Maternal Health Assessment
Roughly 10% of the NARM written examination — about 24–36 scored items of the ~300 on the exam.
History. Collect and maintain a thorough history: demographics and psychosocial context (including allostatic stressors), medical and surgical history, and a complete reproductive history — menstrual, gynecologic, sexual, and childbearing history; contraception; and STI history. Capture family/genetic history, mental-health and abuse history, and both parents' substance use. Establish Rh type and the plan of care if Rh-negative.
Physical examination. Perform and interpret a baseline exam: vital signs, height/weight, HEENT including thyroid palpation, heart and lungs, breast exam and self-exam teaching, abdominal exam, CVA tenderness (kidney), deep tendon reflexes (baseline for later pre-eclampsia assessment), a vascular check for edema/varicosities/thrombophlebitis, and pelvic assessment (bimanual sizing of uterus/ovaries, speculum exam of the cervix, and inspection of the vulva, vagina, perineum, and anus).
The goal of assessment is to establish a baseline of normal for this individual, so that later deviations — a rising blood pressure, a change in reflexes, an abnormal fundal-height trend — stand out early.
Sample questions from this domain
Three of the 45 questions in this domain, with the reasoning. The full set is in the question bank.
The obstetric term 'gravida' refers to:
- A. The number of cesarean births
- B. The total number of pregnancies, regardless of outcome ✓
- C. The number of living children
- D. The number of births after 20 weeks
Why: Gravida is the number of times a person has been pregnant, regardless of outcome. Para refers to the number of pregnancies carried to a viable gestational age (commonly ≥20 weeks).
During history-taking, a client discloses current intimate partner violence. The midwife's most appropriate response is to:
- A. Document it but avoid discussing it further
- B. Tell her it is outside the scope of prenatal care
- C. Respond supportively, ensure privacy and safety, and offer resources and referrals ✓
- D. Insist she leave the relationship immediately
Why: Disclosure of intimate partner violence calls for a supportive, nonjudgmental response with attention to safety, confidentiality, and connection to appropriate resources — part of the midwife's human-rights-aware assessment.
A bimanual examination early in care is used chiefly to assess:
- A. Maternal lung sounds
- B. Deep tendon reflexes
- C. Fetal heart rate
- D. The size and position of the uterus and adnexa ✓
Why: Bimanual examination assesses uterine size, shape, and position and the adnexa (ovaries), helping confirm dating and detect abnormalities early in care.
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