General Healthcare Skills
Roughly 5% of the NARM written examination — about 12–18 scored items of the ~300 on the exam.
Infection control. Apply Universal/Standard Precautions: hand hygiene, correct gloving/ungloving, sterile technique, and safe injection practice (never recap needles two-handed; use a sharps container; one needle/syringe per patient).
Supplements and non-allopathic modalities. Know the rationale, benefits, and cautions for common supplements — prenatal multivitamin, folic acid (neural-tube-defect prevention, ideally preconception), iron (anemia), calcium, magnesium, vitamin D, B-complex/B6 (nausea), and vitamin C/E. Be able to counsel on herbs, hydrotherapy, waterbirth, homeopathy, chiropractic, and acupuncture, including their contraindications.
Pharmacology used in out-of-hospital midwifery. Know indications, benefits, and risks of the agents a CPM may carry or administer within scope and protocol:
- Oxytocin (Pitocin) — postpartum hemorrhage (uterotonic).
- Methylergonovine (Methergine) — PPH uterotonic; contraindicated in hypertension/pre-eclampsia.
- Misoprostol (Cytotec) — PPH uterotonic (off-label), often rectal/sublingual.
- Oxygen — maternal/neonatal support.
- Vitamin K — newborn prophylaxis against vitamin-K deficiency bleeding.
- Erythromycin ophthalmic ointment — neonatal eye prophylaxis.
- RhoGAM (Rh immune globulin) — for the Rh-negative mother to prevent isoimmunization.
- Antibiotics for GBS — intrapartum prophylaxis.
- IV fluids, epinephrine, and local anesthetic (for laceration repair).
Instruments, equipment, and labs. Know when and how to use the amnihook, bulb syringe/DeLee suction, bag-and-mask resuscitator, doppler/fetoscope, nitrazine paper, speculum, catheter, and suturing equipment. Be able to order or refer for cultures and to interpret common labs — H&H/CBC, blood type & Rh with antibody screen, glucose/HbA1c, GBS, rubella immunity, syphilis (RPR/VDRL), HIV, hepatitis B/C, gonorrhea/chlamydia, thyroid panel, and urinalysis — and to counsel on ultrasound and the biophysical profile (indications, benefits, limits).
Sample questions from this domain
Three of the 22 questions in this domain, with the reasoning. The full set is in the question bank.
Nitrazine paper is used during labor assessment primarily to help determine:
- A. Cervical dilation
- B. Whether the membranes have ruptured (amniotic fluid is alkaline) ✓
- C. Fetal heart rate
- D. The mother's blood glucose
Why: Nitrazine paper turns blue in the presence of alkaline amniotic fluid, helping distinguish ruptured membranes from urine or normal secretions (which are acidic). It can give false results with blood or semen.
A newborn is given vitamin K after birth (with consent) primarily to prevent:
- A. Vitamin K deficiency bleeding (hemorrhagic disease of the newborn) ✓
- B. Neonatal jaundice
- C. Hypoglycemia
- D. Eye infection
Why: Newborns have low vitamin K stores and immature clotting; vitamin K prophylaxis prevents vitamin K deficiency bleeding. Eye prophylaxis (erythromycin) addresses ophthalmia neonatorum — a different indication.
A bulb syringe or DeLee suction device is used with a newborn to:
- A. Clear secretions from the mouth and nose when needed ✓
- B. Measure oxygen saturation
- C. Deliver positive-pressure ventilation
- D. Administer medications
Why: A bulb syringe (or DeLee) clears mouth and nasal secretions when a newborn needs airway clearing; routine deep suctioning of vigorous newborns is not recommended.
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