Question 1

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?

Accepted Answer

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. A

Question 2

A client is in the second stage of labor and has been pushing for almost an hour. Which of the following suggestions from the doula is the most appropriate for the client at this stage?

Accepted Answer

A)  Offer clear fluids in between contractions.
B)  Encourage ambulation.
C)  Instruct the client to push with each contraction.
D)  Encourage frequent changes in position. C

Question 3

All of the following describe transition EXCEPT:

Accepted Answer

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 C

Question 4

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?

Accepted Answer

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

Question 5

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?

Accepted Answer

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

Question 6

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

Accepted Answer

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

Question 7

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

Accepted Answer

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.

Question 8

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.

Accepted Answer

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

Question 9

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?

Accepted Answer

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 10

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

Accepted Answer

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.

Question 11

All of the following are true about endorphins EXCEPT:

Accepted Answer

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 12

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

Accepted Answer

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

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:

Accepted Answer

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 14

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?

Accepted Answer

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

Question 15

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?

Accepted Answer

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 16

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

Accepted Answer

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

Question 17

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?

Accepted Answer

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 18

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

Accepted Answer

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 19

A primiparous client at 38 weeks' gestation is admitted to the labor and delivery room after showing signs of true labor. The client asks how long she should expect to be in labor before she gives birth to her baby. The doula informs the client that, on the average, the length of labor for primiparous clients is:

Accepted Answer

A)  13 to 15 hours
B)  8 to 9 hours
C)  18 to 24 hours
D)  5 to 7 hours

Question 20

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

Accepted Answer

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

Exam 3: Labor Birth