Professional Growth and

Development
with
Ethics
History of Midwifery in the
World
• Ancient Times and Primitive Societies
-midwife had both technical or manual aspect and a
magical or mystical aspect.

• Roman and Greek Civilization

• -midwives functioned as respected, autonomous care
providers to women during reproductive cycles. Some
qualifications for the practice midwifery evolve during
this period. Midwife was a woman who had born
children herself. The profession became clearly more
defined at this time, and the midwives needed certain
qualifications to administer their duties
History of Midwifery in the
World
• Medieval Times
• -throughout the Dark and Middle Ages, midwives
relied on a variety of herbs and potions, which are
seen as the forerunner of present day medicine.
• -midwives gained their knowledge and learned their
specific skills as apprentices to someone more
experienced in the field.
• -there was no formal school. Information was passed
down through generations.
•
History of Midwifery in the
World
• Renaissance
• -Midwifery nearly disappeared during the late Middle
Ages and the Renaissance when midwives were
accused of witchery and the surgeons took over the role
of childbirth.
-many women patients died because the surgeons
delivered the babies without washing their hands from an
earlier body dissection.
History of Midwifery in the
World
Renaissance

• Midwife – an English word which means “with

woman”, implying the supportive, not interventive,
functions of the practitioner. In French, a midwife is
a sage femme, or a “wise woman”. A general
thread in all of the preferences regarding ancient
midwifery was support the woman in labor. Labor
was perceived as a basically natural process.
•
History of Midwifery in the
World
• 1940’s
Childbirth Without Fear – publication in 1944 by Grantley
Dick-Reed that closely studied the profession of
Midwifery. The book covered how midwives supported
women through labor and delivery and the child could be
born with relaxation methods rather than medicine or
ether. He also concluded that women who were unafraid
of delivery had less medical problems.
•
History of Midwifery in the
World
1980’s
• -birthing centers and home births were once again
accepted. However, to this day hospital birth is still
considered by most people as the best alternative.
• Present Times
• Midwives – offer women safe, effective care with
good outcomes; now midwives ourselves are
looking at our practice to see just what we do that
makes this so. We believe that the answers lie in
our name; that is, we are “with women”. Midwives
believe that our care can enhance the experience of
pregnancy and birth for women.
HISTORY OF MIDWIFERY IN
THE PHILIPPINES
• Ancient Health Practices in the Philippines
• -care of the sick and promotion of health were
intermingled with superstitions.
• -Mangkukulam, Mangagaway,

• Aswang – expectant mother should cover herself

with black cloth upon sleeping to escape aswang
• Hilot - 10-15 days in order for the woman to be
strong.
• Cord Dressing – ashes, tobacco, sand, powdered
coconut shall give
HISTORY OF MIDWIFERY IN
THE PHILIPPINES
• rise to serious results
• Colostrum – unfit for food for the newborn. Milk was
thrown away
• Pamaoo – sickness attributed to the “nuno”.
• Lugao – diet of the ill child was limited to rice gruel
• Colored bracelet – worn on the wrist of the child was
believed to
• ward off “evil”
• Morga – Governor General of the Philippines from
1595-1596 made reference to the use of wine from
coconut and nipa palms as medicine by the natives.
HISTORY OF MIDWIFERY IN
THE PHILIPPINES
• First Midwifery School in Sampaloc General Hospital
(1922) - Dr Jose Fabella – the first Secretary of Health
founded the first Midwifery School in the Philippines with
10 students
• Development of Midwifery in the Philippines
• Midwifery started as a 6 month course to 1 year. Major
function of the midwives pertained to maternal and child
health care (MCH). In the early years, student midwives
were supported by the government. They had free
tuition, free board and lodging and free laundry with
allowance. These students were considered as
government “pensionados”/then in 1952, Domiciliary
Services (DOS) was included in the curriculum. The
course ran from one year and six months in 1976.
HISTORY OF MIDWIFERY IN
THE PHILIPPINES
• Ricardo Gonzales (father of modern midwifery) –
appointed as chairman of the Board of Midwifery in
1974. He was the director of the Jose Fabella
Memorial Medical Center during this time. He was
one of those who made a study of the curriculum
and a two year program. The DECS adopted this
new course in 1977 and implemented nationwide

• From then on, revision in the midwifery curriculum

were made to upgrade the skills of the midwifery
graduates to be globally comparable. To this date,
the BSM is being offered by some midwifery
schools. This program was approved through the
CHED Memorandum Order 33 series of 2007
READ:

CHED Memorandum Order 33, Series of

2007.
 ETHICS
• The term ethics came from the Greek word, ethos which
means “a characteristic way of acting”. This is suitably
employed to designate the science of human acts and a
human conduct. Various definitions were given to have a
clear understanding of the term ethics:
1. Refers to those rules of conduct recognized
in respect to a particular class of human actions or to a
particular group, such as medical ethics, dental ethics,
nursing ethics and midwifery ethics. (Robles)
2. A study of standards of conduct and the moral
judgment and values upon which these standards are
based. (Cafferty)
• 3. A science that which guides human reaction and
which tends to make a man’s action and man himself
good.
 ETHICS
• IMPORTANCE OF ETHICS

• Ethics teaches us to distinguish what is right from what is

wrong.
• It helps us to make the right judgment and decisions. It
helps us to realize what is good for us by helping to
make a correct decisions and actions in different
situations.
 ETHICS
• ETHICAL THEORIES

Ethical theories - are based on the previously explained

ethical principles. They each emphasize different
aspects of an ethical dilemma and lead to the most
ethically correct resolution according to the guidelines
within the ethical theory itself. People usually base their
individual choice of ethical theory upon their life
experiences.
 ETHICAL THEORIES
• Natural Law
- The system of natural law holds that man should
live life according to an inherent human nature.

Example:
the declaration of independence was an assertion of
natural law - the right to be free, the right not to be taxed
without representation, etc., if you believe you are
entitled to these rights just by virtue of the fact that you
are alive/human, you believe in natural law.
 ETHICAL THEORIES
• Deontology
• The deontological theory states that the people should
adhere to their obligations and duties when analyzing an
ethical dilemma. This theory holds that the most
important aspects of our lives are governed by certain
unbreakable moral rules. a person will follow his or her
obligations to another individual or society because
upholding one’s duty is what is considered ethically
correct. For instance, a deontologist will always keep his
promises to a friend and will follow the law. A person
who follows this theory will produce very consistent
decision since they will be based on the individual’s set
duties.
 ETHICAL THEORIES
• Utilitarianism

This theory basically promotes good or valued ends.

This theory instructs adherents to work for those
outcomes that will give the most advantage to the
majority of those affected in the most impartial way
possible. To a utilitarian, it is ethically correct if the
choice that yields the greatest benefit to the most
people.
 ETHICAL THEORIES
• Utilitarianism
The two types:

• Act Utilitarianism –A person performs the acts that

benefit the most people, regardless of personal feelings
or the societal constraints such as laws.
• Rule Utilitarianism – this takes into account law and is
considered with fairness. A rule utilitarian seeks to
benefit the most people but through the fairest and most
just means available.
 ETHICAL THEORIES
• Virtue Theory

• This ethical theory judges a person by his character

rather than by an action that may deviate from his
normal behavior. It takes the person’s moral,
reputation and motivation into account when rating
an unusual and irregular behavior that is considered
unethical.
• For instance, if a person plagiarized a passage that
was later detected by a peer, the peer who knows
the person well will understand the person’s
character and will be able to judge the friend.
 ETHICAL THEORIES
• Rights

• The rights ethical theory is the rights set forth by a

society that are protected and given the highest priority.
Rights are considered to be ethically correct and valid
since a large or ruling population endorses them.
Individuals may also bestow rights upon others if they
have the ability and resources to do so. For example, a
person may say that her friend may borrow the car for
the afternoon. The friend who was given the ability to
borrow the car now has a right to the car in the
afternoon.
 ETHICAL THEORIES
• Casuist

• The casuist ethical theory is one that compares a

current ethical dilemma with examples of similar
ethical dilemmas and their outcomes. This allows one
to determine the severity of the situation and to create
the best possible solution according to others’
experiences.

• -Casuistry is a specific method of doing ethics that

relies on the analysis of individual cases, exploring
them in relation to paradigm cases and broad
principles
 DIVISION OF ETHICS
Acts of Man
are actions that do not involve the use of intellect
and freewill; these are actions done unconsciously and
without reason.
The natural acts of vegetative and sense faculties:
digestion, beating of the heart, growth, corporal
reactions, and visual or auditive perceptions. However,
these acts become human acts when performed under
the direction of the will, as when we look at something,
or arouse ourselves.
 DIVISION OF ETHICS
Human acts

are imputable to man so as to involve his

responsibility, for the very reason that he puts them forth
deletions deliberatively and with self-determination. This
involves the use of both free will and intellect; these are
actions are performed with use of reasons.

FREE WILL - the ability to choose how to act. : the

ability to make choices that are not controlled by fate or
God.
 DIVISION OF ETHICS
Morals
deal with the conduct of man, the right and wrong
behavior of man in his relationship with his fellow men.
They are the fundamentals of right and wrong learned
and internalized in early childhood.

Morality of Human Acts A human act is one that proceeds

from knowledge and free will. If either adequate
knowledge or freedom is lacking in the act of a person,
then act is not fully human and therefore not fully moral.
 DIVISION OF ETHICS
• Mores as defined by Robles are customs, beliefs
enforced by social pressure. They are the societies
established patterns of action to which an individual is
expected to conform.

• Morality speaks of a system of behavior in regards to

standards of right or wrong behavior. The word morality
is always associated with: moral standards, which is
about human behavior; moral responsibility which refers
to our conscience; and moral identity, or one who is
capable of right or wrong action.
 DIVISION OF ETHICS
Law of Conscience or Natural Law
• According to St. Thomas, Law is an “ordinance of
reason, promulgated for the common good by the one
who has charge of a society.”

Law - is an ordinance of reason promulgated for the

common good or to protect the society at large. - u

• Conscience is a practical judgment of reason upon an

individual act as good, or as evil and to be avoided.
 DIVISION OF ETHICS
Law of Conscience
ensures that people cannot be forced to facilitate
practices or procedures to which they object for reasons
of conscience. These may include abortion, capital
punishment, contraception, sterilization, artificial
reproduction, euthanasia, assisted suicide, human
experimentation, torture, etc.

Virtue
is a good habit that enables us to act according to
right reason, enlightened by faith. It is a firm disposition
to act according to God’s will and disregard the country
impulses of our own will.
 DIVISION OF ETHICS
• Four cardinal virtues:
• Prudence – able to judge between actions with regard to
appropriate actions at a given time.
• Justice – proper moderation between self-interest and
the rights and needs of others.
• Restraints or Temperance – practicing self control,
abstention, and moderation.
• Courage or Fortitude – forbearance, endurance, and
ability to confront fear and uncertainty, or intimidation.
 DIVISION OF ETHICS
• Capital Virtues:

• Humility – is the virtue that counters pride. As pride

leads to other sin, true humility clears a path for holiness.
The virtue of humility is about modest behavior,
selflessness and the giving of respect.
• Generosity - the virtue of liberality id focused not merely
on the appropriate concern regarding one’s earthly
goods, but also on generosity and a willingness to give,
freely and without request for commendation.
• Chastity – embraces moral wholesomeness and purity,
and in both thought and action treats God’s gift of
sexuality with due reverence and respect.
 DIVISION OF ETHICS
• Capital Virtues:

Meekness – focuses on patiently seeking appropriate

resolution to conflicts, and on the ability to forgive and
show mercy.
• Temperance – is centered on self-control and
moderation.
• Kindness – kindness, or love for one’s neighbor is
manifest in the unprejudiced, compassionate and
charitable concern for others.
• Diligence – diligence manifests the appropriately
zealous attitudes toward living and sharing the Faith.
 DIVISION OF ETHICS
• Theological Virtues

• Faith is the theological virtue by which we believe in God

and believe all that he has said and revealed to us.
• Hope is the theological virtue by which we desire the
kingdom of heaven and eternal life as our happiness,
placing our trust in Christ’s promises and relying not on
our own strength, but on the help of the grace of the Holy
Spirit.
Charity is the theological virtue by which we love God
above all things for his own sake, and our neighbor as
ourselves for the love of God.
 DIVISION OF ETHICS
Applied Ethics applies the general concepts and
principles but also specifies the particular situation in life
in which they are valid and legitimate moral. It is also
called Special ethics and deals with:
• Individual Ethics which deals with duties to God; duties
to one self and others.
• Social Ethics right to property and the right to marriage.
• Political Ethics deals with the state; the political authority
and the international authority.
• Professional Ethics is the branch of moral science which
treats the obligations which a member of a profession
owes to the public, to the profession, to his colleagues
and client.
 BIOETHICS
• BIOETHICS

- Common morality theories are usually based

on principles that are used to guide ethical thinking,
based on a shared moral belief. One of these theories is
bioethics, the ethics of biology, biological research and
the applications of that research. It is an ethical theory
that brings together medicine, the law, social sciences,
philosophy, theology, politics and other disciplines to
address questions related to clinical decision making and
medical research.
 BIOETHICS
• IMPORTANCE OF BIOETHICS IN HEALTH CARE
– Bioethics explores critical issues in clinical and research
medicine, including truth telling, informed consent, confidentially,
end-of-life care, conflict of interest, no abandonment, euthanasia,
substituted judgment, rationing of and access to health care, and
the withdrawal and withholding of care.
• Bioethics enables ethical reflection to keep pace with
scientific and medical breakthroughs. With each new
technology or medical breakthrough, the public finds
itself in uncharted ethical terrain it does not know how to
navigate.
• Bioethics challenges the presumptions of international
and population-based efforts in public health and the
delivery of health care in economically underdeveloped
parts of the globe.
 BIOETHICS
• ETHICAL FRAMEWORKS FOR DECISION MAKING

I. Ethical System and Principles

Not all ethical principles are applicable in all
situations because of the different variables that may
affect every situation. The moral principles help us in
making a moral analysis of ethical issues in our
professional practice.
It is important for the individual to determine which
principle is applicable or carries more weight to a specific
situation.
 BIOETHICS
• ETHICAL FRAMEWORKS FOR DECISION MAKING

II. Patient’s Bill of Rights - This enumerates the privileges

the patient duly deserves and the ethical behavior that
the health care professionals should observe.
1. The PATIENT has the right to considerate and
respectful care.
1. The PATIENT has the right to considerate and
respectful care.
 2. The PATIENT has the right to and is encouraged to
obtain from physicians and other direct caregivers
relevant, current, and understandable information
concerning diagnosis, treatment and prognosis.

Except in emergencies when the patient lacks decision-

making capacity and the need for treatment is urgent, the
patient is entitled to the opportunity to discuss and request
information related to the specific procedures and/or
treatments, the crisis involved, the possible length of their
recuperation, and the medically reasonable alternatives
and their accompanying risks and benefits.
The patient has the right to know the identity of
physicians, nurses, and others involved in his/her
care, as well as when those involved are students,
residents, or trainers. The patient also has the right to
know the immediate and long-term financial
implications of treatment choices, insofar as they are
known.

(RIGHT to relevant information-informed consent)

3. The PATIENT has the right to make decisions about the
plan of care prior to and during the course of treatment
and to refuse a recommended treatment plan of care to
the extent permitted by law and hospital policy and to be
informed of the medical consequences of this action.

In case of such refusal, the patient is entitled to other

appropriate care and services the hospital provides or
transfer to another hospital. The hospital should notify
patients of any policy that might affect patient choice
within the institution.

(RIGHT to decide plan of care)

 4. The PATIENT has the right to have an advance
directive (such as a living will) concerning treatment or
designating a surrogate decision maker with the
expectation that the hospital will honor the intent of that
directive to the extent permitted by law and hospital policy.
Healthcare institutions must advise patients of their rights
under state law and hospital policy to make informed
medical choices, ask if the patient has an advance
directive, and include that information in patient records.
The patient has the right to timely information about
hospital policy that may limit its ability to implement fully a
legally valid advance directive.

(RIGHT to have advance directive)

 5. The PATIENT has the right to every consideration of
his privacy. Case discussion, consultation, examination,
and treatment should be conducted so as to protect each
patient’s privacy.
 6. The PATIENT has the right to expect that all
communications and records pertaining to his care should
be treated as confidential by the hospital, except in cases
such as suspected public health hazards where reporting
is permitted or required by law.

The patient has the right to expect that the hospital will
emphasize the confidentiality of this information when it
releases it to any other parties entitled to review
information in these records.

(RIGHT to confidentiality of records)

 7. The PATIENT has the right to review the records
pertaining to his medical care and to have the information
explained or interrupted as necessary except when
restricted by law.

(RIGHT to review one’s medical records)

 8. The PATIENT has the right to expect that, within its
capacity and policies, a hospital will make reasonable
response to the request of a patient for appropriate and
medically indicated care and services.

The hospital must provide evaluation, service, and/or

referral as indicated by the urgency of the case. When
medically appropriate and legally permissible, or when a
patient has so requested, a patient may be transferred to
another facility.
 The institution to which the patient is to be transferred
must first have accepted the patient for transfer. The
patient must also have the benefit of complete information
and explanation concerning the need for risks, benefits,
and alternatives to such a transfer.

(RIGHT to request relevant care)

9. The PATIENT has the right to ask and be informed of
the existence of business relationships among the
hospital, educational institutions, other health care
providers, or players that may influence the patient’s
treatment and care.

(RIGHT to disclosure of business interests)

10. The PATIENT has the right to consent or to decline to
participate in proposed research studies or human
experimentation affecting his care and treatment or
requiring direct patient involvement, and to have those
studies fully explained prior to consent.

A patient who declines to participate in research or

experimentation is entitled to the most effective care that
the hospital can otherwise provide.

(RIGHT to refuse participation in research)

11. The PATIENT has the right to expect continuity of care
when appropriate and to be informed by the physicians
and other caregivers of available and realistic patient care
options when hospital care is no longer appropriate.

(RIGHT to continuity of care)

 12. The PATIENT has the right to be informed of hospital
policies and practices that relate to patient care, treatment,
and responsibilities. The patient has the right to be
informed of available resources for resolving disputes,
grievances, and conflicts, such as ethics committees,
patient representatives, or other mechanisms available in
the institution. The patient has the right to be informed of
the hospital’s charges for services and available payment
methods.

(RIGHT to information on hospital policies)

 BIOETHICS
• ETHICAL FRAMEWORKS FOR DECISION MAKING

III. Professional Code of Ethics

This outlines how midwives should practice the

profession in ethical and moral manner. This guides the
midwives in her practice, in establishing interpersonal
relationship with colleagues, patient, superiors and other
significant others involved in patient care.
•
 BIOETHICS
• ETHICAL FRAMEWORKS FOR DECISION MAKING

• III. Institutional Policies

The set rules, regulation and policies of the
institution may affect the decision making of the midwife.
This guides the midwives in her practice in the institution
where she is connected.
IV. Laws
It is an ordinance promulgated for the common good
by one who has legitimate authority. In general, a rule of
being or of conduct, established by an authority able to
enforce its will; a controlling regulation; the mode or
order according to which an agent or a power acts.
 BIOETHICS
In morals, law is the will of God and as the rule for
the disposition and conduct of all responsible
beings toward him and toward each other; a rule of
living, conformable to righteousness; the rule of
action as obligatory on the conscience or moral
nature.
PRINCIPLES OF BIOETHICS
- Decision making in the field of bioethics has
become increasingly complex. There is no
predetermined order of preference; each is essentially of
equal importance. In different situations a particular
principle may assume a greater or lesser priority.
• Autonomy
• Nonmaleficence
• Beneficence
• Justice
• Veracity
 ETHICAL ISSUES

• Abortion
• While infanticide is legally and socially
treated as murder and few in our culture
would approve of it, the killing of unborn
infants (often called foetuses in order to
still the conscience and minimize the
social stigma) has become both legally
and socially acceptable.
 ETHICAL ISSUES

• Euthanasia
 ETHICAL ISSUES

• Living Wills
• The “living will” is a written document
which speaks for the patient if he becomes
incompetent and helps protect the
physician from legal liability. These laws
are binding upon the physician so that if
he does not wish to observe the “will” he
must cooperate in transferring the patient
to another physician.
 ETHICAL ISSUES

• Donation of Organs and the Body

 Principles that will Guide the
Midwife in her Practice
I. The Golden Rule. This states that “Do unto others
what you would like others to do unto you”. For a midwife
to follow this principle she should:
•
• Treat others according to how one would like others to
treat them;
• Treat others as you would like to be treated;
• Not treat others in ways one would not like to be treated
• Not treat others in ways you would not like to be treated
Principles that will Guide the
Midwife in her Practice
II. The Two-Fold Effect. This aims to provide
specific guidelines for determining when it is ethically
permissible for a human being to engage in conduct in
pursuit of a good end with full knowledge that the
conduct will also bring about bad results. This set of
criteria states that an action having foreseen harmful
effects practically inseparable from the good effect is
justifiable if upon satisfaction of the following:
 Principles that will Guide the
Midwife in her Practice
III. Principle of Totality An individual may not dispose
of his organs or destroy their capacity to function, except
to the extent that this is necessary for the general well-
being of the whole body. Destroying an organ or
interfering with its capacity to functions prevents the
organ from achieving its natural purpose.
•
IV. Epikia “Exception to the Rule”
 MIDWIFERY ETHICS

• It is a system of principle governing

conduct of midwives (Robles). The term
connotes the conduct or behavior of
midwifery practitioners, which by reason of
public approval or practice of the group,
has become customary among practicing
midwives.
CODE OF ETHICS FOR
MIDWIVES

Adopted June 30,1988

 Preamble

The principles and rules of conduct embodied in this Code

aim to help midwifery practitioners, as
individuals and as a professional group, to pursue and
maintain a high level of ethical conduct in the practice of
midwifery. They are simply criteria or measures by which a
midwife may be guided in her professional conduct
and in her relationship with her patients, co-practitioners,
members of allied professions and the public in
general.
 Section I

The primary objective of the midwifery profession is for its

members to render service within the scope
of their legitimate functions, having in mind that their
patients, regardless of religion, social or economic status,
deserve respect as human beings. A midwife should
endeavor to deserve the confidence of the patients under
her care by rendering to each of them dedicated and
selfless service to the full extent of her skill and
competence.
 Section II

A midwife should try her best to continually improve her

knowledge & skill for the benefit of her patients
and to share with her co-practitioners any valuable
practical knowledge that she may have gained by
experience in the practice of her profession.
 Section III

A midwife is expected to practice on a scientific basis and

to desist in the performance of any midwifery
procedure which is of doubtful or questionable propriety
from the standpoint of medical or scientific principles.
 Section IV

The midwifery profession should contribute to the

safeguarding of public health and should protect itself
against the admission into its membership midwives who
are deficient in professional competence and requisite
moral character. It is incumbent upon every midwifery
practitioner to observe the law, to uphold the honor and
dignity of her profession, and to adhere faithfully to
professional discipline. It is the professional duty of every
midwife to bring to the attention of the proper authority,
through legitimate procedures, the illegal or unethical
conduct of any co-member of the midwifery profession,
without bias or personal animosity, but solely for the
maintenance of the good name of the profession as well
as public interest and welfare.
 Section V

A midwife who has accepted a patient under her care

should render service to the patient the best of
her ability. She should not neglect the patient under any
circumstance within her control.
 Section VI

A midwife should not compromise her services to the

patients under terms or conditions which would
impair the quality of patients- care.
 Section VII

In the practice of midwifery, a midwife must confine the

source of her income to the midwifery services
she has actually rendered. Her fees should be
commensurate with the services performed and, if need
be, with
the patient’s ability to pay. It is highly improper for a
midwifery practitioner to pay or receive a commission for
referral of patients made to or by her.
 Section VIII

A midwifes- legitimate functions cover performance of

midwifery services only to normal pregnant
women and normal newborn infants. Accordingly, in a
doubtful or difficult case, she should seek consultation or
refer such case to a qualified obstetrician or physician.
She should not persist in handling the case and thereby
risk liability for any injury that may arise.
 Section IX

A midwife is bound by professional ethics not to reveal any

information given by her patient in the
course of the Patients- care or treatment, whether such
information is addressed to her or to the attending
physician, unless under the law, she is required to testify
on such information to serve the ends of justice.
 Section X

The ideals of service envisioned by the midwifery

profession call for a dedication of the midwifes capabilities
not only individual but also to the community in which she
practices to the end that she may be able
to contribute to the improvement of the health of her
patients and to the health and well-being of her
community.
 Section XI

A midwife should participate in research activities or in

any effort of the midwifery profession to improve
midwifery training and practice, and to take part in
establishing and maintaining conditions of employment
conducive to high-quality maternity and infant care.
 Section XII

As a member of the health team, a midwife should work

with interest and concern, together with other
members of the health team, in promoting efforts to meet
the health needs of the public. The formulation of a
code of midwifery ethics that is complete and all-
embracing is not feasible. A registered midwife, in the
course
of her professional practice, will realize that a code of
ethics, however, well it is formulated has certain
limitations.
 Section XII

The code for instance, may not point out how a midwife
may resolve or reconcile a conflict between
personal and professional views. The code may not
likewise indicate a remedy for resolving conflict that may
stem from changing social principles, goals and standards
which are held or may later be accepted by the
midwifery profession.
 Section XII

Such inadequacy of the code ultimately leaves the midwife

to herself in deciding what
moral principles should govern her course of action when
faced with ethical problems in the practice of her
profession. In brief, a code of midwifery ethics, like any
other code of professional ethics, cannot be expected to
cover in detail all the activities of the midwife.
 Section XII

Hence, a midwife is not duly bound to confine herself to

the rules
set by any adopted code of midwifery ethics. However, it is
incumbent upon her to observe at all times the
ideals of her profession and to adhere faithfully to the well-
recognized unwritten ethical and professional rules
generally accepted by the midwifery profession.
 Section XIII

This code shall take effect upon approval by the

Commission and after fifteen (15) days following its
publication in the Official Gazette. Done in the City of
Manila, this 30th day of June, 1988.
 PRACTICE IN THE
•
PHILIPPINES
A midwife must be able to give necessary supervision,
care and advice to women during pregnancy, labor and
the post partum period, to conduct deliveries on her own
responsibility and to care for the newborn and the infant;
this care includes preventive measures, the detection of
abnormal conditions in the mother and child, the
procurement of assistance and the execution of
emergency measures in the absence of medical help.
• A midwife has an important task in the
counseling and education, not only for the patients but
also within the family and community. The work involves
antenatal education and preparation for parenthood and
extends to certain areas of gynecology, family planning,
and child care. A midwife may practice in a hospital,
clinic, health unit, domiciliary services or in any other
services.
 SKILLS AND ABILITIES OF
PROFESSIONAL MIDWIFE
I. Technical Skills are that a midwife should apply
in performing the procedures assigned to her.
Examples of such skills are:
• Provision of sound family planning information and
advice
• Diagnose pregnancies and monitor normal pregnancies;
to carry out examinations necessary for the monitoring of
the development of normal pregnancies
• Formulation of program for parenthood preparation and
a complete preparation for childbirth including advice on
hygiene and nutrition
•
 SKILLS AND ABILITIES OF
PROFESSIONAL MIDWIFE
II. Communication Skills are the skills of the
midwife that should be used and applied in expressing
her thoughts either orally or in writing.
• Examples of such skills are:
• Maintain adequate, accurate and contemporary records
of practice, include all documentation required under
legislation, documentation of care given, response to
care and evaluation of care.
• Keeping a detailed record of observations, care given
and problems of all mothers and babies.
• Report to the relevant person or authority any
circumstances in the care environment/settings, which
could jeopardize standards of practice or where
 SKILLS AND ABILITIES OF
PROFESSIONAL MIDWIFE
III. Analytical Skills are that are used in decision
making. These may include:
• Ensure that adequate strategies are in place for referral
to a relevant health professional or agency as part of
providing midwifery care and in the event of potential or
actual problems for the woman and her child.
• Protect all confidential information concerning the
woman obtained in the course of professional practice
and make disclosures only with the consent of the
woman or when legally obliged/required.
THE MIDWIFERY LICENSURE
EXAMINATION
• Qualifications of Applicants
• In order to be admitted to the midwifery examination, an
applicant shall, at the time of filing of his/her application
therefore, establish to the satisfaction to the Board that
he/she:
1. Is in good health and of good moral character;
2. Is a graduate of midwifery in a government
recognized and duly accredited institution at the time
of the issuance of a certificate of registration;
3. The applicant shall be a citizen of the Philippines;
at least eighteen (18) years of age. In case the
applicant is below 18 years old who successfully passes
the examination shall not be permitted to practice
midwifery until he/she reaches the legal age.
THE MIDWIFERY LICENSURE
EXAMINATION
• Scope of the Examination
1. Infant care and feeding; 2. Obstetrical anatomy and
physiology; 3. Principles of bacteriology as applied to
midwifery practice; 4. Obstetrics; 5. Midwifery procedures;
6. Domiciliary midwifery; 7. Community hygiene and first
aid; 8. Nutrition; 9. Ethics of midwifery practice; 10. Primary
health care; 10. Professional Growth and Development; 11.
Family planning; and
Other subjects which the Board may deem
necessary for addition or inclusion from time to time.
•
THE MIDWIFERY LICENSURE
EXAMINATION

Read Chapter 3 of the Textbook by Sia

THE MIDWIFERY LICENSURE
EXAMINATION
• Passing the Examination

• To pass the board examination for midwives, a candidate

must obtain a general rating of seventy five percent
(75%) in the written test with no grade lower than fifty
percent (50%) in any subject.
•
• Results of the Examination
•
• The board shall, within one hundred twenty (120) days
after examination, report the ratings obtained by each
candidate to the Commissioner of the PRC.
THE MIDWIFERY LICENSURE
EXAMINATION
• REGISTRATION OF MIDWIFE
• Issuance of Certificate
• The Certificate of Registration as midwife shall, upon
payment of the required fees, be issued to any applicant
who passes the examination. Every certificate of
registration shall show full name of registrant, have a
serial number, bear the signatures of the members of the
Board, be attested by the Secretary of the board, I be
duly authenticated by the official seal of the Board. The
issuance of a certificate of registration by the Board to
the registrant shall be evidence that the person named
herein is entitled to all rights and privileges of a
registered midwife until said certificate, for jut case, is
suspended temporarily or revoked.
 THE MIDWIFERY LICENSURE
EXAMINATION
• REGISTRATION OF MIDWIFE
• The applicant for registration must comply with the following
requirements before the certificate will be issued the applicant
must:
• Have passed the licensure examination;
• Be a citizen of the Philippines;
• Be at least 18 years old;
• Not have convicted of a crime involving moral turpitude;
• Not have found guilty of immoral and dishonorable conduct;
• Pay the required registration fee.
• In case the Board shall refuse to issue certificate, the Board
shall give the applicant a written statement setting forth the
reason or reasons for its action, which statement shall be
incorporated in the records of the Board.
 THE MIDWIFERY LICENSURE
EXAMINATION
• Inhibition against Practice of Midwifery

• No person shall practice or offer to practice midwifery in the

Philippines, as defined in this Act, without holding a valid
certificate of registration & professional license as midwife.
•
• A midwife must be registered and licensed to practice
Midwifery in the country. This means that she has to pass the
Midwifery Licensure Examination and comply with the
registration requirements before she can practice the
profession.
•
 THE MIDWIFERY LICENSURE
EXAMINATION
• REVOCATION AND SUSPENSION OF
CERTIFICATES/LICENSE
•
• A licensed is a right to a person under certain circumstances
or condition. Failure to comply with the condition that goes
with it may mean revocation or suspension by the agency or
licensing board entitled to issue the license.
•
• Revocation is the cancellation of the midwife’s certificate or
license due to failure to meet the condition that is inherent to
her license or certificate or many commission of act that is not
within the scope of her practice. This means that the
professional midwife can no longer practice the profession and
all the rights and privileges accorded to her as professional
midwife will be withdrawn.
 THE MIDWIFERY LICENSURE
•
EXAMINATION
Suspension is the temporary withdrawal of a right, privilege or
license to practice midwifery profession. Temporarily the midwife is
prohibited to practice midwifery for a certain period of time but she
remains a member of the profession and is expected to practice the
Code of Conduct for Midwives.

• The board of Midwifery has the power to revoke or suspend the

license or certificate after due process. “Due Process of law implies
the right of the person affected thereby to be present before the
tribunal which pronounces judgment upon the question of life,
liberty, or property, in its most comprehensive sense; to be heard,
by testimony or otherwise, and to have the right of controverting, by
proof, every material fact which bears on the question of right in the
matter involved. If any question of fact or liability be conclusively
presumed against him, this is not due process of law.” (Black’s Law
Dictionary, 6th Edition, page 500)
 THE MIDWIFERY LICENSURE
EXAMINATION
• CAUSES OF REVOCATION
•
• Criminal Offense is an act punishable by law; usually
considered an evil act.

• Moral Turpitude
• It is gross violation of standards of moral conduct, vileness,
such that an act involving moral turpitude was intentionally
evil, making the act a crime. It is a personal conduct which
goes against public morals. Such conduct is regarded as a
black mark against someone’s reputation, and may cause
problems in the future after conviction because people who
have been committed of crimes involving moral turpitude may
be regarded as less trustworthy or honorable.
 THE MIDWIFERY LICENSURE
EXAMINATION
• Negligence
•
• Is the commission of an act that a prudent person would not
have done or the omission of a duty that a prudent would have
fulfilled, resulting in injury or harm to another person.
•
• It can also be defined as any action or an omission in reckless
disregard of the consequences to the safety or property of
another. Negligence is a ‘legal cause’ of damage. If it directly
and in natural and continuous sequence produces or
contributes substantially to producing such damage, so it can
reasonably be said that if not for the negligence, the loss,
injury or damage would not have occurred.
 THE MIDWIFERY LICENSURE
EXAMINATION
• Malpractice (Professional Negligence)

In particular, in a malpractice suit, a professional person is

negligent if harm to a client results from such an act or such
failure to act, but it must be proved that other prudent
members of the same profession would ordinarily have acted
differently under the same circumstances. Negligence may be
misfeasance, malfeasance, or nonfeasance. (Mosby’s Medical
Dictionary, 8th edition, © 2009, Elsevier).
 THE MIDWIFERY LICENSURE
EXAMINATION
Malpractice (Professional Negligence)

In particular, in a malpractice suit, a professional person is

negligent if harm to a client results from such an act or
such failure to act, but it must be proved that other prudent
members of the same profession would ordinarily have
acted differently under the same circumstances.
Negligence may be misfeasance, malfeasance, or
nonfeasance. (Mosby’s Medical Dictionary, 8th
edition, © 2009, Elsevier).
 THE MIDWIFERY LICENSURE
EXAMINATION
Misfeasance improper and unlawful execution of an act
that in itself is lawful and proper (The American Heritage
Dictionary of the English Language).
•
Malfeasance is the doing of an act which a person ought
not to do at all. A midwife who caused uterine inversion to
a woman by pulling the umbilical cord during the third
stage of labor to hasten placental expulsion is an
example of this act.
•
Nonfeasance means the omission of an act which
a person ought to do. An eclamptic patient falls out of bed and
sustained an injury convulsion because the midwife failed to
raise the side rails is an example of this act.
 THE MIDWIFERY LICENSURE
EXAMINATION
Malpractice
• Is any professional misconduct, lack of ordinary skill, or breach
of duty in the performance of a professional service that
results in injury or loss. The plaintiff must usually demonstrate
a failure by the professional to perform according to the field’s
accepted standards.
•
Incompetence
•
This means that a midwife has no adequate ability,
knowledge, fitness, and qualities to meet
requirements to perform her duties properly and
skillfully.
 THE MIDWIFERY LICENSURE
EXAMINATION
• Ignorance
•
• Webster defines ignorance as “lack of knowledge or
awareness of a particular thing”. In midwifery practice,
ignorance will denote the inability of the midwife to apply
professional skills in the delivery of her duty. This lack of
professional skills can cause damage or injury to patient under
her care.
 THE MIDWIFERY LICENSURE
EXAMINATION
Fraud and Deceit
•
Fraud is an international perversion of truth for the
purpose of obtaining some valuable thing or promise from
another. Fraud is a crime, and also a civil law violation.

Deceit is the fraudulent representation of a material fact

made with knowledge of its falsity, or without
reasonable grounds for believing its truth and with
intent to induce reliance on it. Both terms means
giving false impression causing someone to believe
something that is false.
•
 THE MIDWIFERY LICENSURE
EXAMINATION
• The types of criminal fraud that a midwife may commit may
include:
•
• Benefit fraud, committing fraud to get government benefits
• Embezzlement, taking money which one has been entrusted
with on behalf of another party
• False advertising
• False billing
• Documents or signatures
• Health fraud, for example selling of products known not to be
effective
• Not reporting revenue or illegally avoiding taxes
•
THE MIDWIFERY LICENSURE
EXAMINATION
Five primary forms of deception that a midwife
may commit are:
1. Lie is giving information that is opposite or very
different from the truth.
• 2. Equivocation is making an indirect, ambiguous, or
contradictory statement.
• 3. Concealment is omitting information that is
important or relevant to the given context, or engaging
in behavior that helps hide relevant information.
• 4. Exaggeration is an overstatement or stretching the
truth to a degree.
• 5. Understatement is minimization or downplaying
aspects of the truth.
 THE MIDWIFERY LICENSURE
EXAMINATION
• Misconduct is a legal term meaning a wrongful, improper, or
unlawful conduct motivated by premeditated or intentional purpose
or by obstinate indifference to the consequences of one’s acts. It is
where something is seen as unacceptable but it is not a criminal
offence like poor timekeeping, absenteeism, use of workplace
facilities, personal appearance, negligence or sub-standard work.
•
• Gross Misconduct is where a midwife can be dismissed straight
away because it is serious enough to justify suspension and
revocation of license. Midwives would include intoxication (whether
from drink or drugs), fighting or other physical abuse, indecent
behavior, theft, dishonesty, sabotage, serious breaches of health
and safety rules, offensive behavior (such as discrimination,
harassment, bullying, abuse and violence) and gross
insubordination as examples of gross misconduct.
THE MIDWIFERY PROFESSION
OPPORTUNITIES OF THE MIDWIFE ABROAD
• Abroad all midwives wish to work abroad to have a
better opportunity not only in terms of experience
but as well as for greener pasture. Through the
Philippine Overseas Employment Agency (POEA),
a midwife may know job vacancies abroad. Hiring
here is done through government – government
basis. Aside from POEA, different recruitment
agencies are available for job placement but
placement fees are being charged to them. Another
way working abroad is the direct hiring scheme
where the employers hire directly the midwives.
They take care of the processing of their papers
including the visa, employment contract and the
tickets.
THE MIDWIFERY PROFESSION
• Documents needed when travelling abroad
• Passport is a document that provides one’s nationality and is issued by
the department of foreign affairs. For the midwife to acquire a passport
she must have: birth certificate, marriage contract, and two 2 x 2 pictures
and the processing fee.
• Visa is a document that allows a person to enter a foreign country issued
by the foreign embassies in every country, a visa maybe categorized:
student, tourist, working and immigrant. Documents needed in applying
for a visa are:
• Six 2 x 2 photos
• High school Diploma authenticated by the DepEd
• Midwifery Diploma, transcript of Records, and Clinical Experience
authenticated by CHED
• Board Rating and Board Certificate authenticated by the PRC
• Birth certificate and Marriage Contract authenticated by the NSO
• National Bureau of Investigation (NBI) Clearance
• Certificate of employment
• The above documents are brought to the Department of foreign affairs for
authentication and to the foreign embassy for final authentication.
THE MIDWIFERY PROFESSION
• Responsibilities of the Midwife Working
Abroad

Maintain her dignity and professionalism.

• Maintain loyalty to people and country.
• Always respect laws, tradition, and culture of the
country where she is working.
• Maintain good traits and attitude as a Filipino
working abroad.
• Follow Code of Midwifery Ethics of the host
country.
 THE MIDWIFERY
PROFESSION
• PROFESSIONAL ORGANIZATION
• Integrated Midwives Association of the Philippines, Inc.
(IMAP, Inc.) is a non-profit, non-stock, and non-governmental
national organization of the registered midwives in the
Philippines, accredited by the Professional Regulation
Commission.
• IMAP, Inc. is committed to serve the Filipino people through an
effective delivery of basic health services in the country. It also
aims to elevate the standards of midwifery profession, provide
continuing midwifery education and professional growth, and
foster and maintain the ideas of integrity conduct

• WHAT DOES IT OFFER?

THE MIDWIFERY PROFESSION

• Continuing Professional Education – this aims to

improve the competency of midwives in the practice
of their profession and give service that meets
professional standards.

• Scholarship Program – offers a Three-Year

Midwifery Program to deserving children of bonafide
members of the association willing to take up the
course at the IMAP Foundation School in Iloilo City.
THE MIDWIFERY PROFESSION
Outreach Programs

• Project ABCC – a joint with the Philippine Obstetrical and

Gynecological Society and NESTLE Philippines which has generated
cancer awareness and consciousness among women and the
importance of preventive health care.
• Operational Tule – conducted in depressed areas for children whose
parents cannot afford the operating costs and medicine for
circumcision.
• Christmas Gift-Giving – a yearly project since 1996. The
organization conducts gift-giving program at depressed barangays in
Guimaras.
• Basic Life Support Program – a community health emergency
preparedness and response program conducted for midwives to
enable them to respond to emergencies in the community (initiated
under the STOP DEATH program of the DOH).
THE MIDWIFERY PROFESSION
• Classification of IMAP Members

• The members of the Association are classified as

follows:
• Active – are graduate registered midwives with a right
to vote and participate.
• Affiliate – are members of a graduating class with no
voting privilege but is to be represented.
• Associate – a registered nurse and a registered
midwife can be a member but she has no right to vote.
• Honorary – not necessarily a graduate registered
midwife but any individual who has rendered
meritorious work in the development of the midwifery
profession or assisted in the promotion of the interest
and welfare of the association.
 THE MIDWIFERY
PROFESSION
• The International Confederation of Midwives

• The International Confederation of Midwives supports,

represents and works to strengthen professional associations
of midwives on a global basis. At present ICM has (Member
Associations in 88 countries. The ICM works with midwives
and midwifery associations globally to secure women’s right
and access to midwifery care before, during and after
childbirth.
• It has the following objectives:
THE MIDWIFERY PROFESSION
It has the following objectives: (ICM)

• Promote among member associations knowledge and

good understanding of all problems relating to reproduction
and childbirth including family planning.
• Assist the member associations in working together for the
purpose of promoting family health, improving the standard
of maternal care and advancing the training and
professional status of the midwife.
• Provide means of communication between midwives of
various nationalities and with other international
organization with a view to improving the standard of
maternal and child care.
THE MIDWIFERY PROFESSION
It has the following objectives: (ICM)

• Maintain the facilities for the promotion of international

understanding and the interchange of international
hospitality.

• Create opportunities for discussion of questions relating to

the social aspects of midwifery and the advancement of
midwives.
 PERSONALITY DEVT
• Manners – refer to polite, civil, well-breed behavior
(Funk and Wagnalls).

• Good Manners – are always important in all

contacts of life but they must spring from kindness of
spirit, or they will not ring true. Genuine concern for
another person is so vital to good manners that it is
better to be kind than to be correct. Manners are the
heart of courteous behavior.
•
• Manners and Etiquette – used synonymously but
etiquette means the conventional rules of behavior,
the customs that are handed down to us or the ones
we formulate to meet specific situations.
 PERSONALITY DEVT
• Everyday Manners and Etiquette
• Please, thank you
• Shaking of hands/nice to meet you
• Cover your mouth when sneezing or coughing
• Avoid burping, passing gas or rude bodily voices
• Wait for your turn to talk
• Remove hat when entering a room
• Say hello
• When Dining (Proper Table Manners)
• Use silverware if offered to you. Use them correctly
• Do not blow your nose on the table
• Never speak when your mouth is full of food
• Avoid keeping your elbows on the table and put your hands in your lap
when not in use.
• Always turn off your cell phones before entering the restaurant
• Do not start eating unless everybody is seated and served
PERSONALITY DEVT
• When in Public
• Wait for your turn when your are falling in line
• Turn off devices while watching a movie in the cinema and
refrain from talking
• Be careful with your words
• When Entertaining
• Always say thank you or send a thank you note when
receiving a gift or a good deed has been done for you
• It is improper to ask a guest to remove his shoes. When
expected to be shoeless, slippers must be provided
• Introduce guests to one another
• Keep conversation flowing and avoid awkward pauses.
Change subject when vulgar or rude and controversial matter
arises
• Offer refreshments to each guest upon entering social room
• The Telephone

• When using an answering machine, proper phone

etiquette is to be as brief and focused as possible
• Return call within 24 hours unless you’re away from
home
• Speak in low, clear voice.
• Turn off tv or music and talk at a time when children
are quiet
• Never yell or slam down the phone. If you must put
the other party on hold, only do so for 30 seconds.
Personality Development
DEFINITION: enhancing and dressing one’s
outer and inner self or the organized pattern of
behaviors and attitudes that makes a person
distinctive.

PERSONALITY: dynamic and organized set of

characteristics possessed by a person that
uniquely influences his or her cognitions,
emotions, motivations, and behaviors in various
situations.
– refers to individual differences in characteristic
patterns of thinking, feeling and behaving.
 Personality Development
GROOMING: art of cleaning, grooming, and
maintaining parts of the body
UNIFORM: wearing the pescribed uniform
VOICE: develop voice quality, voice tone, pitch,
pace and voice modulation
POISE: carrying one’s self and professional
bearing
CONDUCT: how you act, or deal with other
people
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 THE LAW AND THE SOCIETY
• LAW
• the skeleton of our society
• controls what we do
• when we do
• how we do it
• break the law, you’ll be punished by it.
• an orderly society without legal system, even if it is just one simple
rule or regulation to follow,
• a system of law can control people operate their lives. Without it,
people would be:
• free to make decisions based solely on their principles,
• they would be free to steal, murder, damage, rape, trespass and
terrorize what or whomever they wanted when it suited them
 THE LAW AND THE SOCIETY
• Importance of Law
• regulate relationships between conflicting interests
• ensures safety of future generations
• without laws, there would be nothing one could do if another
were violating their peace and enjoyment.
•
• Characteristics of Law
• a rule of conduct or action which determines what can be done
and what cannot be done
• law is obligatory
• promulgated by legitimate authority
• it is of common observance and benefit
 THE LAW AND THE SOCIETY
• Sources of Law
• statutes or statutory law – written enactment of the will of the
legislative branch of the government rendered authentic by
certain prescribed forms or solemnities are more also known
as enactment of congress. The two types of statutory are the
Constitution and Legislative enactments which includes the
municipal charter, municipal legislations, court rules,
administrative rules and order, legislative rules and
presidential issuances.
•
• Jurisprudence or case law – is a case decided or written
opinion by courts and by persons performing judicial functions.
Also included are all rulings in the administrative and
legislative tribunals such as decisions made by the President
or Senate or House Tribunals
 THE LAW AND THE SOCIETY
• Legal Responsibilities of a Midwife
• Assume legal responsibilities during the practice of her
profession. It is important that the midwife knows what she is
doing and has the necessary skills to perform her duties in the
care of the patient.
• Perform her task easier if she knows her legal responsibilities
because she knows how to conduct herself legally
• Avoid criminal liability due to incompetence or negligence
• Be careful in the execution of her duties
• A midwife should always remember that she should only apply
her skills that are within her scope of function in the care of the
patient. Every position that a midwife will handle is paired with
legal implications.
 THE LAW AND THE SOCIETY
• Negligence – refers to the commission or omission of an act,
pursuant to a duty, that a reasonably prudent person in the
same or similar circumstance would or would not do, and
acting or the non-acting of which is the proximate cause of
injury to another person or his property

• Elements of a Professional Negligence

• existence of a duty on the part of the person charged to use
due care under circumstances
• failure to meet standard of due care
• the foreseability of harm resulting from failure to meet the
standard
• the fact that the breach of this standard resulted in an injury to
the plaintiff
 THE LAW AND THE SOCIETY
• Examples of Negligence
• Burns resulting from hot water bags, heat lamps, vaporizers or
sitz baths
• Objects left inside the patients body such as sponges
• Drugs given to the wrong person
• wrong medicine, wrong concentration, wrong route or wrong
dose
 THE LAW AND THE SOCIETY
• Doctrine of RES IPSA LOQUITUR- “the thing speaks for itself”
• Rule: When a thing which has caused an injury is shown to be under
the management of the party charged with negligence and the accident
is such as in the ordinary course of things will not happen if those who
have such management use proper care, the accident itself affords
reasonable evidence in the absence of explanation by the parties
charged, that is rose from the want of proper care.
• Three conditions required to establish a defendant’s negligence without
proving specific conduct:
• 1. that the injury was of such nature that it would not normally occur
unless there was a negligent act on the part of someone
• 2. that the injury was caused by an agency within control of the
defendant
• 3. that the plaintiff himself did not engage in any manner that would
tend to bring about the injury.
• Example of such case is the presence of sponges in the patient’s
abdomen after an operation.
 THE LAW AND THE SOCIETY
• Doctrine of FORCE MAJEURE – means an irresistible force,
one that is unforeseen or inevitable.

• Rule: When a debtor is unable to comply with his obligation

because of force majeure he cannot be held liable for such
performance. In the absence of stipulations to the contrary,
impossibility of performance, without the negligence of the
parties, prevents the enforcement of bond or contract.
• Circumstances such as floods, fire earthquakes and accidents
falls under this doctrine and nurses who fail to render service
during these circumstances are not held negligent.
 THE LAW AND THE SOCIETY
• Doctrine of RESPONDEAT SUPERIOR – let the master
answer for the acts of the subordinate.
• Rule: The master is responsible for the want of care on the
part of the servant toward those to whom the master is under
the duty to use care, provided the failure of the servant to use
such care occurred in the course of his employment.

• Example of this is that if the hospital will decides to hire under

board nurses or midwives in place of professional nurse in an
effort to cut down on expenses and these persons prove to be
incompetent then the hospital will be held liable.
• Incompetence – lack of ability, legal qualifications of fitness to
discharge the required duty.
 SITUATIONS AND CIRCUMSTANCES
WITH LEGAL IMPLICATIONS
• Registrations of Births
• Every birth must be registered in the Local Civil Registrar. The
physician or the midwife who attended the birth of the child is
required to register the child. If the physician who attended the
birth of the child is unavailable, the midwife can gather the
information from the mother and the father maybe adequate
for the registration.
•
• Birth certificate should be correctly accomplished accurate
information and data.
SITUATIONS AND CIRCUMSTANCES
WITH LEGAL IMPLICATIONS
Hospital records as Evidence proves the condition
of the patient at the time of confinement because
written records are the best forms of evidences to
be presented. Hospital records kept in the hospital
is a form of privilege communication. Privilege
Communication is a communication concerning
which one cannot legally be compelled or required
to divulge or reveal. This privilege is lost if the
patient is permitted to read his record or has
asked a nurse who made a part of the hospital
record or a hospital personnel to be a witness or
testify as to the part of the contents of the same
record.
•
SITUATIONS AND CIRCUMSTANCES
WITH LEGAL IMPLICATIONS

Incident Report is used by the health

care agencies to document the
occurrence of anything out of ordinary
that results in, harm to a patient,
employee or visitor.
• CHAPTER 6: The Midwife and Crimes
Crimes Punishable by Law
Felony
Quasi Offenses
Negligence
The Midwife and Crimes
Crime is defined as an act committed or omitted in
violation of the law. Criminal offenses are
composed of two elements:
• (1) criminal act and
• (2) evil/criminal intent

In criminal action, the state seeks the punishment of

the wrongdoers.
• Conspiracy to commit a crime: A conspiracy to
commit a crime exists when two or more persons
agree to commit a felony and decide to do it.
The Midwife and Crimes
• Person who commit felonies are either principals,
accomplices or accessories.

• Principals - are those who take a direct part in the execution

of the act: who directly force or induce others to commit it: or
who cooperate in the commission of the offense by another
act without which it would not have been accomplished.

• Accomplice - are those persons who, not being principals,

cooperate in the execution of the offense by previous or
simultaneous act.
To hold the person liable as an accomplice, it must be
shown that he has knowledge of the criminal intention of the
principal. This may be demonstrated by previous or
simultaneous that contribute to the commission of the
offense as aid thereto, whether physical or moral.
The Midwife and Crimes
• Person who commit felonies are either principals,
accomplices or accessories.

Accessories - are those who, having knowledge of the

commission of the crime and without having
participated therein either as principals or
accomplices, take part subsequent to its commission
by profiting themselves or assisting the offender to
profit from the effects of the crime by concealing or
destroying the body of the crime, or the effects or
instrument thereof, in order to prevent its discovery of
by harboring, concealing, or assisting in the escape of
the principal of the crime, provided the accessories act
with abuse of their public functions or are known to be
habitually guilty of some other crimes.
The Midwife and Crimes
• Criminal Actions: Criminal actions deal with acts or
offenses against public welfare. These vary from minor
offenses and misdemeanors to felonies.

• A misdemeanor is a general name for a criminal

offense which does not in law amount to felony,
punishment is usually a fine or imprisonment for a term
of less than one year.

• A felony is a public offense for which a convicted

person is liable to be sentenced to death or to be
imprisoned in a penitentiary or prison. It is far more
atrocious in nature than misdemeanor.
The Midwife and Crimes
• A felony is committed with deceit and fault.

• Deceit – exists when the act is performed with

deliberate intent and there is fault when the
wrongful acts result from imprudence,
negligence, or lack of skill or foresight.
The Midwife and Crimes
• Criminal negligence may be classified into:
• Reckless imprudence - It is reckless imprudence
when a person does an act or fails to do it
voluntary but without malice, from which material
damage results immediately.
• Simple imprudence – means that the person or
midwife did not use precaution and the damage
was not immediate or the impending danger was
not evident or manifest.
Criminal intent is the state mind of a person at the
time the criminal act is committed, that is, he/she
knows that an act is not lawful and still decided to
do it anyway.

• To be criminal, an act must be defined as a crime.

The Midwife and Crimes
• Deliberate intent includes two other elements
without which there can be no crime. These
are:
• Freedom
• Negligence.

• However, when a person accused of the

crime offers evidence showing insanity,
necessity, compulsion, accident, or infancy
the court will decide if he did not commit a
criminal offense and will declare the person
not guilty.
The Midwife and Crimes
• Classes of Felonies: Felonies are classified according to the
degree of the acts of execution which produces the felony
into:
1. A felony is consummated when all the elements necessary
for its execution and accomplishment are present.
2. It is frustrated when the offender performs all the acts or
execution which will produce it by reason of causes
independent of the will of the perpetrator.
3. There is an attempt to commit a felony when the offender
commences the commission of the same directly by overt
(open or manifest) acts, and does not perform all the acts or
execution which shall produce the felony, by reason of some
cause or accident other than this own spontaneous
desistance.
Consummated felonies, as well as those which are frustrated
and attempted, are punishable.
•
 The Midwife and Crimes
Felonies are also classified according to the degree of punishment
attached to the felony whether:
• Grave felonies – are those to which the law attaches the capital
punishment (death) or penalties which in any of their periods are
afflictive (imprisonment ranging from six (6) years and one (1) day
to life imprisonment or a fine not exceeding P6.000.00).
• less grave felonies - are those which the law punishes with
penalties which in their maximum period are correctional
(imprisonment ranging from one month and one day to six (6)
years, or a fine not exceeding P6.000.00 but not less than
P200.00).
• light felonies - are those infractions of law for the commission of
which the penalty of arresto menor (imprisonment for one (1) day
to thirty (30) days or a fine not exceeding P200.00 or both of which
are imposed). Light felonies are punishable only when they have
been consummated, with the exception of those committed
against a person or property.
 The Midwife and Crimes
• The best defenses a midwife can have against being sued by
patients are to remain competent in skills and knowledge, practice
nursing at the highest standards of care, and document
thoroughly.

• Midwives have the minimal ethical obligation or duty of

nonmaleficence, which means doing no harm to patients. If
nothing else, remaining competent in one’s skills and knowledge
helps prevent injury to patients. Another important factor in
preventing lawsuits is to establish a friendly, trusting relationship
with the patient and his or her family.
•
• Most patients and their families have an inherently positive
attitude toward midwives, whom they see as the only ( Aiken,
2003)
 The Midwife and Crimes
• Circumstances Affecting Criminal Liability
• A. Justifying Circumstances
A person may not incur criminal liability under the following
circumstances:
• 1) When he/ she acts in defense of his person or rights provided
that: (a) there is unlawful aggression on the part of the offended or
injured party; (b) there is reasonable necessity for the means
employed by the person defending himself/herself to prevent such
aggression; and (c) there is lack of sufficient provocation on the
part of the person defending himself.
• 2) When he/she acts in defense of the person of the rights of
his/her spouse, ascendant, descendants, or legitimate or natural
or adopted brothers or sisters, or relatives by affinity in the same
degree, provided that the first and second requisites presented in
the next preceding circumstances are present, and further
requisite, in the case of provocation was given by the person
attacked, that one making defense had not part therein.
 The Midwife and Crimes
• 3.When he or she acts in defense of the person or rights of
stranger provided that the first and second requisites mentioned in
the first circumstance and that the person defending is not induced
by revenge ,resentment or other evil motives.
•
• 4. When any person who in order to avoid an evil or injury, does
an act which causes damage to another provided that the evil
sought to be avoided actually exists, the injury feared is greater
than that done to avoid it and there is no other practical and less
harmful means to prevent it.
•
• 5. When he/she acts in the fulfillment of a duty or lawful exercise
of a right or office.
• B. Exempting Circumstances
• These are certain circumstances under which the law exempt
a person from criminal liability for the commission of a crime. The
following persons under the circumstances stated are expressly
exempted by law from criminal liability for the crime they may have
committed:
• An imbecile or an insane person unless the latter has acted a lucid
interval.
• A person under nine years of age.
• A person over nine years of age and under fifteen unless he acted
with discernment.
• Any person who, while performing a lawful act with due care,
causes an injury which is merely an accident without fault or
intention of causing it.
• Any person who acts under compulsion of an irresistible force.
• Any person who acts under the impulse of an uncontrollable fear
of an equal or greater injury.
• Any person who fails to perform an act required by law, when
prevented by some lawful or insuperable cause.
 The Midwife and Crimes
• C. Mitigating Circumstance
• Are those which do not constitute justification or excuse of
the offense in question but which, in fairness and mercy, may be
considered as extenuating or reducing the degree of moral
culpability. Following are some of the circumstances considered
by law to be mitigating and, as such, lessen the criminal liability of
the offenders.
– Circumstances which are otherwise justifying or exempting
were it not for the fact that all requisites necessary to justify the
act or to attempt the offender from criminal liability in the
respective cases are not attendant.
– When the offender has no intention to commit so grave a
wrong as the one committed.
– When the offender is under eighteen years of age over
seventy years old.
– When sufficient provocation or threat on the part of the
offended party immediately precedes the act.
 The Midwife and Crimes
– When the act is committed in the immediate vindication of a
grave offense to the one committing the felony, his or her
spouse, ascendants, descendants, legitimate, natural or
adopted brothers or sisters, or relative by affinity within the
same degree.
– When a person acts upon an impulse so powerful as naturally
to have produced obfuscation (confusion).
– When the offender voluntarily surrender himself to a person in
authority or his agents, or that he/she voluntary confesses
his/her guilt before the court prior to the presentation of the
evidence for the prosecution.
– When the defender is deaf and dumb, blind or otherwise
suffering from some physical defect which thus restrict his/her
means of action, defense or communication with his/her fellow
beings.
– When the offender is suffering from such illness as would
diminish the exercise of his/her willpower without, however,
depriving him/her of consciousness of his/her acts.
 The Midwife and Crimes
D. Aggravating Circumstances are those attending the
commission of a crime and which increase the
criminality liability of the offender or make his guilt
more severe. Some of the circumstances considered
by law as aggravating the guilt of the offender are the
following:
• when an offender takes advantage of his public position.
– When the crime is committed in contempt of or with insult
to public authorities:
– When the act is committed with insult or in disregard of
the respect of the offended party on a account of his/her
rank, age, or sex or that it is committed in the dwelling of
the offended party, if the latter has not given provocation:
– When the act is committed with abuse or confidence or
obvious ungratefulness:
– When the crime is committed in a place of worship:
 The Midwife and Crimes
– When the crime is committed on the occasion of a
conflagration, shipwreck, earthquake, epidemic or other
calamity or misfortune:
– When the crime is committed in consideration of a price,
reward, or promise:
– When the crime is committed by means of inundation,
fire, poison, explosion, standings of a vessel or
intentional damage thereto, derailment of a locomotive,
or the use of any other artifice involving great waste and
ruin:
– When the act is committed with evident premeditation or
after an unlawful entry:
– When craft, fraud, or disguise is employed: and
– When the wrong done in the commission of the crime is
deliberately augmented by causing other wrongs not
necessary for its commission.
end