pgd 2014

Diapositiva 1

Professional Growth and Development

Dwight E. Legaspi, RN,RM,MN

History of Midwifery in the World

Biblical Recognition a.Exodus 1:15-22 the experience of two Hebrew Midwives who refused to kill male infants in defiance of the King of EgyptTherefore God dealth well with the midwives: and the people multiplied, and waxed very mightyb.Genesis 35:17;38:28 makes references to midwifery attendants at birth, implying that it was ubiquitous.And when she (Rachel) was in hard labor, the midwife said to her,Fear not ,for now you will have another son.


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


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.


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.


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.


1940sChildbirth 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.


1980s-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 TimesMidwives 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 aswangHilot - 10-15 days in order for the woman to be strong.Cord Dressing ashes, tobacco, sand, powdered coconut shall giveHISTORY OF MIDWIFERY IN THE PHILIPPINES

rise to serious resultsColostrum unfit for food for the newborn. Milk was thrown awayPamaoo sickness attributed to the nuno.Lugao diet of the ill child was limited to rice gruelColored bracelet worn on the wrist of the child was believed to ward off evilMorga 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 studentsDevelopment 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 nationwideFrom 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

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 mans 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 THEORIESEthical 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 THEORIESNatural 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 THEORIESDeontologyThe 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 ones 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 individuals set duties.ETHICAL THEORIESUtilitarianism

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 THEORIESUtilitarianismThe 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 THEORIESVirtue 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 persons 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 persons character and will be able to judge the friend.

ETHICAL THEORIESRights

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 THEORIESCasuistThe 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 LawAccording 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 Gods 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 ones 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 Gods 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 ones 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 Christs 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 CAREBioethics 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 MAKINGI. Ethical System and PrinciplesNot 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 MAKINGII. Patients Bill of Rights - This enumerates the privileges the patient duly deserves and the ethical behavior that the health care professionals should observe.

BIOETHICS

ETHICAL FRAMEWORKS FOR DECISION MAKING III. Professional Code of EthicsThis 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 PoliciesThe 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. LawsIt 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.AutonomyNonmaleficenceBeneficenceJustice

ETHICAL ISSUES

AbortionWhile 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 WillsThe 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 PracticeI. 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 treatedNot treat others in ways you would not like to be treated

Principles that will Guide the Midwife in her PracticeII. 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 PracticeIII. 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

SPHERE OF MIDWIFERY 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 adviceDiagnose pregnancies and monitor normal pregnancies; to carry out examinations necessary for the monitoring of the development of normal pregnanciesFormulation of program for parenthood preparation and a complete preparation for childbirth including advice on hygiene and nutrition


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 appropriate care cannot be provided.


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 ApplicantsIn 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.


Scope of the Examination1. 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; andOther subjects which the Board may deem necessary for addition or inclusion from time to time.THE MIDWIFERY LICENSURE EXAMINATION

Requirements for 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 ExaminationThe board shall, within one hundred twenty (120) days after examination, report the ratings obtained by each candidate to the Commissioner of the PRC.


REGISTRATION OF MIDWIFEIssuance of CertificateThe 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.


REGISTRATION OF MIDWIFEThe 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.


Inhibition against Practice of MidwiferyNo 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.


REVOCATION AND SUSPENSION OF CERTIFICATES/LICENSEA 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 midwifes 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.


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. (Blacks Law Dictionary, 6th Edition, page 500)


CAUSES OF REVOCATIONCriminal Offense is an act punishable by law; usually considered an evil act.

Moral TurpitudeIt 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 someones 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.


NegligenceIs 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.


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. (Mosbys Medical Dictionary, 8th edition, 2009, Elsevier).


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. (Mosbys Medical Dictionary, 8th edition, 2009, Elsevier).


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.


MalpracticeIs 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 fields accepted standards.IncompetenceThis means that a midwife has no adequate ability, knowledge, fitness, and qualities to meet requirements to perform her duties properly and skillfully.


IgnoranceWebster 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 DeceitFraud 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 types of criminal fraud that a midwife may commit may include:Benefit fraud, committing fraud to get government benefitsEmbezzlement, taking money which one has been entrusted with on behalf of another partyFalse advertisingFalse billingDocuments or signaturesHealth fraud, for example selling of products known not to be effectiveNot reporting revenue or illegally avoiding taxes


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.


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 ones 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 ABROADAbroad 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.


Documents needed when travelling abroadPassport is a document that provides ones 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 photosHigh school Diploma authenticated by the DepEdMidwifery Diploma, transcript of Records, and Clinical Experience authenticated by CHEDBoard Rating and Board Certificate authenticated by the PRCBirth certificate and Marriage Contract authenticated by the NSONational Bureau of Investigation (NBI) ClearanceCertificate of employmentThe 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.


PROFESSIONAL ORGANIZATIONIntegrated 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.Outreach ProgramsProject 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).


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 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 womens right and access to midwifery care before, during and after childbirth.It has the following objectives:


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.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 DEVTManners 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 DEVTEveryday Manners and Etiquette Please, thank youShaking of hands/nice to meet youCover your mouth when sneezing or coughingAvoid burping, passing gas or rude bodily voicesWait for your turn to talkRemove hat when entering a roomSay helloWhen Dining (Proper Table Manners)Use silverware if offered to you. Use them correctlyDo not blow your nose on the tableNever speak when your mouth is full of foodAvoid 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 restaurantDo not start eating unless everybody is seated and served

PERSONALITY DEVTWhen in Public Wait for your turn when your are falling in lineTurn off devices while watching a movie in the cinema and refrain from talkingBe 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 youIt is improper to ask a guest to remove his shoes. When expected to be shoeless, slippers must be providedIntroduce guests to one anotherKeep conversation flowing and avoid awkward pauses. Change subject when vulgar or rude and controversial matter arisesOffer 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 possibleReturn call within 24 hours unless youre away from homeSpeak in low, clear voice. Turn off tv or music and talk at a time when children are quietNever yell or slam down the phone. If you must put the other party on hold, only do so for 30 seconds.

Personality DevelopmentDEFINITION: enhancing and dressing ones 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 behaviorsin various situations.refers to individual differences in characteristic patterns of thinking, feeling and behaving.87Personality DevelopmentGROOMING: art of cleaning, grooming, and maintaining parts of the bodyUNIFORM: wearing the pescribed uniformVOICE: develop voice quality, voice tone, pitch, pace and voice modulationPOISE: carrying ones self and professional bearingCONDUCT: how you act, or deal with other people88RA 7392

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THE LAW AND THE SOCIETYLAW the skeleton of our societycontrols what we dowhen we dohow we do itbreak the law, youll 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 SOCIETYImportance of Law regulate relationships between conflicting interestsensures safety of future generationswithout laws, there would be nothing one could do if another were violating their peace and enjoyment.Characteristics of Lawa rule of conduct or action which determines what can be done and what cannot be donelaw is obligatorypromulgated by legitimate authorityit is of common observance and benefit

THE LAW AND THE SOCIETYSources of Lawstatutes 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 SOCIETYLegal Responsibilities of a MidwifeAssume 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 legallyAvoid criminal liability due to incompetence or negligenceBe careful in the execution of her dutiesA 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 SOCIETYNegligence 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 Negligenceexistence of a duty on the part of the person charged to use due care under circumstancesfailure to meet standard of due carethe foreseability of harm resulting from failure to meet the standardthe fact that the breach of this standard resulted in an injury to the plaintiff

THE LAW AND THE SOCIETYExamples of NegligenceBurns resulting from hot water bags, heat lamps, vaporizers or sitz bathsObjects left inside the patients body such as spongesDrugs given to the wrong personwrong medicine, wrong concentration, wrong route or wrong dose

THE LAW AND THE SOCIETYDoctrine of RES IPSA LOQUITUR- the thing speaks for itselfRule: 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 defendants 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 someone2. that the injury was caused by an agency within control of the defendant3. 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 patients abdomen after an operation.

THE LAW AND THE SOCIETYDoctrine 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 SOCIETYDoctrine 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 BirthsEvery 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.


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.


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 CrimesCrimes Punishable by LawFelonyQuasi OffensesNegligenceThe Midwife and CrimesCrime 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 CrimesPerson 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 CrimesPerson 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 CrimesCriminal 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 CrimesA 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 CrimesCriminal 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 CrimesDeliberate intent includes two other elements without which there can be no crime. These are:FreedomNegligence.

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 CrimesClasses 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 CrimesFelonies 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 CrimesThe 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 ones 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 CrimesCircumstances Affecting Criminal LiabilityA. Justifying CircumstancesA 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 Crimes3.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 CircumstancesThese 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 CrimesC. Mitigating CircumstanceAre 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 CrimesWhen 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 CrimesD. 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 CrimesWhen 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: andWhen the wrong done in the commission of the crime is deliberately augmented by causing other wrongs not necessary for its commission.

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