Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

September 20, 2019

DEPARTMENT CIRCULAR
No. 2019-_ 0436

FOR: ALL CENTERS FOR HEALTH AND DEVELOPMENT

DIRECTORS, LICENSED PUBLIC AND PRIVATE BIRTHING
CENTERS, AND ALL OTHER CONCERNED OFFICES

SUBJECT: Moratorium for the Implementation of Selected Sections of the

Implementing Guidelines of Administrative Order (AO) No. 2019-
0026 entitled, “National Policy in the Provision of Birthing
Assistance to Primigravid and Grand Multigravid Women

Pursuant to AO No. 2019-0026, Sections 3, 4, 5, and 6, to wit:

3. In instances where antenatal care is provided in a non-hospital doctor-

managed Birthing Center such as the Rural Health, primigravid and
grand multigravida women shall be referred for a supervised antenatal
care, delivery and postnatal care by a specialist in a CEmMONCprovider
facility (Level II or IIT hospital).

Upon his or her prudent assessment of the case and in extreme situations
where an appropriate referral facility or specialist is not available, a
doctor who is a general practitioner and trained on basic emergency
obstetric and newborn care may assist in the delivery of GI and G5 or
higher gravidity in a well-equipped birthing center.

To ensure that the risks associated with primigravida and grand

multigravida are appropriately managed, Birthing Centers managed by
Midwives and Nurses shall be required to refrain from handling
primigravid and grand multigravid women. In situations where the area
is geographically difficult and no appropriate referral facility is
available, they shall be referred to the nearest Rural Health Unit where
a doctor is available. Proper arrangements with a referral facility and
half-way home type of maternity care shall be made during the antenatal
period to ensure that optimum care possible is provided for their safe
delivery.

All Birthing Center staff shall observe and practice extraordinary

prudence and judicious judgment to
give counsel and inform the woman
specially if she lives in a geographically isolated and disadvantaged

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 area or cultural community, of the signs and symptoms of complications
of pregnancy in preparation for delivery. At all times, the health care
provider as well as the women, shall be vigisant in detecting and
reporting early signs and symptoms of complcations, immediately
manage the complication or refer to a Level II or Level III hospital.

In consideration to the Universal Health Care Act andtoalign to its provisions

specifically focusing on the marginalized and geographically isolated and
disadvantaged areas, these aforementioned sections of the AO ace hereby put on hold
until December 31, 2019, or until the policy has been amended..

Meanwhile, the CHDs are directed to continuously conduct strict monitoring of

maternity care providers and Birthing Centers on the provision of maternal health
services to ensure the safety and quality of services pursuant <o AO No. 2016-0035
entitled, “Guidelines on the Provision of Quality Antenatal Care in All Birthing Centers
and Health Facilities Providing Maternity Care Services” an} AO No. 2012-0012
entitled, “Rules and Regulations Governing the New Classification of Hospitals and
Other Health Facilities in the Philippines” and its annexes C, D, and F pertaining to
birthing homes.

All other provisions and sections not mentioned in this Order stand
in effect.
For urgent dissemination.

FRANCISCO T. D uf\n, MD, MSc.

Secretary ealth q {>0 | | 4