Midwives are primarily considered as professionals with expertise in assisting women before, during, and after childbirth. Thus, the competencies for midwifery as defined by the International Confederation of Midwives revolve principally around assessment and provision of care to women and the fetus/newborn/infant during the pre-pregnancy and antenatal periods, labor and birth, postnatal/postpartum periods.1 The availability of skilled midwives in communities has allowed women, especially those who belong to lower income groups, to access professional services around childbirth, as reflected in responses from the National Demographic and Household Survey.2 For instance, while 50% of all women surveyed received antenatal care from a midwife, it is notable that 70% of those who belonged to the lowest wealth quintile were seen by a midwife during the antenatal period. Furthermore, midwives assisted 30% of deliveries reported by respondents, while roughly a little over a third of deliveries for each of the three lowest quintiles were attended by a midwife. Furthermore, in the Philippine setting, midwives are recognized as the first professional point of contact for most members of a community, especially in rural and remote places, as midwives are the ones deployed to manage Barangay Health Stations. Elaborating the scope of the practice of midwifery in relation to the provision of “primary health care services in the community” as stipulated in Republic Act No. 73923, the Board of Midwifery of the Professional Regulation Commission, in a primer for the profession, stated that midwives are expected to, among others, (a) implement government health programs in accordance with policies and guidelines of the Department of Health; (b) supervise barangay health workers; and (c) manage a Barangay Health Station.4 Stated differently, midwives, given the scope of work that they do and the areas where they are deployed, serve as the face and touchpoint of the health sector in our communities. They are the embodiment of the different health policies and programs enacted at the national and local levels through which Filipinos experience, individually and collectively, the drive for better health (or lack thereof ) advanced by different agencies, personalities, and stakeholders. However, as pointed out by Felipe-Dimog et al.5 in this issue of Acta Medica Philippina, midwives, especially those working in the public health sector, may take on roles beyond that contemplated by law. For instance, in the course of my professional practice during which I was deployed briefly in a rural health unit, and worked with an urban health department, I have encountered midwives who were tasked to work as program coordinators (or assistant coordinators), sanitation inspectors, field epidemiologists, and supply managers, among others, because of scarcity in the overall staff complement of health departments. Given their close ties with their areas of assignments, midwives are also expected to be community coordinators, if not organizers. The extent to which midwives are assigned these additional tasks depend on their professional relationship with their immediate supervisor; the level of trust and confidence reposed on them by their superiors; in some instances, their attendance to specific training workshops; as well as the availability of more qualified personnel (or lack thereof ) in the locality. Yet despite all these – placement in remote, if not hardship posts; additional assignments beyond their job description – midwives receive salaries that may not be commensurate after consideration of the job context. Staff midwife positions (i.e., Midwife I to III) in government institutions are remunerated at Salary Grades 9 to 13 (i.e., approximate gross pay of PHP 21,000 to PHP 31,000, based on the fourth tranche of the Salary Standardization Law, but may be lower depending on the income classification of the local government unit6). Additional compensation and benefits under special laws may not always be provided as this will depend on the paying capacity of the employing agency. Furthermore, midwives – especially those who completed the two-year program under the previous policy – also must contend with issues concerning their professional status. I have personally encountered community members who do not consider midwives as professionals in the same league as nurses or physicians, or who view midwives as “assistants” or “subordinates” of nurses and physicians, forgetting that a certain degree of independent practice is allowed each professional licensed by the Republic of the Philippines. Midwives play a crucial role in caring for Filipinos not only around childbirth – this is their primary professional duty – but throughout the lifespan – especially for midwives working in local health departments. Stakeholders must not forget to give due recognition to the value and worth contributed by midwives in shaping the health and well-being of each generation of Filipinos.
midwives

PURPOSE: This study was to understand the meaning of women's experience of spontaneous delivery with midwives at midwifery clinics or home. METHODS: van Kaam's Psychophenomenological method composed of a four-stage, 12-step format was used. In-depth interviews were carried out from January to July, 2011, with twelve women. RESULTS: Through the data analysis, 403 significant statements, 172 elements, 48 subcategories, and 19 categories were extracted, and from the 19 categories, 8 themes were drawn. The eight themes were: "Conflict on whether a hospital or a midwifery clinic", "Choosing natural delivery with the assurance of her ability to delivery spontaneously and having trust in the midwives." "Being encouraged by a midwife and family members with one accord", "Experience of the spontaneous delivery process on body", "Comfortable delivery in spite of painful process", "Deeply impressed by the overwhelming joy of birth", "Satisfaction with spontaneous delivery", and "Deeper love among family members". CONCLUSION: Through this study, women's delivery experiences with midwives was of spontaneous delivery. Women's birth of self-confidence and trust between the midwives and the women to predict a spontaneous delivery is a powerful factor. Also, family support and midwives delicate care was identified as factors in spontaneous delivery.
Female ; Humans ; Love ; Midwifery* ; Natural Childbirth ; Nurse Midwives ; Parturition ; Pregnancy ; Qualitative Research ; Statistics as Topic

BACKGROUND AND OBJECTIVE

Midwives play a vital role in the attainment of Sustainable Development Goals related to the health and well-being of mothers and newborns. Strengthening the leadership and management capacities of midwives is pivotal to the fulfillment of their mandate beyond assisting in birth and delivery. The study explores the perspectives of midwives about professional education and practice, which are aimed to serve as bases for developing a leadership course for midwives to enhance their roles in public health.

The study employed a descriptive-qualitative design. Using a semi-structured questionnaire, online focus group discussions (FGDs) with midwives from the academe, professional organization, and clinical practice were conducted. Through directed content analysis, the gathered information was analyzed to include the participants’ insights on midwifery competencies, teaching methods and assessment strategies, supplementary courses and training, and factors affecting midwifery practice.

A total of eleven (11) participants contributed to the FGDs, which included midwives from the academe (dean, faculty), professional organization (board member of the Professional Regulation Commission), and clinical practice (public and private institutions). Notably, participants shared their perspectives regarding the similarities/differences in the terminal competencies of midwifery programs. The demands of outcomes-based education, coupled by the shift to online learning due to the pandemic, pushed the need for modifications in program delivery for the students. Results highlighted the need for supplementary courses and capacity building on leadership and management, research, and interprofessional collaboration. Midwives shared factors that affect their professional practice, which include insufficient training, inadequate manpower, and differences in expectations/standards in task performance.

The findings indicate the need to develop capacity-building courses for midwives to enhance their contribution towards universal health care. The results of this study also highlight the importance of understanding and improving the competencies of midwives across the building blocks of the health system, which include health service delivery, human resources for health, health information systems, health financing, health governance, and health regulation. Notably, key concepts recommended for the Leadership Development Course for Midwives include: leadership and management, research, and interprofessional collaboration.

Han Shin Gwang, born in an early Christian family in Korea in 1902, could get western education different from the ordinary Korean girls in that period. She participated in the 1919 Samil Independence Movement in her teens, and got nursing and midwifery education in a missionary hospital. She got a midwife license and worked as a member in an early mother-and-child health center. She organized 'Korean Nurses' Association' in 1924 and focused on public health movement as the chairwoman. She actively participated in women's movement organizations, and Gwangjoo Student's Movement. She was known to be a representative of leading working women, and wrote articles on woman's right, the needs and works of nurses and midwives. From late Japanese colonial period, she opened her own clinic and devoted herself to midwifery. After the Korean Liberation in 1945, she began political movement and went in for a senate election. During the Korean War, she founded a shelter for mothers and children in help. After the War, she reopened a midwifery clinic and devoted to the works of Korean Midwives' Association. Han Shin Gwang's life and works belong to the first generation of Korean working women in modern times. She actively participated in women's movement, nurses' and midwives professional movement, Korea liberation movement, and mother-and-child health movement for 60 years. Her life is truly exemplary as one of the first generation of working women in modern Korea, distinguished of devotion and calling.
Women's Rights/history ; Nurse Midwives/history ; Midwifery/*history ; Maternal-Child Health Centers/history ; Korea ; Humans ; History, 20th Century ; History of Nursing

There is a decrease in the number of new midwives, resulting from the shutdown of midwifery education program in hospitals due to a decrease in birthrate in the Republic of Korea. To solve this problem, the current medical laws on midwifery education system in Korea should be revised; nurse-midwifery specialist programs must be established in educational institutes with nursing programs. To support this argument, the midwifery education programs of America, Europe, Australia, and Japan have been discussed, and a nurse-midwifery specialist curriculum at the master's level, based on the nurse-practitioner system of Korea, has been suggested. Since this assertion is very important and urgent for solving the future population problem of Korea and providing health care for women and children, it should be realized into action immediately.
Academies and Institutes ; Americas ; Australia ; Child ; Curriculum ; Delivery of Health Care ; Education* ; Europe ; Female ; Humans ; Japan ; Jurisprudence ; Korea ; Midwifery ; Nurse Midwives* ; Nursing ; Republic of Korea ; Specialization

Background: Midwives have been frontline health professionals at the grassroots level, especially in rural communities. Their role was expanded from maternal and child healthcare providers to primary healthcare services providers. Despite their expanded functions, there have been limited studies investigating the professional practice of midwifery in the Philippines in a rural setting. Objective: This study aimed to investigate the professional practice of midwives in selected rural areas in the Cordillera Administrative Region, Philippines. Methods: This research is a qualitative pilot study using a semi-structured interview guide to collect the data. Key informant interviews were conducted through mobile phone calls convenient for the participants from September to October 2021. Data were analyzed through qualitative content analysis. Results: A total of seven rural health midwives participated in this study. From the data analysis, six themes emerged related to the professional functions of rural Filipino midwives: 1) antenatal and postnatal care, 2) basic emergency obstetrical and newborn care, 3) health education and counseling, 4) treating common children and adult infections, 5) health promotion, and 6) beyond midwifery role. Conclusion Rural midwives play a role in providing several primary healthcare services mandated by the government and the profession. They also offer health services beyond their scope as midwives because of geographical difficulties and logistic issues. The findings inform the policymaker to review and amend the expanded roles of practicing midwives so that they will be empowered in providing quality and legal healthcare services. The study results will also be important in preparing midwives for rural midwifery practice.
midwives ; professional practice

This study was done to develop a digital textbook for students to use over the internet for maternity nursing practice. The textbook is not only for student nurses, but also for nurse midwives and nurses working in the maternity. The process used was as follows; 1.Existing educational media on maternity nursing were reviewed and examined. 2.Workshops and meetings were held to decide the most appropriate type of presentation. 3. The digital content including text, pictures, audios, and videos were developed using Macromedia Dreamweaver, Adobe Photoshop and Adobe Premier. 4.Revisions were made recursively as the content was previewed and implemented over the internet by professionals and the end-users. 5. A database of members and a web survey module were developed and posted. The clinical implication of a digital textbook over the internet is the possibility of using it to educate many student nurses throughout the country and to disseminate the content for whoever needs it in practice settings and facilities. Another implication is that this site stressed interactivity by developing member database and web survey. In conclusion, the study found this first trial of digital textbook to be a unique educational media for nursing skills practice. Further refinement of this media is strongly recommended.
Female ; Humans ; Infant, Newborn ; Internet* ; Maternal-Child Nursing* ; Nurse Midwives ; Nursing Care* ; Nursing* ; Pregnancy

PURPOSE: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. METHODS: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. RESULTS: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. CONCLUSION: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.
Costs and Cost Analysis ; Female ; Humans ; Insurance, Health, Reimbursement/*economics ; Korea ; National Health Programs/*economics ; Nurse Midwives/*economics ; Pregnancy ; *Relative Value Scales

Background: Healthcare workers remain the key players in the delivery of healthcare services. Their supply and distribution must be carefully monitored and taken care of. Objectives: To describe the stock of doctors, nurses, and midwives in the Philippines in 2020. Methods: This study employed a descriptive ecologic design and involves a secondary-data analysis where the relevant statistical data were retrieved from the public database in the country’s Department of Health. The data source also provides the statistics of other health professions such as medical technologists, nutritionists/dieticians, pharmacists, and dentists. However, this study limited the numerical data of the doctors, nurses, and midwives because there are readily available data for comparison. Descriptive statistics such as frequency counts, percentages, and population density were used to analyze the data. Results: The available density of health workers (14.76 per 10,000 population) composed of doctors, nurses, and midwives in the country remains at par with the recommendation of the World Health Organization (44.5 per 10,000 population). Likewise, data showed maldistribution of the health workforce still exists where a greater number of them are found in urban areas such as the National Capital Region (NCR) and CALABARZON. Majority of them are also working in the hospitals (doctors = 86.64%, nurses = 76.75%, and midwives = 48.46%) than in the primary healthcare facilities (doctors = 13.36%, nurses = 23.25%, and midwives = 51.54%). Conclusions The study revealed that maldistribution and shortage of doctors, nurses, and midwives prevail in the country. Likewise, the available workers in the country remain at par with the recommendations to meet the targets of the sustainable development goals (SDGs). The health agency and policymakers must focus on strategies to accelerate the number of health workers required in the country and redistribute them according to the areas in dire need.
Midwifery ; Nurses ; Philippines

Objective: This research aims to unravel the local knowledge, practices, and experiences of care during pregnancy and childbirth in one community in Batangas. Methods: Qualitative interviews with two hilots and a mother, two focus group discussions with mothers from different generations, and indigenous research methods – pakikipagkwentuhan (story-telling or informal discussions with the locals) and pagmamasid (observations of the local practices in the community) were used in this ethnographic study. The data gathered through these methods were analyzed using an interpretive approach. Results: Data showed that knowledge and practices related to pregnancy and childbirth which were viewed as rituals remain to be significant in the community because they are sources of psychological support in a highly intimate situation. These practices also help in creating a feeling of security and safety during this very uncertain period. The data also showed the different ways of making sense of risks associated with pregnancy and childbirth and this affects the decisions made by mothers, midwives and hilots during birthing. Lastly, we saw the effects of the implementation of the no home birthing policy on the hilots and the life and well-being of the pregnant women in the community. Conclusions Local practices of care during pregnancy and childbirth remain significant today because these cater to the overall well-being of women giving birth. For these women, the implementation of the no home birthing policy that changed the status of the hilots (TBAs) in the community does not address the real issues on maternal healthcare. For them, the government should have focused on continuing to address the structural and institutional problems that they have encountered in their experiences of birthing. This can be done by providing more facilities that would readily cater to the needs of birthing women and by creating a more holistic healthcare system.
Pregnancy ; Parturition ; Midwifery