Question 1

A doula is creating a teaching plan for an adolescent girl who is pregnant for the first time. The main purpose is to promote nutritional health during pregnancy. Which of the following considerations is LEAST important when creating the teaching plan?

Accepted Answer

When teaching a group of adolescent girls who are pregnant, the doula should mainly consider the involvement of the clients' families, the financial status of the clients and the clients' cultures. Even a client who is receptive to changing her eating habits may have some difficulties if her family resists the changes. In adolescents, it is most important that the food preparers are willing to effect the change. If a client belongs to a low-income group, the client should be helped to secure financial assistance during her pregnancy. Food intake and eating habits are greatly influenced by culture.

Question 2

A doula is helping a 13-year-old client at 12 weeks' gestation consider her nutritional status. When working with an adolescent client, which of the following interventions is the most effective?

Accepted Answer

The doula should allow the client to reject traditional foods and respect her decisions. This is the most effective intervention when working with an adolescent client. Adolescents are searching for their identities during this stage, and they have a tendency to reject foods that their primary caregivers or parents see as important for them. The other options would be less effective interventions. The doula should recommend that the client's diet includes adequate nutrients and advise her to consume more than 2,500 calories per day. The client can be taught to prepare her snacks early in the day because it is during this time when she has the most energy. The doula should consider the client's food preparer because adolescents are not usually in charge of cooking the food they eat.

Question 3

A client is in her 18^th week of pregnancy. Which of the following psychosocial changes is expected at this time?

Accepted Answer

During the 18^th week of pregnancy, the client begins to concentrate on how it will feel to be a parent or how she will feel during the delivery. During the first trimester, the major developmental task is to accept the pregnancy. Ambivalence is a common reaction, and it can also occur in women who planned for the pregnancy. During the second trimester, an important developmental task is to accept the baby as a separate entity, and during the third trimester, the major developmental task is to prepare for the baby. Options C and D are commonly seen in clients during the third trimester.

Question 4

A doula is visiting a 25-year-old postpartum client who gave birth 18 hours ago. No complications were noted during the labor process. The newborn is brought to the client for feeding and to have the mother and child bond for the night. The client says, "I'm too tired. Please get her back to the nursery, just for tonight. I need to get some sleep." Which of the following is the most appropriate reaction from the doula?

Accepted Answer

The most appropriate action of the doula is to accept the client's behavior as an indication that she is in the taking-in phase. The taking-in phase occurs in the first 24 hours after birth. In this stage, the client is more concerned about her own needs than the baby's. The taking-hold phase is the next phase. A client in this phase demonstrates signs of readiness to learn and face responsibilities. The letting-go phase may begin weeks after the delivery. In this phase, the client incorporates the newborn into the family unit.

Question 5

A client who is due to give birth any time asks the doula what changes in the reproductive system she should expect after the delivery. Which of the following statements by the doula is the most appropriate?

Accepted Answer

The uterus never completely returns to its pre-pregnancy state. Involution is the process by which the reproductive organs return to their pre-pregnancy state. Although the uterus returns to its pre-pregnant size, its cavity becomes larger, its vessels become more convoluted, the external orifice is more marked, fissures are observed on its edges and the muscles are more defined. After birth, the uterus will weigh about 1,000 grams, but by the 6^thweek, it will weigh about 50 grams. The rate of uterine involution follows a usual pattern and rate. An hour after delivery, the fundus is palpated at the level of the umbilicus. In the next 24 hours, the fundus is expected to go down by one finger's breadth. On the second day, it is palpated two finger's breadths from the uterus. On the 10^th day the fundus is non palpable.

Question 6

A client who is pregnant for the first time asks the doula if she and her husband can still engage in sexual intercourse during her pregnancy. She is concerned that having sex may hurt the baby and cause a miscarriage. The client is at 12 weeks' gestation. The most recent physical examination reveals normal findings. The client's history is not remarkable. Which of the following statements made by the doula is the most appropriate?

Accepted Answer

The doula may inform the client that she and her husband may engage in sex as far into pregnancy as they wish and that they may need to adjust their positions during sexual intercourse. A position in which partners are side-by-side or the woman is in the superior position may be more comfortable, especially during the third trimester. There is no harm in engaging in sexual intercourse during pregnancy unless the client has a history of spontaneous miscarriage or vaginal spotting, or if she is at risk for premature rupture of membranes. Sexual intercourse should also be avoided in cases of untreated sexually transmitted diseases. She should consult her doctor or midwife to be sure there is no reason to abstain. The libido is most heightened during the second trimester. Increased sexual desire during pregnancy is due to increased blood flow to the pelvic area, increasing the sensations, and increased vaginal discharges.

Question 7

This theory of pain management supposes that pain messages to the brain travel on pathways that can be interrupted, or "gated-off," by other signals to the brain, such as touch, pressure, etc.

Accepted Answer

The gate control theory of pain management was proposed Melzack and Wall in the 1960s as a way of understanding how the body processes exposure to painful stimuli. The idea is that pain messages travel on small-fiber pathways to the brain, while other stimuli, such as touch, pressure, and even mental processing, travel on larger nerve pathways. These larger nerves can effectively "close the gate" on the noxious stimuli. Comfort theory is a nursing framework espousing meeting basic human needs. The Bradley method is a childbirth education model involving the partner as the coach. The fear-tension-pain cycle is a pain management model popularized by Grantly Dick-Read.

Question 8

Outlining the risks, benefits, and alternatives of any proposed procedure or treatment during pregnancy, labor, birth, and postpartum is known as?

Accepted Answer

Informed consent is the general term meaning that the healthcare provider educates the patient about the risks, benefits, and alternatives to any procedure, including doing nothing. The phrase implies that the patient will consent once all of the information is outlined for them, but the patient does have the right to informed refusal, as well. A pregnant or laboring mother may need help understanding her options to make a truly informed decision. Satisficing, problem analysis, and cost-benefit analysis are decision-making strategies.

Question 9

For pregnant couples, the benefits of attending a childbirth preparation class include:

Accepted Answer

A pregnant woman and her partner should be encouraged to attend childbirth preparation classes in order to learn more about the normal course of pregnancy, labor, birth, and the postpartum period. In addition to this practical information, couples will have the opportunity to make connections with others at the same stage of development, a benefit that should not be overlooked. In addition, research shows women who attend birthing classes are more confident in the decisions they make.

Question 10

Research shows that doula care during labor and birth can:

Accepted Answer

Doula care not only reduces the chance of a Caesarean birth, but also lessens the need for pain medication and assisted delivery (forceps or vacuum extraction). Mothers who have a doula during their labor and birth report fewer negative feelings about the overall experience, and have an easier time adjusting to their new parenting role. While some people may initially think the doula usurps the partner's place as the mother's support person, the doula actually supports both mom and her partner during the birth process.

Question 11

Relaxation can reduce the perception of pain, as well as increase the pain threshold. Active relaxation techniques can effectively reverse negative trends in which of the following pain management models?

Accepted Answer

Described by Grantly Dick-Read in 1959, the fear-tension-pain cycle supposes that an increase in fear can increase tension which can in turn increase pain. If the cycle can be stopped or reversed at any point, pain can be lessened. For example, relaxation can lessen pain, making a woman less fearful about the contractions of labor. Dissociation is focusing on the non-painful feelings of an experience to transform the pain sensation. The Hawthorne effect describes what happens when a subject believes an expert is helping them achieve what they could not on their own. Cognitive control is a pain management theory of focusing on other activities to limit the noxious sensations.

Question 12

What does the term "doula" mean and where did it originate?

Accepted Answer

The word "doula" is from ancient Greek meaning "female slave" or "a woman who serves." It has come to mean a person who is trained to provide continuous emotional and physical support during childbirth. It can also refer to an experienced professional who supports a mother and baby after birth. These modern usages originated from anthropological literature in the 1970s.

Question 13

Which of the following is NOT a principle of ethics that applies to childbirth?

Accepted Answer

While doulas do need to protect their clients' privacy and confidentiality, HIPAA stands for the Health Insurance Portability and Accountability Act, a policy enacted by the US Congress in 1996 to protect health data, among other provisions. Ethics is the study of morality, or what is considered right and wrong. Morality can be influenced by culture, race, gender, etc. The study of ethics in the perinatal period is typically focused on bioethics, or the moral implications of the use of technological advances and biological discoveries to inform healthcare options. Autonomy is the right of self-determination, and applies to informed consent and informed refusal in the perinatal period. Nonmaleficence means "first, do no harm" and is the overriding principle of all medicine. Justice is the ethical principle that everyone has the right to be treated fairly and equally without prejudice.

Question 14

While all doulas hope to only help couples through happy births, occasionally unexpected outcomes cause grief reactions in the couples doulas support, as well as in the doula herself. Which of the following is NOT a way to help with grieving?

Accepted Answer

The doula can continue to be an integral source of emotional support during a period of grieving, whether from the death of a baby, or from a birth that did not go as planned. The doula can serve as a resource - an independent party who can answer questions about what happened, and help the couple find sources of answers and support. Individuals all grieve in their own ways, and a doula can support them in healthy progression or by suggesting professional counseling. The doula should see that her own mental and emotional tank is refilled, either by discussing the situation with a trusted colleague or a mental health professional.

Question 15

Why is professional labor support needed in the modern maternity care model?

Accepted Answer

Historically, in almost all cultures, women have been supported by women throughout labor and birth. With the move to hospital birth in the 20th century, many of the traditions associated with this care were lost. While hospital births are safer in some conditions, for most births the hospital is not a necessity. In fact, a mother's risk of complications is increased once she gets to the facility. A doula can counteract this trend. Research shows that women who are cared for by a doula have fewer interventions, use less pain medication, and have a more positive outlook on the birth than those without a doula. While women inherently know how to birth, they may lack the confidence necessary to trust their inner wisdom. Partners are an important component in the birth process, but may be too emotionally invested to provide the best care.

Question 16

Which of the following is NOT within the scope of practice for a doula?

Accepted Answer

Vaginal exams are outside the scope of practice for doulas. Clinical and medical tasks should only be performed by a trained healthcare professional, such as an obstetrician, midwife, or nurse. A doula is hired by expectant couples to prove physical and emotional support to the couple during the perinatal period. She will work with the mother-to-be and her partner to sort through childbirth choices, write a birth plan, and to advocate for their wishes.

Question 17

Which of the following is a past experience that might impact a woman's ability to birth confidently?

Accepted Answer

Prior reproductive history can have a huge impact on a woman's confidence with her body. If she has had a history of infertility, miscarriage, previous Caesarean birth, etc. she may not believe her body is capable. If she has given a baby up for adoption or terminated a previous pregnancy, she may have feelings of inadequacy in her ability to mother. A history of sexual abuse as well as previous traumatic birth experiences can cause a woman to feel unable to confront situations involving her most intimate body parts, including birth. Level of education and rural upbringing do not have much impact on a woman's psychological ability to birth. Previous health challenges can impact birth in both positive and negative ways - she may either feel capable for overcoming them, or weak and frail from being subjected to them.

Question 18

Which of the following BEST describes the emotional stages of pregnancy?

Accepted Answer

A woman first accepts the reality of pregnancy and incorporates the new identity into her self-perception. She then begins to see the fetus as separate from herself, and starts to form attachment bonds to her unborn baby. Lastly, she realizes the baby will become physically separate from her body, perhaps taking birthing classes to prepare for this eventuality. A doula needs to be aware of the typical stages women go through emotionally during pregnancy so she can look for any warning signs that the woman may need more in-depth counseling so her emotions do not impact labor and birth. The progression from denial to resolution describes grief processing. The stages of labor (1^st, 2^nd, 3^rd) are the way childbirth is typically discussed. Early, active and transition are the phases of first stage labor.

Question 19

Which of the following is NOT a frustration doulas have to contend with?

Accepted Answer

Doulas help clients to advocate for themselves, and being able to see their teaching in action is rewarding. Some frustrations doulas might face include uncertainty about the time of birth (hence, being "on-call"), doctors and nurses who resent the intrusion of a doula on "their turf," and parents who expect the doula to take ultimate responsibility for the choices and outcomes of birth. Doulas need patience, creativity, knowledge, good communication skills, and more in order to deal with these situations.

Question 20

"Women's ways of knowing" is a phrase that implies women have the inherent knowledge necessary to make decisions and these decisions may stem from intuition. This is opposed to a power-based model where the keepers of knowledge know best what decisions a woman should make. The terms for these two thought processes might be viewed as:

Accepted Answer

Embodied knowledge is derived from the woman's perception of her own body and its natural abilities, while authoritative knowledge takes power away from the mother and gives it to an "expert." Doulas need to remain open to embodied knowledge from mothers, and not let their expert status take over in decision-making. Expectant versus active management is usually used in reference to the third stage of labor. Woman-centered care focuses on the needs of the individual woman as opposed to the desires of the medical establishment.

Quiz 6: Psychology Philosophy