1. Professional issues, knowledge and skills (1-15) Flashcards
1 . You’re collecting data on maternal mortality in your state in order to look for any recurring causes. For your first figure, you want to divide causes into ‘direct’ and ‘indirect’. Which of the following is the most accurate grouping?
a) Direct: PPH in grand multipara, eclampsia in a patient carrying triplets, sepsis from injury at work, pulmonary embolism. Indirect: Seizure following cessation during pregnancy of epileptic medications, asthma, COVID-19, cardiomyopathy.
b) Direct: PPH, eclampsia, sepsis from infection of cesarean wound, pulmonary embolism. Indirect: Seizure following cessation during pregnancy of epileptic medications, asthma, COVID-19, cardiomyopathy
c) Direct: Seizure following cessation during pregnancy of epileptic medications, asthma, COVID-19, cardiomyopathy. Indirect: PPH, eclampsia, sepsis from infection of cesarean wound, pulmonary embolism.
d) Direct: Seizure due to eclampsia, asthma attack in labor, COVID-19 contracted at OB visit, cardiomyopathy. Indirect: PPH, eclampsia, sepsis from infection of cesarean wound, pulmonary embolism.
B
2 . Anna is 16 weeks pregnant. In today’s appointment, you discuss her diet and are disappointed to find that she has been eating white rice when you had told her at 12 weeks that she should switch to brown because it is healthier. You again stress this point, and also tell her that she should buy organic beans and cook them herself, rather than buying canned. Your relationship with Anna seems to turn sour after this exchange. What might you have done wrong?
a) You failed to take into account social determinants of health factors when considering how to help Anna have a healthful diet.
b) You should have been more explicit in your previous appointment, stressing the fact that a good diet is vital for a healthy pregnancy.
c) Canned beans are more healthful than dry beans cooked at home, because the nutrients are sealed inside the can when cooking.
d) Beans are not one of the ‘dirty dozen’, so it is not worth spending the money on buying organic beans.
A
3 . At 20 weeks, your client Benji has an ultrasound confirming twins, and you explain that you are not experienced with this and need to transfer care to another provider. Benji shows you the state law, which says that midwives are legally allowed to care for multiple pregnancies, and tells you that you are not allowed to terminate care. What is your response?
a) Explain that multiple births are never safe out of hospital and the state law needs to be changed to reflect this before babies die.
b) The law does indeed say that you should care for multiple pregnancies, and so you must remain the primary midwife unless you can convince Benji to change providers.
c) The law states that you are allowed to care for multiple pregnancies if your knowledge and skill level mean that this would be safe, but that is not the case for you, and so you need to transfer care.
d) Reluctantly agree to remain primary midwife as long as there is a second midwife present for the birth.
C
4 . Bill is 26 weeks pregnant when he brings up the subject of chestfeeding with you. You’ve never heard of this.
a) You ask Bill what he means and work out that he’s describing breastfeeding. He’s entitled to use his own word for it, but you should continue using the officially-recognized medical term for it.
b) You ask Bill for clarification and discover that she’s talking about breastfeeding. You explain to her that you’ve always called it breastfeeding at it would be hard for you to change to such a weird word.
c) You ask Bill for clarification, and quickly discover that she’s describing what you normally think of as ‘breastfeeding’ using a term that she’s more comfortable with. You work hard to change your language to be more inclusive, and use this word with her from now on.
d) You ask Bill for clarification, and quickly discover that he’s describing what you normally think of as ‘breastfeeding’ using a term that he’s more comfortable with. You work hard to change your language to be more inclusive, and use this word with him from now on.
D
5 . You move to a state that regulates midwifery. One law there states that you must transfer care to an obstetrician at 42.0 weeks. However, your Practice Guidelines state that you will provide care up to 42.6 weeks. What does this imply?
a) If a client goes beyond 42 weeks, they should go to a hotel across the state line once labor is active so that you can legally care for them during the birth.
b) Since you would be following your Practice Guidelines if you continued care through to 42.6 weeks, you are legally entitled to do so.
c) You should lobby to change the state law to allow care through to 42.6 weeks, and should continue this practice in the interim to show that it is safe to do so.
d) The state laws supersede your Practice Guidelines and must be followed. You should update your guidelines to reflect the laws in this state.
D
6 . You’re doing a peer review of a client who had type 2 diabetes, controlled by diet. There was a 1 minute 37 second shoulder dystocia at the birth, and signs of an Erb’s palsy injury in the neonate. The midwives discuss whether this was a case of direct or an indirect neonatal morbidity. Which are correct rationale for each?
a) It was a clear case of direct morbidity because the shoulder dystocia was directly caused by the diabetes.
b) It could be argued that it’s direct morbidity because it was caused by a shoulder dystocia, which is an obstetric complication. It could be argued that it’s indirect, because the shoulder dystocia most likely occurred due to the fact that the client was diabetic.
c) It could be argued that it’s indirect morbidity because it was caused by a shoulder dystocia, which is an obstetric complication. It could be argued that it’s direct, because the shoulder dystocia most likely occurred due to the fact that the client was d
d) It was a clear case of indirect morbidity because the provider should have been able to resolve a shoulder dystocia without causing a brachial plexus injury.
B
7 . Aliyah, a Black woman, has been interviewing midwives before choosing who to go to for her care. She has just finished talking to your white partner, and has told her that she will be choosing someone else. Your partner discusses her thoughts on this with you. She feels that Aliyah’s main reason for not choosing her is that she’s white. Which of the following is the best response you could give her?
a) There is no such thing as ‘reverse racism’, and so Aliyah could not have decided against your partner because she’s white.
b) You’re quite sure your partner would have done a great job caring for Aliyah, and it’s her loss for having made the wrong decision by choosing someone else for her care.
c) Your partner should take a class in cultural diversity, as she clearly did not do a good job when talking to Aliyah.
d) Even with healthcare providers who say they are not racist, Black women have far poorer outcomes on average than do white women. If Aliyah felt she would be more comfortable with a Black provider, that is her choice and it should be respected, and understood.
D
8 . You’re having an initial interview with Carla, who explains that she’s not yet sure whether she wants to give birth in a hospital or out of hospital. She says that finances are playing a big role in her decision. What should you do?
a) Tell Carla of your own hospital and birth center births and how much more empowering the latter was. Explain that if she chooses a hospital birth, she will forever regret it.
b) Talk to Carla about the pros and cons of hospitals and birth centers/home births, and encourage her to think carefully about what she’s looking for. Discuss ways in which she could address the financial side of the equation.
c) Tell Carla of all the risks of a hospital birth and all the benefits of birth center and home birth. Explain that an out of hospital birth is so important that she just must find a way to be able to afford it.
d) Talk to Carla about the pros and cons of hospitals and birth centers/home births, and encourage her to think carefully about what she’s looking for. Tell her that cost should never be a factor when considering the health and safety of herself and her baby.
B
9 . At Abril’s 36-week appointment, you meet her husband for the first time and discover that he only speaks Spanish. Abril acts as translator throughout the appointment, which works well and you feel he’ll be a supportive birth partner. What do you need to do for him?
a) Arrange to have a bilingual assistant at the birth who can communicate with him directly so that conversations do not need to go through Abril when she’s in labor.
b) Encourage him to attend a birth class, as he’s not been attending prenatal appointments and so probably needs some childbirth education.
c) Encourage him by telling him you believe he’ll be a great help to Abril during labor and birth and you think he’ll make a great Dad.
d) Give him paperwork about labor, birth and the postpartum period in Spanish.
A
10 . You’re caring for Caroline, a client from a religious group that you’ve never heard of. Caroline explains to you that women are considered ‘unclean’ for 30 days after birth and are not allowed in the presence of men during this time. Which of these is the best response you could give her?
a) You should invite her to attend your church on Sunday so that you can introduce her to a more loving religion.
b) You understand what she’s saying to you, but she’s wrong. Women are blessed and beautiful after birth, and she should not be following such outdated religious regulations.
c) You understand what she’s saying to you, and respect her beliefs. You will arrange to meet her husband in another room postpartum to discuss any concerns he may have.
d) You understand what she’s saying to you, and will look more into the religious beliefs and practices so that you can do your best to follow them when caring for her. If you do misstep, apologize and learn from the mistake.
D
11 . Dafne is transferring care to you from a midwife in another state. She’s asked for her records to be sent to you, so you’ve emailed the midwife your fax number. You’re surprised to find the records in your email inbox an hour later. Why?
a) It would have been far easier to fax the records than to email them, so the other midwife has done more work than necessary.
b) You’re pleasantly surprised because the fax service you have would have charged you to receive the records, whereas the email is free.
c) It normally takes far longer than an hour for records to be sent through.
d) The email isn’t HIPAA-compliant, so confidential records should not be sent that way unless the client has given permission.
D
12 . You attended a peer review remotely yesterday, and learned details of a case where the well-respected midwife, Dee, had forgotten an important procedure in her panic. Today, a potential client is meeting with you, and they tell you they’re considering going with Dee. What do you do?
a) Tell the client about your guiding principles as a midwife and your background, and ask them why they’re considering a midwife. When they mention Dee, tell them the basic details of the case, because client confidentiality doesn’t apply since it wasn’t your client.
b) Tell the client about your philosophy of care, experience and training, and ask them what they want from their care. If they ask your opinion on Dee, tell them she’s well-respected and that she ensures she’s always improving her skills and knowledge. Encourage them to meet with her.
c) Tell the client about how you practice and how many clients you have each month, and suggest that they ask Dee how many clients she has. Tell them Dee was recently involved in a birth with a negative outcome, but that you can’t discuss the details because of client confidentiality.
d) Tell the client about your midwifery practice, including some quotes from past clients on your care. When they mention Dee, tell them she’s a well-respected member of the birth community, working on improving her skills.
B
13 . A colleague conducts a research study looking at maternal lifestyles and neonatal outcomes, and finds a strong negative correlation between the number of cups of coffee drunk per day in the 6 months immediately preceding a pregnancy and the APGAR scores of the neonates. What does this mean?
a) In general, clients who drank more coffee tended to have babies with lower APGAR scores. However, the research shows only a correlation and does not imply causation.
b) A decrease in the number of cups of coffee drunk immediately prior to a pregnancy causes a significant reduction in the APGAR scores of the neonate.
c) An increase in the number of cups of coffee drunk immediately prior to a pregnancy causes a significant reduction in the APGAR scores of the neonate.
d) In general, clients who drank less coffee tended to have babies with lower APGAR scores. However, the research shows only a correlation and does not imply causation.
A
14 . You’re delighted to be invited to a Christmas party with labor and Delivery staff from the local hospital. At the party, one of the nurses starts loudly discussing a client you transferred to them in derogatory terms. Do you…?
a) Tell the nurse to stop talking about your client in such a way: it’s unprofessional and unkind. If she wants to continue telling others about the patient, she should say only positive things about her.
b) Ask the nurse to please stop discussing this. It paints your client in a very unfavorable light, which isn’t kind.
c) Quietly but forcefully request that the nurse stop talking about this. Not only is it inappropriate and unprofessional to discuss patients in this way, but it’s also a breach of patient confidentiality.
d) Laugh along with the nurse to show you’re part of the team, but talk to her the next day to explain that you felt it was inappropriate.
C
15 . At your 36 week home visit with Christa, you notice that the house is perfectly clean and the fridge is well-stocked. You help make up the spare bed for the birth, inflate her pool to check it, and connect the hot water tap to the hose. You’re happy for the physical work as it’s chilly in the house and there’s no heating. What do you still need to discuss?
a) Tell Christa that it’s nice to see a clean house because most of your recent appointments have been postpartum, and those clients had ‘let things slip’ a little!
b) Explain to Christa that it’s very important that the birth room be warm when the baby arrives, and ensure she has a heater there by 37 weeks.
c) Ensure that Christa has music planned for listening to during labor. A selection of calm and powerful songs would be ideal.
d) Explain that Christa’s partner will need to set up the birth pool and fill it on the day of the birth, because you’ll need to conserve your energy.
B
