Certified Midwife Exam Prep Certified Professional Midwife 3 — Questions and Answers
Question 1: During second-stage labor, a client pushes for 2.5 hours with an epidural. The baby is at +2 station in occiput posterior position. What is the MOST appropriate action for a CPM attending a planned home birth?
- Encourage continued pushing for another hour
- Attempt manual rotation to occiput anterior
- Initiate transport due to prolonged second stage (Correct answer)
- Apply fundal pressure to assist descent
Correct answer: Initiate transport due to prolonged second stage
A prolonged second stage (>2 hours with epidural) with persistent OP position warrants transfer to a hospital for evaluation and potential operative delivery.
Question 2: What is the recommended protocol for Group B Streptococcus (GBS) prophylaxis in out-of-hospital birth settings?
- Administer oral amoxicillin in early labor
- Transfer to hospital for IV penicillin G administration (Correct answer)
- Use topical chlorhexidine vaginal wash as equivalent prophylaxis
- Observe without treatment and monitor newborn for 24 hours
Correct answer: Transfer to hospital for IV penicillin G administration
IV penicillin G is the gold-standard GBS prophylaxis and requires hospital administration; CPMs must arrange transfer for GBS-positive clients requiring prophylaxis.
Question 3: Which finding on a prenatal urinalysis warrants immediate further evaluation and possible treatment?
- Trace ketones in a fasting state
- Specific gravity of 1.020
- 2+ leukocytes and positive nitrites (Correct answer)
- pH of 6.0
Correct answer: 2+ leukocytes and positive nitrites
Positive leukocytes combined with positive nitrites strongly indicates a urinary tract infection requiring urine culture and antibiotic treatment.
Question 4: A client at 20 weeks gestation reports her fundal height measures 24 cm. Which condition should the midwife consider FIRST?
- Gestational diabetes
- Multiple gestation
- Polyhydramnios
- All of the above warrant evaluation (Correct answer)
Correct answer: All of the above warrant evaluation
Fundal height measuring 4+ cm greater than gestational age (large-for-dates) can indicate multiple gestation, macrosomia, polyhydramnios, or gestational diabetes, all requiring ultrasound evaluation.
Question 5: What is the primary purpose of the Informed Consent and Informed Refusal process in midwifery care?
- To protect the midwife from legal liability
- To ensure the client has adequate information to make autonomous healthcare decisions (Correct answer)
- To document that the client understands all risks before signing paperwork
- To comply with state licensing board requirements
Correct answer: To ensure the client has adequate information to make autonomous healthcare decisions
Informed consent is fundamentally an ethical process to support client autonomy by ensuring decisions are made with full understanding of benefits, risks, and alternatives.
Question 6: During a newborn assessment, a CPM notes a soft, fluctuant swelling on the parietal bone that does not cross the suture lines. This finding is MOST consistent with:
- Caput succedaneum
- Cephalohematoma (Correct answer)
- Subgaleal hemorrhage
- Epidural hematoma
Correct answer: Cephalohematoma
A cephalohematoma is a subperiosteal bleed that is confined within the periosteum, so it does not cross suture lines, distinguishing it from caput succedaneum.
Question 7: A client declines newborn eye prophylaxis. According to ethical midwifery practice, what is the BEST response?
- Administer it anyway because it is legally required in all states
- Document the refusal after providing thorough education about Neisseria gonorrhoeae ophthalmia risks (Correct answer)
- Transfer care immediately as this refusal constitutes neglect
- Respect the decision without any further discussion
Correct answer: Document the refusal after providing thorough education about Neisseria gonorrhoeae ophthalmia risks
The midwife should provide thorough education on the purpose of prophylaxis and then document informed refusal if the client still declines; laws vary by state.
Certified Midwife Exam Prep Certified Professional Midwife 3
During second-stage labor, a client pushes for 2.5 hours with an epidural.
The baby is at +2 station in occiput posterior position.
What is the MOST appropriate action for a CPM attending a planned home birth?