Certified Midwife Exam Prep Certified Midwife 5 — Questions and Answers
Question 1: A breastfeeding client at 6 weeks postpartum asks about contraception. Which method has the least impact on milk supply?
- Progestin-only pill (minipill) (Correct answer)
- Combined oral contraceptive pill
- Estrogen-containing contraceptive patch
- Combined hormonal vaginal ring
Correct answer: Progestin-only pill (minipill)
Progestin-only methods do not suppress prolactin and are preferred in breastfeeding women; estrogen-containing methods can reduce milk volume.
Question 2: Which neonatal condition presents with a 'blueberry muffin' rash, cataracts, and sensorineural hearing loss?
- Congenital rubella syndrome (Correct answer)
- Congenital cytomegalovirus infection
- Neonatal herpes simplex virus infection
- Congenital toxoplasmosis
Correct answer: Congenital rubella syndrome
The classic triad of congenital rubella syndrome includes cataracts, sensorineural deafness, and cardiac defects, often with purpuric 'blueberry muffin' skin lesions.
Question 3: During informed consent for a birth plan that includes declining IV access, the midwife's ethical obligation is to:
- Provide complete information about risks, document the discussion, and respect the client's autonomous decision (Correct answer)
- Refuse care unless the client agrees to standard interventions
- Obtain surrogate consent from the client's partner
- Notify hospital administration before the birth
Correct answer: Provide complete information about risks, document the discussion, and respect the client's autonomous decision
Informed refusal requires the midwife to disclose risks, document the conversation thoroughly, and honor the competent client's autonomous choice.
Question 4: A newborn at 2 hours of life has a blood glucose of 38 mg/dL and is asymptomatic. The first intervention should be:
- Encourage breastfeeding or provide formula feeding and recheck glucose in 1 hour (Correct answer)
- Administer IV dextrose immediately
- Transfer to NICU for continuous monitoring
- Perform a heel stick glucose every 15 minutes without feeding
Correct answer: Encourage breastfeeding or provide formula feeding and recheck glucose in 1 hour
Asymptomatic hypoglycemia in the newborn is first managed with enteral feeding before escalating to IV dextrose.
Question 5: Which maternal position is most effective for managing second-stage arrest due to persistent occiput posterior position?
- Hands-and-knees (all-fours) position (Correct answer)
- Supine lithotomy position
- Left lateral Sims' position
- Sitting upright at 90 degrees
Correct answer: Hands-and-knees (all-fours) position
The hands-and-knees position uses gravity and abdominal relaxation to encourage rotation of an occiput posterior fetus.
Question 6: The Edinburgh Postnatal Depression Scale (EPDS) is best administered at which time points in the postpartum period?
- Within the first 2 weeks and again at 6 weeks postpartum (Correct answer)
- Only at the 6-week postpartum visit
- Daily for the first week then monthly for 6 months
- At the time of delivery and at 1-year follow-up
Correct answer: Within the first 2 weeks and again at 6 weeks postpartum
ACOG and ACNM recommend universal depression screening with the EPDS at least once in the early postpartum period and again at 4–6 weeks.
Question 7: Under the ACNM philosophy of care, which statement best describes the midwifery model?
- Pregnancy and birth are normal life processes that benefit from individualized, woman-centered care (Correct answer)
- Obstetric technology should be applied routinely to prevent all possible complications
- Midwifery care is defined primarily by the absence of physician oversight
- The midwife's primary role is to execute physician-directed care plans
Correct answer: Pregnancy and birth are normal life processes that benefit from individualized, woman-centered care
The midwifery model views pregnancy and childbirth as normal physiologic events and centers care on the individual woman's needs, values, and preferences.
Certified Midwife Exam Prep Certified Midwife 5
A breastfeeding client at 6 weeks postpartum asks about contraception.
Which method has the least impact on milk supply?