Certified Midwife Exam Prep Certified Midwife 3 — Questions and Answers
Question 1: A primigravida at 41+3 weeks has a Bishop score of 3. What is the most appropriate management?
- Cervical ripening followed by labor induction (Correct answer)
- Expectant management until 42 weeks without intervention
- Immediate cesarean delivery
- Membrane sweeping alone as definitive management
Correct answer: Cervical ripening followed by labor induction
A Bishop score ≤6 indicates an unfavorable cervix; cervical ripening (e.g., prostaglandins or balloon catheter) before oxytocin induction improves success.
Question 2: During a water birth, the midwife observes tight nuchal cord. The safest initial management is:
- Attempt to slip the cord over the head or somersault maneuver (Correct answer)
- Immediately clamp and cut the cord before delivery of shoulders
- Apply fundal pressure to expedite delivery
- Transfer out of water before any further management
Correct answer: Attempt to slip the cord over the head or somersault maneuver
Slipping the cord over the head or the somersault maneuver preserves umbilical circulation while allowing delivery to continue.
Question 3: Regarding placenta accreta spectrum, which maternal history most significantly raises clinical suspicion?
- Prior uterine surgery combined with anterior low-lying placenta (Correct answer)
- History of gestational hypertension in a previous pregnancy
- Grand multiparity without prior uterine surgery
- First-trimester subchorionic hematoma
Correct answer: Prior uterine surgery combined with anterior low-lying placenta
The combination of prior uterine scar (especially cesarean) with placenta previa or low-lying anterior placenta is the strongest risk factor for accreta spectrum.
Question 4: What is the maximum recommended cumulative dose of oxytocin during active labor augmentation?
- There is no recommended maximum dose; titration is based on contraction pattern and fetal response (Correct answer)
- 40 milliunits per minute
- 20 milliunits per minute
- 10 units total IV
Correct answer: There is no recommended maximum dose; titration is based on contraction pattern and fetal response
Oxytocin is titrated to achieve adequate uterine activity (typically 200–250 Montevideo units) with no absolute upper dose limit, guided by maternal and fetal response.
Question 5: A postpartum client on day 3 develops a temperature of 38.5°C, tachycardia, uterine tenderness, and foul-smelling lochia. The most likely diagnosis is:
- Endometritis (Correct answer)
- Urinary tract infection
- Wound infection
- Deep vein thrombosis
Correct answer: Endometritis
Fever, uterine tenderness, tachycardia, and malodorous lochia after delivery are classic signs of postpartum endometritis.
Question 6: According to ACNM standards, which condition falls within the independent scope of practice of a Certified Midwife?
- Managing uncomplicated vaginal birth after cesarean (VBAC) (Correct answer)
- Performing a primary cesarean section
- Managing ruptured ectopic pregnancy surgically
- Prescribing general anesthesia
Correct answer: Managing uncomplicated vaginal birth after cesarean (VBAC)
Uncomplicated VBAC is within certified midwifery scope when appropriate collaborative consultation and emergency backup are available.
Question 7: When a newborn has meconium-stained amniotic fluid and is vigorous at birth, the initial management is:
- Clear the airway with a bulb syringe and provide routine newborn care (Correct answer)
- Perform immediate endotracheal intubation for tracheal suctioning
- Transfer to NICU before any assessment
- Withhold skin-to-skin contact until respiratory status is confirmed
Correct answer: Clear the airway with a bulb syringe and provide routine newborn care
Current NRP guidelines no longer recommend routine intubation for vigorous meconium-stained newborns; routine care with airway positioning is appropriate.
Certified Midwife Exam Prep Certified Midwife 3
A primigravida at 41+3 weeks has a Bishop score of 3.
What is the most appropriate management?