Philippine Midwifery Law

Governance: Board of Examiners for Midwives

Section 2 creates the Board of Examiners for Midwives, placed under the direct supervision and control of the President of the Philippines.
The Board is composed of:
- A chairman who must be an obstetrician; and
- Two members: one registered nurse-midwife and one registered midwife.
The President appoints Board members with the consent of the Commission on Appointments and upon recommendation of the Commissioner of Civil Service.
Board appointments are drawn from:
- For chairman: among five obstetricians certified by the Association of Obstetricians or the Philippine Medical Association; and
- For members: among ten registered nurse-midwives and registered midwives certified by recognized pertinent national associations.

Qualifications and disqualifications

Section 3 requires all Board members to be citizens and residents of the Philippines, of good moral character and reputation, and at least thirty years of age.
Section 3 requires at least five years of successful practice prior to appointment.
Section 3 prohibits Board members from being members of the faculty of any school of midwifery:
- During the year preceding appointment,
- During incumbency, and
- During the year after their terms expire.
Section 3 prohibits Board members from having any direct or indirect pecuniary interest in midwifery schools.
The chairman must be an obstetrician, the nurse-midwife members must be registered both as a nurse and a midwife, and the midwife member must be a registered midwife and preferably have a college degree from a duly recognized college or university.

Powers, duties, and Board functions

Section 4 vests the Board with authority to issue, suspend, revoke or reissue certificates of registration for the practice of midwifery in the Philippines.
The Board must exercise its powers to maintain an efficient, ethical, technical and moral standard in midwifery practice.
Section 4 authorizes the Board to investigate violations of the Act.
For investigations, the Board may issue summons, subpoena, or subpoena duces tecum to violators and witnesses and compel attendance and production of records and documents.
Section 4 requires the Board to regularly look into conditions affecting midwifery practice and, when necessary, recommend or adopt measures for improvement and vigorous enforcement.

Terms, removal, records, and compensation

Section 5 sets Board membership at a term of three years, or until successors are appointed and duly qualified.
Section 5 provides staggered initial terms for the first Board: one member for three years, one member for two years, and one member for one year.
Section 5 provides that vacancies are filled only for the unexpired portion.
Section 5 requires each Board member to qualify by taking the proper oath of office before performing duties.
Section 6 names the Commissioner of Civil Service as the Executive Officer of the Board.
Section 6 provides that the Secretary of the Board appointed under Republic Act Numbered Five hundred and forty-six also serves as Secretary of this Board, and that Board records and minutes—including examination papers—are kept by the Bureau of Civil Service under the Secretary’s direct custody.
Section 7 provides compensation: each Board member receives ten pesos per capita of the candidates examined.
Section 8 authorizes the President of the Philippines, upon recommendation of the Commissioner of Civil Service, to remove a Board member for:
- Continued neglect of duty,
- Incompetency,
- Commission or toleration of irregularities in the examination, or
- Unprofessional or dishonorable conduct.
Section 8 requires removal only after giving the member an opportunity to defend in a proper administrative investigation.
Section 9 allows the Board to promulgate rules and regulations necessary to carry out the Act, subject to approval of the President of the Philippines.

Annual reporting and examination schedule

Section 10 requires an annual report to the President after the close of each fiscal year, detailing:
- Board proceedings,
- A statement of moneys received and expenses incurred, and
- Recommendations the Board desires to make.
Section 12 requires Board-held examinations for midwifery practice candidates on:
- The second Tuesday of August and
- The second Tuesday of February,
- In Manila and in other places the Commissioner of Civil Service deems necessary and expedient, subject to the President’s approval.

Midwifery examinations, admission requirements, and passing

Section 11 requires all applicants for registration for midwifery practice to undergo an examination, except where Section 20 permits registration for nurse-midwives without standard exam prerequisites.
Section 13 defines the written examination scope to include:
- (1) obstetrical anatomy and physiology,
- (2) principles of bacteriology as applied to midwifery practice,
- (3) obstetrics,
- (4) midwifery procedures,
- (5) domiciliary midwifery,
- (6) infant care and feeding,
- (7) community hygiene and first aid,
- (8) normal nutrition, and
- (9) ethics of midwifery practice.
Section 13 requires examination questions to be of types used in recognized schools of midwifery in the country.
Section 14 sets applicant prerequisites at the time of filing the application, requiring proof to the Board’s satisfaction that the applicant:
- Is a citizen of the Philippines,
- Is at least twenty-one years of age,
- Is of good health and good moral character,
- Has finished a standard academic high school, and
- Has finished a midwifery course in an accredited, legally constituted institution teaching specified subjects, including:
  - Introduction to General Anatomy and Physiology,
  - Principles of Bacteriology,
  - Obstetrics,
  - Midwifery Procedures (including personal hygiene and care of patients environment),
  - Delivery room technique,
  - Nursery technique and infant care and feeding,
  - Ethics, Nutrition, Domiciliary midwifery, Community hygiene and first aid, and Mothercraft.
Section 17 establishes passing ratings:
- A general rating of seventy-five per cent, and
- No lower than sixty per cent in Obstetrics, Infant Care and Feeding, Midwifery procedures, and Domiciliary midwifery, and
- No grade lower than fifty per cent in the other subjects.
Section 18 requires the Board to report results to the Commissioner of Civil Service within one hundred twenty days after the examination.

Midwifery schools: permits, hospital ties, ratios, and graduation

Section 15 requires a midwifery school to be recognized as duly accredited and legally constituted by securing a permit from the Department of Education.
Section 15 requires the school to be associated (as owner or part owner, or under control) with a hospital of at least fifty beds for maternity cases, authorized by the Department of Health to operate as such.
Section 15 allows operation with hospitals having over thirty but less than fifty beds for maternity cases if the school is affiliated, preferably with a government hospital meeting the Act’s required qualifications.
Section 15 prohibits authorization for schools whose hospitals have less than thirty beds for maternity cases.
Section 15 requires minimum staffing ratios:
- Trained resident staff to maternity beds: 1:10, and
- Teaching staff to students: 1:12.
Section 15 imposes graduation requirements:
- Students must have attended eighteen months of the midwifery course; and
- Students must personally attend, under staff authority, at least twenty deliveries in the hospital(s) and at least five deliveries in domiciliary service.
Section 16 requires existing midwifery schools that do not conform to make adjustments within two years from the date of approval, otherwise their permits or recognition are automatically deemed revoked.

Certificates, nurse-midwife registration, and fees

Section 19 requires issuance of a Certificate of Registration as midwife to applicants who pass the examination and pay required fees.
Section 19 requires each certificate to show:
- The full name of the registrant,
- A serial number,
- Signatures of Board members,
- Attestation by the Secretary of the Board, and
- Authentication by the Board’s official seal.
Section 19 provides that issuance evidences entitlement to the rights and privileges of a registered midwife until the certificate is revoked temporarily or cancelled for just cause.
Section 20 allows certificate issuance to registered nurses who pass the examination for midwives, and also allows issuance to nurses who show evidence to the Board of having actually handled twenty delivery cases, certified by a director or chief of a duly registered or recognized hospital, or by the Director of Health Services upon recommendation of the proper city or provincial health officer.
Section 21 sets fees for:
- Examination fee: thirty pesos, and
- Registration fee for successful applicants: fifteen pesos.
Section 22 requires inhibition from practice: no person shall practice or offer to practice midwifery in the Philippines without a valid certificate of registration issued by the Board, unless exempt from registration.

Grounds for refusal, suspension/revocation, and appeal

Section 25 requires the Board to refuse to issue a certificate of registration to:
- Any person convicted of any criminal offense involving moral turpitude, and
- Any person guilty of immoral or dishonorable conduct.
Section 25 requires the Board to issue a written statement setting forth its reasons for refusal and incorporate the statement in the Board’s records.
Section 26 empowers the Board to revoke or suspend a certificate for causes including:
- Causes mentioned in Section 25, and
- Unprofessional conduct, malpractice, incompetency, or serious ignorance or negligence in the practice of midwifery,
- Or making use of fraud, deceit, or false statements to obtain a certificate.
Section 26 provides that decisions of the Board may be appealed to the Secretary of Health, whose decision is final.

Reissue, replacement, and foreign reciprocity

Section 27 allows the Board to issue another copy of a revoked certificate (original or duplicate) for reasons of equity and justice upon proper application and payment of ten pesos, and allows the Board in its discretion to exempt the applicant from the necessity of undergoing examination.
Section 27 permits replacement of a lost, destroyed, or mutilated certificate subject to Board rules and payment of ten pesos.
Section 23 bars foreign nationals from rights and privileges under the Act unless the applicant shows to the Board’s satisfaction that their country permits citizens on the same basis.
Section 23 requires that foreign countries have midwifery school and graduation requisites substantially the same as those in the Philippines.

Definition of midwifery practice and exemptions

Section 24 defines “practising midwifery” as performing, for a fee, salary, or other reward or compensation, services requiring understanding of principles and applications of procedures and techniques for care of:
- Normal child-bearing women from the beginning of pregnancy until the end of puericulture, and
- Normal infants during the neonatal period.
Section 24 exempts midwifery school students from the Act’s application when they perform midwifery services under the supervision of their instructors.
Section 24 also exempts cases of emergency from the Act’s coverage as defined.

Prohibitions and criminal penalties

Section 28 makes it a misdemeanor for any person to practice midwifery within the Act’s meaning without:
- A certificate of registration issued according to the Act, or
- Having been declared exempt from examination and registration.
Section 28 makes it a misdemeanor for a person to:
- Present or use as their own another person’s certificate of registration,
- Give any false or forged evidence to obtain a certificate,
- Use a revoked or suspended certificate,
- Assume, use, or advertise as a registered midwife or registered nurse-midwife, or
- Append the letters R.M. without having been conferred the title by the Board authorized to confer it, or
- Advertise any title or description conveying the impression that the person is a registered midwife.
Section 28 provides that upon conviction, the misdemeanor is punishable by a fine of not less than one thousand pesos nor more than five thousand pesos, or imprisonment of not less than one year nor more than five years, or both, at the court’s discretion.
Section 28 applies the same penalty to any person found guilty of violating any rule or regulation issued pursuant to the Act.
Section 28 allows continued practice for:
- “hilots” registered with the Department of Health as trained in midwifery under the UNICEF Philippine Department of Health project, and
- “hilots” in localities where services of a practising physician or registered midwife are not available, who have safely handled twenty delivery cases as certified by the proper health officer.

Administration, repeal, and funding

Section 29 repeals all laws, parts of laws, orders, or regulations inconsistent with Republic Act No. 2644.
Section 30 appropriates two thousand pesos from funds in the National Treasury not otherwise appropriated for carrying out the Act within the fiscal year of approval.
Section 30 requires thereafter that funds necessary to maintain and operate the Board be included in the annual General Appropriations Act.