices, unlearning harmful
                                practices, clinical case
                                conference, maternal death
                                review).
              Monitoring

• Licensing & Regulating
  of Birthing Homes (BH)
• PhilHealth monitoring
  of Accredited BH
• Board of Midwifery (BOMid)
  monitoring of BH or solo
  practice
• Joint BOMid-CHED
  assessment of poorly
  performing schools
 Achieving & maintaining competence
             of Midwives
• Caseload (e.g. childbirth
  attended) is needed to
  gain and maintain
  competence?
• Tools for assessing
  different competence
• Standardization
  (harmonize) of modules
 * 15462 currently enrolled AY 2009-2010
    7053 Midwifery graduates AY 2008-2009
Some observations on monitoring
Some observations on monitoring




          (Birthing Clinic Chart)
Some observations on monitoring




          (Birthing Clinic Chart)
          Some challenges
1. Compliance with required
   competencies (caseload)
2. Getting support of LGU leaders
3. No appropriate items in hospital for
   midwives (Nursing Attendant)
4. Proliferation of “unregulated” birthing
   homes
5. Overmedicalization of childbirth
6. Health system not fully functioning
       Attendance during childbirth
                    (Bulacan Province 2009)


•   Doctors (33.24%)
•   Midwives (60.46%)
•   Nurses    (0.26%)
•   Hilots    (6.04%)
    59.94% are Homebirths

    65,189 births in 2009
    Source: Bulacan 2009 Annual Report
    on Natality by Attendance
               Reminder
• Graduate midwives
  of the old curriculum
  (before 1996) are
  required to attend
  a Professional
  Regulation
                          Rule 10. No. 4.
  Commission (BoMid)      Only registered midwives with
                          the proper training on
  accredited training     intravenous insertion and
                          suturing perineal laceration will
  program to acquire      be allowed to perform such
                          procedures….. and by the year
  competence on the       1996 no midwife will be allowed
                          to renew her/his license without
                          the needed training.
  added skills.           Source: Resolution 100 R.A.7392.
         Key Message

Competent, committed,
compassionate and
connected midwives
supported by an
enabling environment
can help achieve
MDGs’ 4 & 5 and
protect public safety!