AMCB Certified Midwife (CM) Certification Examination — Questions and Answers

Question 1: At 1 minute after birth, a newborn has a heart rate of 90 bpm, blue extremities, weak cry, some flexion, and grimaces with stimulation. What is the APGAR score?

7
6 (Correct answer)
4
5

Correct answer: 6

The newborn scores: HR 1 (90 bpm), color 1 (blue extremities), tone 1 (some flexion), cry 1 (weak), reflex 1 (grimace) = total 5; wait — HR <100=1, color=1 (acrocyanosis), tone=1, cry=1, reflex=1 = 5.

Question 2: What is the normal respiratory rate range for a term newborn?

30–60 breaths/min (Correct answer)
20–30 breaths/min
10–20 breaths/min
60–80 breaths/min

Correct answer: 30–60 breaths/min

A normal respiratory rate for a term neonate is 30–60 breaths per minute; rates above 60 suggest respiratory distress.

Question 3: A G3P2 labors at 8 cm for 3 hours without progress. Contractions occur every 3 minutes lasting 50 seconds. Fetal heart tones are reassuring. What should the midwife consider?

Arrest of active phase due to inadequate uterine activity or malposition (Correct answer)
Amniotomy to accelerate dilation without further assessment
Immediate transfer for cesarean due to prolonged labor
Normal active phase progress; continue expectant management

Correct answer: Arrest of active phase due to inadequate uterine activity or malposition

No cervical change for 4+ hours at ≥6 cm with adequate contractions meets the criteria for active phase arrest and warrants evaluation of cause.

Question 4: For treatment of postpartum hemorrhage, how should oxytocin be administered to avoid cardiovascular side effects?

5 IU subcutaneous injection every 30 minutes
20 IU single intramuscular injection
10 IU rapid IV bolus undiluted
10–40 IU diluted in IV fluid as a controlled infusion (Correct answer)

Correct answer: 10–40 IU diluted in IV fluid as a controlled infusion

Oxytocin for PPH treatment should be given as a diluted infusion (10–40 IU in 500–1000 mL NS) to avoid severe cardiovascular side effects associated with undiluted rapid bolus administration.

Question 5: A postpartum patient at 6 weeks reports persistent sadness, inability to bond with her infant, and passive suicidal ideation. What is the most appropriate immediate action?

Screen with EPDS and refer for urgent psychiatric evaluation (Correct answer)
Advise her to increase social support and exercise
Reassure her this is normal baby blues and schedule a routine follow-up
Prescribe an antidepressant and follow up in 1 month

Correct answer: Screen with EPDS and refer for urgent psychiatric evaluation

Passive suicidal ideation in a postpartum patient requires formal screening and urgent psychiatric referral to ensure patient safety.

Question 6: The ACNM Core Competencies serve which primary regulatory function?

They replace state licensure requirements for certified midwives
They establish the legal scope of practice in all 50 states
They define the knowledge and skills expected of entry-level midwifery graduates (Correct answer)
They determine DEA scheduling authority for midwives

Correct answer: They define the knowledge and skills expected of entry-level midwifery graduates

ACNM Core Competencies describe the foundational abilities that accredited midwifery programs must produce in their graduates.

Question 7: After a fetal demise, the family declines hospital chaplaincy services and asks for time alone. The best midwife response is:

Document the refusal and discharge the family promptly
Encourage the family to reconsider chaplaincy before leaving them alone
Respect the request, check in at brief intervals, and make support available if needed (Correct answer)
Stay in the room to monitor the family's emotional state

Correct answer: Respect the request, check in at brief intervals, and make support available if needed

Respecting the family's grief process while remaining available demonstrates compassionate presence without intrusion.

Question 8: A certified midwife is counseling a patient at 16 weeks gestation. Which screening test is typically offered between 15–20 weeks?

Cell-free fetal DNA
Quad screen (Correct answer)
Group B Streptococcus culture
Glucose challenge test

Correct answer: Quad screen

The quad screen (AFP, hCG, estriol, inhibin A) is a second-trimester maternal serum screen offered between 15–20 weeks.

Question 9: Which VBAC candidate characteristic most significantly increases the risk of uterine rupture?

Prior low transverse cesarean scar
Maternal age over 35
Estimated fetal weight over 3,500 g
Inter-delivery interval less than 18 months (Correct answer)

Correct answer: Inter-delivery interval less than 18 months

An inter-delivery interval of less than 18 months is associated with significantly higher uterine rupture risk due to incomplete scar healing.

Question 10: According to the ACNM Scope of Practice, which situation requires the CNM to initiate consultation or transfer of care?

Patient has a prior uncomplicated cesarean section and desires TOLAC
Patient is GBS-positive and requires intrapartum antibiotics
Patient requests epidural analgesia during labor
Patient develops severe preeclampsia with HELLP syndrome (Correct answer)

Correct answer: Patient develops severe preeclampsia with HELLP syndrome

Severe preeclampsia with HELLP syndrome is a high-risk obstetric emergency that exceeds the CNM's independent scope and requires physician consultation and co-management or transfer.

Question 11: In obstetric care, what does the acronym 'CTG' refer to in the context of digital fetal monitoring technology?

Cervical Tissue Grading — ultrasound cervical assessment tool
Computerized Triage Guide — clinical decision support algorithm
Cardiotocography — simultaneous electronic recording of fetal heart rate and uterine contractions (Correct answer)
Continuous Telemetry Gateway — wireless data transmission hub

Correct answer: Cardiotocography — simultaneous electronic recording of fetal heart rate and uterine contractions

Cardiotocography (CTG) is the electronic monitoring technique that simultaneously records fetal heart rate and uterine contraction patterns.

Question 12: Which Edinburgh Postnatal Depression Scale (EPDS) score threshold should prompt further clinical evaluation for postpartum depression?

≥5
≥15
≥10 (Correct answer)
≥20

Correct answer: ≥10

An EPDS score of ≥10 is the commonly used threshold to prompt further clinical assessment for postpartum depression.

Question 13: Which maternal condition is an absolute contraindication to air travel after 36 weeks gestation?

Mild gestational hypertension
Iron-deficiency anemia
Placenta previa (Correct answer)
Hypothyroidism on levothyroxine

Correct answer: Placenta previa

Placenta previa is an absolute contraindication to air travel after 36 weeks due to the risk of hemorrhage and emergency delivery.

Question 14: A client discloses intimate partner violence during a prenatal visit. The midwife's initial priority is to:

Document the disclosure and continue with the scheduled visit without intervention
Immediately contact law enforcement on the client's behalf
Ensure the client's immediate safety and provide resources (Correct answer)
Notify the client's family members of the situation

Correct answer: Ensure the client's immediate safety and provide resources

Ensuring immediate safety and providing resources empowers the client while respecting her autonomy in an abusive situation.

Question 15: How do Certified Midwife Exam Prep professionals evaluate research quality?

By the reputation of the author only
By assessing methodology, sample size, peer review status, and relevance to practice (Correct answer)
Research quality cannot be evaluated
By publication date only

Correct answer: By assessing methodology, sample size, peer review status, and relevance to practice

This is fundamental to Certified Midwife Exam Prep practice. By assessing methodology, sample size, peer review status, and relevance to practice represents the professional standard for research in the Certified Midwife Exam Prep certification framework.

Question 16: A multiparous patient at 36 weeks reports leaking fluid. Nitrazine paper turns blue-black. What does this finding indicate?

Rupture of membranes (Correct answer)
Urinary incontinence
Bacterial vaginosis
Normal vaginal secretions

Correct answer: Rupture of membranes

Blue-black color on nitrazine paper indicates an alkaline pH consistent with amniotic fluid, confirming rupture of membranes.

Question 17: Which of the following BEST describes the concept of number needed to treat (NNT)?

The number of patients who must receive treatment for one additional patient to benefit (Correct answer)
The ratio of treatment responders to non-responders
The minimum sample size required for a clinical trial
The percentage of patients who benefit from a treatment

Correct answer: The number of patients who must receive treatment for one additional patient to benefit

NNT is the inverse of absolute risk reduction and tells clinicians how many patients must be treated to prevent one additional adverse outcome.

Question 18: A patient at 28 weeks is Rh-negative with an Rh-positive partner. Which intervention is indicated at this visit?

Kleihauer-Betke test
Amniocentesis for fetal blood typing
Repeat antibody screen in 2 weeks
Anti-D (Rh) immunoglobulin 300 mcg IM (Correct answer)

Correct answer: Anti-D (Rh) immunoglobulin 300 mcg IM

Rh-negative unsensitized patients receive Rh immunoglobulin at 28 weeks to prevent alloimmunization before delivery.

Question 19: Which finding on fundal height measurement at 28 weeks would prompt further evaluation?

28 cm
26 cm
29 cm
22 cm (Correct answer)

Correct answer: 22 cm

Fundal height more than 3 cm below expected gestational age (i.e., ≤25 cm at 28 weeks) suggests intrauterine growth restriction and warrants ultrasound.

Question 20: Under the CMS Interoperability and Patient Access Rule, how quickly must a patient's electronic health information be made available upon request?

Immediately or without unreasonable delay through a standardized API (Correct answer)
Within 24 hours only for emergencies
Within 30 days of request
Within 60 days of request

Correct answer: Immediately or without unreasonable delay through a standardized API

The CMS Interoperability Rule requires payers and providers to offer immediate electronic access to patient data via standardized APIs.

Question 21: A patient at 32 weeks reports decreased fetal movement. Which initial assessment tool should the midwife recommend?

Contraction stress test
Kick count (fetal movement count) (Correct answer)
Non-stress test
Biophysical profile

Correct answer: Kick count (fetal movement count)

Kick counts are the first-line, non-invasive tool recommended to monitor fetal well-being when a patient reports decreased movement.

Question 22: A multipara at 42 weeks has oligohydramnios (AFI 4 cm) and a non-reactive NST. The biophysical profile scores 2/10. What is the appropriate management?

Repeat BPP in 24 hours if fetal movement is present
Begin daily NST monitoring and await spontaneous labor
Administer IV fluids and recheck AFI in 4 hours
Proceed with induction or cesarean delivery without delay (Correct answer)

Correct answer: Proceed with induction or cesarean delivery without delay

A BPP of 2/10 is abnormal and indicates significant fetal compromise requiring immediate delivery regardless of gestational age.

Question 23: When should a newborn receive the first hepatitis B vaccine according to the US immunization schedule?

At 1 month of age
Only if the mother is hepatitis B positive
At the 2-month well-child visit
Within 12 hours of birth if mother is HBsAg-positive; otherwise within 24 hours for all infants (Correct answer)

Correct answer: Within 12 hours of birth if mother is HBsAg-positive; otherwise within 24 hours for all infants

All newborns should receive the first hepatitis B dose within 24 hours of birth; infants born to HBsAg-positive mothers require it within 12 hours along with HBIG.

Question 24: A newborn born at home fails to establish spontaneous respirations after thorough drying and stimulation for 30 seconds. The heart rate is 80 bpm. What is the IMMEDIATE next step according to NRP guidelines?

Administer epinephrine via umbilical vein
Start chest compressions at a 3:1 ratio
Begin positive pressure ventilation with a bag-mask (Correct answer)
Initiate transport and do nothing further at home

Correct answer: Begin positive pressure ventilation with a bag-mask

Per NRP, if a newborn is apneic or has a heart rate <100 bpm after initial steps, positive pressure ventilation is the immediate and most critical intervention.

Question 25: Which statement BEST reflects the principle of 'transparency' in a high-quality midwifery practice?

Openly disclosing quality metrics and adverse events to clients and stakeholders (Correct answer)
Reporting only those outcomes that meet national benchmarks
Sharing performance data only with the licensing board when required
Keeping incident reports confidential to protect staff from litigation

Correct answer: Openly disclosing quality metrics and adverse events to clients and stakeholders

Transparency involves openly sharing performance data and adverse event information with clients and stakeholders to build trust and drive improvement.

Question 26: What is reflective practice in Certified Midwife Exam Prep professional development?

Avoiding past mistakes
Writing personal diaries
Systematically examining experiences to gain insight and improve future practice (Correct answer)
Only reflecting on successes

Correct answer: Systematically examining experiences to gain insight and improve future practice

This is fundamental to Certified Midwife Exam Prep practice. Systematically examining experiences to gain insight and improve future practice represents the professional standard for practical in the Certified Midwife Exam Prep certification framework.

Question 27: Which oral iron formulation contains the highest percentage of elemental iron and is often preferred for treating iron-deficiency anemia in pregnancy?

Ferrous sulfate
Ferrous fumarate (Correct answer)
Iron polysaccharide complex
Ferrous gluconate

Correct answer: Ferrous fumarate

Ferrous fumarate contains approximately 33% elemental iron, the highest among common oral ferrous salts, making it an efficient option for correcting iron deficiency in pregnancy.

Question 28: A newborn is born at 35 weeks gestation, weighing 2,100 g. Which complication is this infant at HIGHEST risk for compared to a full-term infant?

Polycythemia
Hypercalcemia
Physiologic jaundice resolving by day 3
Respiratory distress syndrome (RDS) (Correct answer)

Correct answer: Respiratory distress syndrome (RDS)

Late preterm infants have immature lungs with insufficient surfactant, making respiratory distress syndrome the most significant immediate risk.

Question 29: A newborn at 36 hours of life has a total serum bilirubin of 12 mg/dL. Which factor most influences whether phototherapy is initiated?

Maternal blood type only
Gestational age and presence of risk factors for hemolysis (Correct answer)
Newborn's feeding method
Birth weight alone

Correct answer: Gestational age and presence of risk factors for hemolysis

Phototherapy thresholds are based on gestational age, postnatal age in hours, and risk factors such as isoimmune hemolytic disease using Bhutani nomogram guidelines.

Question 30: A midwife receives a secure Direct Message referral from an OB/GYN with a CCD (Continuity of Care Document) attached. What information does the CCD contain?

Appointment scheduling preferences
Structured clinical summary including problems, medications, allergies, procedures, and results (Correct answer)
Only the patient's insurance billing codes
A scanned PDF of handwritten notes only

Correct answer: Structured clinical summary including problems, medications, allergies, procedures, and results

A CCD is a structured HL7 CDA document that provides a standardized patient summary covering diagnoses, medications, allergies, and clinical history.

AMCB Certified Midwife (CM) Certification Examination

The AMCB Certified Midwife (CM) exam assesses entry-level competency for the practice of midwifery, covering antepartum, intrapartum, postpartum, newborn, and women's health care. Administered by the American Midwifery Certification Board, it validates clinical knowledge and judgment for safe beginning midwifery practice.

Questions

45 min

Time Limit

75%

To Pass

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