Question 1

A laboring mother has an internal exam and it reveals her cervix is fully dilated. The caregiver tells her it is time to begin pushing. She says she feels like she needs to have a bowel movement, and she is grunting and groaning during contractions. What is the BEST way for the doula to help?

Accepted Answer

If the mother is coping well, and seems to be spontaneously working with her body, she should be left alone to continue birthing the way she is. If the mother begins to lose focus, or pushing becomes ineffective, the doula might suggest changing positions and using exhale pushing. Some hospitals have policies that require a mother assume a specific position during the second stage, but this is counterproductive, and the mother should be allowed to assume whatever position gives her the most comfort and helps the baby move down the most effectively. Directed pushing with breath holding can be used, but does have risks such as less oxygen to the baby, which might cause fetal heart rate changes, leading to interventions such as forceps, vacuum extractor, or Caesarean birth.

Question 2

A doula is supporting a woman who is having contractions 2-3 minutes apart, with each one lasting 90 seconds. Mom is shaking, and nauseous, and feels very overwhelmed by the labor. Which of the following support techniques is NOT helpful in dealing with panic during transition?

Accepted Answer

A woman at risk of panicking during transition needs support. Leaving her to cope on her own can increase her feelings of losing control, and can lead to many labor interventions in an effort to calm her. The best strategies to help this mother include making eye contact, using firm touch, breathing with her to help her focus, and reassuring her that all is progressing smoothly. Talking quietly, stroking away pain with touch and massage, and encouraging the use of preplanned relaxation techniques are also strategies for the doula and labor partner.

Question 3

Which of the following is NOT true about eating and drinking during labor?

Accepted Answer

Restrictions on consuming anything by mouth during labor come from the belief that vomiting is more likely when anesthesia is used, and if an emergency Caesarean is needed, the stomach should be empty. Caesareans are rarely performed under general anesthesia anymore, and vomiting does not always lead to aspiration (and aspiration doesn't always lead to morbidity, for that matter). So women should be encouraged to eat and drink for comfort during labor. Recent studies show that when a woman is allowed this leeway, she may have a shorter labor (by an average of 90 minutes), may be less likely to need augmentation, and will be less likely to use pain medications. Babies born to mothers who could eat and drink throughout labor have higher Apgar scores than of those whose mothers were prohibited from doing so.

Question 4

One way to change pain perception is to think of the pain of labor in a new way, sometimes called "reframing pain." Which of the following is not a description of this technique?

Accepted Answer

While some women make noise during labor, the "N" when reframing the pain of childbirth typically denotes "normal" - labor is the normal progression of the reproductive cycle necessary for birth. The labor pains are purposeful in that they are associated with the physiologic changes necessary for the baby to be born. Labor pain means everything is going right rather than wrong. Labor pain can be anticipated or prepared for ahead of the actual onset. Having a set of coping and comfort measures in place can ease labor pain. Labor pain is intermittent - it happens mainly during contractions with a rest period in between - as opposed to chronic or continuous pain.

Question 5

Which of the following is a consequence of limiting mobility during labor?

Accepted Answer

When a mother is kept from moving and changing position in response to the signals of her body, contractions are likely to become ineffective and labor is more likely to stall. Other consequences of limiting mobility include increased pain, increased use of pain medication, longer labor, increased use of Pitocin for augmentation, and a sense of losing control for the mother. If a mother has preterm labor or severe pregnancy induced hypertension, or if she is using pain medications, she will be restricted to lying in bed. Helping her shift positions in bed can normalize labor.

Question 6

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

Because the mother wants to focus on the labor, practicing specific breathing techniques helps her work with her contractions and resting periods. The doula might also suggest the mother visualize the baby moving down through the pelvis, or that she move in response to contractions. If the mother has a ritual, the doula can continue to honor that ritual without interference. Dimming the lights also creates an environment of privacy allowing the mother to focus on labor. A change of locations or positions, as well as proposing distractions, may cause the mother to lose her focus and disrupt her coping.

Question 7

Which of the following is NOT something a doula might suggest for optimal fetal positioning?

Accepted Answer

A mother should assume sitting positions where her knees are lower than her hips to facilitate an optimal position for the baby to be birthed. Working with her center of gravity for balance, and practicing good posture when sitting or standing are both techniques to ease the baby into a favorable position for birth. Thinking of the belly as a hammock, which the baby's back needs to settle into, can help women assume postures that facilitate optimal positioning, including a hands and knees position.

Question 8

Which of the following BEST describes what should be done if a woman's bag of waters breaks at the onset of labor?

Accepted Answer

If a woman's water breaks she should think of TACOs! This will help her remember to note the time, amount, color, and odor of the water. Her care provider will expect labor contractions to start within the next 24 hours, and if they don't will likely suggest induction. The amount may be a trickle or gush, the fluid should be odorless, and the color is typically clear. If the waters are brown or green, the baby has a slight risk of respiratory problems following birth, so the care team would want to be prepared. A mother can remain at home even if her waters break. She does not need to remain immobile, though she may want to wear a sanitary napkin (not tampon) to catch the leaking fluid as she moves. Some care providers say a woman should not immerse herself in water after her amniotic sac ruptures because there is an increased risk of infection. There is no solid evidence to support this claim, and many women find warm water supportive and comforting as labor progresses.

Question 9

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

Accepted Answer

Fetal monitoring is used in labor to assess the fetal heart rate and the strength of uterine contractions. The care provider may assess fetal position from the exterior by feeling the size, shape, firmness, and movement of the baby. Mothers can be taught to do this for themselves, as well. The baby can also be assessed during a vaginal exam - the care provider can determine if the baby is in a cephalic or breech presentation, and if the baby is head down the provider can determine if the baby is in an anterior or posterior lie. Ultrasound imaging can also be used to visualize the fetus.

Question 10

Aside from dilation and effacement, there are other ways to determine that labor is progressing. Which of the following is NOT one of these ways?

Accepted Answer

While for about 10% of women, the bag of waters breaks at the onset of labor, for most mothers this happens at some point during labor. The "six ways to progress" in labor were popularized by Penny Simkin, and include the cervix ripening or softening, the movement of the cervix from back to front to better align with the birth canal, effacement, dilation, rotation of the fetal head to fit through the pelvis, and fetal descent measured as pelvic station. This is why labor takes so long!

Question 11

A doula is supporting a client who is in early labor. Which of the following guidelines is least important?

Accepted Answer

The doula should avoid projecting a definite time limit for labor to be completed. The length of labor can vary from client to client and still be within the normal limits. The outcomes should be realistic. The female client and her support person should be incorporated so that the labor experience is a shared one. Comfort promotion is essential.

Question 12

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

Increased amounts of vaginal discharge are commonly reported when lightening has occurred. Lightening may occur 10 to 14 days before labor. The client may report relief from diaphragmatic pressure and shortness of breath as the uterus becomes lower and more anterior. Although the client may report relief, the abdominal pressure increases, resulting in increased urinary frequency, shooting leg pains, and increased amounts of vaginal discharge.

Question 13

A doula is supporting a client who is in the first stage of labor. The client's amniotic membranes have not ruptured. Which of the following interventions is the most effective during this stage of labor?

Accepted Answer

The most effective intervention during the first stage of labor is to instruct the client to void at least every two hours. A full bladder may be misinterpreted as sensations of labor by the client. The doula may use distraction if the client proposed that as a means of handling contractions, though she may need uninterrupted focus as labor progresses. If the amniotic membranes have not ruptured, the client must be encouraged to ambulate. Therapeutic touch is recommended.

Question 14

A client's healthcare provider is about to perform an amniotomy on a client who is in the active phase of labor. Before the procedure, the doula counsels the client that after the amniotomy, she can expect:

Accepted Answer

The doula can share with the client that after amniotomy, many women experience increased efficiency of uterine contractions. Amniotomy is an artificial method of rupturing the membranes to induce labor. Rupturing the membranes allows the fetal head direct contact with the cervix, increasing the efficiency of the contractions. A fluttery feeling in the chest is expected after the administration of tertbutaline.

Question 15

A client telephones her doula to say she is in labor and is having some contractions. The client is at 37 weeks' gestation. Which of the following signs indicates that the client is in true labor?

Accepted Answer

Contractions that are initially felt in the lower back and then sweep around to the abdomen in a wave are a sign of true labor. Other signs of true labor include irregular contractions becoming regular; continuous contractions independent of activity level; increase in the duration, frequency and intensity of the contractions; and the occurrence of cervical dilatation. The other options are signs of false labor.

Question 16

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 successful labor depends on the 4 Ps: the passage, the passenger, the power of labor and the client's psyche. The passage is the route the fetus has to travel from the uterus, through the cervix and vagina and into the external perineum. The passenger is the fetus. Power refers to adequate uterine contractions without which full dilation may not be possible. Clients who have a strong sense of self-esteem manage labor the best.

Question 17

A client's healthcare provider notes that the presenting part of the fetus is at the +2 station. The doula explains to her client that means that the baby's presenting part is:

Accepted Answer

A +2 station indicates that the fetal presenting part is 2 cm below the ischial spine. A 0 station indicates that the fetal presenting part is at the level of the ischial spine and that engagement has occurred. A -2 station indicates that the fetal presenting part is above the ischial spine.

Question 18

A client is being monitoredduring labor and assessment findings reveal that the fetus is in LOA position. The healthcare provider notes that the presenting part of the fetus is at 0 station. The doula can share with the client that this means that:

Accepted Answer

A 0 station indicates that the presenting part, the head of the fetus, is at the level of the ischial spines and that engagement has occurred. Option A indicates a +4 station. Option C indicates a negative station. Option D describes descent, the first cardinal movement of labor. Station refers to the relationship of the presenting part of the fetus to the level of the ischial spines.

Question 19

A client in labor is expected to give birth less than three hours after the onset of contractions due to her previous birth history. Which of the following actions by the doula is the most effective during the labor process?

Accepted Answer

The most effective action during a precipitous labor is for the healthcare provider to deliver the infant between contractions should an immediate delivery become necessary. The client has to pant in between contractions. The healthcare provider should not attempt to keep the fetus from being delivered. The client can expect her provider to apply gentle pressure upward, toward the vagina, to prevent vaginal lacerations and damage to the fetal head.

Question 20

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

The client is in the active phase of labor. The active phase of labor is the second phase of the first stage of labor. The latent phase is manifested by cervical dilation from 0 to 3 cm and by contractions lasting 20 to 40 seconds. The active phase of labor is manifested by cervical dilation from 4 to 7 cm and by contractions occurring every three to five minutes, each lasting 40 to 60 seconds. The transitional phase is manifested by cervical dilation from 8 to 10 cm and by contractions lasting 60 to 90 seconds.

Quiz 3: Labor Birth