NM 704 EXAM 1 QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE
Compare outcomes for hospital, birth center and home birth, including perinatal
mortality and obstetrical interventions
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
good transfer process + collaboration improves maternal and fetal outcomes
Compare and contrast the "pain relief" paradigm and the "working with pain"
paradigm
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
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
Know what Albers means by the "over-treatment of normal childbirth."
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
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
Midwifery Management Process
- Data Collection (subjective/objective data)
- Making an assessment (differentiate normal vs abnormal)
SOLUTIONS VERIFIED LATEST UPDATE
Compare outcomes for hospital, birth center and home birth, including perinatal
mortality and obstetrical interventions
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
good transfer process + collaboration improves maternal and fetal outcomes
Compare and contrast the "pain relief" paradigm and the "working with pain"
paradigm
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
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
Know what Albers means by the "over-treatment of normal childbirth."
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
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
Midwifery Management Process
- Data Collection (subjective/objective data)
- Making an assessment (differentiate normal vs abnormal)
