NARM Postpartum Care 1 — Questions and Answers
Question 1: What is the expected rate of uterine fundal descent during normal postpartum involution?
- Returns to pre-pregnancy size within 2 weeks with no measurable daily change
- Descends approximately 1 cm (one fingerbreadth) per day (Correct answer)
- Remains at the umbilicus for the first 5 days postpartum
- Rises above the umbilicus on day 2 before beginning to descend
Correct answer: Descends approximately 1 cm (one fingerbreadth) per day
The uterine fundus descends approximately 1 cm (one fingerbreadth) per day, returning to the pelvic cavity by approximately 10–14 days postpartum.
Question 2: Which description best characterizes normal lochia rubra?
- Pink-brown watery discharge beginning immediately after delivery and lasting 3 weeks
- Yellow-white creamy discharge present from birth through 6 weeks
- Dark red discharge containing decidual tissue that may include small clots, lasting 1–4 days (Correct answer)
- Bright red discharge with large clots and an offensive odor throughout the first week
Correct answer: Dark red discharge containing decidual tissue that may include small clots, lasting 1–4 days
Lochia rubra is dark red, may contain small clots and decidual tissue, and is normal for the first 1–4 days postpartum; large clots or foul odor would be abnormal findings.
Question 3: Which intervention is most effective in preventing postpartum hemorrhage?
- Routine episiotomy to reduce perineal trauma
- Active management of the third stage of labor including uterotonics and controlled cord traction (Correct answer)
- Immediate cord clamping within 30 seconds of delivery
- Keeping the mother in a supine position for 2 hours after birth
Correct answer: Active management of the third stage of labor including uterotonics and controlled cord traction
Active management of the third stage of labor — encompassing uterotonic administration, controlled cord traction, and uterine massage — is the evidence-based standard for significantly reducing postpartum hemorrhage.
Question 4: After repair of a second-degree perineal laceration, which perineal care instruction is most appropriate?
- Keep the area completely dry and avoid all water contact for 2 weeks
- Apply ice packs continuously for 48 hours and avoid sitz baths for the first week
- Use warm sitz baths, keep the perineum clean, and pat dry after voiding (Correct answer)
- Change sterile dressings twice daily and apply antibiotic ointment to the suture line
Correct answer: Use warm sitz baths, keep the perineum clean, and pat dry after voiding
Warm sitz baths, front-to-back wiping, and gentle drying after voiding promote healing and comfort while reducing infection risk following perineal laceration repair.
Question 5: During the first hour after an uncomplicated vaginal birth, how frequently should the midwife assess maternal vital signs?
- Every 5 minutes continuously
- Every 15 minutes (Correct answer)
- Every 30 minutes
- Once at 60 minutes if the mother appears stable
Correct answer: Every 15 minutes
Vital signs should be assessed every 15 minutes during the first postpartum hour to detect early signs of hemorrhage, hemodynamic instability, or other complications.
Question 6: Which statement best distinguishes postpartum blues from postpartum depression?
- Postpartum blues requires initiation of antidepressant therapy
- Postpartum blues typically resolves spontaneously within 10–14 days without treatment (Correct answer)
- Postpartum depression always begins within 24 hours of delivery
- Both conditions require psychiatric hospitalization and medication management
Correct answer: Postpartum blues typically resolves spontaneously within 10–14 days without treatment
Postpartum blues affects up to 80% of new mothers and resolves on its own within 10–14 days; postpartum depression persists beyond this window and may require clinical intervention.
Question 7: What is the expected timeframe for a postpartum woman to achieve her first spontaneous void after an uncomplicated vaginal delivery?
- Within 1 hour of delivery
- Within 6–8 hours of delivery (Correct answer)
- Within 24–48 hours of delivery
- Within 3–5 days as perineal swelling resolves
Correct answer: Within 6–8 hours of delivery
The first postpartum void should occur within 6–8 hours of delivery; inability to void within this timeframe warrants catheterization to prevent bladder distension.
NARM Postpartum Care 1
What is the expected rate of uterine fundal descent during normal postpartum involution?