Deck 3: Labor Birth

Question 1

The difference between anterior position and posterior position is BEST described as:

A)The baby's bottom is the presenting part (closest to the cervical opening) in the anterior position, while the baby's head is presenting in the posterior position.
B)The baby is facing the back of the mother's pelvis in the anterior position, and front of her pelvis in the posterior position.
C)The baby is facing the front of the mother's pelvis in the anterior position, and back of her pelvis in the posterior position.
D)The baby's head is the presenting part (closest to the cervical opening) in the anterior position, while the baby's bottom is presenting in the posterior position.

Answer 1

The baby is facing the back of the mother's pelvis in the anterior position, and front of her pelvis in the posterior position.

Question 2

Which of the following pelvic changes during pregnancy makes it more likely a woman's labor will proceed smoothly?

A)The pelvis tilts from the weight of the growing baby.
B)Pregnancy hormones contribute to the relaxation of the joints to allow stretching as the baby descends through the pelvis.
C)The pelvis stays rigid to support the weight of the uterus.
D)Increased blood flow helps make the pelvis malleable.

Answer 2

Pregnancy hormones contribute to the relaxation of the joints to allow stretching as the baby descends through the pelvis.

Question 3

As a doula, you are supporting a mother who has been having mild contractions all evening. They are getting a little stronger. When would you suggest she begin timing contractions?

A)Time contractions briefly now to get a baseline for how often they are occurring.
B)When she has had more than five in an hour
C)If they start to really hurt
D)Every now and then to determine if the contractions are progressing

Answer 3

Time contractions briefly now to get a baseline for how often they are occurring.

Question 4

All of the following make "back labor" take longer EXCEPT:

A)A baby needs additional time to rotate into an occiput anterior position.
B)Contractions are not as effective if the baby is malpositioned.
C)Pushing takes longer if the baby is still malpositioned at the beginning of second stage.
D)A baby cannot be born in an occiput posterior position.

Question 5

All of the following are techniques for helping a mother with "back labor" EXCEPT:

A)Staying in bed
B)Walking
C)Sitting on a birth ball
D)Massage

Question 6

Which of the following emotional factors may interfere with labor progress?

A)Fear releases fight-or-flight hormones that interfere with uterine contractions and dilation.
B)Fear is healthy and decreases mother's tension.
C)Tension and pain are not affected by fear.
D)Since all women give birth, emotions must have little to do with the process.

Question 7

If a mother does not have the urge to push once she is fully dilated, which of the following is the BEST position for her to adopt?

A)Squatting
B)Lithotomy
C)Side-lying
D)Semi-recumbent

Question 8

It is important a woman relax which muscles when pushing?

A)Biceps
B)Pelvic floor muscles
C)Quadriceps
D)Facial

Question 9

Which of the following is TRUE about episiotomy?

A)An episiotomy will heal better than a tear.
B)An episiotomy will enlarge the vaginal opening to facilitate a faster birth.
C)An episiotomy will lessen the mother's risk of urinary incontinence later in life.
D)An episiotomy can improve sexual satisfaction after birth.

Question 10

All of the following are medical indications for Caesarean birth EXCEPT:

A)Cord prolapse
B)Placenta previa
C)Previous Caesarean birth
D)Cephalopelvic disproportion

Question 11

Comfort measures for labor include all of the following EXCEPT:

A)Aromatherapy
B)Warm water
C)Walking
D)Remaining in bed

Question 12

Which of the following is a NOT true about continuous electronic fetal monitoring (EFM)?

A)EFM improves outcomes, especially if used continuously in labor.
B)EFM increases the risk of Caesarean birth and other interventions.
C)EFM can be invasive.
D)Immobility can increase discomfort and slow contractions.

Question 13

As a doula, you are supporting a laboring mother whose contractions are 12 minutes apart, and last 30 seconds each. She is uncomfortable, but still feels she can relax in between contractions. Which of the following is NOT a suggestion you make to this mother?

A)Suggest she walk during contractions to alleviate pain.
B)Encourage her to leave for the hospital or birthing center.
C)Ask her if she would like massage during a contraction.
D)Recommend a warm bath or shower.

Question 14

Narcotic pain relievers have all of the following effects on birth EXCEPT:

A)"Taking the edge off" the pain
B)Helping mothers to focus
C)Slowing labor
D)Depressing the central nervous system

Question 15

Risks of epidural anesthesia include all of the following EXCEPT:

A)Maternal fever
B)Increased length of labor
C)Increased blood pressure
D)Inefficient pushing

Question 16

It is common for women to feel which of the following emotions after a Caesarean birth?

A)Anger and resentment
B)Relief
C)Guilt and disappointment
D)All of the above

Question 17

Which of the following is NOT a purpose of amniotic fluid?

A)To help a fetus maintain body temperature
B)To cushion the baby from outside insult
C)To allow symmetrical musculoskeletal development
D)To keep the lungs from developing too soon

Question 18

What is the role of relaxin in pregnancy?

A)It helps the placenta produce other hormones.
B)It causes the uterus to contract.
C)It relaxes the ligaments.
D)It relieves pain.

Question 19

What is the BEST definition of Kegel exercises?

A)Contracting and releasing the pelvic floor muscles in various patterns to strengthen and tone
B)A yoga position for pregnancy
C)Tilting the pelvis so stretch and strengthen the lower back
D)Sitting cross-legged to stretch the pelvis and thighs

Question 20

Effacement as it applies to labor can BEST be defined as:

A)Thinning of the cervix
B)Positioning of the baby in relation to the ischial spines
C)Opening of the cervix
D)Delivery of the placenta

Question 21

Dilation as it applies to labor and birth can BEST be defined as:

A)Thinning of the cervix
B)The position of the fetus in relation to the ischial spines
C)Artificially rupturing the amniotic sac
D)Opening of the cervix

Question 22

Which of the following BEST describes how to time contractions?

A)Time from the start to finish of a single contraction.
B)Time from the beginning of one contraction to the beginning of the next contraction.
C)Time from when the contraction ends to when the next one begins.
D)Time throughout labor - from the first sign of tightening to the birth of the baby.

Question 23

All of the following are hallmarks of the first stage of labor EXCEPT:

A)The cervix opens from 0 cm to 10 cm.
B)The cervix thins from 0% to 100%.
C)The baby is born.
D)The contractions get longer, stronger and closer together over time.

Question 24

Which of the following BEST describes the second stage of labor?

A)Dilation and effacement of the cervix
B)Pre-labor contractions
C)Delivery of the placenta
D)Pushing and delivery of the baby

Question 25

The third stage of labor can best be categorized as:

A)The early phase of labor
B)Delivery of the placenta
C)The birth of the baby
D)A strengthening of contractions

Question 26

Emotional changes in the first stage of labor include:

A)Anticipation and excitement
B)Fear of the unknown
C)Confidence
D)All of the above

Question 27

The BEST description of the emotional changes in the second stage is:

A)Exhaustion
B)Ecstasy
C)Relief
D)All of the above

Question 28

Doula and physical therapist Penny Simkin has said that women who cope well with labor without using pain medication all seem to exhibit 3 "R's." Which of the following is NOT one of these?

A)Rapid breathing
B)Rhythm
C)Relaxation
D)Ritual

Question 29

All of the following describe transition EXCEPT:

A)When a laboring women is most likely to panic
B)Long, intense contractions with very little time between to rest
C)Pushing during contractions
D)The final push to open the cervix from 7cm to 10 cm

Question 30

All of the following physical changes happen during a uterine contraction EXCEPT:

A)The top of the uterus tightens.
B)The top of the uterus pushes down on the baby.
C)The bottom of the uterus is pulled up, causing the cervix to open and thin.
D)The bottom of the uterus tightens.

Question 31

All of the following are hormones of labor and birth EXCEPT:

A)Insulin
B)Oxytocin
C)Endorphins
D)Adrenaline

Question 32

Which of the following BEST describes the purpose of a birth plan?

A)A way for a woman to clarify and communicate her wishes for labor, birth and the early postpartum.
B)A way to make mom feel like a failure if she does not achieve the birth she had envisioned.
C)A binding contract between the pregnant woman and her healthcare provider.
D)A list of demands a laboring woman presents to her support staff.

Question 33

Which of the following statements BEST describes why a woman should practice active relaxation techniques before labor begins?

A)She will be better able to recognize muscle tension, and will have a tool to effectively deal with it.
B)She will get more rest during pregnancy.
C)So she and her partner can find something to do together during the last uncomfortable weeks of pregnancy.
D)As a way to bond with her unborn baby

Question 34

A doula has been supporting her client through early labor at home. Now that contractions have increased in intensity, they have just arrived at the birth location. The mother's contractions have slowed. The doula's BEST response is:

A)To let the healthcare staff know that augmentation is needed
B)To assure her client that this is normal, and help her to create an environment where she feels safe and secure so that her body can do the work of labor
C)To tell the mother she will probably need pain medication because her fear is blocking contractions
D)To tell the laboring woman that she needs to rest in bed

Question 35

All of the following non-pharmacological techniques might be used for labor induction or augmentation EXCEPT:

A)Accupressure
B)Nipple stimulation
C)Herbal remedies
D)Episiotomy

Question 36

Which of the following is NOT a benefit of forceps or vacuum assisted delivery?

A)Aids in fetal descent when the mother's efforts are insufficient
B)Decreased incidence of episiotomy
C)Helps the baby rotate into an anterior position
D)Speeds delivery in cases of fetal distress

Question 37

Breathing techniques used during labor can do all of the following EXCEPT:

A)Improve oxygenation of the fetus keeping the fetal heart rate more stable
B)Make a mom lightheaded
C)Increase oxygen to the uterus, which decreases pain and makes contractions more effective
D)Reduce the risk of Caesarean birth when exhale pushing is used as opposed to directed pushing

Question 38

What is the definition of placenta previa?

A)A condition where the placenta grows through the uterine wall
B)A condition where the placenta is implanted low in the uterus, sometimes covering the cervix
C)A condition where the placenta begins to detach from the uterine wall before the birth of the baby
D)When the umbilical cord enters the birth canal ahead of the baby

Question 39

Which of the following practices can increase a woman's chances of having a vaginal birth?

A)Going to the hospital as soon as contractions begin
B)Trying to use only one position to maintain comfort throughout labor
C)Use directed pushing in a lithotomy position
D)Avoiding an induction unless medically necessary

Question 40

A doula is supporting a mother who is complaining of excruciating pain in the lower back with each contraction as well as in between contractions. What is the best way to describe the double hip squeeze as a means for alleviating back pain?

A)The partner or doula presses his or her palm against mom's sacrum using the other palm for support on the opposing side of the body.
B)The partner or doula watches for where mom seems to be tensing her muscles, then touches or strokes her in that location until she relaxes the muscle.
C)The partner or doula places both hands on the flat planes of the pelvis while mom is on her hands and knees, then presses in and up, holding the pressure for the entire contraction.
D)The laboring mom kneels on her hands and knees, then pulls her pelvis in while tightening her abdomen and arching her back, then relaxes.

Question 41

What does the term "vertex presentation" mean?

A)The baby's head is the part closest to the cervix.
B)The baby is lying sideways, cradled in the hipbones.
C)The baby is bottom-first in the uterus.
D)The baby is facing the front of mom's pelvis.

Question 42

Which of the following is NOT true about a baby in breech presentation?

A)The baby cannot be born vaginally.
B)The mother may need a Caesarean delivery.
C)The care provider may try to manually turn the baby before labor.
D)The baby is at increased risk for oxygen deprivation during birth.

Question 43

Which of the following BEST describes "station" as it applies to pregnancy, labor, and birth?

A)The mother's birth history
B)The direction of the baby's head in relation to the cervix
C)The direction the baby's head in relation to the front or back of the mother's pelvis
D)The location of the top of baby's head in relation to the ischial spines of the pelvis

Question 44

Which of the following is NOT associated with labor induction?

A)Increased risk of Caesarean birth
B)Increased chance of fetal distress
C)Having a quick vaginal birth
D)Increased risk of assisted delivery

Question 45

Which of the following is NOT a good indication for induction of labor?

A)The amniotic sac has been ruptured for more than 24 hours without the onset of contractions.
B)The provider believes the baby is larger than average.
C)The pregnancy has progressed beyond 42 weeks.
D)The woman has developed a pregnancy related complication such as pregnancy induced hypertension or gestational diabetes that would make it more dangerous to remain pregnant.

Question 46

Which of the following BEST describes the phrase "cascade of interventions"?

A)A chain of events that have unintended effects on the natural progression of labor
B)A sudden gush of amniotic fluid
C)Any intervention done without medical indication
D)The result of pharmacological pain management in labor

Question 47

Which of the following is NOT a technique a doula might suggest so a mother can avoid having an episiotomy?

A)Use upright positions such as squatting or kneeling
B)Practice exhaling while pushing, or spontaneously working with the body's contractions while bearing down
C)Teaching the partner to do perineal support while the mother is pushing
D)Holding her breath and pushing to the count of 10 several times during each contraction

Question 48

What is "Friedman's Curve"?

A)A way of moving the hips to aid in fetal descent
B)The arch of the lower back caused by a shift in the mother's center of gravity
C)A graph depicting the progress of labor by plotting centimeters dilation over time
D)A modern measure of cervical dilation

Question 49

Prolapsed cord can BEST be described as:

A)A wrapping of the umbilical cord around the baby's neck
B)An emergency situation where the umbilical cord precedes the baby into the birth canal
C)Allowing the umbilical cord to stop pulsing before it is clamped and cut
D)A normal variation of labor

Question 50

Prior to labor, your client said she did not want to use pain medication. During labor, she hits a point where she is overwhelmed and doesn't feel like she's coping well with the pain. She says she is afraid the pain will only get worse. As her doula, which of the following is NOT an option you try at this point?

A)Suggest changing positions for the next few contractions and then reassessing her options.
B)Encourage her to take some long slow breaths through the next three contractions before deciding for sure.
C)Ultimately honor her decision, while still supporting her physically through birth.
D)Agree that she is not coping, and tell her an epidural is her best option.

Question 51

The BEST way to describe the role of oxytocin in labor is:

A)It is the hormone that is produced as a result of fear.
B)It is the hormone that causes the uterus to contract.
C)It slows labor.
D)It is a natural pain reliever.

Question 52

The role of catecholamines in labor can BEST be described as:

A)Can slow labor if released because of fear
B)Help the mother feel more relaxed
C)Create feelings of euphoria at the time of birth
D)Help to start milk production

Question 53

All of the following are true about endorphins EXCEPT:

A)They are natural pain reliever hormones.
B)They create an altered state of consciousness.
C)Their production is inhibited when narcotic pain relievers are used.
D)They are fight-or-flight hormones.

Question 54

As a hormone of labor, prolactin can BEST be described as:

A)A pain reliever
B)A substance that promotes aggressive protective behaviors in a new mother
C)An unnecessary side effect of intervention
D)A hormone that interferes with the progress of labor

Question 55

All of the following actions interfere with the "hormone cocktail" of labor and birth EXCEPT:

A)Use of epidural anesthesia
B)A quiet dim environment
C)Induction of labor
D)Mother baby separation

Question 56

Midwife and author Ina May Gaskin has coined the term "Sphincter Law" in relation to how the cervix works in labor. Which of the following is NOT part of her theory?

A)Sphincters hold bodily openings closed and, when relaxed, expel something, then close again.
B)The cervix can be opened with relaxation.
C)Keeping the jaw tight can help the cervix to open.
D)Fear can contribute to cervical closing.

Question 57

All of the following will optimize birth hormones EXCEPT:

A)Choosing caregivers a woman trusts
B)Using non-pharmacologic comfort measures during labor
C)Avoiding labor induction unless medically necessary
D)Accepting all interventions without question

Question 58

All of the following physical changes contribute to the pain of labor EXCEPT:

A)Changes in breathing patterns
B)Movement
C)Pulling and stretching of the ligaments supporting the uterus
D)Pressure on nerves in the pelvis

Question 59

Second stage is going very quickly, and a woman's care provider has suggested she slow it down a little to give her perineum time to stretch. Which of the following is NOT a technique the doula might try to help this mother?

A)Assist the woman into a squatting position.
B)Encourage the woman to lie on her side.
C)Help the mother focus on taking panting breaths.
D)Support the perineum with a warm, wet washcloth, or encourage the partner to do so.

Question 60

A client asks her doula how she will know when she is really in labor. The doula's BEST response is:

A)"If you lose your mucous plug, labor is starting."
B)"The only way to truly know you are in labor is if you have contractions that get progressively longer, stronger, and closer together."
C)"If you are nesting, it's time for birth."
D)"If your doctor or midwife tells you you've started to dilate, labor will start almost immediately."

Question 61

A laboring mother has an internal exam and it reveals her cervix is fully dilated. The caregiver tells her it is time to begin pushing. She says she feels like she needs to have a bowel movement, and she is grunting and groaning during contractions. What is the BEST way for the doula to help?

A)Encourage the mother to find a comfortable position, then take a breath and exhale while pushing several times during each contraction, then rest between contractions.
B)Support her in continuing what she is already doing.
C)Tell the woman she will need to get into a semi-reclining position on the birthing bed.
D)Instruct the woman to hold her breath and push to the count of ten several times with each contraction.

Question 62

A doula is supporting a woman who is having contractions 2-3 minutes apart, with each one lasting 90 seconds. Mom is shaking, and nauseous, and feels very overwhelmed by the labor. Which of the following support techniques is NOT helpful in dealing with panic during transition?

A)Make eye contact.
B)Use firm touch on her hands, shoulders or face to help her focus her attention.
C)Leave her alone so she can refocus.
D)Breathe with her.

Question 63

Which of the following is NOT true about eating and drinking during labor?

A)It can minimize dehydration and the need for IV fluids.
B)It increases the risk of aspiration.
C)It can help the mother keep up her energy for the work of labor.
D)It can shorten the length of labor.

Question 64

One way to change pain perception is to think of the pain of labor in a new way, sometimes called "reframing pain." Which of the following is not a description of this technique?

A)P = Purposeful
B)A = Anticipated
C)I = Intermittent
D)N = Noisy

Question 65

Which of the following is a consequence of limiting mobility during labor?

A)Reduced contraction strength and effectiveness
B)Decreased pain
C)Shorter labor
D)A greater sense of control over the birth process

Question 66

A laboring mother is having contractions about every five minutes apart, and they last for about 50 seconds each. They are painful at the peak. In between contractions, she can relax her muscles, but she wants to focus only on labor: she doesn't want any distractions. What can a doula do to support this mother?

A)Suggest she practice patterned breathing.
B)Tell her it's time to leave for her birthing location.
C)Brighten the lights.
D)Tell her it's still early in labor, and she should consider doing something to pass the time, like watching TV or playing a game.

Question 67

Which of the following is NOT something a doula might suggest for optimal fetal positioning?

A)The mother should practice good posture during pregnancy.
B)The mother should be conscious of balance and shifts in her center of gravity.
C)A mother should keep her knees higher than her hips when sitting during pregnancy and labor.
D)A mother should wash the floor on her hands and knees during pregnancy.

Question 68

Which of the following BEST describes what should be done if a woman's bag of waters breaks at the onset of labor?

A)She should immediately go to her birth location.
B)She should take note of the time, amount, odor, and color of the fluid, and notify her healthcare provider.
C)She should lie down and rest so she has energy for the rest of labor.
D)She should not take a tub bath.

Question 69

All of the following can be used to determine fetal positioning EXCEPT:

A)Palpation of the fetus through the abdomen
B)Electronic fetal monitoring
C)Vaginal exam
D)Ultrasound

Question 70

Aside from dilation and effacement, there are other ways to determine that labor is progressing. Which of the following is NOT one of these ways?

A)The cervix moves from a posterior to anterior position.
B)The fetus engages in the pelvis.
C)The amniotic sac ruptures.
D)The cervix ripens.

Question 71

A doula is supporting a client who is in early labor. Which of the following guidelines is least important?

A)Be certain that the outcomes are realistic
B)Incorporate both the client and her support person.
C)Project a definite time limit for labor to be completed.
D)Address the discomforts of labor.

Question 72

A few weeks before labor, the client may experience subtle signs that indicate the onset of labor, including lightening. The doula teaches the client to recognize the signs of lightening. Which of the following is NOT a sign of lightening?

A)Relief from diaphragmatic pressure and shortness of breath
B)Abdominal contour changes
C)Increased urinary frequency
D)Decreased amounts of vaginal discharge

Question 73

A doula is supporting a client who is in the first stage of labor. The client's amniotic membranes have not ruptured. Which of the following interventions is the most effective during this stage of labor?

A)Apply distraction techniques during contractions.
B)Instruct the client to lie on her left side and to avoid frequent change of positions.
C)Instruct the client to void at least every two hours.
D)Limit therapeutic touch.

Question 74

A client's healthcare provider is about to perform an amniotomy on a client who is in the active phase of labor. Before the procedure, the doula counsels the client that after the amniotomy, she can expect:

A)Increased efficiency of uterine contractions
B)Increased number of uterine contractions
C)A fluttery feeling in the chest
D)Decreased number of uterine contractions

Question 75

A client telephones her doula to say she is in labor and is having some contractions. The client is at 37 weeks' gestation. Which of the following signs indicates that the client is in true labor?

A)Contractions are initially felt in lower back and then sweep around to the abdomen in a wave.
B)The contractions are relieved with ambulation and sleep.
C)The contractions do not achieve cervical dilatation.
D)The contractions remain irregular.

Question 76

Which of the following factors contribute(s) to a successful labor?
I. The client's pelvis is of adequate size and contour.
II. The fetus is in an advantageous position and presentation and is of appropriate size.
III. The uterine contractions are adequate.
IV. The client has a strong sense of self-esteem.

A)I and II
B)I and III
C)I, II and III
D)Successful labor depends of all of the above factors.

Question 77

A client's healthcare provider notes that the presenting part of the fetus is at the +2 station. The doula explains to her client that means that the baby's presenting part is:

A)At the level of the ischial spine
B)2 cm below the ischial spine
C)2 cm above the ischial spine
D)2 inches above the ischial spine

Question 78

A client is being monitoredduring labor and assessment findings reveal that the fetus is in LOA position. The healthcare provider notes that the presenting part of the fetus is at 0 station. The doula can share with the client that this means that:

A)The presenting part is at the perineum, and the fetal head is crowning.
B)The presenting part is at the level of the ischial spines, and the fetal head is engaged.
C)The presenting part is above the level of the ischial spines, and the fetal head is floating.
D)The presenting part has descended to within the pelvic inlet.

Question 79

A client in labor is expected to give birth less than three hours after the onset of contractions due to her previous birth history. Which of the following actions by the doula is the most effective during the labor process?

A)Encourage the client to pant with each contraction.
B)Keep the fetus from being delivered.
C)Deliver the infant between contractions.
D)Encourage the client to focus on her coping strategies.

Question 80

A doula is supporting a client who was admitted to the labor and delivery unit about five hours ago. The healthcare provider has noted a cervical dilatation of 5 cm. The contractions are occurring every five minutes and usually lasting between 50 and 55 seconds. The client is in which phase of labor?

A)Latent phase
B)Active phase
C)Transition phase
D)Second stage of labor