NARM Midwifery Practice and Professionalism 3 — Questions and Answers
Question 1: A midwife's client at 39 weeks is GBS-positive and declines IV antibiotics in labor. The midwife should:
- Refuse to attend the birth until the client agrees to antibiotics
- Provide thorough counseling on risks to the newborn, document the informed refusal, and attend the birth with enhanced newborn monitoring (Correct answer)
- Transfer care immediately to a hospital-based provider
- Administer antibiotics without the client's knowledge for the newborn's safety
Correct answer: Provide thorough counseling on risks to the newborn, document the informed refusal, and attend the birth with enhanced newborn monitoring
The midwife must respect autonomy, ensure the client is fully informed of neonatal GBS risks, document the refusal, and plan enhanced surveillance for the newborn.
Question 2: Which of the following is a core tenet of the midwifery model of care as recognized by MANA and reflected in NARM competencies?
- Routine use of electronic fetal monitoring for all low-risk labors
- Watchful waiting and non-intervention in normal processes unless warranted (Correct answer)
- Mandatory physician co-management for all clients
- Standardized intervention protocols regardless of individual client circumstances
Correct answer: Watchful waiting and non-intervention in normal processes unless warranted
The midwifery model emphasizes supporting physiologic birth, avoiding unnecessary interventions, and individualizing care based on client needs.
Question 3: A postpartum client at day 3 calls reporting a temperature of 100.6°F (38.1°C), tender uterus, and foul-smelling lochia. What is the midwife's priority action?
- Advise increased fluid intake and call back in 24 hours
- Assess urgently, as these findings suggest endometritis requiring prompt evaluation and likely antibiotic treatment (Correct answer)
- Reassure the client that mild fever is normal in the first week postpartum
- Recommend a sitz bath and over-the-counter pain relievers
Correct answer: Assess urgently, as these findings suggest endometritis requiring prompt evaluation and likely antibiotic treatment
Fever, uterine tenderness, and foul lochia are classic signs of endometritis, a serious infection requiring urgent evaluation and treatment.
Question 4: During a prenatal visit, a client discloses recreational marijuana use. The midwife's most appropriate response is to:
- Report the client to child protective services immediately
- Provide non-judgmental education on risks, document the disclosure, and continue supportive care (Correct answer)
- Discharge the client from midwifery care
- Ignore the disclosure to preserve the therapeutic relationship
Correct answer: Provide non-judgmental education on risks, document the disclosure, and continue supportive care
Non-judgmental counseling, education about fetal risks, and documentation are the appropriate professional responses; mandatory reporting thresholds vary by state and typically involve more serious concerns.
Question 5: The NARM Skills Assessment requires demonstration of competency in which of the following?
- Surgical first-assist techniques
- Newborn resuscitation, including bag-mask ventilation (Correct answer)
- Placement of epidural catheters
- Interpretation of fetal MRI imaging
Correct answer: Newborn resuscitation, including bag-mask ventilation
Newborn resuscitation, including effective bag-mask ventilation, is a core clinical skill assessed in the NARM Skills Assessment for CPM candidates.
Question 6: A midwife learns that a colleague is practicing outside her approved scope by routinely performing vacuum-assisted deliveries at home births. The midwife should:
- Confront the colleague publicly at the next professional meeting
- Report the concern through appropriate professional or regulatory channels to protect client safety (Correct answer)
- Assume the colleague has special training and take no action
- Share the information only with mutual clients who ask
Correct answer: Report the concern through appropriate professional or regulatory channels to protect client safety
Peer accountability requires that unsafe or out-of-scope practice be reported through appropriate channels—this is an ethical obligation to protect clients.
Question 7: Which documentation element is most critical after every prenatal visit according to professional midwifery standards?
- A signed waiver from the client for each visit
- A legible, contemporaneous record including findings, discussions, client questions, and the plan of care (Correct answer)
- A billing invoice with procedure codes
- A standardized hospital-style progress note regardless of birth setting
Correct answer: A legible, contemporaneous record including findings, discussions, client questions, and the plan of care
Contemporaneous, legible documentation that captures findings, counseling, client questions, and the care plan is the standard for all prenatal encounters.
NARM Midwifery Practice and Professionalism 3
A midwife's client at 39 weeks is GBS-positive and declines IV antibiotics in labor.
The midwife should: