Midwifery Care Concepts and History

Basic Concepts of Man

The concept of Man is the foundational component of Nursing and Midwifery, essential for providing individualized, holistic, humane, ethical, and quality care. This concept is categorized into four primary characteristics.

First, man is a Biological Being, composed of cells, tissues, organs, and organ systems that function together as a single, integrated organism. Second, man is a Psychosocial Being who is capable of rational and logical thinking. However, man can also become irrational and illogical when provoked. Joyce Travelbee describes man as being endowed with the specific capacities to love, to like, to know, to respond, and to appreciate the unique qualities of others.

Third, man is a Social Being. In this context, man is considered like some other men, as groups of people share common attributes and social characteristics. Fourth, man is a Spiritual Being. The human intellect provides the ability to understand the meaning of events as they relate to the individual or their loved ones. It is through this intellect that a person is able to accept life events as God’s will.

Man and His Environment

The environment is defined as the overall surroundings of any object. In the field of ecology, it encompasses all factors that affect the survival and reproduction of living organisms. The elements of the environment include building components, energy-supplying components, and regulatory components. It is composed of material factors decisive for survival and development, such as oxygen, carbon, and hydrogen, alongside factors that regulate living processes.

Both man and the environment are continuously altered by the processes of urbanization and migration. These processes introduce innumerable stressors to which humans must respond. These stressors include changes in population structure and characteristics, changes in social and cultural organizations, and changes in genetic composition and structure, which often occur as a result of social factors. Responses to these stressors occur at both physiological and developmental levels.

Human beings interact constantly with the kingdom of nature, a relationship established since early historical periods. Nature influences man through the air he breathes, the water he drinks, the food he eats, and the flow of energy and information. Any change in the environment can result in devastating effects and pose a direct threat to human existence.

The Fourteen Fundamental Needs of Man

There are $14$ fundamental needs that humans must address to maintain health and well-being. These needs include the ability to breathe, eat and drink, and perform elimination of body wastes. Man must also be able to move and maintain posture, sleep and rest, and select suitable clothing. Maintaining a stable internal environment and keeping the self-clean and well-groomed are also essential.

Safety is a core requirement, involving the avoidance of danger in the environment and avoiding injuring others. Social and communicative needs include the ability to communicate with others to express emotions, needs, fears, or opinions. Spiritual and productivity needs involve the ability to worship according to one’s faith, work in a way that provides a sense of accomplishment, and play or participate in various forms of recreation. Finally, there is the need to learn, discover, or satisfy the curiosity that leads to normal development and health while utilizing available health facilities.

History of Midwifery in the Philippines

Midwifery in the Philippines was first regulated on December $4, 1901$, with the enactment of Public Act No. $310$. This law created the Medical Board of Examiners, which regulated both the Medicine and Midwifery professions. Historically, Martinez de Zuniga noted that Filipinos practiced superstitious remedies during difficult childbirth, which often endangered the patient's life. Specifically, when individuals became ill with a sickness called "Pamaoo," which they attributed to their gods known as "nuno," they would pray and offer food.

Formal education for midwives evolved significantly over the following century. On June $18, 1960$, Republic Act No. $2644$ was enacted. The Bachelor of Science in Midwifery Program was eventually approved through the CHED Memorandum Order $33$ Series of $2007$. Currently, there are $306$ colleges and universities offering Midwifery programs in the country.

Dr. Jose Fabella, the first Filipino appointed as the First Secretary of Health, founded the first Midwifery school in the Philippines in May $1922$. The school was named the Maternity and Children’s Hospital. High school graduates were accepted for a one-year training program. The school had three primary objectives: to train young women in midwifery to replace unlicensed midwives (known as "hilot"), to train doctors and nurses for rural assignments, and to provide health services and education with an emphasis on maternal and child health (MCH).

Key legislative milestones include Republic Act No. $310$ in $1901$, and Republic Act No. $2382$, also known as the Medical Act of $1959$, which eventually led to the regulation of Midwifery being separated from the regulation of Medicine. Formal education structure was initiated by Dr. Jose Fabella in the mid-$1900s$ when he established the curriculum for direct-entry midwives.

Midwifery as a Profession and Core Competencies

Midwifery is a specialized profession involving specific education and training to care for women during pregnancy, childbirth, and the postnatal period. Professionals monitor the health of the mother and fetus, perform check-ups, and offer advice on nutrition and exercise. They provide labor and delivery support, managing pain and monitoring progress, and are authorized to administer certain medications or perform emergency interventions. Postnatal care includes breastfeeding assistance, monitoring recovery, and providing newborn care guidance.

Midwives adopt a holistic approach, focusing on the physical, emotional, and social well-being of families. They collaborate with obstetricians, pediatricians, and nurses. They are also responsible for health promotion, advocacy for women's rights, and maintaining accurate documentation for legal and medical purposes. Continuous Professional Development is required to stay updated on evidence-based practices.

The International Confederation of Midwives (ICM) defines the essential competencies required for the designation of Midwife. These are divided into four framework categories:

Category I: General Competencies. This covers accountabilities as a health professional, the relationship with other providers, and core activities. Midwives must assume responsibility for their own decisions as autonomous practitioners, engage in self-care and self-development, delegate care appropriately, use research to inform practice, uphold human rights, and adhere to jurisdictional laws and codes of conduct. Communication and the facilitation of normal birth in various settings are also vital.

Category II: Pre-Pregnancy and Antenatal Care. This includes providing pre-pregnancy care, determining health status, assessing fetal well-being, monitoring pregnancy progress, and promoting healthy behaviors. It also involves providing anticipatory guidance for breastfeeding and parenthood, detecting and referring complications, and helping families plan the place of birth.

Category III: Care During Labor and Delivery. This focuses on specialized support and monitoring during the active phase of childbirth.

Category IV: Ongoing Care of Newborn and Children. This involves providing postnatal care for healthy women and newborns, promoting breastfeeding, detecting and treating postnatal complications, managing health problems in newborns, and providing family planning services.

Maslow’s Hierarchy of Basic Human Needs

Human needs are categorized into a five-level hierarchy, where lower-level needs must generally be met before higher-level needs motivate behavior. Failure to meet these needs results in homeostatic imbalances, which can lead to illness.

$1.$ Physiological Needs: These are vital to survival and include food, water, breathing, and homeostasis. Shelter, clothing, and sexual reproduction (essential for species propagation) are also included in this level.

$2.$ Security and Safety Needs: As needs become more complex, people seek control and order. This includes financial security, health and wellness, and safety against accidents or injuries. Actions like obtaining insurance or moving to a safer neighborhood are motivated by these needs.

$3.$ Love and Belonging: Social needs drive behavior at this level, including friendships, romantic attachments, family relationships, and involvement in social or community groups. This helps individuals avoid loneliness, depression, and anxiety.

$4.$ Self-Esteem Needs: This level focuses on appreciation, respect, and recognition. It includes internal feelings of competence and external validation of accomplishments. It involves building self-worth and feeling respected in social or professional roles.

$5.$ Self-Actualization Needs: At the peak of the hierarchy, individuals focus on personal growth and fulfilling their potential. Self-actualizing people are self-aware and less concerned with the opinions of others, following the principle: "What a man can be, he must be."

Universal and Patient Rights

The Universal Declaration of Human Rights (UDHR) was adopted by the United Nations General Assembly on December $10, 1948$. It consists of $30$ articles outlining fundamental freedoms. Key rights include the right to life, liberty, equality, education, work, and a fair trial. In the Philippines, the Magna Carta of Women (Republic Act No. $9710$) provides the legal basis for gender and development programs, emphasizing empowerment and human rights.

Patients have specific rights in healthcare settings, including the right to appropriate medical care, informed consent, privacy and confidentiality, and the right to information. Patients have the right to choose their healthcare provider, the right to self-determination, and the right to religious belief. They are entitled to access their medical records, the right to leave the facility, and the right to refuse participation in medical research. Additionally, they have the right to correspond with visitors, express grievances, and be informed of their rights and obligations.