Objective
- To enhance midwives' capacity to effectively respond to pregnancy-related emergencies and reduce maternal and neonatal morbidity and mortality through administration of life-saving drugs.
General Principles
- Emphasis on planned pregnancies and safe deliveries.
- Employ gender- and culture-sensitive services.
- Utilize a three-pronged approach: skilled birth attendance with continuum of care, emergency obstetric and newborn care access, universal family planning and reproductive health services.
- Encourage facility-based deliveries.
- Employ system-wide and rights-based approaches.
Definitions
- BEmONC: Basic Emergency Obstetric and Neonatal Care.
- E/EmONC: Essential and Emergency Obstetric and Neonatal Care.
- ENC protocol: Essential Newborn Care protocol.
- Midwife: Registered and licensed persons duly qualified in midwifery.
- Life-Saving Drugs: Medications to prevent/manage pregnancy complications e.g., Magnesium Sulphate, Oxytocin, Steroids, Antibiotics.
- Emergency Conditions:
- Pre-eclampsia: Hypertension and proteinuria after 20th week gestation.
- Eclampsia: Convulsions and coma in pregnant/newly delivered women.
- Post-partum hemorrhage: >500ml blood loss after delivery.
- Premature labor: Active uterine contractions before 37 weeks.
- Infections.
Scope and Coverage
- Applies to all licensed midwives providing skilled care.
- Targets those seeking PhilHealth MCP and NCP accreditations.
- Includes entire DOH hierarchy, LGUs, and partners implementing maternal-neonatal care strategies.
General Guidelines
- Midwives authorized under additional functions (beyond Midwifery Act) to administer life-saving drugs during emergencies when no physician is available.
- Prerequisite: Appropriate training and certification.
Implementing Guidelines
- Midwives must undergo two-part on-the-job training: didactic and practicum using approved modules.
- Post-training evaluation includes written exam and practical skill application; passing required before practicum.
- Certification issued upon satisfactory practicum within six months.
- Supervision mandated by local health authorities with technical guidance from professional societies (POGS, PSNbM, PPS).
- Legal assistance granted for midwives performing authorized duties.
- Clinical protocols dictate use of specific drugs:
- Magnesium sulphate for eclampsia prevention/management.
- Oxytocin for active management of third stage labor and postpartum hemorrhage.
- Steroids for preterm labor.
- Antibiotics for infections.
Roles and Responsibilities
- POGS: Conduct training, issue proficiency certificates, conduct monitoring, participate in maternal and perinatal death reviews.
- PSNbM/PPS/PAPI: Coordinate in training, supervision, and death reviews focusing on newborn care.
- Midwives Associations: Maintain member rosters, represent in mortality reviews, monitor adherence to standards.
- LGUs: Ensure licensed midwives, support training, ensure adequate supplies and facility readiness, enable accessibility for training and reviews, manage enrollment and PhilHealth accreditation, establish referral systems.
- DOH Offices:
- Disease Prevention and Control: Provide technical assistance, ensure protocol compliance.
- Human Resource Development: Support training and education.
- International Health Cooperation: Coordinate technical and financial support from partners.
- Centers for Health Development: Monitor and evaluate local implementation.
- Retained hospitals: Serve as training venues and clinical access points.
- Development partners: Provide technical and financial support for implementation.
Monitoring and Evaluation
- Monthly quality assurance and clinical audits by DOH CHDs and retained hospitals.
- Progress reports submitted to DOH Secretary.
- Annual review with stakeholders on implementation progress.
Repealing Clause
- Previous inconsistent orders and related issuances are repealed or modified.
- Unaffected provisions of existing issuances remain valid.
Effectivity
- The order shall take effect 15 days after publication in major newspapers.