Postpartum
Roughly 15% of the NARM written examination — about 39–51 scored items of the ~300 on the exam.
Involution and the postpartum timeline. Assess physical and emotional recovery, including normal involution of the uterus and the progression of lochia (rubra → serosa → alba). Evaluate mother and baby across the standard visit timeline: day 1–2, day 3–4, week 1–2, week 3–4, and week 5–6.
Counseling and complications. Counsel on lochia vs. abnormal bleeding, return of menses, elimination, pelvic-floor recovery, and the condition of the perineum. Distinguish and manage or refer for postpartum complications — endometritis (fever, uterine tenderness, foul lochia), mastitis (a red, tender, warm breast segment with fever/flu-like symptoms — usually managed with continued breastfeeding, rest, and antibiotics when indicated), delayed/secondary hemorrhage (often retained tissue or subinvolution), urinary retention, and thromboembolism (a swollen, painful calf, or chest pain/shortness of breath — an emergency).
Perinatal mental health. Distinguish transient "baby blues" (days 1–2 to ~2 weeks) from postpartum depression (persistent, functionally impairing) and postpartum psychosis (a psychiatric emergency — confusion, hallucinations, delusions, risk to self or infant — requiring immediate referral). Screen, counsel, mobilize support, and increase follow-up as needed.
Sample questions from this domain
Three of the 68 questions in this domain, with the reasoning. The full set is in the question bank.
Immediately after birth, the fundus is normally palpated at approximately:
- A. Mid-thigh
- B. At or just below the umbilicus ✓
- C. Below the pubic symphysis
- D. At the xiphoid process
Why: After delivery the fundus is typically at or just below the umbilicus and firm; it descends about one fingerbreadth per day during involution. A boggy or high, deviated fundus suggests atony or a full bladder.
Which postpartum bleeding pattern is abnormal and needs evaluation?
- A. Rubra for the first two to three days
- B. Gradual transition from rubra to serosa to alba
- C. Return to heavy, bright-red bleeding after lochia had progressed to serosa/alba ✓
- D. Light spotting at two weeks
Why: A return to heavy, bright-red bleeding after lochia had lightened can indicate subinvolution or retained tissue and warrants evaluation. The normal course is a steady progression rubra → serosa → alba.
A typical postpartum visit schedule for assessing mother and baby includes checkpoints at:
- A. Daily visits for the first month
- B. Day 1–2, day 3–4, week 1–2, week 3–4, and week 5–6 ✓
- C. No visits unless problems arise
- D. Only a single visit at six weeks
Why: Midwifery care typically includes several postpartum contacts across the first six weeks (day 1–2, 3–4, 1–2 weeks, 3–4 weeks, 5–6 weeks) to monitor recovery, feeding, and mental health.
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