NM 704 Exam 1 - Questions & Detailed Explanations
Compare outcomes for hospital, birth center and home birth, including
perinatal mortality and obstetrical interventions Right Ans - A key take-
home point is that the outcomes of home birth as compared to hospital birth
depend on many factors.
- The qualification of the attendants.
- The integration of home birth into the broader maternity care system so that
necessary transfers to the hospital are efficient and respectful.
- Use of appropriate criteria to determine candidates for home birth.
- The risks of hospital birth, based on the increase in interventions in that
setting.
Understand the importance of integrating out of hospital birth into the
maternity system in maximizing safety Right Ans - good transfer process +
collaboration improves maternal and fetal outcomes
Compare and contrast the "pain relief" paradigm and the "working with pain"
paradigm Right Ans - Pain relief: pain is unnecessary, should be eliminated
completely, pain medication always outweighs the risks
- may not understand why you want to go without pain relief
Working with pain: pain is a normal part of labor, it is necessary and allows
patient to move and to progress labor
- supportive environment can help to release endorphins
Discuss the relationship between pain and suffering Right Ans - Pain vs
suffering: do not necessarily go together
Pain without suffering: training for a marathon/labor because they have
prepared for this by being educated, having support, feelings of safety and
other factors
Suffer: even with epidural, distress d/t long labor, feeling isolated, worrying
for baby; pain and suffering together
Non-pharmacological: gate-control theory: if you activate nerves in a non-
painful way at the same time, it blocks the pain signals from getting to your
brain
,- examples: labor in a warm bath, massage, pressure on back, reposition,
warm packs, TENS, mental control pain method (hypnobirthing, education,
aromatherapy, etc.)
Understand the "coping with labor" algorithm Right Ans -
Know what Albers means by the "over-treatment of normal childbirth."
Right Ans - Patients that are treated within the hospital by OBs are having
more interventions performed
Identify the 3 primary hormonal systems involved in the hormonal physiology
of childbirth and know the benefits of each system and how each system can
be disrupted: Oxytocin Right Ans - Oxytocin: reduces stress by centrally
activating the parasympathetic nervous system to promote calm, connection,
healing, and growth.
In perinatal period it optimizes labor, birth and postpartum transitions of
mother and baby through:
- released into the maternal bloodstream - causes rhythmic uterine
contractions, to include the late-labor oxytocin surge that benefits pushing
(Ferguson reflex)
- central calm and analgesic effects
- positive feedback from central oxytocin itself - that helps to augment and
accelerate in-labor effects
- postpartum maternal adaptations that reduce stress, increase sociability,
and prime reward centers, imprinting pleasure with infant contact and care
(promoting longer-term infant survival)
Prelabor increases in uterine oxytocin receptors and oxytocin receptors in the
brain and mammary glands maximize these effects.
Hour or so after physiologic birth - skin to skin maternal-newborn
interactions foster peak oxytocin activity, these benefits include:
- stronger contractions (reducing PPH risk)
- natural warming for the newborn through vasodilation of mother's chest
- activation of hormonally mediated maternal-infant biologic bonding
- facilitation of breastfeeding initiation, including reducing newborn and
maternal stress
, Disruption: epidural anesthesia reduces maternal oxytocin in labor (likely
because of numbing of sensory feedback that promotes central oxytocin
release)
List and describe the steps of the Midwifery Management Process/Clinical
Reasoning Right Ans - Midwifery Management Process
- Data Collection (subjective/objective data)
- Making an assessment (differentiate normal vs abnormal)
- Developing a plan of care (shared decision making, consultation as needed)
- Implementing plan
- Evaluating outcomes (successfulness of plan, consider alternative
interventions as needed)
Clinical Reasoning Cycle
- Consider that patient situation -> collect cues/information -> process
information -> identify problems/issues -> establish goal(s) -> take action ->
evaluate outcomes -> reflect on processing and new learning
Define Shared Decision Making Right Ans - one of the hallmarks of
midwifery
- a collaborative process that allows patients and their providers to make
health care treatment decisions together; taking into account the best
scientific evidence available as well as that patient's values and preferences
- 3 components: collaboration, education, and consideration
List and describe the steps of the Shared Decision Making process Right
Ans - Formulate diagnosis or condition: This is a mental process carried out
by the midwife
- use clinical reasoning/midwifery management process
- Make sure you have collected all necessary information and have an accurate
diagnosis before moving on to next step
Name and explain diagnosis or condition: the woman needs to hear and
understand the diagnosis in order to understand the care options
Name care options: List care options clearly and simply before reviewing pros
and cons
Compare outcomes for hospital, birth center and home birth, including
perinatal mortality and obstetrical interventions Right Ans - A key take-
home point is that the outcomes of home birth as compared to hospital birth
depend on many factors.
- The qualification of the attendants.
- The integration of home birth into the broader maternity care system so that
necessary transfers to the hospital are efficient and respectful.
- Use of appropriate criteria to determine candidates for home birth.
- The risks of hospital birth, based on the increase in interventions in that
setting.
Understand the importance of integrating out of hospital birth into the
maternity system in maximizing safety Right Ans - good transfer process +
collaboration improves maternal and fetal outcomes
Compare and contrast the "pain relief" paradigm and the "working with pain"
paradigm Right Ans - Pain relief: pain is unnecessary, should be eliminated
completely, pain medication always outweighs the risks
- may not understand why you want to go without pain relief
Working with pain: pain is a normal part of labor, it is necessary and allows
patient to move and to progress labor
- supportive environment can help to release endorphins
Discuss the relationship between pain and suffering Right Ans - Pain vs
suffering: do not necessarily go together
Pain without suffering: training for a marathon/labor because they have
prepared for this by being educated, having support, feelings of safety and
other factors
Suffer: even with epidural, distress d/t long labor, feeling isolated, worrying
for baby; pain and suffering together
Non-pharmacological: gate-control theory: if you activate nerves in a non-
painful way at the same time, it blocks the pain signals from getting to your
brain
,- examples: labor in a warm bath, massage, pressure on back, reposition,
warm packs, TENS, mental control pain method (hypnobirthing, education,
aromatherapy, etc.)
Understand the "coping with labor" algorithm Right Ans -
Know what Albers means by the "over-treatment of normal childbirth."
Right Ans - Patients that are treated within the hospital by OBs are having
more interventions performed
Identify the 3 primary hormonal systems involved in the hormonal physiology
of childbirth and know the benefits of each system and how each system can
be disrupted: Oxytocin Right Ans - Oxytocin: reduces stress by centrally
activating the parasympathetic nervous system to promote calm, connection,
healing, and growth.
In perinatal period it optimizes labor, birth and postpartum transitions of
mother and baby through:
- released into the maternal bloodstream - causes rhythmic uterine
contractions, to include the late-labor oxytocin surge that benefits pushing
(Ferguson reflex)
- central calm and analgesic effects
- positive feedback from central oxytocin itself - that helps to augment and
accelerate in-labor effects
- postpartum maternal adaptations that reduce stress, increase sociability,
and prime reward centers, imprinting pleasure with infant contact and care
(promoting longer-term infant survival)
Prelabor increases in uterine oxytocin receptors and oxytocin receptors in the
brain and mammary glands maximize these effects.
Hour or so after physiologic birth - skin to skin maternal-newborn
interactions foster peak oxytocin activity, these benefits include:
- stronger contractions (reducing PPH risk)
- natural warming for the newborn through vasodilation of mother's chest
- activation of hormonally mediated maternal-infant biologic bonding
- facilitation of breastfeeding initiation, including reducing newborn and
maternal stress
, Disruption: epidural anesthesia reduces maternal oxytocin in labor (likely
because of numbing of sensory feedback that promotes central oxytocin
release)
List and describe the steps of the Midwifery Management Process/Clinical
Reasoning Right Ans - Midwifery Management Process
- Data Collection (subjective/objective data)
- Making an assessment (differentiate normal vs abnormal)
- Developing a plan of care (shared decision making, consultation as needed)
- Implementing plan
- Evaluating outcomes (successfulness of plan, consider alternative
interventions as needed)
Clinical Reasoning Cycle
- Consider that patient situation -> collect cues/information -> process
information -> identify problems/issues -> establish goal(s) -> take action ->
evaluate outcomes -> reflect on processing and new learning
Define Shared Decision Making Right Ans - one of the hallmarks of
midwifery
- a collaborative process that allows patients and their providers to make
health care treatment decisions together; taking into account the best
scientific evidence available as well as that patient's values and preferences
- 3 components: collaboration, education, and consideration
List and describe the steps of the Shared Decision Making process Right
Ans - Formulate diagnosis or condition: This is a mental process carried out
by the midwife
- use clinical reasoning/midwifery management process
- Make sure you have collected all necessary information and have an accurate
diagnosis before moving on to next step
Name and explain diagnosis or condition: the woman needs to hear and
understand the diagnosis in order to understand the care options
Name care options: List care options clearly and simply before reviewing pros
and cons
