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1101 Cards in this Set
- Front
- Back
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The midwife's most basic task is to do everything she can to promote...
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a mother's relaxation and peace of mind. 7
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The midwife's most precious tool:
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her hands 7
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A tenet of woman-centered care:
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surrendering expectations to whatever the mother and her supporters need or desire 7
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What must we never forget to do in crisis situations or when we are trying to facilitate progress?
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Ask the mother's opinion and perceptions 7
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What is the cornerstone of effective midwifery practice?
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prenatal assessment; the better we do our work prenatally, the less we are surprised by long, drawn-out labors 11
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Assessment is particularly crucial during what period of pregnancy?
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the last 6 weeks 11
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What is crucial to establish from the very beginning of your relationship with a client?
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the mother's responsibility for her own experience 12
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What is your most important task in the initial interview?
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To determine whether you and the mother are suited to work together 12
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Social instincts include:
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the need to belong, to be a member of a group and to be recognized by that group. These instincts lead us to make socially recognized choices 12
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Biological instincts include:
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need for survival and self-realization 12
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What must you disclose to your client at the initial prenatal visit?
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Your training, philosophy, style of practice and expectations of clients 13
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Early in caregiving, the two most serious emergencies ___ and ___, require detailed discussion.
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Hemorrhage and fetal distress 14
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Medical history can be taken by ___ or provided by the mother via a ____.
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Interview, take-home form 14
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Preexisting conditions that contraindicate home birth:
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preexisting diabetes, hypertension, thyroid disease (hyper), chronic lung disease, severe asthma, epilepsy, clotting disorders, congenital heart disease (grades 2-4) and kidney disease 14
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Conditions arising in pregnancy that rule out home birth:
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Rh- with antibodies, severe anemia unresponsive to treatment and acute viral infections (depending on when they occur) such as rubella, cytomegalovirus, toxoplasmosis, chicken pox or herpes 14
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History of previous childbirth losses requires attention to ___ and ___.
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physical factors and mother's emotional recovery 14
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Any history of abortion should be discussed (when)...
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as soon as the mother is ready 14
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Psychological issues for a mother desiring a VBAC are..
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formidable. She may have been told she needed surgery because her bones were too small, her hormone levels too low, or she simply failed to progress. Such comments leave devastating scars and before vaginal birth is attempted, some healing must take place 15
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Prime symptom of fibroids:
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painless bleeding with intercourse 15
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Which benign uterine masses vary in size but tend to grow considerably during pregnancy?
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Fibroids 15
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Depending on whether they are external or internal, fibroids may affect a pregnancy in the following ways:
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reduced intrauterine space, disrupted placental implantation and immediate postpartum may be complicated by hemorrhage 15
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If the mother has had a cone biopsy, _____ may retard dilation.
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considerable scarring 15
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Cervical cauterization and cryosurgery are less traumatic than cone biopsy, but the cervix should still be check for ____.
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scarring 15
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Scar tissue may be softened by _____ massaged gently onto the cervix in the last few weeks of pregnancy.
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evening primrose oil 15
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LEEP, a laser procedure similar in effect to cone biopsy, has been correlated to ____ and ___.
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incompetent cervix and premature labor 15
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If a mother had an IUD prior to conception, she may be ____ due to excess menstruation and should be checked for this as soon as possible.
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anemic 15
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IUD can cause scarring of _____ which predisposes to ectopic pregnancy, irregular implantation of the placenta and third-stage hemorrhage.
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the uterine lining 16
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Pelvic inflammatory disease has been correlated to
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ectopic pregnancy, irregular implantation of the placenta and third-stage hemorrhage 16
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If the mother used hormonal contraception immediately prior to pregnancy, she may be deficient in _____ and should be advised to begin supplementation at once.
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folic acid 16
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Any incidence of _____ or ____ is significant and should be closely tracked by both mother and midwife.
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bleeding or spotting 16
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The window for ectopic rupture is _____ weeks gestation.
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10-13 weeks page 16
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If a woman reports bleeding or spotting combined with nonrhythmic pain, the midwife should...
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immediately consult with backup to rule out tubal pregnancy 16
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Generalized edema experienced before conception or prior to 24 weeks should be...
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medically evaluated 16
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If bleeding during pregnancy becomes chronic, ___ and ___ must be ruled out.
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missed abortion and molar pregnancy 16
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If a woman experiences bleeding in late pregnancy, _____ must be ruled out.
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placental problems 16
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Generalized edema occurring late in pregnancy indicates possible...
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preeclampsia 16
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In the case of generalized edema at any stage of pregnancy, immediately have the mother change her diet in the following ways:
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eliminate heavily processed foods, suggest plenty of high-quality protein, fresh veggies, salt to taste and ample fluids 16
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______ and _____ may cause occasional headaches.
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Hormones and circulatory changes 16
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A persistent headache, particularly in combination with signs of preeclampsia, indicates...
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a medical crisis and the need for immediate referral 16
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Urgent warning signs of preeclampsia:
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visual problems, upper abdominal pain, epigastric pain - especially on the right side 16
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Any history of flu-like symptoms such as swollen glands, extreme fatigue or generalized body aches should be noted, as they could indicate...
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an acute viral infection 16
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A fairly common infection (60% of the general population has antibodies) that is most damaging in the first trimester.
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Cytomegalovirus 16
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Toxoplasmosis is known to cause severe neurological damage to the fetus but only if contracted after ____ weeks.
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10 weeks 16
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Mothers can minimize their risk of contracting toxoplasmosis by avoiding ____ and ___.
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uncooked meat and any contact with cat feces 16
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A report of painful vaginal sores combined with flu-like malaise in early pregnancy may indicate an initial outbreak of...
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herpes 16
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In case of a suspected initial herpes outbreak what should the midwife do?
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Check the mother's history, do a visual inspection and take cultures, immediately consult backup 16
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What is the standard of care for delivery if a mother has active herpes lesions at the onset of labor?
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cesarean section, as neonatal infection can lead to CNS damage and death 16
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Any history of vomiting with the pregnancy should be carefully explored to rule out
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hyperemesis gravidarum 17
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A mother with _____ cannot retain either food or liquid and must be restabilized with intravenous replacement therapy before she can eat or drink again.
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hyperemesis gravidarum 17
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If chronic vomiting persists beyond the first trimester the midwife should...
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consult with a colleague or physician backup 17
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_____ is one of the only conditions for which conventional medicine acknowledges emotional underpinnings.
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Hyperemesis gravidarum 17
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___ combined with dizziness or nausea beyond the first trimester may indicate anemia.
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Fatigue 17
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During pregnancy characteristic signs of UTI may be nearly absent due to...
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progesterone's softening effect on the urethra 17
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UTI can lead to pyelonephritis (kidney infection) which can lead to...
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premature labor 17
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The blood-brain barrier, which ordinarily protects the brain from harmful substances, is ____ in the fetus.
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undeveloped 17
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Women should avoid over the counter medications with the same vigilance they do ____ or ____.
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alcohol or recreational drugs 17
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Any substance that can harm the fetus or cause fetal anomalies is called a ...
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teratogen 17
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Every woman should have a complete _____ early in her pregnancy, unless she has had one within the past year.
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physical examination18
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How do you calculate Naegele's rule?
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Count back three months and add one week to get EDD 19
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The Mittendorf study showed the average length of human gestation to be ____
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41 weeks plus 1 day 19
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_% of women give birth on their due date
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5% 19
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Nichols Rule takes into account:
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variations in cycle length and previous childbearing 21
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Before proceeding to physical assessment in the initial prenatal, ask the mother's permission and ____
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clearly obtain her consent 21
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Assuming a woman's starting weight (prepregnancy) was normal for her height and frame, an average gain is about ___
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a pound a week 21
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Ketones in urine signal...
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inadequate food intake or dehydration 21
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Blood or protein found in urine require....
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another clean-catch sample to rule out contamination from vaginal discharge 21
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Anything over ___ protein in urine may indicate preeeclampsia.
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a trace of 21
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____ or ____ in urine are suggestive of UTI.
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Blood or nitrates 21
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The systolic reading indicates pressure in the arteries when...
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the heart is actively pumping 21
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The diastolic reading indicates pressure in the arteries when
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the heart is at rest 21
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Normal blood pressure during pregnancy ranges from ___ to ___
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90/50 to 140/90 although reading higher than 130/80 or a steady rise from baseline are cause for concern 21
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Medical texts claim that only the systolic reading (blood pressure) is influenced by ____
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emotional state 21
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Women with consistent BP readings of 130/80 or more in early pregnancy may have...
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undiagnosed essential hypertension 21
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Occasionally women have greenish or bloody discharge from the nipples which is...
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perfectly normal but should still be evaluated by an expert 22
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Many women give up on self breast exam because they feel ___ or because they are alarmed to find ____
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the technique is complicated, their breasts are lumpy instead of smooth 22
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When doing a breast exam, focus on the _____ as this is the area that contains the most tissue and is therefore the most likely site for abnormal growth.
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upper, outer quadrant of the breast 22
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If at any time you find a lump or mass during a breast exam, immediately ____
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check the same spot in the other breast (if structures match, everything is fine) 22
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During a breast exam, be sure to feel directly beneath the nipple and then _____
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squeeze the nipple gently to check for any secretion 22
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Colostrum may be evident after...
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the first months of pregnancy 22
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The midwife should begin the breast exam by observing te woman's breasts while she is sitting upright. The midwife should be looking for:
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symmetry, noting nipples pointing in an unnatural way, any puckering or pull around the areola, or irregularities in skin texture 22
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During an initial internal exam, the midwife should note the following about the cervix:
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consistency, length, patency, position (central, posterior or anterior), any growth at or from the os, which may be cysts or polyps 23
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If the woman is 16 weeks or fewer, you may confirm the EDD by doing a ____ to size the uterus.
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bimanual exam 23
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EDD can be confirmed at less than 16 weeks by doing a bimanual exam. Where should the fundus be at 10, 12 and 16 weeks?
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"Press up firmly on the cervix with your internal hand while using your other hand to palpate the fundus. As you bring your hands together, you will get an idea of how large the uterus has grown. At 10 weeks the fundus barely clears the pubic bone; at 12 weeks it is generally a few centimeters above the pubis; at 16 weeks it is midway between the pubic bone and the umbilicus 23
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When doing pelvimetry, if the sacral curve feels flat, you should note the possibility of which type of pelvis?
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android 23
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____ is unreliable in predicting pelvic capacity.
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Hip size 25
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What are the 5 assessments made when doing pelvimetry?
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1) Depth of sacral curve
2) Size of pelvic inlet (diagonal conjugate, obstetric conjugate) 3) Contour of and distance between ischial spines (interspinous diameter) 4) Angle, or width of pubic arch 5) Outlet dimension, or intertuberous diameter 24-25 |
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What is considered an adequate measurement for the obstetrical conjugate?
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10.5 cm or greater 24
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What is considered an adequate interspinous diameter?
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10.5 cm or great 25
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What is considered an adequate width of the pubic arch?
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2 finger breadths or 90 degrees 25
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What is considered an adequate intertuberous diameter?
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8.5 cm or greater 25
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In terms of pelvic type, it basically all comes down to ___ in relationship to ____.
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depth (sacral curve and inlet dimension) in relationship to width (between spines, of pubic arch and between ischial tuberosities) 25
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The pelvis where the depth and width are relatively equal.
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gynecoid 25
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The most common type of female pelvis.
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Gynecoid 25
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The pelvis that provides a round space for the baby to pass through.
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gynecoid 25
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The pelvis that is notably deeper than it is wide.
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Anthropoid 25
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What are the 5 assessments made when doing pelvimetry?
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1) Depth of sacral curve
2) Size of pelvic inlet (diagonal conjugate, obstetric conjugate) 3) Contour of and distance between ischial spines (interspinous diameter) 4) Angle, or width of pubic arch 5) Outlet dimension, or intertuberous diameter 24-25 |
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What is considered an adequate measurement for the obstetrical conjugate?
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10.5 cm or greater 24
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What is considered an adequate interspinous diameter?
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10.5 cm or great 25
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What is considered an adequate width of the pubic arch?
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2 finger breadths or 90 degrees 25
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What is considered an adequate intertuberous diameter?
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8.5 cm or greater 25
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In terms of pelvic type, it basically all comes down to ___ in relationship to ____.
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depth (sacral curve and inlet dimension) in relationship to width (between spines, of pubic arch and between ischial tuberosities) 25
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The pelvis where the depth and width are relatively equal.
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gynecoid 25
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The most common type of female pelvis.
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Gynecoid 25
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The pelvis that provides a round space for the baby to pass through.
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gynecoid 25
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The pelvis that is notably deeper than it is wide.
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Anthropoid 25
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The pelvis that is a tall oval with great depth in the sacral curve.
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Anthropoid 25
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The pelvis that is more narrow in width than the average gynecoid.
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Anthropoid 25
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The pelvis that is wider than it is deep.
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Platypelloid 25
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The pelvis that is a wide oval, with less depth in the sacral curve but more width than the average gynecoid
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Platypelloid 25
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The pelvis with prominent, close-set spines.
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Android 25
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The pelvis with tapering sidewalls.
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Android 25
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The pelvis with a narrow pubic arch (less than 80 degrees) and close-set tuberosities.
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Android 25
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The "funnel" pelvis.
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Android 25
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Why is the android pelvis sometimes called the "funnel" pelvis?
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Because is gets more and more narrow toward the outlet 25
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The four pelvic joints:
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1) symphysis pubis; 2) sacrococcygeal joint, 3 and 4) sacroiliac joints 25
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When referring to "passage" in the three P's, passage is not just the pelvis, but includes ___ as well.
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vaginal muscles 25
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What are the three P's?
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passage, passenger and powers 25
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The significance of the three P's is based on their ___
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interrelationship 25
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Fundal height may be assessed beginning at __ weeks.
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18 weeks, page 28
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Your evaluations of the uterus and baby from 24 weeks on include determinations of ...
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fetal lie, presentation, position and attitude as well as assessment of fetal growth, fetal responsiveness and amniotic fluid volume 28
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What is the relationship of the baby to the long axis of the mother's body?
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Fetal lie 28
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Define fetal lie.
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The relationship of the baby to the long axis of the mother's body 28
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Fetal lie can be ___, ___ or ___
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longitudinal, oblique or transverse 28
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The part of the fetus used to determine the position of the baby is the ...
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denominator 28
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If the lie is longitudinal with the butt at the pubic bone, the presentation is ...
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breech 28
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If the lie is longitudinal with the head at the pubic bone, the presentation is ...
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cephalic 28
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With breech presentation, the denominator is the ...
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sacrum 30
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____ is based on the location of the denominator within the mother's pelvis.
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Fetal position 30
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What is the position when the baby is head down with its occiput and back on the mother's right side?
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Right occiput transverse (ROT) 30
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What is the position if the baby is breech with sacrum and back on the mother's left near her pubic bone?
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Left sacrum anterior (LSA) 30
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____ is a subtle assessment of the degree of fetal head flexion
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Attitude 30
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Deflexion of the head can be corrected most effectively around ___ weeks gestation
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35 weeks page 30
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The fetal heart should be audible by ___ weeks with a fetascope.
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20 weeks page 30
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Variability in FHT should be documented by ___ weeks.
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28 weeks page 30
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How do you check for variability with a Doppler?
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Listen for several 15 second increments, determining the BPM rate for each and charting the overall range 30
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Variability typically occurs in response to ...
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palpation, uterine contractions or the baby's own movements 30
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Heart tone variability is considered a sign of ____ health
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neurological 30
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There is hardly a perinatal complication that cannot be forestalled or mediated to some degree by _____
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good nutrition 32
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Base your nutritional recommendations on the mother's ____ day record of her food and fluid intake, including all supplements.
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3-day 32
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High quantities of vitamin C taken near the time of delivery can cause newborn withdrawal symptoms, including...
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scurvy 32
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Sesame butter (tahini) is an excellent source of ...
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calcium 32
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Orange juice "plus ___" is an excellent source of ____
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calcium 32
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Pumpkin seeds are a good source of ...
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iron 32
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Dried fruits are a good source of ...
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iron 32
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Almonds are a good source of ...
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iron 32
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Shiitake mushrooms contain lots of ___ but also contain the analog to this vitamin which blocks absorption of the real thing.
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B-12 page 32
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Seaweed contains lots of __ but also contains analogs of the vitamin that can block absorption of the real thing.
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B-12 page 32
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Spirulina is high in ___ but also contains analogs of the vitamin that can block absorption of the real thing.
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B-12 page 32
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Fermented soy products are said to contain high amounts of ___ but also contains analogs of the vitamin that can block absorption of the real thing.
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B-12 page 32
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Fortified soy products are excellent sources of ___
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B-12 page 32
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Fortified fresh juices can be excellent sources of ___
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B-12 page 32
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The natural voice of hunger only operates in women free of addictions to...
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sugar, caffeine, alcohol or marijuana 33
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A sudden drop in activity can cause __, ___ or __ for the active mother.
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constipation, circulatory problems or nervous irritability 34
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Psychological contraindications to home birth include...
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an irresponsible attitude, hostility in response to basic suggestions for self-care, or an otherwise rigid belief system should give the midwife pause 35
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The CBC (complete blood count) or prenatal panel is primarily used to help you determine whether the mother is ____
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anemic, and, to some extent, what type of anemia she has 35
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HGB, or hemoglobin, is...
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the amount of hemoglobin per red blood cell 35
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HCT, or hematocrit, is...
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the percentage of red blood cells per total blood volume 35
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The HGB should be above...
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11 page 35
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The HCT should be ...
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33 or more page 35
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Because red blood cells are the oxygen carriers, low HGB or HCT readings mean that mother and baby will suffer some degree of ___
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oxygen deprivation 35
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If a mother is anemic at the onset of labor, there is risk of ...
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fetal distress, incoordinate or prolonged labor, postpartum hemorrhage (from "tired uterus") and infection 36
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Why can even a moderate blood loss be very serious for an anemic woman?
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because her blood is poorly oxygenated to begin with, predisposing her to shock 36
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Syphilis can cause...
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miscarriage, prematurity, neonatal infection, fetal malformation or death 36
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A Pap smear tests for...
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irregular cells at the cervix 36
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Why is a Pap smear crucial in pregnancy?
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Because hormonal change in pregnancy may precipitate abnormal cell growth 36
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Why should you do the Pap prior to pelvic assessment?
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to prevent lubricating gel from contaminating test results 36
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Cells for the Pap smear should be taken from the ...
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squamo-columnar junction 36
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Where is the usual site for abnormal cervical cells?
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the squamo-columnar junction 36
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If the squamo-columnar junction is invisible, where can it be found?
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just inside the cervical os 36
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The squamo-columnar junction is also called the...
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transformation zone 36
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___ is now the most prevalent sexually transmitted disease.
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HPV 36
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HPV resides in the ____ in the genital area
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nerve ganglia 36
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HPV can manifest as visible genital warts or flat lesions called...
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condyloma accuminata 36
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___ is the second most prevalent sexually transmitted disease in the US.
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Chlamydia 36
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Chlamydia is four times more prevalent than ____
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gonorrhea 36
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Gonorrhea infection in the mother can lead to ...
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chorioamnionitis, premature rupture of membranes and premature labor 36-7
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____ the usual treatment for chlamydia, is contraindicated during pregnancy because it can discolor fetal tooth enamel.
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Tetracycline 37
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___ is nearly as effective as tetracycline in treating chlamydia and is considered safe in pregnancy.
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Erythromycin 37
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Hepatitis B (HBV) is transmitted through ...
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blood, blood by-products, saliva, vaginal secretions or semen 37
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HBV is ___ contagious.
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highly 37
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Babies born to mothers infected with HBV should be immunized within __ after birth.
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12 hours 37
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If a baby born to a HBV positive mom is immunized for HBV after birth, is breastfeeding contraindicated?
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No, breastfeeding is ok 37
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What are signs of an active HBV infection?
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Nausea, vomiting, right upper quadrant abdominal pain, chills and fever 37
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What should be done in case an expectant mother presents with signs of an active HBV infection?
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The mother should be hospitalized and all family members screened 37
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If an expectant mother is found to be a carrier of HBV but has no signs of active infection, what should be done?
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No special care is required (baby should receive HBV vaccine after birth) 37
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Is breastmilk affected by Hepatitis C?
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NO 37
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Is there an immunization for hepatitis C (HCV)?
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No 37
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If a mother contracts rubella during pregnancy what kinds of defects would her baby be at risk for?
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Heart, vision and hearing 38
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What is the process by which the mother produces antibodies against her baby's red blood cells, rendering it severely anemic?
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Isoimmunization 38
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What is RhoGAM?
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an antigen that blocks the development of antibodies 38
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RhoGAM must be administered within what time frame after birth to be effective?
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72 hours 38
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Any woman who coughs up blood, has difficulty breathing, and suffers weight loss, fever or fatigue should be immediately referred to a physician for ___ screening.
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tuberculosis 39
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Parents of Greek or Italian descent have a fetus that is at higher risk for ...
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B-Thalassemia 39
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Asian or Filipino parents have a fetus with a greater risk for ...
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A-Thalassemia 39
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A-Thalassemia and B-Thalassemia are ...
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life threatening anemias 39
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If parents are of African descent, they may carry ____ that can cause severe anemia.
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the sickle-cell gene 39
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Jewish couples may be carriers of ____ or ____ diseases.
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Tay-Sachs or Canavan diseases 39
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Tay-Sachs and Canavan diseases both lead to ...
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central nervous system degeneration and death 39
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European parents are at risk for a fetus with ____.
|
cystic fibrosis 39
|
|
|
Cystic fibrosis is characterized by ____ and ____.
|
lung disease and limited life span 39
|
|
|
What is the first layer of genetic screening offered?
|
Alpha-fetoprotein screening (MsAFP) 39
|
|
|
What does MsAFP stand for?
|
alpha-fetoprotein screening 39
|
|
|
What is the acronym for alpha-fetoprotein screening?
|
MsAFP 39
|
|
|
When is MsAFP offered?
|
15 to 20 weeks gestation 39
|
|
|
What does the alpha-fetoprotein test screen for?
|
neural tube defects such as anencephaly, microcephaly, hydrocephaly and spina bifida 39
|
|
|
The MsAFP test detects up to 20% of ____ cases.
|
Down syndrome 39
|
|
|
The MsAFP has a __% false positive rate.
|
20% page 39
|
|
|
The ____, which combines AFP with hCG and unconjugated estrogen levels is much more accurate than the MsAFP screen.
|
The triple screen 39
|
|
|
The triple screen detects __% of Down syndrome cases.
|
65% page 39
|
|
|
If the triple screen is positive, what is the next step?
|
Amniocentesis (although some mothers decide against it due to the invasive nature of the procedure and concomitant risk of infection) 39
|
|
|
___ test cannot be performed before 14 weeks because there is not enough amniotic fluid.
|
Amniocentesis 39
|
|
|
When is the optimal time for amniocentesis to be performed?
|
14 to 16 weeks gestation 39
|
|
|
Chorionic villus sampling can be performed when?
|
At 10-12 weeks gestation 39
|
|
|
Which procedure carries greater risks of miscarriage and infection: amniocentesis or chorionic villus sampling?
|
Chorionic villus sampling because the requisite sample of placental tissue must be obtained through the cervix 39
|
|
|
What is the first sign of fetal group B strep infection?
|
Cessation of breathing 40
|
|
|
Spinal meningitis is a common manifestation of what fetal infection?
|
Group B strep 40
|
|
|
If positive, IV antibiotics for Group B Strep are advised during labor in which three situations?
|
Membranes are ruptured for more than 18 hours, preterm labor, or if the mother develops a fever 40
(this is different than Varney's, which recommends all positive GBS women be treated with antibiotics and the above three situations are only if GBS status is UNKNOWN) |
|
|
The embryonic period of fetal development includes which weeks?
|
The 1st through the 7th weeks postfertilization 41
|
|
|
The fetal period includes all fetal development after ____ and before ____
|
the embryonic period and before the time of birth 41
|
|
|
The pronucleus of the sperm and the ovum fuse to form the ...
|
zygote 41
|
|
|
Each pronucleus contains __ chromosomes.
|
23 page 41
|
|
|
What is the haploid number of chromosomes?
|
23 page 41
|
|
|
What is the diploid number of chromosomes?
|
46 page 41
|
|
|
Immediately after fertilization, the zygote undergoes cleavage and becomes a ...
|
morula 41
|
|
|
As the morula develops and fluid enters the mass, it becomes a ...
|
blastocyst 41
|
|
|
When does the heart start to beat?
|
Around the beginning of the 4th week postconception (the 22nd day postconception) or the beginning of the 6th week gestation (dating from the LMP) 41
|
|
|
When do the ears, arms legs, facial and neck structures begin to form?
|
At the end of the 4th week postconception (6th week gestation) 41
|
|
|
When do the brain and eyes begin to develop?
|
During the 5th week postconception (7th week gestation) 41
|
|
|
When do the nose, mouth and palate begin to form?
|
During the 6th week postconception (8th week gestation) 41
|
|
|
When are all essential fetal structures present?
|
By the end of the 7th week postconception (9th week gestation) 41
|
|
|
When can the fetus begin to open and shut his or her mouth?
|
By the end of the 10th week postconception (12th week gestation) 41
|
|
|
When can the fetus urinate?
|
By the end of the 10th week postconception (12th week gestation) 41
|
|
|
When can the fetus make respiratory movements?
|
By the end of the 10th week postconception (12th week gestation) 41
|
|
|
When can the fetus swallow?
|
By the end of the 10th week postconception (12th week gestation) 41
|
|
|
What average weight does the fetus reach by the end of the fifth lunar month?
|
0.75 lbs 41
|
|
|
What average weight does the fetus reach by the end of the fourth lunar month?
|
4 oz 41
|
|
|
What average weight does the fetus reach by the end of the sixth lunar month?
|
1.25 lbs 41
|
|
|
What average weight does the fetus reach by the end of the seventh lunar month?
|
2.25 lbs 41
|
|
|
What average weight does the fetus reach by the end of the eighth lunar month?
|
3.75 lbs 41
|
|
|
What average weight does the fetus reach by the end of the tenth lunar month?
|
7.5 lbs 41
|
|
|
How much weight does the average fetus gain during the 5th lunar month?
|
8 oz 41
|
|
|
How much weight does the average fetus gain during the 6th lunar month?
|
0.5 lbs 41
|
|
|
How much weight does the average fetus gain during the 7th lunar month?
|
1 pound 41
|
|
|
How much weight does the average fetus gain during the 8th lunar month?
|
1.5 lbs 41
|
|
|
How much weight does the average fetus gain during the 9th lunar month?
|
1.75 lbs 41
|
|
|
When does brown fat form?
|
6th lunar month 41
|
|
|
When do the fingernails develop?
|
4th lunar month 41
|
|
|
When do the fetal reflexes manifest?
|
4th lunar month 41
|
|
|
When is the fetus covered in a fine downy hair called lanugo?
|
6th lunar month 41
|
|
|
When does the fetus begin to hiccup?
|
5th lunar month 41
|
|
|
When does vernix cover the fetal body?
|
5th lunar month 41
|
|
|
Which months is this: eyelids are fused, body growth accelerates, fingernails develop, reflexes manifest, sex is distinguishable
|
4th lunar month 41
|
|
|
Which month is this: hair growth is prominent, fetus is covered in fine, downy hair (lanugo), fetus makes crying and sucking motions, brown fat forms
|
6th lunar month 41
|
|
|
Which month is this: toenails develop, fetus hiccups, vernix covers the body
|
5th lunar month 41
|
|
|
Which month is this: eyes begin to open and shut, fetus grows longer and gains significant weight
|
7th lunar month 41
|
|
|
Which month is this: fat deposits smooth fetal body contours, thick vernix, rhythmic breathing motions
|
8th lunar month 41
|
|
|
Which month is this: fetal skin smooth, baby looks chubbier
|
9th lunar month 41
|
|
|
Which month is this: fetus well proportioned, lanugo disappears, vernix decreases
|
10th lunar month 41
|
|
|
Which two topics should be discussed at each and every prenatal visit?
|
Nutrition and exercise 42
|
|
|
___ are experienced as pelvic sensitivity or groin pain when walking.
|
Ligament pains 42
|
|
|
Morning sickness is due primarily to elevated ___ and ___ levels.
|
estrogen and hCG 42
|
|
|
Which vitamin should you recommend for a woman with morning sickness?
|
B-6 42
|
|
|
Plain yogurt upon rising is a recommendation for which common complaint of pregnancy?
|
morning sickness 42
|
|
|
Raspberry leaf tea is a recommendation for which common complaint of pregnancy?
|
morning sickness 42
|
|
|
If fatigue is extreme or persistent, what should the midwife do?
|
screen for anemia 44
|
|
|
How much weight does the average fetus gain during the 10th lunar month?
|
2 lbs 41
|
|
|
Leisurely meals can be recommended to alleviate which common complaints of pregnancy?
|
Indigestion and heartburn 44
|
|
|
Because the gall bladder functions less efficiently in pregnancy, what can be done to alleviate indigestion and heartburn?
|
Reducing fat intake 44
|
|
|
Limiting food intake before going to bed in the evening can help alleviate __
|
indigestion and heartburn 44
|
|
|
Dandelion root is an ____ and can help relieve ____.
|
excellent liver tonic, pruritis 44
|
|
|
Yellow dock root is an ____ and can help relieve ____.
|
excellent liver tonic, pruritis 44
|
|
|
Beets help to ____ and can help relieve _____.
|
cleanse the liver, pruritis 44
|
|
|
Dark greens help to ____ and can help relieve _____.
|
cleanse the liver, pruritis 44
|
|
|
Olive oil helps to ____ and can help relieve _____.
|
cleanse the liver, pruritis 44
|
|
|
Lemon juice helps to ____ and can help relieve _____.
|
cleanse the liver, pruritis 44
|
|
|
Foods rich in choline, like ___, ___ and ___ can help relieve pruritis.
|
egg yolks, wheat germ and brewer's yeast 44
|
|
|
Three teas that can help with headaches.
|
Hops, skullcap and chamomile 44
|
|
|
What would you recommend for the woman complaining of backache?
|
Exercise, pelvic rocks, pillow support while sleeping, elastic bellyband, chiropractic adjustments 44
|
|
|
If a woman complains of a backache near waist-level, what should you rule out?
|
CVAT 44
|
|
|
If a mother jumps or otherwise indicates pain during a CVAT test, what should the midwife do?
|
Immediately refer her to a backup physician 44
|
|
|
What causes varicose veins of the legs and vulva?
|
High levels of progesterone relaxing smooth muscle and hindering venous return through the body, particularly in the extremities 44
|
|
|
Do hereditary factors play a part in varicose veins?
|
Yes 44
|
|
|
Which vitamin should a woman with varicose veins take?
|
vitamin E 45
|
|
|
For best absorption, vitamin E should be taken with what foods?
|
milk, cheese or other fatty food sources 45
|
|
|
Constipation can be caused by ___ or ___.
|
hormones or diet 45
|
|
|
Yeast infection, common in pregnancy, is caused by increased vaginal ___
|
alkalinity 45
|
|
|
The increase in which hormone causes increased vaginal alkalinity?
|
progesterone 45
|
|
|
Yeast infection at term increases the risk of...
|
newborn thrush 45
|
|
|
Bacterial vaginosis is also known as ___ or ___
|
gardnerella or hemophilus 45
|
|
|
Although ordinarily benign and transient, BV during pregnancy can cause...
|
chorioamnionitis, premature rupture of membranes and premature labor 45
|
|
|
BV produces what kind of vaginal discharge?
|
a thin, gray or white discharge that tends to adhere to vaginal walls 45
|
|
|
Trichomonas is characterized by what type of vaginal discharge?
|
malodorous, highly irritating, yellow-green, frothy 45
|
|
|
The usual treatment for Trichomonas, Flagyl, is contraindicated in ....
|
the first half of pregnancy 45
|
|
|
All vaginal infections respond positively to the inclusion of which foods in the diet?
|
Dark-green vegetables, high-quality protein, whole grains, citrus and plenty of fluids 46
|
|
|
Unsweetened cranberry juice or concentrate (in capsules) can help increase vaginal...
|
acidity 46
|
|
|
Eating brewer's yeast can help to combat ...
|
vaginal infection 46
|
|
|
Small, painful blisters are the prime symptom of this sexually transmitted disease.
|
Herpes 46
|
|
|
If a mother reports recurring episodes of herpes, to what should you inquire?
|
the number of outbreaks, severity and usual location of lesions 46
|
|
|
In the event of a herpes outbreak during pregnancy, what should you do?
|
Culture the sores (for a firm diagnosis) and the cervix (to see if the virus is present at this location) 46
|
|
|
Visual inspection of the cervix at the onset of labor is considered sufficient to rule out current __ infection.
|
herpes 46
|
|
|
If membranes rupture prior to the onset of labor in an HSV positive mom, be sure to screen the cervix within ___ as the baby may be rapidly affected without the barrier of intact membranes.
|
2 hours 46
|
|
|
Herpes can have a devastating effect on the baby's ___
|
central nervous system 46
|
|
|
If an initial herpes outbreak occurs during the first trimester, the midwife should...
|
immediately consult with backup 46
|
|
|
Hot baths tend to aggravate ___ symptoms.
|
herpes 46
|
|
|
Application of lysine ointment is reputed to be healing and soothing for ____.
|
herpes sores 46
|
|
|
Application of ___ is reputed to be healing and soothing for herpes sores.
|
cold milk, lysine ointment, zinc oxide, A&D ointment, ice and calendula cream 46
|
|
|
Increased ___ intake is recommended in combatting herpes outbreaks.
|
lysine 46
|
|
|
Elimination of __, __, __ and __ helps to combat herpes outbreaks.
|
coffee, black tea, alcohol and sugar 46
|
|
|
When trying to combat a herpes outbreak, avoid foods containing ___.
|
arginine (an amino acid that supports the herpesvirus) 46
|
|
|
Which foods contain arginine?
|
Nuts and nut products, seeds and chocolate. 46
|
|
|
Which foods should be avoided when combatting a herpes outbreak?
|
coffee, black tea, alcohol, sugar, nuts, nut products, seeds and chocolate 46
|
|
|
Goldenseal is _______ during pregnancy.
|
contraindicated 47
|
|
|
Which herbs are contraindicated during pregnancy?
|
Goldenseal, ephedra, cotton root bark, blue cohosh, pennyroyal and birthroot 47
|
|
|
Herb to prevent postpartum hemorrhage.
|
Nettle leaf 48
|
|
|
Herb to prevent leg cramps.
|
Nettle leaf 48
|
|
|
Herb to ease postpartum afterpains.
|
Nettle leaf 48
|
|
|
Herb to reduce hemorrhoids.
|
Nettle leaf 48
|
|
|
Herb to encourage abundant breastmilk.
|
Nettle leaf 48
|
|
|
Herb rich in vitamins A, C, D and K, as well as calcium, potassium, phosphorus, iron and sulfur.
|
Nettle leaf 48
|
|
|
Three herbs rich in calcium
|
Nettle leaf, red clover and dandelion leaf 48
|
|
|
Two herbs that provide kidney support
|
Nettle leaf and dandelion leaf 48
|
|
|
Herb that nourishes and revitalizes the liver.
|
Dandelion leaf 48
|
|
|
Two herbs rich in potassium.
|
Nettle leaf and dandelion leaf 48
|
|
|
Herb rich in phosphorus.
|
Nettle leaf 48
|
|
|
Two herbs rich in iron.
|
Nettle leaf and Dandelion leaf 48
|
|
|
Herb essential in the prevention and treatment of preeclampsia.
|
Dandelion leaf 48
|
|
|
Herb that is a reliable digestive aid.
|
Dandelion leaf 48
|
|
|
In which vitamins in Dandelion leaf rich?
|
A, B complex, C and D 48
|
|
|
What nutritive properties does Dandelion leaf contain?
|
Vitamins A, B complex, C, D, calcium, potassium, iron 48
|
|
|
What nutritive properties does Nettle leaf contain?
|
Vitamins A, C, D, K, calcium, potassium, phosphorus, iron and sulfur 48
|
|
|
Which herb contains sulfur?
|
Nettle leaf 48
|
|
|
Which herb can ease morning sickness and gently aid digestion?
|
Red raspberry leaf 48
|
|
|
Which herb is rich in magnesium?
|
Red clover 48
|
|
|
Which herb is rich in trace minerals?
|
Red clover 48
|
|
|
Red clover is rich in which nutritive elements?
|
Calcium, magnesium and trace minerals 48
|
|
|
Red clover nourishes which two body systems?
|
Reproductive and endocrine systems 48
|
|
|
Herbal and green sources of iron (4 of them).
|
Dandelion, nettle, kelp and parsley 48
|
|
|
Parsley is rich in ...
|
iron 48
|
|
|
Kelp is rich in ...
|
iron 48
|
|
|
Which 3 herbal/natural remedies relieve heartburn?
|
Slippery elm lozenges, chewing raw almonds, raw papaya 48
|
|
|
What does chewing raw almonds help to relieve?
|
Heartburn 48
|
|
|
What does eating raw papaya or taking papaya enzymes help?
|
Heartburn 48
|
|
|
Herbal and homeopathic remedies for sleeplessness?
|
Eyepillow of flax and lavender, skullcap, valerian, hops, homeopathic aconite 48
|
|
|
Herbal remedy for sciatica.
|
St. John's wort 48
|
|
|
Homeopathic equivalent to St. John's Wort
|
hypericum 48
|
|
|
Application of gel compound, ____, can help with sciatica.
|
arniflora 48
|
|
|
Homeopathic equivalent for witch hazel.
|
Hamamelis 49
|
|
|
__ and __ infusion can help with hemorrhoids.
|
Red clover and nettle 49
|
|
|
Two natural remedies for constipation.
|
psyllium seed and prunes 49
|
|
|
Three strange remedies for preventing dehydration in case of diarrhea.
|
Rice water (pour excess water off rice and drink it) and tea x3 (brew same tea bag three times and drink it), polarity therapy 49
|
|
|
Moxa is a roll of tightly compacted ...
|
mugwort 49
|
|
|
In times of threatened preterm labor ___ is critical.
|
good hydration 49
|
|
|
___ supplements have proven invaluable in preventing preterm labor in any woman with predisposing factors or forestalling it if it occurs.
|
Magnesium supplements 49
|
|
|
Too much magnesium causes ...
|
diarrhea 49
|
|
|
Homeopathic to prevent preterm labor.
|
Mag phos 49
|
|
|
Homeopathic that can be taken to soften the cervix of a post dates woman.
|
Cimicifuga 49
|
|
|
In a postdates woman, often one dose of ___ before bed will result in labor during the night.
|
caulophyllum 49
|
|
|
Contrary to the medical model's premium on clinical detachment, ___ is integral to the midwife/client relationship.
|
personal involvement 50
|
|
|
What is the ultimate aim of counseling?
|
to elicit responsibility 50
|
|
|
What is the focus of the last six weeks of caregiving?
|
the birth 54
|
|
|
__ can be corrected if the head is not too far into the pelvis.
|
Lack of flexion 54
|
|
|
When doing internal exams near term, the midwife should check for...
|
dilation, effacement, station, increase in vaginal lubrication or softening of musculature 54
|
|
|
Condition of cervix until labor begins in a primiparous woman.
|
somewhat closed, with perhaps a centimeter of dilation 54
|
|
|
Condition of cervix until labor begins in a multiparous woman.
|
may be 2-3 centimeters dilated 54
|
|
|
An uneffaced cervix is about ___ long.
|
1 inch 54
|
|
|
A cervix that is 50% effaced is about __ long.
|
half an inch 54
|
|
|
It is fairly common to find __ to __% effacement in the final weeks of pregnancy.
|
60 to 80% 54
|
|
|
Rarely, the cervix is __% effaced at term.
|
100% 54
|
|
|
Some women dilate to __ or __ cm before labor begins. These labors are apt to go quick.
|
5 or 6 cm 54
|
|
|
The uterus is comprised of three layers:
|
1) the external, longitudinal layer; 2) the internal, circular layer, 3) the middle, connective layer 54
|
|
|
In incoordinate labor, only certain ___ segments of the uterus contract, but all must work together harmoniously in order to pull open circular muscles of the cervix.
|
long muscle segments 56
|
|
|
The ____ usually mark the midpoint of the pelvis.
|
ischial spines 56
|
|
|
If the top of the head is exactly level with the spines, it is at __ station.
|
0 page 56
|
|
|
Rarely will the presenting part be lower than ___ station before labor begins.
|
+2 station 56
|
|
|
Which muscle is most likely to tear at birth?
|
bulbocavernosus 56
|
|
|
What is a caruncle?
|
a hymenal skin tag irregular in shape 57
|
|
|
A most crucial assessment during the 35 week home visit is...
|
for adequate heat in the birth room 58
|
|
|
Newborns are almost impossible to resuscitate if ...
|
cold 58
|
|
|
The birth tub should be scrubbed with ___ and rinsed thoroughly before it is filled with water.
|
iodine 58
|
|
|
The dive reflex keeps the ____ closed when the baby is submerged.
|
glottis 58
|
|
|
The mother must be in the water for at least ___ before maximum benefits are realized.
|
30 minutes 59
|
|
|
After ____ benefits as per hormone stimulation to being in the water diminish.
|
2-3 hours 59
|
|
|
In a water birth it is best to ___ touching the baby as it is born.
|
avoid 59
|
|
|
___ accounts for 95% of nutritional anemias
|
Iron deficiency anemia 65
|
|
|
___ is rarely enough to remedy iron deficiency anemia.
|
Supplemental iron 65
|
|
|
___ maintains the integrity of cell membranes.
|
Folic acid 65
|
|
|
__ is crucial for iron absorption.
|
Vitamin C 65
|
|
|
Which vitamins combat stress?
|
Vitamin C and B-complex 65
|
|
|
What is the best approach to dealing with anemia?
|
Dramatically revamp and improve the entire diet by adding more fresh fruit and vegetables, high-quality protein, whole grains, mineral-rich seeds and nuts, and nourishing herbal teas 65
|
|
|
Supplemental iron can cause...
|
constipation, indigestion and black stool 66
|
|
|
Supplemental calcium and dairy products virtually block absorption of supplemental...
|
iron 66
|
|
|
Prune juice is a good source of ...
|
iron 66
|
|
|
Molasses is a good source of ...
|
iron 6
|
|
|
Sesame seeds are an excellent source of ...
|
iron 66
|
|
|
Sunflower seeds are rich in...
|
iron 66
|
|
|
Beans are rich in ...
|
iron 66
|
|
|
Raisins are good sources of...
|
iron 66
|
|
|
Dark greens contain lots of ...
|
iron 66
|
|
|
Beef liver, of course, contains ...
|
iron 66
|
|
|
The ____ woman is more susceptible to infection and premature labor.
|
anemic 66
|
|
|
The ____ woman's uterus is less likely to contract efficiently after birth, placing her at risk for postpartum hemorrhage.
|
anemic 66
|
|
|
Anemia in the postpartum period puts the mother at higher risk for...
|
infection, poor healing, difficulties with establishing milk supply and postpartum depression 66
|
|
|
During labor, decreased oxygen levels in the maternal bloodstream due to anemia can lead to...
|
fetal distress, a cesarean or the need for neonatal resuscitation 66
|
|
|
Before treating the mother for iron-deficiency anemia, double-check her lab work to rule out a 5% chance of anemia caused by a deficiency of either __ or __.
|
folic acid or B-12 66
|
|
|
What does MCV stand for?
|
Mean corpuscular volume (average size of red blood cells) 66
|
|
|
What does MCH stand for?
|
Mean corpuscular hemoglobin (average amount of hemoglobin per cell) 66
|
|
|
In iron-deficiency anemia, the MCV is __ and the MCH is ___.
|
MCV = normal
MCH = lower than normal 66 |
|
|
Which type of anemia is considered microcytic (small cell) anemia?
|
Iron-deficiency anemia 66
|
|
|
In B-12 and folic acid anemias, the MCV is ___ and the MCH is ___.
|
MCV = elevated
MCH = normal 66 |
|
|
Which type of anemias are considered macrocytic or megaloblastic (large cell) anemias?
|
B-12 and folic acid anemias 66
|
|
|
If it appears a mother suffers from a macrocytic or megaloblastic anemia, what must be done?
|
further testing to determine whether a deficiency of folic acid or B-12 is at fault 66
|
|
|
Egg yolks are a good source of ...
|
folic acid 66
|
|
|
Orange juice is rich in ...
|
folic acid 66
|
|
|
Melons are full of ..
|
folic acid 67
|
|
|
Strawberries contain lots of ...
|
folic acid 67
|
|
|
Dark greens (the darker the better) contain high levels of...
|
folic acid 67
|
|
|
B-12 deficiency can cause ___ damage in a newborn.
|
central nervous system damage 67
|
|
|
Certain types of hereditary, microcytic anemias such as thalassemia or sickle-cell anemia will have _____ MCV values.
|
unusually low 67
|
|
|
As a rule of thumb, the expectant mother should gain at least ___ pounds by __ weeks.
|
10 pounds by 20 weeks 67
|
|
|
As a rule of thumb, the expectant mother should gain about __ a week after __ weeks.
|
1 pound a week after 20 weeks 67
|
|
|
What causes weight gain in pregnancy?
|
increased water retention due to hormones, fatty insulation deposited over the belly and backside, increased weight in the breasts, increased blood volume, weight of the enlarged uterus including amniotic fluid, placenta and fetus 67
|
|
|
How much weight does the average woman lose with the birth or a few days later?
|
15 pounds 67
|
|
|
If a mother seems to be gaining weight more rapidly than usual, check for ___
|
a fetal growth spurt (corresponding jump in fundal height) 67
|
|
|
Cottage cheese is a low-fat ___ source.
|
protein 67
|
|
|
Miscarriage occurring after 20 weeks is considered ...
|
fetal demise 68
|
|
|
___ is presumed whenever the mother has vaginal bleeding in the first half of pregnancy, particularly if combined with cramping or persistent backache.
|
Threatened abortion 69
|
|
|
____ occurs when there is bleeding in the first half of pregnancy accompanied by cramping or persistent backache, ruptured membranes or dilation of the cervix.
|
Inevitable abortion 68
|
|
|
What are qualifying s/s of inevitable abortion?
|
Bleeding in first half of pregnancy accompanied by cramping or persistent lower back pain and ruptured membranes and/or cervical dilation 69
|
|
|
In case of threatened abortion, what should the midwife recommend?
|
Bedrest and complete cessation of all sexual activity 69
|
|
|
If there is cramping in the first half of pregnancy but no bleeding, what may halt uterine activity and forestall miscarriage?
|
a glass of wine 69
|
|
|
If a woman reports light bleeding (brownish in color) for many weeks, with no distinct episode of resolution, what should you rule out?
|
Missed abortion 69
|
|
|
What is a missed abortion?
|
The fetus has died but is retained in utero 69
|
|
|
What is the most conclusive sign of missed abortion?
|
Lack of fetal heart tones 69
|
|
|
What disorder may result from retained products of conception?
|
Disseminated intravascular coagulation (DIC) 69
|
|
|
The incidence of ___ increases exponentially the longer the mother has been pregnant and the longer the fetus is retained after it dies.
|
DIC 69
|
|
|
If a mother with signs of missed abortion notes excessive bleeding from the gums, nose or minor injury sites, she is at extremely high risk for ___
|
DIC 69
|
|
|
When does miscarriage become habitual?
|
When it occurs more than three times, in which case genetic or other factors may be at fault 70
|
|
|
When does a tubal pregnancy usually rupture?
|
Between 8 and 10 weeks 70
|
|
|
Tubal pregnancy may be misdiagnosed as __, __, or __, particularly if the woman does not know she is pregnant.
|
PID, severe gastrointestinal upset or appendicitis 70
|
|
|
What is the primary cause of tubal pregnancy?
|
pelvic inflammatory disease 70
|
|
|
What are symptoms of tubal pregnancy?
|
Pelvic pain (consistent and more intense than cramping), often spot bleeding, sometimes brown. Pain becomes quite severe with rupture and may be referred to the shoulder area 70
|
|
|
What is a definite sign that a mother is suffering from tubal rupture as opposed to miscarriage?
|
the degree of shock far exceeds what would normally be expected for the amount of blood loss 70
|
|
|
In a complete mole, there is no ___.
|
fetus 71
|
|
|
95% of hydatidiform mole cases are considered __ moles.
|
complete 71
|
|
|
5% of moles are ___ moles.
|
partial 71
|
|
|
Molar pregnancy is more common in women over ___.
|
40 page 71
|
|
|
What is the most outstanding symptom of hydatidiform mole?
|
Light brown bleeding persisting for weeks or months (though rarely past the first trimester) 71
|
|
|
What distinguishes hydatidiform mole from other complications correlated to light brown bleeding, such as missed abortion or ectopic pregnancy?
|
the uterus is typically large for dates and feels woody hard or doughy to the touch 71
|
|
|
Which 3 complications of pregnancy present with (often persistent) light brown bleeding?
|
Ectopic pregnancy, missed abortion and hydatidiform mole 71
|
|
|
In a hydatidiform mole pregnancy, the overgrowth of chorionic villi leads to abnormally high ___ levels
|
hCG levels 71
|
|
|
How can you use hCG levels to distinguish between hydatidiform mole and missed abortion or ectopic pregnancy?
|
hCG levels in hydatidiform mole are abnormally high. In missed abortion and ectopic pregnancy they are abnormally low. 71
|
|
|
When elevated hCG levels tax the liver, as in hydatidiform mole, it gives rise to secondary symptoms of __ and __.
|
hypertension and proteinuria 71
|
|
|
____ occurs in 25-30% of all cases of hydatidiform mole.
|
Hyperemesis gravidarum 71
|
|
|
When a woman has a hydatidiform mole with secondary hyperemesis gravidarum due to elevated hCG levels, when does hyperemesis tend to develop?
|
At the onset of the second trimester 71
|
|
|
If the midwife suspects hydatidiform mole, what should she do?
|
Refer to a physician promptly 71
|
|
|
What are possible causes of bleeding in the third trimester?
|
increased vascularity of cervix (bleeding after intercourse), vaginal infections (mucosa is irritable and more prone to bleeding after sex), ruptured cervical polyp, placental abruption, placenta previa 71
|
|
|
What is placental abruption?
|
premature separation of the placenta 71
|
|
|
What are the possible causes of placental abruption?
|
hypertension, physical trauma, cord entanglement, unknown (often cause is unknown) 71
|
|
|
What are the types of placental abruption?
|
Marginal abruption, concealed abruption, complete abruption 71
|
|
|
What is a marginal placental abruption?
|
the separation at the edge of the placenta only, cause blood to flow from the vagina 71
|
|
|
What is a concealed placental abruption?
|
separation of the central portion of the placenta while margins remain attached, so bleeding is concealed 71
|
|
|
What is a complete placental abruption?
|
total separation of the placenta 71
|
|
|
Abruption may prove ___ for the baby and sometimes for the mother.
|
fatal 71
|
|
|
If abruption occurs during labor and delivery is imminent, the baby will probably ___ and the mother will be ___.
|
survive, fine 71
|
|
|
What are the symptoms of a concealed placental abruption?
|
bleeding is not evident but there is acute abdominal pain, distinct from uterine contractions in its persistence and location, the uterus is woody hard and exceedingly tender to the touch 71
|
|
|
What are the symptoms of a marginal placental abruption?
|
bright-red bleeding is apparent but abdominal pain may be less intense (and less noticeable in hard labor) 71
|
|
|
In case of a suspected placental abruption during labor, if birth is not imminent, what should the midwife do?
|
Administer oxygen, treat for shock and transport immediately 71
|
|
|
What might repeated episodes of light bleeding or heavy spotting with no report of abdominal pain during the third trimester indicate?
|
placenta previa 72
|
|
|
What is placenta previa?
|
placenta implanted low in the uterus 72
|
|
|
Most risk factors associated with placenta previa are associated with ___.
|
uterine scarring 72
|
|
|
What are the risk factors for placenta previa (6 of them)?
|
1) previous uterine surgery 2) endometritus (uterine infection) 3) multiparity 4) pregnancies with short intervals between 5) maternal age over 35 6) unusually large placenta (ie multiple pregnancy) 72
|
|
|
Why does blood loss occur with placenta previa?
|
In late pregnancy, the lower uterine segment begins to distend and thin as the presenting part of the baby enters the pelvis and presses downward; if the placenta is imbedded in this area, small portions will detach wherever underlying uterine tissues stretch 72
|
|
|
What are the 4 types of placenta previa?
|
1) total previa, 2) partial previa, 3) marginal previa, 4) low-lying placenta 72
|
|
|
Define total placenta previa.
|
the placenta completely covers the cervical os 72
|
|
|
Define marginal placenta previa.
|
the edge of the placenta is at the edge of the cervical os 72
|
|
|
Define partial placenta previa.
|
the cervical os is partially covered by the placenta 72
|
|
|
Define low-lying placenta.
|
the placenta is close to the cervical os but does not actually touch it 72
|
|
|
Which two types of placenta previa necessitate cesarean section?
|
Total and partial previa 72
|
|
|
Does a marginal placenta previa require a cesarean delivery?
|
It depends on the degree of maternal blood loss; maybe 72
|
|
|
Is vaginal delivery possible with a low-lying placenta?
|
Yes, but blood loss must be monitored carefully 72
|
|
|
Placenta previa is associated with an increased risk of ___.
|
postpartum hemorrhage 72
|
|
|
Why is placenta previa associated with an increased risk of postpartum hemorrhage?
|
due to poor contractibility of the lower uterine segment 72
|
|
|
Placenta previa may manifest as early as ___ weeks.
|
24 page 72
|
|
|
How must diagnosis of placenta previa must be done?
|
by ultrasound 72
|
|
|
What should you NEVER do when there is bleeding in late pregnancy?
|
a vaginal exam 72
|
|
|
What are four predisposing risk factors for gestational diabetes?
|
1) family history of the disease, 2) marked obesity, 3) age over 35, 4) previous delivery of a baby weighing nine pounds or more 73
|
|
|
Why would the baby of a diabetic mother have respiratory problems?
|
Production of surfactant in the lungs can be interrupted by increased levels of insulin 73
|
|
|
What are maternal risks associated with gestational diabetes?
|
preeclampsia, polyhydramnios, postpartum hemorrhage 74
|
|
|
What are newborn risks associated with gestational diabetes?
|
hypoglycemia and hypocalcaemia 74
|
|
|
If a mother is gestationally diabetic, monitoring of the fetus via nonstress testing and kick counts should begin no later than __ weeks.
|
36 page 74
|
|
|
In severe cases of gestational diabetes, ___ is recommended and the woman will be risked out for home birth.
|
insulin therapy 74
|
|
|
What is essential hypertension?
|
a preexisting condition indicated by initial and subsequent readings of 140/90 or more 74
|
|
|
When high blood pressure readings first occur in the latter part of pregnancy, this condition is called ___
|
gestational hypertension 74
|
|
|
When can it be hard to tell the difference between essential hypertension and gestational hypertension?
|
when a woman begins care in her last trimester and presents with hypertension 74
|
|
|
___ is contraindicated for women with essential hypertension and may be contraindicated with gestational hypertension, depending on the degree.
|
Home birth 74
|
|
|
Gestational hypertension, independent of other clinical signs of preeclampsia, can be considered ___ and may be treated by the midwife.
|
low risk 74
|
|
|
No conclusions can be drawn unless blood pressure is high on at least _____.
|
two occasions a full six hours apart 74
|
|
|
For greatest accuracy in taking blood pressure, do repeat readings with the woman ____, as this position indices optimal circulation.
|
on her left side 74
|
|
|
Severe and prolonged hypertension may cause ____.
|
intrauterine growth restriction 74
|
|
|
Why would severe and prolonged hypertension cause IUGR?
|
the resulting vasoconstriction affects the flow of oxygen (and nutrients) to the baby
|
|
|
Elevated blood pressure can cause fetal ___.
|
distress 74
|
|
|
If blood pressure readings rise to ___ medical intervention will be necessary to prevent vascular damage from occurring.
|
160/100 page 74
|
|
|
What are five suggestions for treating a consistent rise in blood pressure?
|
1) exercise, 2) deep relaxation, 3) no stimulants whatsoever, 4) good diet and healing herbs, 5) counseling 75
|
|
|
If the woman's blood pressure rises to above 140/90, ___ takes precedence over exercise.
|
rest 74
|
|
|
What should a mother with a blood pressure of 140/90 or above do?
|
lie on her left side for extended periods of time to allow optimal uptake of oxygen 74
|
|
|
Mustard should be avoided if a mother has ___.
|
high blood pressure (it causes vasoconstriction) 75
|
|
|
Black pepper should be avoided if a mother has ___.
|
high blood pressure (it causes vasoconstriction) 75
|
|
|
Ginger should be avoided if a mother has ___.
|
high blood pressure (it causes vasoconstriction) 75
|
|
|
Nutmeg should be avoided if a mother has ___.
|
high blood pressure (it causes vasoconstriction) 75
|
|
|
Which spices should be avoided if a mother has high blood pressure?
|
mustard, nutmeg, black pepper and ginger 75
|
|
|
Which foods specifically reduce blood pressure?
|
watermelon, cucumber, parsley, onion and garlic 75
|
|
|
Watermelon is helpful for relieving...
|
high blood pressure 75
|
|
|
Cucumber has been show to help relieve...
|
high blood pressure 75
|
|
|
Garlic is a must for a mom with...
|
hypertension 75
|
|
|
Parsley can help to lower ...
|
blood pressure 75
|
|
|
Onion should be eaten if a mom has ...
|
high blood pressure 75
|
|
|
If a mom is hypertensive, how much salt should she eat?
|
salt should be eaten to taste 75
|
|
|
Which herbs are helpful for the mother with a high systolic blood pressure, who needs to calm down?
|
hops, skullcap, passionflower, hawthorn and chamomile 75
|
|
|
Passionflower herb can be used to help a woman...
|
lower her systolic blood pressure 75
|
|
|
Hawthorn is helpful for ...
|
reducing systolic blood pressure 75
|
|
|
____ replicates the effects of aerobic exercise and can help to lower diastolic blood pressure.
|
Cayenne pepper 75
|
|
|
Cayenne pepper should be eaten to...
|
lower diastolic blood pressure 75
|
|
|
Natural remedies to treat a mother with high blood pressure:
|
hops, skullcap, passionflower, hawthorn, chamomile, cayenne peppers, chinese herbs, acupuncture, increased fluids, calcium, potassium, magnesium, aerobic exercise, relaxation, no stimulants whatsoever (avoid mustard, black pepper, ginger and nutmeg), watermelon, cucumber, parsley, onion, garlic, salt to taste, high-quality protein, whole grains, lots of mineral-rich fruits and veggies, counseling 75
|
|
|
Acupuncture may be helpful in lowering...
|
blood pressure 75
|
|
|
A woman with high blood pressure should increase intake of these 3 minerals:
|
calcium, magnesium and potassium 75
|
|
|
Recent data indicate that ___ reduces the risk of hypertension in pregnancy.
|
calcium 75
|
|
|
What is the standard hospital treatment for hypertension?
|
intravenous magnesium sulfate 75
|
|
|
It is not uncommon for a previously normal blood pressure to rise to ___ with the most rigorous transition contractions.
|
140/90 page 76
|
|
|
A steady rise in blood pressure during labor may herald ___
|
preeclampsia 76
|
|
|
One of the main reasons for prenatal care is to screen for ___
|
preeclampsia 76
|
|
|
When does preeclampsia generally occur?
|
After 26 weeks 76
|
|
|
What are 5 early signs of preeclampsia?
|
1) hemoconcentration, 2) hypertension, 3) generalized edema, 4) sudden and excessive weight gain, 5) protein in the urine 76
|
|
|
What are the nutritional guidelines for preventing preeclampsia?
|
a minimum of 80g of protein daily, combined with ample calories, complex carbohydrates, as well as fresh fruits and veggies, high-fiber foods and adequate fluid intake 76
|
|
|
What may be the earliest indicator of preeclampsia?
|
hemoconcentration 76
|
|
|
When is preeclampsia diagnosed?
|
when hypertension and an additional sign (edema, proteinuria, hyperreflexia) are present on two occasions at least six hours apart 76
|
|
|
__ edema is physiologic and therefore not significant in diagnosing preeclampsia.
|
Ankle 76
|
|
|
Edema of the __, ___ or ___ is definitive in diagnosing preeclampsia.
|
upper shins, breastbone or sacrum 76
|
|
|
Pitting edema of __ or greater is a sign of preeclampsia.
|
+2 or greater (4 mm or greater) 76
|
|
|
Anything over ___ of protein in the urine is significant for preeclampsia.
|
trace 77
|
|
|
____ is a transitional sign, indicating that preeclampsia has progressed to a more serious stage.
|
Hyperreflexia 77
|
|
|
How do you check for hyperreflexia?
|
by checking for clonus 77
|
|
|
What should the midwife do with a preeclamptic mother?
|
Have her lie on her left side immediately and contact the physician 77
|
|
|
What are signs that preeclampsia is worsening?
|
1) severe headache, 2) epigastric pain (pain in upper abdomen), 3) visual disturbances, 4) decreased output of urine, 5) extreme nervous irritability, 6) decrease in fetal movement 77
|
|
|
What are the dangers of preeclampsia?
|
IUGR, fetal distress in labor, placental abruption, fetal or maternal death, convulsions in labor 77
|
|
|
Polyhydramnios often occurs in conjunction with ___, ___, ___, ___.
|
Rh incompatibility, diabetes, multiple pregnancy, fetal anomalies 77
|
|
|
With which fetal anomalies is polyhydramnios most closely associated?
|
atresia of the esophagus, hydrocephaly, anencephaly or spina bifida 77
|
|
|
When is it most common to notice polyhydramnios begin to manifest?
|
a slight elevation in fundal height at 28 weeks 77
|
|
|
What is the classic sign of polyhydramnios?
|
fluid thrill 78
|
|
|
If a baby is difficult to feel in the third trimester, the fundal height is elevated and and heart tones are challenging to find, what could you suspect?
|
polyhydramnios 78
|
|
|
A woman with noticeable polyhydramnios should be seen again in ___ regardless of gestational age.
|
in several days 78
|
|
|
Polyhydramnios can lead to ___ labor.
|
premature 78
|
|
|
Which serious complications during labor can be caused by polyhydramnios?
|
uterine dysfunction, placental abruption and postpartum hemorrhage, due to overdistension of the uterus; also fetal malpresentation and cord prolapse 78
|
|
|
What are common side effects of polyhydramnios?
|
severe ankle edema and varicosities of the legs and vulva 78
|
|
|
Oligohydramnios is associated with a marked increase in ____.
|
fetal mortality 78
|
|
|
Why is oligohydramnios associated with a marked increase in fetal mortality?
|
due to conditions such as intrauterine growth restriction, postmaturity syndrome and congenital anomalies, cord compression and fetal distress/hypoxia during labor 78
|
|
|
When is oligohydramnios readily detected?
|
when the fetus is tightly compacted in the uterus and fundal height is lagging 78
|
|
|
Studies have show that amniotic fluid can be increased by ___
|
adequate hydration 78
|
|
|
The more a mother ___, the mother amniotic fluid she produces.
|
drinks 78
|
|
|
A fundal measurement greater than gestational age in weeks should lead you to consider ___
|
twins 78
|
|
|
What are the two types of twinning?
|
identical (monozygotic) and fraternal (dizygotic) 79
|
|
|
___ twins have separate placentas and separate amniotic sacs.
|
Dizygotic 79
|
|
|
Do monozygotic twins have separate placentas?
|
No, they share a placenta 79
|
|
|
Do monozygotic twins share an amniotic sac?
|
Sometimes, but usually there are two separate sacs 79
|
|
|
Which is more common: dizygotic or monozygotic twinning?
|
60-75% of twins are dizygotic 79
|
|
|
____ syndrome can cause blood to be shunted from one twin to the other, putting the "donor" baby at risk for growth restriction and other complications.
|
Twin to twin transfusion syndrome (TTTS) 79
|
|
|
What is the greatest risk for breech birth?
|
cephalopelvic disproportion 80
|
|
|
What are wise criteria for breech birth at home?
|
ample gynecoid pelvis, average-sized baby, multipara, frank breech or complete breech in anterior or transverse position and with head well flexed; in order to make certain of these factors, ultrasound must be used 80
|
|
|
If a baby remains in a transverse lie after 27 weeks, what should the midwife check for?
|
check for placenta previa, which could be preventing the baby from presenting either breech or vertex, by listening in the lower portion of the mother's abdomen for placenta sounds (swishing sounds at the same rate as the mother's pulse) 80
|
|
|
What is defined as prematurity?
|
birth prior to 37 weeks page 82
|
|
|
What is the chief concern in premature birth?
|
the baby's lungs may not be mature 82
|
|
|
By when are the baby's lungs almost always fully mature?
|
34 weeks 82
|
|
|
What are signs of respiratory distress syndrome (5 of them)?
|
1) cyanosis, 2) tachypnea, 3) grunting (with expiration), 4) retractions, 5) nasal flaring 82
|
|
|
What is the lubricant that permits the alveoli to inflate called?
|
surfactant 82
|
|
|
What are the causes of premature labor?
|
vaginal or urinary tract infections leading to chorioamnionitis and premature rupture of the membranes, incompetent cervix, polyhydramnios, multiple pregnancy, uterine anomalies, faulty implantation of the placenta, substance abuse, short interval between pregnancies, malnutrition, fetal death, maternal dehydration and extreme or chronic stress 82
|
|
|
Mothers with chronic gum disease in the 2nd trimester are at a greater risk for ___ due to an increase in prostaglandins.
|
premature labor 82
|
|
|
Any mother with a history of __ or __ is automatically at risk for premature labor.
|
miscarriage or previous premature birth 82
|
|
|
What should a woman at risk for premature labor make sure she eats at least once a week?
|
fatty fish - salmon, mackerel, sardines or trout 82
|
|
|
Women who take a ____ supplement have a decreased risk of premature labor.
|
fish oil 82
|
|
|
What are two medications commonly used to stop premature labor?
|
magnesium sulfate and terbutaline 82
|
|
|
If a woman with a high risk of premature labor starts to efface, what should you advise?
|
immediately stop sexual activity, make sure she knows how to distinguish contractions from fetal movement and see her weekly thereafter 82
|
|
|
If you have a woman presenting with premature labor and you check her cervix, to find that it is only minimally changed and contractions are mild, what should you recommend?
|
a couple of stiff drinks; alcohol inhibits oxytocin and relaxes the uterus 82
|
|
|
What are the causes of SGA with regard to uterine size?
|
miscalculated dates, fetus transverse or low-lying, hereditary predisposition to small babies, IUGR 83
|
|
|
When should IUGR be suspected?
|
when fundal height has been normal to 24 weeks and then begins to fall behind the average 84
|
|
|
With IUGR, the growth curve ____.
|
flattens out 84
|
|
|
If a baby is SGA and care begins later in pregnancy, hospital birth is ____
|
by default 84
|
|
|
Complications linked to a minor degree of IUGR are ___ and ___, both due to insufficient body fat.
|
hypoglycemia and hypothermia 84
|
|
|
Even with minor degrees of IUGR, it is wise to do ___, ___ and ___ because some studies show a correlation between IUGR and stillbirth.
|
nonstress testing, assess amniotic fluid volume and have the mother start fetal kick counts at 34 weeks 84
|
|
|
Should you ever give a newborn honey?
|
No, due to the risk of infant botulism 85
|
|
|
What should you give a newborn instead of honey?
|
molasses 85
|
|
|
Even a minor degree of IUGR puts the baby at risk for ___ which predisposes to severe jaundice.
|
polycythemia 85
|
|
|
Causes for LGA?
|
miscalculated dates, hydatidiform mole, gestational diabetes, twins, polyhydramnios, maternal obesity, hereditary predisposition for big babies, fetal anomalies, baby high in fundus due to placenta previa or abdominal muscle tone, fibroids (internal or external), and postmaturity 85
|
|
|
Whenever a baby measures large for dates, which possibilities must be considered and ruled out? (11 of them)
|
1) miscalculated dates
2) hydatidiform mole 3) gestational diabetes 4) twins 5) polyhydramnios 6) fibroids 7) placenta previa or abdominal muscle tone keeping baby high in pelvis 8) predisposition to large babies 9) postmaturity 10) maternal obesity 11) fetal anomalies 85 |
|
|
A woman with a multiple gestation is at higher risk for ____.
|
anemia 79
|
|
|
A big baby is of concern only if ____
|
the mother's pelvis is not ample 85
|
|
|
Successful induction largely depends on the condition of the ____.
|
cervix 86
|
|
|
Risks attendant to LGA deliveries:
|
prolonged labor, arrested progress and postpartum hemorrhage, shoulder dystocia, neonatal resuscitation due to hypoxia from maternal exhaustion 86
|
|
|
What is the standard definition of postdatism?
|
pregnancy progressing past 42 weeks (based on Naegele's rule) 86
|
|
|
What are the twofold risks of postdatism?
|
1) large baby: cephalopelvic disproportion and shoulder dystocia; 2) small baby: mother ceases to eat and drink sufficiently for fear of having a large baby, fetus suffers weight loss, cord compression due to oligohydramnios, fetal distress or even stillbirth 86
|
|
|
Maternal malnutrition and chronic dehydration leading to reduced blood volume and oligohydramnios, which in turn lead to cord compression and fetal compromise after 42 weeks gestation is called...
|
fetal postmaturity syndrome 86
|
|
|
An uncomplicated postdates pregnancy IS/IS NOT an indication for induction of labor.
|
IS NOT 87
|
|
|
Early delivery in a postdates pregnancy is necessary when ....
|
tests of fetal health show that deterioration is taking place. 87
|
|
|
The postdates mom should do ___ every day for an hour after her largest meal.
|
fetal kick-counts 87
|
|
|
How many kicks should a mom notice in an hour who is doing fetal kick-counts?
|
8-10 page 87
|
|
|
A nonstress test evaluates...
|
fluctuation in heart rate in response to its own movements 87
|
|
|
What is the desired or positive response in a nonstress test?
|
moderate acceleration 87
|
|
|
____ in a postdates pregnancy is concerning, especially in combination with a poor nonstress response.
|
Decreased amniotic fluid volume 88
|
|
|
What is included in the biophysical profile (BPP)?
|
1) fetal muscle tone
2) amniotic fluid volume 3) fetal movement counts 4) fetal breathing movements 5) NST results (heart rate variability) 88 |
|
|
BPP screening generally begins at __ weeks and is performed __ weekly.
|
41 weeks, twice weekly 88
|
|
|
For the truly postmature fetus, the most stressful time in labor is ...
|
the onset 88
|
|
|
A very athletic woman is more at risk for ___, ___ and ___ because she may push past physical imperatives for rest and relaxation during pregnancy.
|
infection, hypertension and premature labor 88
|
|
|
An emotionally based woman is more at risk for __, __ and __ because she may forget to eat or get aerobic exercise.
|
dehydration, anemia and prolonged labor 89
|
|
|
The mentally oriented woman is more at risk for __, __ and __ because she may deny her feelings in favor of logic and intellect.
|
hypertension, postdatism and postpartum depression 89
|
|
|
___ tends to manifest as aches and pains at night or insomnia.
|
Stress 91
|
|
|
Which vitamins and minerals are good for coping with stress?
|
Vitamins B and C, trace minerals, calcium and protein 91
|
|
|
Which herbal tinctures are good for inducing sleep?
|
hawthorn, hops, passionflower 91
|
|
|
Can chiropractic adjustments help with stress?
|
yes 91
|
|
|
Women who work to term are frequently ___, as if making up for lost time.
|
overdue 92
|
|
|
If the mother plans to return to work soon after the birth, emphasize the importance of taking as much time off as possible so she can ___, ___ and ___.
|
1) get to know the baby, 2) establish a good milk supply and 3) develop a workable routine at home 92
|
|
|
Limiting nursing periods leads to __ and __.
|
reduced milk supply and early weaning 92
|
|
|
Both partners must understand that a pregnant woman's desire for ___ fluctuates dramatically.
|
sex 98
|
|
|
Which is the love hormone associated with sexual arousal, nipple stimulation and orgasm?
|
oxytocin 98
|
|
|
Which changes serve to boost sexual desire during the latter part of pregnancy?
|
high levels of estrogen, progesterone and oxytocin, and increased pelvic circulation 98
|
|
|
When are repressed memories of sexual abuse likely to arise?
|
1) during the perinatal cycle, 2) when a woman gets married or commits to monogamous relationship, 3) when her own daughter reaches the ages when she herself was first molested, 4) when her perpetrator dies 99
|
|
|
What is an involuntary contraction of the vaginal muscles if any attempt is made at penetration called?
|
vaginismus 100
|
|
|
What could vaginal bleeding in the first trimester indicate?
|
threatened, spontaneous or missed abortion, molar pregnancy, ectopic pregnancy 104
|
|
|
What could vaginal bleeding in the second or third trimesters indicate?
|
placenta previa, placental abruption, ruptured cervical polyp or other causes 104
|
|
|
What could an initial outbreak of blisters in the perineal or anal area during the first trimester indicate?
|
herpes virus 104
|
|
|
What could severe pelvic or abdominal pain indicate?
|
tubal pregnancy (first trimester), placental abruption (last trimester) 104
|
|
|
What could persistent and severe midback pain indicate?
|
kidney infection/pyelonephritis 104
|
|
|
What could swelling of hands and face indicate?
|
preeclampsia 104
|
|
|
What could severe headaches, blurry vision, or pain under ribcage indicate?
|
a preeclamptic condition becoming critical 104
|
|
|
What would a gush of fluid from the vagina indicate?
|
in the first or 2nd semester this may indicate miscarriage; if in late 2nd or 3rd trimester, indicates premature delivery (PROM) 104
|
|
|
Obvious signs that labor is impending are __, __ or __.
|
bloody show, SROM or regular ctx (at least 20 minutes apart) 105
|
|
|
Globs of mucus are often passed in the final weeks of pregnancy, but only if the secretions are ___ can you assume that cervical changes are occurring.
|
blood-tinged 105
|
|
|
If a woman reports a gush of water from the vagina with no more following, this is called a ___
|
hind leak 106
|
|
|
If a mother with ruptured membranes ____, her body will defend itself by increasing the production of amniotic fluid, which flushes the vagina and discourages bacteria from migrating upward.
|
drinks sufficient amounts of liquid at regular intervals 106
|
|
|
After membranes have ruptured, ____ can be taken every few hours to ward off infection.
|
vitamin C 106
|
|
|
In case of ruptured membranes at term at night or prolonged prodromal labor, suggest...
|
a glass of wine, which will allow the mom to sleep 106
|
|
|
If labor starts in the morning what should you recommend?
|
Ask if she got enough sleep, then suggest a good breakfast and an outing with her partner in some natural setting. Encourage her to keep eating and drinking and take a nap in the afternoon if things have not changed 107
|
|
|
If labor starts in the afternoon, what should you recommend?
|
Make sure she had a good lunch then suggest a hot shower or bath and a nap. In this case, the priority is rest rather than activity. To help her rest, suggest hops tincture in tea or a massage. Remind her that she should plan to have dinner and should call you after she rests to check in 107
|
|
|
If labor starts at night, what should you recommend?
|
Rest and good dinner, remind her to keep fluids by the bed - she should drink and urinate frequently 107
|
|
|
If a baby is postdates, when should you attend the labor?
|
as soon as it begins 108
|
|
|
In general, what signals the onset of active labor?
|
Contractions one minute long, coming every five minutes 108
|
|
|
Fetal heart tones during labor must be taken ____ in order to gauge fetal response.
|
during and immediately after a contraction 109
|
|
|
When doing vaginal exams during labor use ___ with ____.
|
sterile gloves with lubricating jelly (or a squirt of Betadine or other antiseptic if the membranes are ruptured and labor is well progressed) 109
|
|
|
If labor is already well underway and a tight-rimmed cervix seems to be hindering progress, what should you do?
|
apply pressure to the rim edge- it should break up under your fingers (EPO takes as long as 12 hours to work - should be used in early labor or before labor ) 109
|
|
|
In general, women who commence with close set contractions give birth ____ than those who begin with contractions every 20 minutes.
|
sooner 108
|
|
|
What are factors that stimulate the neocortex?
|
Speech, bright light, a sense of being observed 111
|
|
|
What can you use to help a mom complaining of nausea in labor?
|
accupressure on the inner wrist 112
|
|
|
If the baby is high (-2 or -3) and posterior in early to active labor, what should you recommend?
|
hand-and-knees position with pelvic rocking or standing and leaning forward with one foot on a low stool to encourage rotation 112
|
|
|
What position should be avoided in early to active labor in the case of a high, posterior baby?
|
deep squatting, as it closes the inlet 112
|
|
|
Water increases ____ helping it to work more efficiently.
|
blood flow to the uterus 112
|
|
|
If labor has been prolonged for any length of time - three hours or so without apparent progress - what should the midwife check?
|
the urine for ketones 113
|
|
|
What three symptoms indicate maternal exhaustion?
|
rising pulse, rising temperature and ketonuria 113
|
|
|
In case of clinical exhaustion during labor, what is advisable?
|
transport 113
|
|
|
What is the simple solution for variable decelerations during labor?
|
have the mother try another position 113
|
|
|
What is a FHT that dips and bobs dramatically during a contraction, with lows below 80 BPM and highs well above 160 BPM called?
|
variable decelerations 113
|
|
|
What causes variable decelerations?
|
cord entanglement or cord compression 113
|
|
|
Although not an immediate emergency, serious fetal distress may ensue if ___ are ignored.
|
variable decelerations 113
|
|
|
What are two ominous FHT patterns?
|
1) flat baseline with no variability, 2) late decelerations 114
|
|
|
___ is considered to be the most important indicator of fetal well-being in labor.
|
Good variability 114
|
|
|
What does a late deceleration of FHT look like during labor?
|
the FHT is normal through the first part of a contraction but dips down at the peak, slowly returning to baseline as the contraction ends 114
|
|
|
Late decelerations may be linked to ___ or ___.
|
placental insufficiency or maternal ketoacidosis 114
|
|
|
In the case of late decelerations, there is not enough ____ reaching the baby to get it through the contraction.
|
oxygen 114
|
|
|
If the baby is very compromised during labor, a late deceleration will _____.
|
extend past the end of the contraction 114
|
|
|
What is poor recovery?
|
when a late deceleration extends past the end of the contraction 114
|
|
|
What should you do if you pick up either flat baseline or late decelerations during first stage?
|
give the mother oxygen and transport 114
|
|
|
What is a normal FHT response to a contraction in labor?
|
slight acceleration to the peak, with return to baseline by the end 113
|
|
|
When does the plateau phenomenon occur?
|
At 4 cm, 7 cm and again at 9 cm 114
|
|
|
What is the plateau phenomenon?
|
labor slowing periodically for the mother to integrate; occurs at 4cm (challenging transition from control to surrender), 7 cm (transition contractions are overwhelming) and 9 cm (confusion of bearing-down urges disrupting relaxation) 114
|
|
|
An arrest of ___ during labor is fine as long as the mother's condition is good, her morale is high and the baby is doing well.
|
several hours 115
|
|
|
To assess position during an internal exam, the cervix must be dilated to at least ___
|
6 cm 115
|
|
|
Which suture is most subject to molding?
|
the saggital 115
|
|
|
If the baby is term, how many fontanelles will be felt during an internal exam?
|
one 115
|
|
|
What is the acronym for syphilis screening?
|
VDRL or RPR 36
|
|
|
Like herpes, ___ resides in the nerve ganglia in the genital area.
|
HPV 36
|
|
|
Women with HPV are advised to have pap smears how often?
|
every 6 months 36
|
|
|
If a mother is HIV positive, what is the possibility her baby will contract the virus?
|
25% 37
|
|
|
TRUE or FALSE: 83% of women are Rh+
|
TRUE 38
|
|
|
What are 4 types of neural tube defects?
|
anencephaly, microcephaly, hydrocephaly, spina bifida 39
|
|
|
What testing does the triple screen include?
|
alpha-fetoprotein
hCG levels unconjugated estrogen levels 39 |
|
|
By age 40, the incidence of Down syndrome is 1 in __
|
100 page 39
|
|
|
The incidence of Down syndrome at age 35 is 1 in __, equal to the risk of miscarriage or infection caused by amniocentesis.
|
365 page 39
|
|
|
Group B streptococcus (GBS) lurks harmlessly in the vagina or rectum of __% of women.
|
30% page 40
|
|
|
When is the optimal time to perform amniocentesis?
|
14 to 16 weeks 39
|
|
|
Indigestion and heartburn in pregnancy result from ...
|
displacement of the stomach and intestines by the growing uterus 44
|
|
|
Although the rate of GBS infection for newborn babies is only __%, __% of infected babies die.
|
6%, 5% 40
|
|
|
What is a natural treatment for BV?
|
Refrain from sex during treatment:
Insert one unnicked, peeled garlic clove into vagina and change 3x daily; follow with 5 days acidophilus treatment (buy at health food store and insert soaked tampon, change every 3 hours). If this doesn't work, medical treatment is necessary. 45 |
|
|
What are 6 herbs contraindicated in pregnancy?
|
goldenseal, ephedra, pennyroyal, birth root, cotton root bark, blue cohosh 47
|
|
|
The usual treatment for trichomonas, ___, is contraindicated in the first half of pregnancy.
|
Flagyl 45
|
|
|
Name 2 homeopathics to use for muscle pain.
|
hypericum (St. John's wort) and arnica gel applied directly 48
|
|
|
Name three homeopathics for treatment of nausea.
|
Nux vomica, sepia, pulsitilla 48
|
|
|
Homeopathic treatment to turn a breech baby?
|
pulsitilla 30c taken several times a day 49
|
|
|
What does light bleeding, brownish in color, for many weeks, with no distinct episode of resolution suggest?
|
missed abortion or hydatidiform mole 69
|
|
|
___ is critical whenever blood pressure is just starting to rise, as long as it is no more than moderately elevated.
|
Aerobic exercise 74
|
|
|
Whenever there is a marked increase in the strength of contractions, check _______ to _____.
|
fetal heart tones more frequently to see how the baby is adjusting 118
|
|
|
How often in transition should you check the FHT?
|
every 20 minutes 118
|
|
|
What should the mother do during transition as each contraction ends and before she slips away into rest?
|
take a sip of tea or water 118
|
|
|
Old meconium creates a ___ tinge to the water and is evidence of a brief episode of hypoxia much earlier in labor or in the days preceding it.
|
yellow 118
|
|
|
What color and consistency is water stained with fresh meconium?
|
Particulate and green or brown like pea soup 118
|
|
|
What does particulate, green amniotic fluid indicate?
|
Fresh meconium,indicative of recent or current fetal distress 118
|
|
|
What should you do when you encounter fresh meconium in the amniotic fluid?
|
Immediately listen to FHT for several contractions, tracking even the slightest deviation from normal. Unless the baby sounds absolutely perfect, with a healthy acceleration response to each and every contraction, consider transport. 118
|
|
|
If the mother pushes only at the peak of contractions, or with every other one, she _____.
|
still has some dilating to do 118
|
|
|
Why is it important to make sure there are no open flames or lit candles in the birth room as second stage approaches?
|
In case you need to run your oxygen 118
|
|
|
Make sure the mother ____ before second stage begins.
|
urinates 119
|
|
|
Why is it important to make certain that the mother urinates before beginning second stage?
|
a full bladder can hinder descent and lead to postpartum hemorrhage 119
|
|
|
In second stage, the contractions typically become _____.
|
further apart 119
|
|
|
What is the kite-shaped area of the lower spine with points at the waist, coccyx and sacroiliac joints?
|
the rhombus of Michaelis 119
|
|
|
Which area in the lower back must "open" in second stage in order for the baby to descend?
|
the rhombus of Michaelis 119
|
|
|
Make sure the mother ____ before second stage begins.
|
urinates 119
|
|
|
If the mother is leaning forward with her knees lower than her hips during second stage, this allows the baby's head to contact the ___, which triggers the sacrum to open
|
G-spot 119
|
|
|
Why is it important to make certain that the mother urinates before beginning second stage?
|
a full bladder can hinder descent and lead to postpartum hemorrhage 119
|
|
|
As the baby's head contacts the G-spot in second stage and triggers the sacrum to open, what three things will the mother do?
|
1) grab forward for support
2) spread her knees apart and let her belly sag 3) arch her back and wriggle her lower body 119 |
|
|
In second stage, the contractions typically become _____.
|
further apart 119
|
|
|
What is the series of movements made by the mother that has been termed the "fetus ejection reflex"?
|
1) Mother grabs forward for support
2) spreads her knees apart and lets her belly sag 3) arches her back and wriggles her lower body 119 |
|
|
What is the kite-shaped area of the lower spine with points at the waist, coccyx and sacroiliac joints?
|
the rhombus of Michaelis 119
|
|
|
The hospital convention of forced, sustained bearing down has been linked to ___, ___ and ___.
|
fetal bradycardia, episiotomy and neonatal resuscitation 120
|
|
|
Which area in the lower back must "open" in second stage in order for the baby to descend?
|
the rhombus of Michaelis 119
|
|
|
During second stage, contractions vary in intensity until the head is at __ station; after this, pressure on the pelvic floor and the urge to push remain fairly constant contraction to contraction.
|
+2 station 120
|
|
|
If the mother is leaning forward with her knees lower than her hips during second stage, this allows the baby's head to contact the ___, which triggers the sacrum to open
|
G-spot 119
|
|
|
As the baby's head contacts the G-spot in second stage and triggers the sacrum to open, what three things will the mother do?
|
1) grab forward for support
2) spread her knees apart and let her belly sag 3) arch her back and wriggle her lower body 119 |
|
|
What is the series of movements made by the mother that has been termed the "fetus ejection reflex"?
|
1) Mother grabs forward for support
2) spreads her knees apart and lets her belly sag 3) arches her back and wriggles her lower body 119 |
|
|
The hospital convention of forced, sustained bearing down has been linked to ___, ___ and ___.
|
fetal bradycardia, episiotomy and neonatal resuscitation 120
|
|
|
During second stage, contractions vary in intensity until the head is at __ station; after this, pressure on the pelvic floor and the urge to push remain fairly constant contraction to contraction.
|
+2 station 120
|
|
|
During labor, fetal catecholamines (____ and ____) rise to prepare the baby for the challenging transitions at birth.
|
adrenaline and noradrenaline 120
|
|
|
Head compression during second stage intensifies ____ release, particularly ___, which helps protect the baby from asphyxia by bringing more blood to the heart, brain, adrenals and placenta.
|
catecholamines, noradrenaline 120
|
|
|
During second stage, _____ levels rise which help offset the potential negative effects of soaring adrenalines.
|
endorphin 120
|
|
|
Just as the mother is primed for birth by vaginal stimulation and increased oxytocin, the baby is ....
|
stimulated and prepared 120
|
|
|
When the head first begins to show, ask the mother to ....
|
blow through a contraction 120
|
|
|
Why would you want the mom to blow through a contraction as the head is beginning to show?
|
1) to give her a chance to practice before delivery
2) to see how rapidly descent is taking place 120 |
|
|
If mother is tightening up involuntarily with pushing it is probably because she is overwhelmed. What is one technique to try?
|
get her in knees-chest position, which will ease pressure on the head, which can then complete its accommodations to the pelvis without undue stress from the vaginal muscles 120
|
|
|
The greater the degree of head compression, the more likely the baby is to be ...
|
compromised 121
|
|
|
During second stage, listen to the FHT every ...
|
few contractions, during and immediately after each ends 121
|
|
|
Once the head is on the pelvic floor during second stage, listen to the FHT with ...
|
every contraction 121
|
|
|
Typically, head compression causes ___ decelerations.
|
early 121
|
|
|
What does an early deceleration sound like?
|
FHTs decelerate as the contraction begins, reach a low point as it peaks, and return to baseline as it ends (in other words, mirror the contraction) 121
|
|
|
What are FHTs that decelerate as the contraction begins, reach a low point as it peaks, and return to baseline as it ends called?
|
Early decelerations 121
|
|
|
What are decelerations that mirror the contraction called?
|
Early decelerations 121
|
|
|
In the early part of second stage, early decels of ___ points are considered normal.
|
10 points 121
|
|
|
With perineal dilation, early decels of ___ points are not uncommon.
|
20 points 121
|
|
|
Approaching the end of second stage, occasional early decels to ___ BPM are not uncommon, but consistent dips to ___ BPM will render the baby hypoxic before too long.
|
80 BPM, 60 BPM 121
|
|
|
Consistent dips to ___ BPM in late second stage necessitate immediate delivery or transport if birth is not imminent.
|
60 BPM 121
|
|
|
What is considered mild bradycardia?
|
FHT 109-100 BPM
|
|
|
Mild bradycardia is considered ____ during labor, but moderate bradycardia necessitates quick delivery or immediate transport.
|
acceptable 121
|
|
|
What is moderate bradycardia?
|
FHT below 100 page 121
|
|
|
For either bradycardia or severe early decelerations, give the mother _____.
|
oxygen by mask, 6 liters per minute 121
|
|
|
A pattern of early decelerations is unusual before the head reaches the pelvic floor, and may be due to _____ linked to ____.
|
extreme muscle tension linked to a history of sexual abuse 121
|
|
|
A short, vigorous second stage can cause ___
|
postpartum hemorrhage 122
|
|
|
The ___ position for giving birth is contrary to the laws of gravity and bad for the baby, due to compression of the maternal vena cava and reduced blood flow to the placenta.
|
supine 122
|
|
|
In which position should a mother with a history of deep perineal scarring or precipitous labor give birth?
|
side-lying with one leg raised to reduce strain on the perineum 122
|
|
|
Which birth position is particularly good for mothers with big babies?
|
hands and knees 122
|
|
|
Which birth position is particularly good for mothers with big babies and for those who have pushed for a long time with the head low?
|
hands and knees 122
|
|
|
Although approaches to preventing tears are many, nothing takes the place of ____
|
a mother's internal awareness in easing her baby out 122
|
|
|
Perhaps the most helpful and appreciated technique for preventing tears is ...
|
the application of hot compresses to the perineum 122
|
|
|
Why are hot compresses applied to the perineum during pushing helpful?
|
1) stimulate circulation
2) promote relaxation 3) provide relief from burning at maximum stretch 123 |
|
|
Early decels to 60 BPM or severe bradycardia indicate the baby should be born at once. If the baby is low but mother can't seem to push it out, the midwife should ....
|
do an episiotomy 123
|
|
|
Episiotomy should be performed only if the perineum is _____, but the head is ____.
|
stretched to half its capacity, but the head is not crowning 123
|
|
|
As the baby nears crowning, what is an equally reliable indicator of fetal wellbeing as FHTs?
|
the color of the baby's scalp 123
|
|
|
In terms of crowning and the color of the baby's scalp, which color is most favorable?
|
pinkish blue 123
|
|
|
In terms of crowning and the color of the baby's scalp, which color is ominous?
|
white-blue 123
|
|
|
During crowning, as long as ____, ____ and ____, you can relax and wait for the birth.
|
the baby is doing well, the scalp color is reassuring and heart tones are fine 123
|
|
|
If the mother is taking her time and is birthing in ______ position, pelvic floor muscles promote fetal head flexion automatically.
|
an upright position 123
|
|
|
Particularly if the baby's head is large, guard the urethral area by positioning the _____ of your hand by the pubic bone, extending your fingers down across the head to _______.
|
wrist, control the rate of expulsion 123
|
|
|
When suctioning with a bulb syringe, insert no more than ___ or you will stimulate the gag reflex at the back of the baby's throat, which can suppress its attempts to breathe.
|
a few inches 124
|
|
|
Suction on the perineum is considered ____ if the baby has passed meconium in labor (which would preclude water birth).
|
mandatory 124
|
|
|
When using a DeLee, insert the tubing about ____ into the baby's mouth.
|
4.5 inches 124
|
|
|
As soon as the baby's head is out, do a quick appraisal of ___ and ___.
|
color and presence 124
|
|
|
After the birth of the head, a white-blue head with a clenched mouth usually indicates a baby that needs ...
|
to be birthed quickly (and may also need help getting started). 124
|
|
|
There is no need to hurry delivery of the ____ as long as the baby's color is good.
|
shoulders 125
|
|
|
What are the two essentials for stabilizing a newborn?
|
warmth and a clear airway 125
|
|
|
Homeopathic for when early labor is intense like transition, with contractions three minutes apart (and especially if the woman is shivering).
|
cimicifuga 127
|
|
|
Promote regular contractions with this homeopathic.
|
caulophyllum 127
|
|
|
If contractions are not yet regular, but are unrelenting and not given to rest, promote regular contractions with this homeopathic.
|
caulophyllum 127
|
|
|
If labor is on again, off again in nature and especially if the mother is whiny and clingy, needing a lot of validation that what she feels is emotionally normal, try this homeopathic.
|
pulsitilla 127
|
|
|
If woman appears to be scrambling away from herself and her contractions in active labor, use this homeopathic.
|
sepia 127
|
|
|
If cervix is 100% effaced, 3 cm dilated and feels like a loop of thread, and labor appears very active or transitional, prepare as if birth were imminent and give this homeopathic.
|
gelsemium 127
|
|
|
If woman is not yet fully dilated but feels an urge to push, give this homeopathic to prevent cervical swelling.
|
arnica 127
|
|
|
If there is a strong urge to push at only 6-7 cm or there is a cervical lip, give these two homeopathics.
|
sepia and arnica 127
|
|
|
If dehydration and exhaustion during labor occur, give one of these three homeopathics.
|
china, carbo veg or ustilago 127
|
|
|
If dehydration or exhaustion occur during labor, an ____ of warm water and honey can help.
|
enema 127
|
|
|
If dehydration or exhaustion occur during labor, a dose of ___ taken orally can revive for the short term.
|
royal jelly 127
|
|
|
If during second stage, contractions come less and less often, give this homeopathic.
|
caulophyllum 127
|
|
|
Which homeopathic is invaluable for helping women release fear or anxiety in labor?
|
aconite 127
|
|
|
Which homeopathic supports quietude and letting go?
|
aconite 127
|
|
|
Which homeopathic to give when pain in labor seems out of proportion to contractions?
|
arnica 127
|
|
|
Which homeopathic can help during the first few days postpartum for soreness and body fatigue?
|
arnica 127
|
|
|
Which herb brings the placenta "like an angel"?
|
angelica
|
|
|
How much angelica should be given to bring the placenta?
|
one dropperful under the tongue with a swig of water following 128
|
|
|
Which herb can be used for partial separation of the placenta?
|
angelica 128
|
|
|
Which herb is used after the placenta is out and you are sure its complete?
|
shepherd's purse 128
|
|
|
Which herb promotes blood clotting?
|
shepherd's purse 128
|
|
|
If you are not sure the placenta is complete, which herb should you use?
|
angelica, to bring on more contractions 128
|
|
|
If you are confronted with a vaginal tear that has ruptured a small vessel, apply direct pressure to the tear and give a dropperful of one of these two herbs...
|
trillium or birth root 128
|
|
|
Which herb constricts small blood vessels?
|
trillium 128
|
|
|
If a baby is making minimal or no respiratory attempts, and looks bluish or feels cold, give this homeopathic.
|
carbo veg 128
|
|
|
If the baby is pale as a ghost, floppy, cold or weak, give this homeopathic.
|
camphora 128
|
|
|
If the baby appears lifeless and pale with no respirations, give this homeopathic.
|
arsenicum 128
|
|
|
For moist, sticky lungs that are not cleared with suction, give this homeopathic.
|
antimonium 128
|
|
|
Which homeopathic is best for the baby that is struggling and warm, perhaps crying inconsolably as if from a great fright, with rapid heart rate and respirations and color red, not blue?
|
aconitum 128
|
|
|
Rescue remedy may be given to the baby orally or ____
|
on the soles of the feet 128
|
|
|
What are 5 remedies for the woman who is dizzy and fainting postpartum?
|
burnt hair under the tongue, placenta under the tongue, rescue remedy, soft bristled brush strokes on her legs, strong black tea 128
|
|
|
If the mother is not kept warm during third stage, _____ will remain high, which can disrupt placental separation by opposing oxytocin.
|
adrenaline 129
|
|
|
What is the key to a safe and uncomplicated third stage?
|
watchful observation 129
|
|
|
How do you rule out a concealed separation in third stage?
|
Rest a hand on the fundus as soon as the baby is out, and keep it there until the placenta delivers. Do not massage or prod; keep your hand still. With a concealed abruption, the uterus will increase in size and become boggy. 129
|
|
|
What is known as "guarding the uterus"?
|
Watching for concealed placental separation by placing the hand on the fundus as soon as the baby is out and keeping it there until the placenta is delivered. 129
|
|
|
Delivery of the placenta is best accomplished with the mother in ____ position.
|
an upright position 130
|
|
|
You should apply cord traction on the placenta when the uterus is ___ and the mother is ____.
|
contracted and pushing 130
|
|
|
Only if the placenta is _____ may you use controlled cord traction to remove it.
|
immediately behind the cervical opening or in the vagina 130
|
|
|
A Shultz placenta correlates to ___ implantation of the placenta with separation beginning at the ____.
|
fundal, center 130
|
|
|
A Duncan placenta correlates to ___ implantation of the placenta with separation starting at the ___.
|
low, edges 130
|
|
|
If the uterus feels soft or asymmetrical in shape after delivery of the placenta, rub up a good contraction, encourage baby to breastfeed and give several droppers of these two herbs.
|
shepherd's purse and blue cohosh
|
|
|
How many arteries and how many veins are there in the fetal cord?
|
2 arteries and 1 vein 132
|
|
|
If there are only two vessels noted in the umbilical cord, the baby may have ____ and the midwife should _____.
|
anomalies not immediately apparent and the pediatrician should be notified 132
|
|
|
What is the name of the bluish-white substance in which the vessels are suspended in the fetal cord?
|
Wharton's jelly 132
|
|
|
If there is no Wharton's jelly present at the junction of the umbilical cord and the placenta, you have discovered a ....
|
velamentous cord insertion 132
|
|
|
What is a succenturiate lobe?
|
a separate bit of placenta detached from the main placenta but attached to the membranes 132
|
|
|
What is the cardinal rule for handling postpartum hemorrhage:
|
determine the cause of bleeding before taking action 133
|
|
|
Check the mother's bleeding and uterus every ____ in the first hour after birth.
|
every 10-15 minutes 133
|
|
|
On the newborn exam, a bright red skin tone is associated with ___ and ___.
|
prematurity and polycythemia 134
|
|
|
A baby with bright-red skin tone during the newborn exam necessitates ___ or ___.
|
a hematocrit or referral to the pediatrician 134
|
|
|
What is another name for peeling skin?
|
desquamation 134
|
|
|
What is a blue ring around the mouth called?
|
circumoral cyanosis 134
|
|
|
If ___ isn't massaged into the baby's skin, it could cause inflammation.
|
vernix 134
|
|
|
Normal molding tends to diminish within ____
|
a couple of hours 134
|
|
|
Cephalhematoma, bruising or excessive molding are signs of significant trauma, necessitating administration of ___
|
vitamin K 134
|
|
|
Cephalhematoma, bruising or excessive molding are signs of significant trauma and the baby should _____
|
be seen by a pediatrician as soon as possible 134
|
|
|
Low lying ears on a newborn are associated with ___
|
kidney problems 134
|
|
|
When a baby breathes, ___ and ___ should inflate and deflate smoothly together.
|
ribs and belly 135
|
|
|
If the baby's chest and abdomen move in a seesaw fashion, the baby has ___ and should be seen by a pediatrician at once.
|
retractions 135
|
|
|
What is a bulge appearing at the base of the cord stump called?
|
an umbilical hernia 135
|
|
|
When can an umbilical hernia be corrected surgically?
|
when the baby is about 2 years old 135
|
|
|
If the femoral pulses on the newborn are not symmetrical, the baby could have a ____
|
congenital heart problem 135
|
|
|
When checking the ____ reflex, let the baby grab your little fingers. You should be able to lift its back slightly off the bed.
|
palmar (or grasp ) 135
|
|
|
Even the tiniest opening in the spine of a newborn indicates a condition called ___
|
spina bifida 135
|
|
|
Spina bifida can lead to major infections like ____
|
meningitis 135
|
|
|
To check the lungs, you listen through the baby's ___.
|
back 135
|
|
|
It is not necessary to insert a thermometer into the newborn's anus to check for ___
|
patency 136
|
|
|
Measure the baby's head circumference at the ____
|
widest point, from occiput to frontal bone 136
|
|
|
Where do you measure the circumference of the baby's head?
|
from occiput to frontal bone 136
|
|
|
The difference in the head and chest circumference in a newborn should be no more than ___
|
a few centimeters 136
|
|
|
If the baby's chest circumference is the same or larger than the head and the baby is over 9 pounds, the mother may have had some degree of ____ and the baby should be checked for ___.
|
glucose intolerance, hypoglycemia 136
|
|
|
An unmistakable crinkling sensation called ____ indicates a fractured clavicle.
|
crepitus 136
|
|
|
When you discover a fractured clavicle on newborn exam what two things should you do?
|
administer vitamin K and contact the pediatrician 136
|
|
|
The impact of ___ on labor cannot be overestimated.
|
maternal emotions 139
|
|
|
What are the 5 steps to handling a complication in labor?
|
1) Determine CAUSE
2) TEST diagnosis 3) Implement REMEDY 4) FOLLOW UP on vital signs and effectiveness of remedy 5) REEVALUATE 139 |
|
|
From the midwife's point of view, labor is only prolonged when ___ threatens.
|
clinical exhaustion 140
|
|
|
For the mother who is in early labor and is overly excited, recommend ___ tincture or ____.
|
hops tincture or a glass of red wine 141
|
|
|
Arrests in labor become a concern only when the woman reaches __ centimeters.
|
6 page 141
|
|
|
Clinical exhaustion is also known as...
|
ketoacidosis, in that the mother's blood becomes abnormally acidic and less able to carry oxygen 141
|
|
|
If ketoacidosis is not reversed, ___ will result.
|
fetal distress 141
|
|
|
If labor begins to slow down, do ______
|
not try to stimulate it! 142
|
|
|
Diminishing contractions in labor indicate ______.
|
that the uterus is fatigued 142
|
|
|
The cervix can open to ____ without pressure from the presenting part.
|
6 cm 142
|
|
|
After 6 cm, how does the cervix dilate?
|
by pressure from the presenting part as it passes through it 142
|
|
|
_____ strengthens contractions and must be uniform for labor to intensify.
|
Pressure on the cervix 142
|
|
|
____ is a condition in which the baby's head cannot readily pass through the mother's pelvis.
|
Cephalopelvic disproportion 145
|
|
|
What are relevant factors in creating a cephalopelvic disproportion?
|
size of baby, size of pelvis, degree to which fetal skull is moldable, amount of flexibility in maternal tissues and joints, flexion of baby's head, strength of uterine contractions, mother's resolve 145
|
|
|
Only __% of all cases of CPD are due to a genuine discrepancy between the size of the baby and that of the mother's pelvis - usually, it is a problem with fetal malpresentation or misalignment.
|
1-2% 145
|
|
|
What are the two main causes of CPD?
|
fetal malpresentation or misalignment 145
|
|
|
What does arrest at 6cm, lack of descent past -3 or -2, asynclitism and cervix not well applied to the head indicate?
|
inlet disproportion 146
|
|
|
An oddity of inlet CPD is the tendency of the cervix to ___
|
reclose 146
|
|
|
How does midpelvic disproportion usually present?
|
with deep transverse arrest, meaning that the head gets wedged behind the ischial spines and cannot rotate to the antero-posterior position 146
|
|
|
Which two types of pelvic disproportion lead to prolonged second stage?
|
midpelvic disproportion and outlet disproportion 146
|
|
|
Prolonged second stage at the perineal phase, with severe early decels or bradycardia may indicate....
|
outlet disproportion (CPD) 146
|
|
|
If presented with inlet disproportion, what can the midwife do?
|
try to reposition the head 146
|
|
|
What are 8 ways to try to reposition the head in case of inlet disproportion?
|
1) manually
2) duck-walking 3) hip twist-and-lift 4) the lunge 5) rebozo 6) chunging 7) bumpy car ride 8) stair climbing 146 |
|
|
Which of the pelvic disproportions is the most difficult to address?
|
inlet disproportion 146
|
|
|
For which types of pelvic disproportion does the pelvic press work best?
|
midpelvic and outlet disproportion 146
|
|
|
When does posterior arrest usually occur?
|
at 6cm 150
|
|
|
A posterior position is normal with which pelvis?
|
anthropoid 150
|
|
|
___ occurs if a baby in LOP or ROP position gets stuck at the pelvic inlet during active, first stage labor.
|
Posterior arrest 150
|
|
|
Posterior arrest occurs at the pelvic _____
|
inlet 150
|
|
|
Which position is very effective for turning a baby with posterior arrest (or any baby arrested at the inlet)?
|
A forward-learning position, with one foot (on the side where the baby is lying) placed on a small stool or stair. This flexes and opens the sacroiliac joint, giving the baby more room to turn. The forward lean is very important in that the baby's posterior shoulder is typically on the other side of the sacral promontory and cannot rotate unless the mother gets her weight forward, well over and in front of her ischial tuberosities. 150
|
|
|
You will not be able to find the ___ if the head is deflexed.
|
posterior fontanel 151
|
|
|
If you have manually rotated the baby out of a malpresentation and into a better one and you check twenty minutes later to find the baby back in the original position, what should you do?
|
Do not be discouraged; you may need to make a few more attempts. With each, the baby should flex and descend a bit more, eventually staying in place 152
|
|
|
If a baby in a malposition cannot be manually rotated to the anterior despite numerous attempts, consider ....
|
turning the baby to OP - at least it can descend this way 152
|
|
|
Where will you find the anterior fontanel on a baby with a deflexed head?
|
up near the pubic bone 151
|
|
|
How should fetal scalp massage be performed in order to determine if a baby is becoming hypoxic?
|
Performed for about 10 seconds, a 15 point FHT acceleration lasting 15 seconds is said to indicate a pH of at least 7.26 (normal, not acidotic) 153
|
|
|
A remedy for variable decels in 2nd stage is to ______
|
press on the mother's abdomen where the baby's back is located - this frequently shifts the baby off the cord 153
|
|
|
When the cord is low enough in the pelvis to be increasingly compressed by the head as it descends, but not low enough to be at the os or in the vagina it is called....
|
occult cord prolapse 154
|
|
|
Persistent ____ constitutes a crisis with very little leeway.
|
bradycardia 154
|
|
|
If cord compression is severe, ____ will develop.
|
bradycardia 154
|
|
|
If persistent bradycardia develops in second stage, what should the midwife do?
|
position mother in knees-chest, give oxygen at 6 L/min. If there is no improvement after 5-6 contractions and birth is not imminent, transport 154
|
|
|
In the case of severe cord entanglement, what might you hear?
|
a swishing like placenta or artery at the baby's rhythm over the FHT 154
|
|
|
If there is severe cord entanglement, descent will probably be ....
|
inhibited 154
|
|
|
Complete cord prolapse is associated with...
|
polyhydramnios, multiple pregnancy, breech or compound presentation and transverse lie 154
|
|
|
Cord prolapse tends to happen in ___ labor.
|
early 154
|
|
|
Cord prolapse is associated with conditions in which...
|
the presenting part is either high in the pelvis or fitting poorly at the inlet 154
|
|
|
If the head is high in the pelvis near term and the mother reports labor's onset with rupture of the membranes, immediately...
|
go and check fetal heart tones 154
|
|
|
If the mother's blood pressure was high in late pregnancy, check her blood pressure every __ in early labor.
|
20 minutes 154
|
|
|
Urinalysis for protein in labor is somewhat unreliable because...
|
cells in the amniotic fluid may wash down and give a false positive reading 154
|
|
|
If concerned about preeclampsia, instead of checking for proteinuria in labor, check for ...
|
clonus 154
|
|
|
Tincture of ___ during labor is the most effective herb for reducing hypertension.
|
hops 154
|
|
|
Why would you want to give a tincture remedy in labor instead of a tea?
|
tea or anything else taken by mouth digests very slowly in labor 154
|
|
|
To reduce blood pressure in labor, the mother can bathe in ...
|
Epsom salts (magnesium sulfate) 155
|
|
|
If blood pressure is stable in early labor but rises at transition, the midwife should...
|
have the mother lie on her left side and give her oxygen at 6 L/min 155
|
|
|
Any woman with borderline hypertension either prenatally or in labor is at risk for ....
|
an even greater rise in blood pressure after delivery 155
|
|
|
When does the risk of infection increase dramatically for the woman with PROM?
|
24 hours after the first vaginal exam 155
|
|
|
What is the only exception to not doing vaginal exams early on when membranes have ruptured?
|
if the mother has a history of herpes, to check for herpes lesions 155
|
|
|
Are tub baths ok for moms who have ruptured membranes but who are not yet in labor?
|
Yes 156
|
|
|
With PROM, it is possible for the mom to be only minimally infected, with the baby decidedly septic. In this case ___ will result.
|
fetal tachycardia 156
|
|
|
Once membranes have been ruptured 24 hours, the midwife should ____
|
check FHTs regularly 156
|
|
|
The first sign of newborn infection is usually ...
|
failure to nurse 156
|
|
|
If membranes rupture and bleeding is noted, the midwife should ...
|
give oxygen and transport immediately 156
|
|
|
What is the exceedingly rare complication in which placental or cord vessels present over the cervical os?
|
vasa previa 156
|
|
|
Vasa previa can present with a ____ or ____
|
velamentous insertion or succenturiate lobe 156
|
|
|
The mechanics of face presentation require that the baby be born ____
|
occiput posterior, that is, chin up 157
|
|
|
What are two possible causes of face presentation?
|
cord around the neck tightening and deflexing the head as the baby descends or inlet CPD 157
|
|
|
Suction is usually necessary for ___ presentations because the baby is facing up and may get a nose full of fluids as the head births.
|
face presentation 157
|
|
|
With a face presentation baby, watch for breathing difficulties due to _____
|
tracheal edema 157
|
|
|
Why must the face presentation baby be born OP?
|
although labor may begin with the baby anterior, descent cannot occur in this position because the brow will impinge on the symphysis 157
|
|
|
During a shoulder dystocia, ____ can impair venous return from the head and can lead to intercranial bleeding, brain damage and death unless the problem is remedied swiftly and competently.
|
chest compression 159
|
|
|
During a shoulder dystocia, what is important to remember?
|
If the head can pass through the pelvis, so can the shoulders, although you may need to do a bit of maneuvering to make this happen 159
|
|
|
When encountering a shoulder dystocia, what does Davis recommend you do first?
|
flip mother to hands and knees 159
|
|
|
Erb's palsy may be detected by an .....
|
asymmetrical Moro's reflex 161
|
|
|
What are the 9 steps to follow in case of an emergency breech birth?
|
1) Warm up the room
2) Have the mother in an upright position 3) The mother must not push until the body is born 4) Once the baby has birthed to the umbilicus and the legs are out, check for tension on the cord 5) Unless the room is very warm, wrap the baby's body in two warmed receiving blankets to prevent stimulation of respiratory efforts 6) If the breech is frank or complete and delivery of the body is arrested, nudge the legs to the antero-posterior position 7) After delivery of the shoulders, make sure the baby is OA 8) Allow the baby to hang until the nape of the neck appears (or jaw line, depending on whether you are in front or in back of the mother) then support the body and slowly ease the head out 9) Remember that babies born breech more often need extra suction, stimulation or blow-by oxygen to help them get started 162 |
|
|
What is the definition of embolism?
|
entry of foreign matter into the bloodstream 162
|
|
|
Alfalfa tablets are rich in ____ and can help facilitate the clotting process after birth.
|
vitamin K 163
|
|
|
What are the two principle causes of bleeding during labor?
|
placenta previa and placental abruption 163
|
|
|
What are the 4 symptoms of placental abruption during labor?
|
1) severe, persistent abdominal pain (different from the ebb-and-flow sensation of contractions
2) abdominal tenderness (abdomen rock hard to the touch) 3) fetal distress (with FHT pattern indicating hypoxia 4) blood appearing at the outlet (will not occur in a concealed abruption) 164 |
|
|
If a woman complains of sharp but sporadic uterine pain during labor, what should you do and what is the likely cause?
|
apply heat to affected area of the uterus and keep a close check on FHTs; it may be due to incoordinate uterine action, but if pain becomes persistent or acute, transport immediately (could be abruption) 164
|
|
|
____ occurs when the normal process of retraction goes on and on until the lower uterine segment becomes so thin that it tears.
|
Uterine rupture 164
|
|
|
Cervical laceration is _____ unless pitocin, forceps or vacuum extraction have been used to force labor.
|
unlikely 165
|
|
|
What is third stage hemorrhage?
|
blood loss in excess of 2 cups or 500 cc after the birth of the baby but before delivery of the placenta 164
|
|
|
What are the three major causes of third stage hemorrhage?
|
1) cervical laceration
2) vaginal tear 3) partial separation of the placenta 164 |
|
|
Bleeding in third stage without lengthening of the cord, and no apparent urge on the mother's part to expel the placenta, signal ____.
|
partial separation of the placenta 165
|
|
|
If you diagnose a partial placental separation, what 3 things should you do?
|
1) give angelica
2) do nipple stim 3) give 10-20 units pitocin by IM or in an IV if possible 165 |
|
|
Why won't pitocin close the cervix?
|
it contracts the longitudinal fibers of the uterus only, not the circular ones at the cervical os 165
|
|
|
If you encounter a partial placental separation during third stage and the mother is bleeding in small occasional gushes, how often should you give pitocin?
|
every 8 minutes 165
|
|
|
What should you do if you encounter a partial placental separation during third stage and the mother is bleeding in small occasional gushes?
|
Give pitocin (10-20 IU IM or IV) and then repeat again in 8 minutes. After several minutes, follow the cord to the cervix again to see if the placenta is present. If not, transport (you will need to ride with the paramedics and monitor the mother's blood loss and changes in condition. You can also repeat pitocin at 8 minute intervals to control bleeding and keep her stabilized. If she begins bleeding heavily during transport, you only option is to manually remove the placenta then and there). 165
|
|
|
If you encounter a partial placental separation during third stage and the bleeding is torrential from the start, ____ is your only option.
|
Manual removal 166
|
|
|
Why is manual removal not indicated for a partial placental separation in third stage with bleeding coming in small, occasional gushes?
|
Small, occasional gushes mean that only a small portion of the placenta is separated. If you attempt to remove it manually, you might encounter large sections morbidly adherent and impossible to detach, and significant blood loss will occur as you distend the uterus with your hand. 165
|
|
|
Fortunately, heavy blood loss during third stage indicates that ____, so manual removal should not be too difficult.
|
a considerable portion of the placenta is separated 166
|
|
|
Why should manual removal of the placenta be performed only as a lifesaving measure?
|
it can be painful for the mother and may lead to postpartum infection 166
|
|
|
If you attempt a manual removal and sections of the placenta cannot be removed manually, what should you do?
|
1) remove as much as you can
2) if mother continues to bleed heavily, give methergine as a last resort (it may close the cervix, but your priority is to save the mother's life by minimizing blood loss during transport) 3) transport 167 |
|
|
Suspect sequestered clots in fourth stage if ____ or ____.
|
the uterus feels slightly enlarged or if a slow trickle bleed begins after the placenta delivers and then gradually increases 167
|
|
|
If you suspect sequestered clots in fourth stage, what should you do?
|
check by doing a sterile exploration at the cervical os and remove them by sweeping them out of the uterus with your fingers 167
|
|
|
In managing fourth-stage hemorrhage, it is important to remember that oxytocic drugs, herbs and homeopathic remedies cannot help a uterus....
|
filled with clots or one prevented from contracting by a distended bladder 167
|
|
|
If you are faced with a seemingly uncontrollable 4th stage bleed - uterine massage and medications do not work - what should you do?
|
1) call for help
2) give oxygen 3) do bimanual compression 169 |
|
|
When dealing with a woman who is hemorrhaging, you must keep her attention...
|
on the here and now; command her to stay present, rally her vital force (particularly if she is drifting or fading out) 169
|
|
|
Why must you keep the mother who is hemorrhaging focused on the here and now, and command her to stay awake and present?
|
blood loss gives them a cozy, warm, delicious feeling that feels very good and it can be easy for them to just check out 169
|
|
|
Which two herbs should you give in case of a slow trickle bleed in fourth stage?
|
blue cohosh and shepherd's purse 169
|
|
|
What may a slow trickle bleed in fourth stage indicate?
|
an emotional problem, the mother has checked out 169
|
|
|
Absence of the characteristic "separation gush" in third stage is a definite sign to ...
|
wait and see 170
|
|
|
In third stage, if the mother is tired and the baby is not yet nursing and you have no signs of a placenta, offer tinctures of ___ and ___.
|
cohosh and angelica 170
|
|
|
After an hour or so in third stage, with no signs of the placenta, you may wish to ____.
|
administer pitocin 170
|
|
|
If you have waited an hour in third stage, given herbs and pitocin and there is no sign of the placenta, what should you do?
|
transport - there may be a problem of abnormal implantation 170
|
|
|
In placenta accreta, the placenta implants in the ____ instead of in the decidua basalis layer of the uterus.
|
myometrium 170
|
|
|
In placenta increta, the placenta has penetrated into but not through the ____
|
myometrium 170
|
|
|
In placenta percreta, the placenta has penetrated through the full thickness of the _____ and sometimes through the serosa of the uterus. Occasionally, the placenta will grow into other organs in the peritoneal cavity, such as the bladder.
|
myometrium 170
|
|
|
Rank placenta increta, percreta and accreta from least severe to most severe.
|
accreta
increta percreta 170 |
|
|
Placenta percreta is associated with a __% maternal mortality rate.
|
50% 170
|
|
|
How long is it safe to wait for the placenta?
|
As long as there is no bleeding, the uterus remains firm and fundal height is stable, you can afford to wait for several hours. 170
|
|
|
How fast does the cervix begins to close after birth?
|
several hours 172
|
|
|
When a baby is born in compromised condition, the top priorities for stabilizing it are ___ and ___.
|
warmth and a clear airway 176
|
|
|
It is not abnormal for ____ to elapse after birth before significant respiratory efforts are made.
|
20 seconds 177
|
|
|
What is a very important element in resuscitating a depressed baby?
|
get the mother to talk to the baby - neonatal intensive care nurses report that babies' oxygen levels surge upon hearing the sound of their mother's voice 177
|
|
|
Sutures should be placed so that the ____ is greater than the ____.
|
depth greater than width 176
|
|
|
How long should you cut the strands from a suture knot?
|
1/4 inch; too short may slip, too long can cause irritation by poking adjacent tissue 176
|
|
|
The baby born in ___, with an Apgar of 2 or less, is easily recognizable by its shocking white and completely limp appearance
|
secondary apnea 178
|
|
|
When doing chest compressions on a newborn, how many should you do a minute?
|
120 page 179
|
|
|
What is the most common fetal anomaly?
|
heart defect 180
|
|
|
A heart defect is indicated by ___ and ___.
|
cyanosis and respiratory distress 180
|
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If you deliver a baby with exposed meninges (spina bifida), you should cover with ....
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sterile gauze soaked in warm saline solution 180
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The coroner must be informed of any stillborn infant weighing ___ or more.
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500 grams 181
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Lactation can be suppressed with ___ or by ____
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sage tea or by binding the breasts 181
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When you come in for the day-one postpartum visit, begin by...
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appraising the environment for order and cleanliness 191
|
|
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What is uterine involution?
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the return of the uterus to prepregnant size 192
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|
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High levels of ____ released with breastfeeding prompt uterine involution and further contract vaginal muscles to restore tone.
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oxytocin 192
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The production of ____ caused when overactive or stressed out, inhibits the process of uterine involution after birth.
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adrenaline 192
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Suggest that the mother walk some every day postpartum in order to prevent _____
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thrombophlebitis 192
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What is an asymmetric latch?
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more areola drawn in at the baby's lower jaw than at the upper 192
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|
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Which vitamin can you apply to the breast for cracked nipples?
|
vitamin E 192
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|
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What is lochia?
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postpartum shedding of excess endometrium 192
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|
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On day one postpartum, expect lochia ____
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rubra 192
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What color is lochia rubra?
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red brown flow, in amounts like a heavy period 192
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|
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If at the one day visit postpartum you discover a bulge at the perineum, what is the most likely cause?
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cystocele or rectocele 192
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What should you do if the mother has a rectocele or cystocele at the one day postpartum visit?
|
suggest that she gradually resume kegel exercises and reassess at day 7 192
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If the baby has not had a bowel movement after ____ contact the pediatrician.
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48 hours 193
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|
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What are the three characteristics of lethargy?
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drowsiness, disinterest in nursing and a lack of muscle tone 193
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|
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What are 7 specific indications at the one-day postpartum visit for a reexamination at 48 hours?
|
1) maternal temperature
2) elevated maternal pulse 3) problems with repair 4) excessive blood loss 5) difficulties with breastfeeding 6) neonatal jaundice 7) neonatal dehydration 194 |
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If breast engorgement is a problem, make sure the mother is ____ and with ____
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nursing on demand and with proper positioning 194
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|
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What are three natural remedies for engorged breasts?
|
cold cabbage leaves, steamed comfrey leaves, hot ginger compresses under the arms or in the upper, outer quadrants of the breasts 195
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By day ___ lochia should be changing from rubra to serosa.
|
3 page 195
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What color is lochia serosa?
|
pink 195
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Elevation of temperature to ___ degrees is normal at the time the milk comes in.
|
101 degrees 195
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The sensation of letdown varies from ___ to a ____.
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mild tingling to a sexual sort of release, almost like orgasm 195
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____ is an antidote for colic.
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Infant massage 196
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By which day should the skin from a perineal repair be closed?
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day 7 196
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____ causes dryness and fragility of vaginal tissues.
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Breastfeeding 197
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Although rare, ovulation can occur as early as ____ after giving birth.
|
6 weeks 196
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If complete perineal healing has not occurred by six weeks postpartum, what should you do?
|
check if her lochia flow has stopped. If it has, and she is feeling fine, you need not worry 196
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|
|
If the uterus is palpable at six weeks postpartum, what should be done?
|
If the uterus is still palpable, she is probably still bleeding, indicating poor recovery. Prescribe rest, long relaxed nursing session to allow oxytocin to do its work, optimal nutrition with plenty of calories, supplements as indicated and involuting tea or tincture of black haw and shepherd's purse 196
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|
|
Which two herbal teas can help with uterine involution?
|
black haw and shepherd's purse 196
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|
The cervix should feel _____ at the six week postpartum checkup.
|
firm, closed and situated high in the vaginal vault 196
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|
|
Some women do not regain their prepregnant cervical position until ....
|
cutting back significantly on breastfeeding 196
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|
|
Postpartum, if the mother's hematocrit is less than __ or her hemoglobin is below ___ treat her for anemia.
|
37, 12 page 198
|
|
|
What is a normal newborn glucose reading?
|
50-60 mg glucose per 1 mL blood 198
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|
|
When taking a newborn glucose reading, anything below ___ is cause for serious concern.
|
30 mg glucose per 1mL blood 198
|
|
|
Which babies are at risk for hypoglycemia?
|
LGA, SGA, postmature, premature, mother is diabetic, babies who suffered hypoxia during labor/birth or any type of depression 198
|
|
|
___ has similar symptoms to hypoglycemia, but is much more rare.
|
Hypocalcemia 198
|
|
|
What are the symptoms of newborn hypoglycemia?
|
apathy, irregular respirations, hypothermia, refusal to nurse, irritability and tremors 198
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|
|
Do not give a postpartum woman ___ drinks.
|
cold 199
|
|
|
Strongly brewed ___ tea brings relief from postpartum afterpains.
|
ginger tea 199
|
|
|
Which two herbs help with postpartum afterpains?
|
motherwort tincture and hellonias viburnum (compound tincture) 199
|
|
|
Which homepathic do you give for prolapse cervix?
|
sepia 199
|
|
|
When there is uterine, bladder or hemorrhoid prolapse, or when a woman seems especially exhausted and compromised in the weeks postpartum, this indicates compromised ___ and she should be referred to a skilled practitioner of ____.
|
compromised liver chi, traditional chinese medicine 199
|
|
|
Which homeopathic promotes healing after surgery?
|
staphysagria 199
|
|
|
Which homeopathic for cracked or bleeding nipples?
|
graphites 199
|
|
|
Which four homeopathics are indicated for engorged breasts?
|
arnica, bryonia, phytolacca and belladonna 200
|
|
|
Which herb should you recommend for breast engorgement in order to prevent mastitis?
|
echinacea 200
|
|
|
Which homeopathic for breast engorgement or lumpy soreness accompanied by rising fever?
|
belladonna 200
|
|
|
Coating engorged breasts with ____ helps reduce the risk of secondary infection.
|
aloe vera 200
|
|
|
Doses of this herb support the body in healing mastitis.
|
Echinacea 200
|
|
|
What is a galactagogue?
|
something that helps a woman maintain an abundant supply of breast milk 200
|
|
|
Name three natural galactagogues.
|
dark beer (sometimes with raw egg mixed in), hops tincture, fennel tea steeped in barley water 200
|
|
|
Which herbal tincture helps minimize engorgement helps to dry up the milk supply?
|
pokeroot 200
|
|
|
Coating engorged breasts with ____ helps reduce the risk of secondary infection.
|
aloe vera 200
|
|
|
Drinking ___ tea can help reduce milk production.
|
sage 200
|
|
|
Doses of this herb support the body in healing mastitis.
|
Echinacea 200
|
|
|
Which three natural remedies can be used to treat the cord stump?
|
echinacea, goldenseal or breast milk 200
|
|
|
What is a galactagogue?
|
something that helps a woman maintain an abundant supply of breast milk 200
|
|
|
Which three natural remedies can help the woman who is continuing to spot bright red after six weeks postpartum?
|
traditional chinese medicine, moxa therapy and shepherd's purse tincture 200
|
|
|
Name three natural galactagogues.
|
dark beer (sometimes with raw egg mixed in), hops tincture, fennel tea steep in barley water 200
|
|
|
Name three homeopathic remedies for colic.
|
chamomilla, nux vomica and mag phos 201
|
|
|
Which herbal tincture helps minimize engorgement and helps to dry up the milk supply?
|
pokeroot 200
|
|
|
Can chiropractic adjustments relieve colic?
|
yes 201
|
|
|
Drinking ___ tea can help reduce milk production.
|
sage 200
|
|
|
Which three natural remedies can be used to treat the cord stump?
|
echinacea, goldenseal or breast milk 200
|
|
|
Which three natural remedies can help the woman who is continuing to spot bright red after six weeks postpartum?
|
traditional chinese medicine, moxa therapy and shepherd's purse tincture 200
|
|
|
Name three homeopathic remedies for colic.
|
chamomilla, nux vomica and mag phos 201
|
|
|
Can chiropractic adjustments relieve colic?
|
yes 201
|
|
|
____ damage can result if blood glucose levels are insufficient.
|
Central nervous system 201
|
|
|
Consult with a pediatrician if the newborn's blood glucose levels dip below ___.
|
45 page 201
|
|
|
What causes transient tachypnea?
|
delayed absorption of fetal lung fluid 202
|
|
|
Tachypnea is associated with which 3 serious conditions?
|
meconium aspiration, sepsis and respiratory distress syndrome 202
|
|
|
If you have a tachypneic baby and there are predisposing factors for meconium aspiration, sepsis or respiratory distress syndrome, or if tachypnea is accompanied by any sign of respiratory distress, what should you do?
|
take the baby promptly to the pediatrician 202
|
|
|
If the mother had fever, foul-smelling fluid during labor (at a point too late to transport), or if fever or uterine tenderness develops postpartum, the baby should immediately be seen by a pediatrician and screened for ___.
|
sepsis 202
|
|
|
If the mother had a fever in labor at a point too late to transport, or develops one postpartum, the baby is at risk for ___.
|
sepsis 202
|
|
|
What are 7 signs of neonatal sepsis?
|
1) tachypnea
2) jitteriness 3) fever 4) dehydration 5) lethargy 6) irritability 7) cyanosis 202 |
|
|
When does physiologic jaundice usually manifest?
|
the second or third day postpartum 203
|
|
|
____ babies are at higher risk for physiologic jaundice.
|
Premature 203
|
|
|
Breast milk jaundice, unlike other varieties of jaundice, manifests ...
|
after the milk comes in 203
|
|
|
High levels of bilirubin can lead to _____.
|
kernicterus 203
|
|
|
What are the signs of kernicterus?
|
high pitched cry and lethargy 203
|
|
|
Kernicterus can lead to permanent ___
|
brain damage 203
|
|
|
Physiologic jaundice appears to be unrelated to ____.
|
late cord clamping 204
|
|
|
Babies born to mothers whose labors have been induced or augmented with pitocin should watch carefully in their newborn for ___.
|
jaundice 204
|
|
|
How long does the foreskin adhere to the glans in an uncircumcised penis?
|
1-2 years 204
|
|
|
Which two herbal gels/creams are helpful for diaper rash?
|
aloe vera and calendula cream 206
|
|
|
Use ____ on the baby's bottom who has wet, open sores from diaper rash.
|
aloe vera gel 206
|
|
|
Use ____ on the baby's bottom who has chafing or inflammation from diaper rash.
|
calendula cream 206
|
|
|
Sometimes diaper rash is due to improper...
|
laundering of diapers (ammonia residue can build up) 206
|
|
|
For cradle cap, apply _____ and leave it on all night.
|
a natural oil 206
|
|
|
Thrush may take ____ to go away.
|
several weeks 206
|
|
|
If thrush is severe enough to interfere with nursing ....
|
the baby should see a physician 206
|
|
|
What are the three best natural remedies for constipation after birth?
|
a daily serving of high-fiber bran cereal, prune juice (in moderation) and adequate fluid intake 206
|
|
|
How much water should a nursing mother drink daily?
|
3 quarts/3 liters 207
|
|
|
If hemorrhoids rupture and bleed postpartum, ____ speeds healing.
|
aloe vera gel 207
|
|
|
Three herbs to help with uterine toning postpartum and to help prevent afterpains.
|
black haw, cottonwood bark, cramp bark 207
|
|
|
What is the primary danger of perineal hematoma?
|
infection 207
|
|
|
What should you do with a woman who has a postpartum hematoma?
|
immediately refer her to a physician; she should begin antibiotic treatment asap 207
|
|
|
A prime cause of uterine infection postpartum is ______
|
overactivity and exhaustion in the first few days postpartum 207
|
|
|
What are signs of severe sepsis?
|
vomiting, chills and extreme pain 207
|
|
|
Women with varicosities are are higher risk for _____
|
thrombophlebitis 208
|
|
|
Superficial thrombophlebitis causes ____, with ___, ____, and ___ at the site of inflammation.
|
leg pain with heat, tenderness and redness 208
|
|
|
Homan's sign can be used to check for _____
|
superficial thrombophlebitis 208
|
|
|
A positive Homan's sign is indicative of _____
|
superficial thrombophlebitis 208
|
|
|
How do you check for Homan's sign?
|
have the mother sit in bed with her leg straight, and gently press on her knee and dorsiflex her foot: if she has pain in her calf, the test is positive 208
|
|
|
When would you check for Homan's sign?
|
If you were suspecting superficial thrombophlebitis 208
|
|
|
High fever, severe pain, edema and tenderness along the entire length of one leg is indicative of...
|
deep thrombophlebitis 208
|
|
|
With either superficial or deep _____, contact a physician immediately.
|
thrombophlebitis 208
|
|
|
What are the symptoms of pulmonary embolism?
|
chest pain, shortness of breath, rapid respirations and elevated pulse 208
|
|
|
Thrombophlebitis can lead to _____ if a blood clot loosens and enters circulation.
|
pulmonary embolism 208
|
|
|
The hormone ____ plays a critical role in stimulating let-down of milk.
|
oxytocin 208
|
|
|
The hormone ____ is primarily responsible for milk production.
|
prolactin 208
|
|
|
Prolactin is inhibited during pregnancy by high levels of ____, which fall immediately after the birth to prompt lactation.
|
estrogen 209
|
|
|
The more relaxed the mother is when she nurse, the greater the release of the two crucial hormones for breastfeeding, ___ and ___.
|
oxytocin and prolactin 209
|
|
|
Each breast has approximately __ lobes.
|
20 page 208
|
|
|
Breast lobes consist of lobules divided into ____ and ___.
|
alveoli and ducts 208
|
|
|
The alveoli of the breasts contain ____ which produce the milk.
|
acini cells 208
|
|
|
The alveoli contain ____ which contract and propel milk from the breast.
|
myo-epithelial cells 208
|
|
|
____carry milk from the alveoli in the breast and empty it into one large duct that widens to create a lactiferous sinus or ampulla near the nipple.
|
Lactiferous ducts 208
|
|
|
____ emerge at the surface of the nipple and release milk from the breast.
|
Lactiferous tubules 208
|
|
|
Engorgement is ....
|
an amount of milk greater than what the baby needs. 209
|
|
|
Engorgement may be uncomfortable but will ____ as the milk supply adjusts to the baby's demands
|
resolve spontaneously 209
|
|
|
Mastitis is characterized by ___ and ____.
|
reddening of the breasts (either lumpy areas or streaks) and high fever (103 or 104 degrees) 210
|
|
|
Once a mastitic fever has spiked to _____, antibiotics are needed.
|
103-104 degrees 210
|
|
|
If mastitis is not treated in a timely manner, _____ may develop.
|
an abscess 210
|
|
|
Up to __% of women experience postpartum blues.
|
70% 210
|
|
|
When do the postpartum blues usually develop?
|
2-3 days postpartum 210
|
|
|
In contrast to postpartum blues, postpartum depression develops at ____ after the birth or later.
|
10 days 212
|
|
|
Any new mother showing signs of depression should be screened for _____
|
thyroid problems (due to a condition known as postpartum thyroiditis - which leads to hypothyroidism) 212
|
|
|
What are natural aids to serotonin production for the depressed mother?
|
amino acid tryptophan, omega fatty acids, vitamins B6, B2, B3, folic acid and magnesium 214
|
|
|
In which foods can you find the amino acid tryptophan?
|
shrimp, tamari soy sauce, raw crimini mushrooms, cod, snapper, halibut, chicken breast, scallops, turkey breast and tofu 214
|
|
|
Why would a depressed mom want to eat foods with tryptophan?
|
tryptophan is a natural aid to serotonin production 214
|
|
|
Which foods must be scrupulously avoided for the depressed mom?
|
coffee, cigarettes, chocolate and alcohol 214
|
|
|
_____ one of the hormones of breastfeeding tends to repress sexual desire.
|
prolactin 215
|
|
|
_____ itself may be a remedy for sexual disinterest postpartum
|
Sex 215
|
|
|
Birth control pills are not really suitable for _____
|
breastfeeding mother 216
|
|
|
Why are birth control pills not really suitable for breastfeeding mothers?
|
estrogen suppresses milk production and progesterone-only minipills are not as effective as the combination formulas 216
|
