Certified Midwife Exam Prep Intrapartum Management & Labor Support 2 — Questions and Answers
Question 1: Which non-pharmacological comfort measure has the strongest evidence for reducing labor pain and improving satisfaction?
- Continuous labor support by a doula or midwife (Correct answer)
- Hot showers alone
- Acupuncture only
- Sterile water injections
Correct answer: Continuous labor support by a doula or midwife
Continuous labor support is the intervention with the strongest evidence base, shown to reduce cesarean rates, labor duration, and pain medication use.
Question 2: A patient is 41 weeks gestation with intact membranes and Bishop score of 4. Which cervical ripening agent is most commonly used?
- IV oxytocin
- Misoprostol (PGE1)
- Mechanical Foley catheter balloon
- Dinoprostone (PGE2) gel (Correct answer)
Correct answer: Dinoprostone (PGE2) gel
Dinoprostone (PGE2) gel or insert is a commonly used pharmacological cervical ripening agent for unfavorable cervices prior to oxytocin induction.
Question 3: How is the second stage of labor defined?
- Onset of regular contractions to 4 cm dilation
- Complete cervical dilation to delivery of the fetus (Correct answer)
- Delivery of the fetus to delivery of the placenta
- Onset of pushing to complete dilation
Correct answer: Complete cervical dilation to delivery of the fetus
The second stage of labor begins at complete cervical dilation (10 cm) and ends with delivery of the fetus.
Question 4: Which maternal position change is recommended first when late decelerations are noted on the fetal monitor?
- Prone position
- Sitting upright
- Left lateral decubitus (left side-lying) (Correct answer)
- Semi-Fowler's position
Correct answer: Left lateral decubitus (left side-lying)
Left lateral positioning relieves aortocaval compression, improves uteroplacental blood flow, and is the first-line positional intervention for late decelerations.
Question 5: A patient requests epidural analgesia at 5 cm dilation. Which assessment must be completed before epidural placement?
- Fetal scalp pH
- IV access confirmation and hydration bolus (Correct answer)
- Cervical culture for GBS
- Amniotomy
Correct answer: IV access confirmation and hydration bolus
IV access and a fluid bolus are required before epidural placement to reduce the risk of hypotension from sympathetic blockade.
Question 6: Which sign indicates placental separation during the third stage of labor?
- Sudden decrease in uterine contractions
- Lengthening of the umbilical cord and a gush of blood (Correct answer)
- Return of fetal heart tones
- Cervical dilation to 3 cm
Correct answer: Lengthening of the umbilical cord and a gush of blood
Placental separation is indicated by sudden cord lengthening, a gush of blood, and the uterus becoming globular and firmer.
Certified Midwife Exam Prep Intrapartum Management & Labor Support 2
Which non-pharmacological comfort measure has the strongest evidence for reducing labor pain and improving satisfaction?