Deck 4: Post-Partum

Question 1

In the immediate postpartum period, what breast changes can a new mother expect?

A)She should have noticed leaking colostrum during pregnancy, and that's the only way she knows whether she can feed her baby at the breast or not.
B)If her breasts did not grow at least two cup sizes during pregnancy, her milk will probably not come in.
C)The breasts should begin filling immediately after the birth.
D)The breasts are producing colostrum, which will transition to a full milk supply over the next couple of weeks.

Answer 1

The breasts are producing colostrum, which will transition to a full milk supply over the next couple of weeks.

Question 2

Uterine involution begins as soon as the baby is born. In the first few days after birth, the uterus will:

A)Need to be massaged
B)Return completely to its pre-pregnancy size
C)Occasionally contract, especially while breastfeeding, and will be about the size of a grapefruit
D)Bleed profusely

Answer 2

Occasionally contract, especially while breastfeeding, and will be about the size of a grapefruit

Question 3

It can be difficult for a mother to have her first bowel movement after the birth of her baby. Which of the following is NOT a recommendation you would share with her?

A)Drink plenty of water.
B)Wait to have your first bowel movement if you have had stitches for the repair of an episiotomy or laceration.
C)Choose high fiber foods, including fresh fruits.
D)Ask your doctor about a stool softener.

Answer 3

Wait to have your first bowel movement if you have had stitches for the repair of an episiotomy or laceration.

Question 4

A full bladder in the postpartum period:

A)Is inevitable
B)Can impede uterine involution
C)Should be encouraged to avoid pain at the site of an episiotomy or laceration
D)Can be avoided by limiting fluid intake

Question 5

Postpartum bleeding, called lochia, is a normal part of the recovery process. Warning signs that should be checked by a doctor or midwife, however, include all of the following EXCEPT:

A)Clots larger than the size of a lemon
B)Bright red bleeding returning after several days
C)A change in color from red to pink to brown to white
D)A fever

Question 6

Postpartum care for an episiotomy or laceration includes all of the following EXCEPT:

A)Removal of the stitches after 10 days
B)Sitz baths
C)Kegel exercises as soon as possible after the birth
D)Ice packs for comfort

Question 7

The placenta is typically delivered soon after the birth of the baby. The placenta will be checked to be sure it is intact, because retained fragments of the placenta can cause all of the following EXCEPT:

A)Extreme pain
B)Inhibition of uterine involution
C)Infection
D)Delayed lactogenesis

Question 8

Typically, as soon as the baby is born, the umbilical cord is clamped and cut. One benefit, though, of delayed cord clamping is:

A)A chance for the doctor or midwife to assess the baby before mom holds him
B)More time for mom to recover before holding her baby
C)An increase in the baby's iron stores
D)Improved temperature regulation

Question 9

A doula can facilitate a successful skin-to-skin experience in the first hour after birth by:

A)Counseling parents before labor begins on the importance of uninterrupted skin-to-skin contact.
B)Encouraging delivery clothing that allows baby easy access to the mother's skin.
C)Helping to position the baby over the mother's belly with relaxed arms and legs extended.
D)All of the above

Question 10

In some facilities, the doctor or midwife may give the mother a prophylactic injection of synthetic oxytocin immediately after the birth. This is done to:

A)Help the mother sleep
B)Decrease the mother's pain
C)Complete the cascade of interventions
D)Aid in uterine involution

Question 11

Babies who are left skin-to-skin with their mothers from birth until the first breastfeeding takes place exhibit all of the following EXCEPT:

A)Improved respiration and heart rate
B)Low body temperature
C)Less crying
D)Stabilization of blood sugar levels

Question 12

Birth is unpredictable, and occasionally the outcome is unexpected, whether due to maternal or newborn complications, disability or death. The doula can BEST help in this situation by:

A)Discontinuing her support since it is a reminder of what happened
B)Encouraging her clients to move on
C)Understanding the stages of grief
D)Only sharing her concerns with her colleagues

Question 13

Which of the following is a potential side effect of routine newborn suctioning?

A)Choking on mucous
B)Defensive tongue positioning and potential aversion to breastfeeding
C)Nerve damage
D)Poorer outcomes if it is not done immediately

Question 14

Creating a womb-like environment for a newborn baby facilitates the adjustment to being born. Suggestions for this include:

A)Carrying the baby in a sling or other soft baby carrier
B)Frequent feeding
C)White noise
D)All of the above

Question 15

Which of the following is NOT TRUE about "rooming-in," or keeping mom and baby together rather than having baby be cared for in a hospital nursery?

A)Babies cry less and are soothed more easily.
B)Moms who room-in get more rest.
C)Moms make more breastmilk faster when they can room-in with their babies.
D)Most hospitals do not encourage rooming-in.

Question 16

When the umbilical cord is cut, a number of changes occur in the baby's respiratory and circulatory systems. Which of the following is NOT part of this physiologic process?

A)The lungs inflate and begin working on their own to exchange oxygen and carbon dioxide in the bloodstream.
B)Amniotic fluid is absorbed from the respiratory system.
C)The pain from cutting the cord causes the infant to take the first breath.
D)Increased blood pressure in the heart causes the foramen ovale to close.

Question 17

Three out of four mothers experience the "baby blues" after birth. Which of the following BEST describes this emotional change?

A)A temporary feeling of letdown in the first few days or weeks after the birth
B)Depression that occurs weeks to months after the birth
C)A long-lasting sadness after the birth of a baby
D)An abnormal hormonal reaction to the birth

Question 18

Postpartum depression occurs in as much as 10% of new mothers and can include all of the following symptoms EXCEPT:

A)Frequent crying
B)Feeling unable to cope
C)Lack of interest in baby
D)Hallucinations

Question 19

Recovery from a Caesarean birth takes longer than for a vaginal birth. In the immediate postpartum, a doula might help a mother by doing all of the following EXCEPT:

A)Ensuring the mother has a support person with her so she can still room-in with her baby.
B)Making sure the mother is comfortable
C)Encouraging the mother to get moving as soon as she feels able after the surgery
D)Instructing her to stay in bed as long as possible

Question 20

A woman can expect her milk to "come-in" two to five days after birth, with colostrum being the perfect nourishment for her newborn until then. Which of the following is NOT suggested for a woman experiencing engorgement when her milk comes in?

A)Use ice packs between feedings to relieve painful breasts.
B)Express just enough milk to relieve the pressure and soften the breast so baby can latch effectively.
C)Analgesics as needed for pain.
D)Limit how long and how often the baby nurses.

Question 21

A postpartum mother asks you how soon she can have sex. Your BEST response is:

A)Most doctors recommend waiting at least six weeks after the birth, but some women feel up to it sooner.
B)You can't get pregnant again right away, so don't worry about contraception.
C)You won't have time to even think about having sex.
D)Leaking breasts are a turn-off.

Question 22

A doula might suggest all of the following to ease the first days at home with a new baby EXCEPT:

A)Limit the number of visitors you have.
B)Rest when the baby rests.
C)Take time to make phone calls and write thank you.
D)Be sure to eat well and stay hydrated.

Question 23

All newborns exhibit a "continuum of arousal" or different states of alertness. Babies interact best with caregivers during which state?

A)Crying
B)Quiet alert
C)Active alert
D)Drowsy

Question 24

All of the following are normal for a newborn's appearance EXCEPT:

A)Birth marks
B)Vernix
C)Lanugo
D)Bruising

Question 25

Which of the following is NOT a routine newborn procedure in the immediate postpartum?

A)Weighing and measuring
B)Prophylactic eye treatment
C)Drying baby and covering baby's head
D)Circumcision

Question 26

A doula is discussing contraceptives with a client. The client gave birth to a healthy baby girl three days ago. The doula is correct when she says that the most effective way to protect against conception is through:

A)Natural family planning
B)Abstinence
C)Oral contraception
D)Surgical methods

Question 27

A 3-day-old newborn is placed under phototherapy lights for the treatment of jaundice. The doula explains to the mother that the healthcare providers expect the newborn to pass:

A)Blackish-green stools
B)Bright green stools
C)Light yellow stools
D)Bright yellow stools

Question 28

A client worries that her newborn has pink patches at the nape of the neck. The doula informs the mother that these patches:

A)Occur more often in males than in females
B)Are caused by an injury during labor
C)Do not fade
D)Disappear by school age without treatment

Question 29

A client who gave birth two days ago informs the doula that she has not had a bowel movement since the delivery of her child. The client had a vaginal birth. Which of the following statements made by the doula is the most appropriate in this situation?

A)"Bowel elimination usually returns a week after birth. Increase your fluid intake to prevent constipation and check with your healthcare provider about your concerns.
B)"Bowel elimination usually returns five to seven days after birth. Walking and increasing your fiber intake may help to prevent constipation."
C)"Bowel elimination usually returns within the first 24 hours. Stay here and I will notify your physician."
D)"Bowel elimination usually occurs within two to three days after birth. You may feel better if you increase your fiber intake to relieve constipation. Check with your healthcare provider if you don't have a bowel movement within the next day."

Question 30

A client who gave birth to a healthy newborn has been crying and expresses feelings of sadness and emptiness. The client delivered her baby three days ago. The doula suspects that the client has:

A)Postpartum depression
B)Postpartum blues
C)Postpartum psychosis
D)A normal behavior during the taking-hold phase

Question 31

A doula is speaking with a client who gave birth to a baby girl two months ago. During the conversation, the client informs the doula that she is hearing voices and that she constantly feels empty. She has a history of clinical depression. Which of the following is the priority action of the doula?

A)Offer compassion
B)Protect the client and child from injury
C)Consider counseling for the client
D)Administer antidepressants

Question 32

A client delivered a healthy infant by Caesarean birth. The doula might encourage the client to eat which food item to promote wound healing?

A)Bananas
B)Wheat bread
C)Oranges
D)Milk