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 Egypt
Therefore God dealth well with the midwives: and the
people multiplied, and waxed very mighty
b.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.

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
1940s
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
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 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 15951596 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

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

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 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 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 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 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 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 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. 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 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

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 wellbeing 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

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
appropriate care cannot be provided.

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
Requirements for Examination

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 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.

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. (Blacks 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 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.

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. (Mosbys 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. (Mosbys 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 fields
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 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 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 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 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.
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 womens 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.
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 MIDWIFERY
PROFESSION

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 youre 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 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 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 ones 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, 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 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 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 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 patients
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
accomplices or accessories.

are

either

principals,

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 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 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.

The Midwife and Crimes