Question 1

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

Accepted Answer

While a woman's uterus is healing, healthcare providers typically recommend she abstain from intercourse. Women all react differently to the hormones of birth and breastfeeding - for some, a decreased libido is the result. For others, the return to normal sexual relations is quick and easy. Intercourse may also be uncomfortable at first due to a healing episiotomy or laceration, or to a lack of lubrication. Return of ovulation is idiosyncratic, and cannot be predicted. So, as soon as partners resume a sexual relationship, they should use contraception. Some couples are so busy with babycare, their sex life takes a back seat for a while. Breast do tend to leak during sex - oxytocin is the hormone of love and of orgasm, while at the same time being the milk-ejection hormone - though whether or not it is a "turn-off" is very individual.

Question 2

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

Accepted Answer

Phone calls, letters, emails, social media posts, etc. can be postponed as new parents focus on their new baby at home. A doula is in a unique position to help ease the transition to parenthood. Some of her suggestions might include limiting how many visitors the new parents have so they do not feel obligated to entertain, encouraging mom to rest or sleep when the baby sleeps (sleep deprivation is the number one obstacle new parents face), and ensuring the new mom eats well and drinks as her thirst dictates (especially if she is breastfeeding). Other suggestions for new parents include regular exercise and fresh air, asking for help from visitors, or hiring a service to help with household chores. The doula might also be trained as a postpartum doula, and may be offering her services in the home.

Question 3

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

Accepted Answer

Babies are most receptive to interaction when they are in the quiet alert state. Wide-open eyes, eye contact, and limited body movement typify this state. Babies are typically in this state for the first couple of hours after birth, and then cycle between states all day long. Sometimes referred to as the "continuum of arousal," the infant states go back and forth from deep sleep (the least aroused) to light sleep, to drowsiness, to quiet alert, active alert, and finally crying (the most highly aroused state). Learning individual infant states and reactions helps new parents recognize hunger and sleep cues, as well as help baby to conserve energy for growth by quickly helping baby to move out of the crying state.

Question 4

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

Accepted Answer

Bruising is sometimes seen in newborns who have had some sort of birth trauma, or who were assisted into the world by forceps or a vacuum extractor, but it is not typical. Normal newborn traits that may concern parents include birthmarks (various types can occur in various locations on the body), vernix (a waxy coating on baby's skin), lanugo (a fine hair all over baby's body), swelling of genitalia and breasts (in both genders), swelling of the face or a cone shaped head (especially after a vaginal birth), and more.

Question 5

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

Accepted Answer

Circumcision is not a routine procedure. It is an elective surgery that usually is not performed until after the first 24 hours of baby's life. In the delivery room, babies are commonly weighed and measured, dried, covered, and assigned APGAR scores. Certain procedures, such as eye ointment and a vitamin K injection, are sometimes routinely done in the delivery room, but can be postponed until after the mother and baby have had a chance to breastfeed (or until after the first hour). All routine newborn care can be performed while mom and baby are skin-to-skin, unless separation is medically necessary.

Question 6

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:

Accepted Answer

Abstinence is the most effective way to protect against conception. Natural family planning has a failure rate of about 20%. Oral contraception has an overall failure rate of about 3%. If used correctly, oral contraceptives are 99.5% effective. Surgical methods have a failure rate between 0.1 and 0.4%.

Question 7

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:

Accepted Answer

A newborn placed under phototherapy lights passes bright green stools because of increased bilirubin excretion. Blackish-green stools are usually passed within 24 hours after birth. Light yellow stools are passed by breastfed newborns by the fourth day of life. Bright yellow stools are passed by formula-fed newborns.

Question 8

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

Accepted Answer

Nevus flammeus lesions, also known as stork's beak marks or stork bites, do not fade, but they are usually covered by the hair line. They are more common in females than in males. These lesions are classified as vascular tumors of the skin. They are not caused by an injury during labor. Mongolian spots may disappear by school age without treatment.

Question 9

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?

Accepted Answer

Bowel elimination usually occurs within two to three days after vaginal birth. For postpartum clients who had a Caesarean section, bowel elimination may not occur until three or four days after birth. The client should be encouraged to increase her intake of fiber and fluids and to engage in safe physical activities to relieve constipation. Constipation commonly occurs after birth due to many factors, such as reduced intake of food, anesthesia, and use of narcotics or pain medications. A doula should always refer a client to her healthcare provider with medical questions, but can certainly provide ideas for increased comfort, as well as information about norms.

Question 10

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:

Accepted Answer

The client has postpartum blues. Postpartum blues occurs shortly after childbirth and dissipates quickly. The client may experience crying and express feelings of emptiness. Research shows that postpartum blues occurs in about 70% of postpartum clients. Postpartum depression, on the other hand, occurs in the first few months after childbirth and may last up to a year. Counseling may be recommended. Postpartum psychosis occurs during the first month after childbirth. Clients may have delusions and hallucinations. Drug therapy and psychotherapy are usually recommended.

Question 11

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?

Accepted Answer

The client has postpartum psychosis, which is manifested by feelings of depression and hallucinations. A history of clinical depression increases a woman's risk for postpartum psychosis. The doula's priority is to protect the client and child from injury. In addition to suicide ideation, it is not uncommon for women with this condition to have the urge to hurt their babies. The doula must be alert when a client reveals this information, helping the client to get help immediately. Offering compassion is more appropriate for clients with postpartum blues. Counseling is usually recommended to client with postpartum depression.

Question 12

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

Accepted Answer

The client should be encouraged to eat oranges. Citrus fruits and juices are high in vitamin C, which is necessary to form collagen. Collagen is used in the synthesis of skin, scar tissues, and blood vessels. Bananas are high in potassium. Wheat bread is high in fiber, which lowers cholesterol and prevents constipation. Milk is high in calcium.

Quiz 4: Post-Partum