Professional Issues, Knowledge, and Skills
Roughly 5% of the NARM written examination — about 12–18 scored items of the ~300 on the exam.
This domain frames midwifery as a profession embedded in a legal, ethical, and social context.
Social determinants of health. Income, literacy, education, housing, sanitation, food security, and environmental hazards shape pregnancy outcomes as much as any clinical variable. Understand allostatic load — the cumulative physiologic wear from chronic stressors such as racism and resource scarcity — as a driver of disparities in maternal and neonatal morbidity and mortality.
Evidence-based practice. Be able to read the professional literature critically: distinguish study designs (randomized trial vs. observational), recognize the difference between relative and absolute risk, and interpret vital statistics such as the maternal mortality ratio (per 100,000 live births) and infant/neonatal mortality rates (per 1,000 live births). Know the leading direct causes of maternal death (hemorrhage, hypertensive disorders, sepsis, thromboembolism) and neonatal death (prematurity, intrapartum-related events/asphyxia, infection).
Resources and referral. Know how to connect families to WIC, breastfeeding support, mental-health and substance-use services, social services, and bereavement care — and how to activate referral to a higher level of care with appropriate communication and transport.
Legal, regulatory, and ethical framework. Understand the laws and professional guidelines that govern out-of-hospital midwifery in your jurisdiction, HIPAA/confidentiality, and informed, shared decision-making as an ongoing process (not a one-time signature). Human-rights awareness includes intimate-partner violence, female genital cutting, and the influence of culture and religion on care choices.
Choosing and equipping a birth site. Facilitate the client's decision about where to give birth by discussing the advantages, risks, and requirements of each setting, and how to prepare and equip the site. Participate in peer review of adverse outcomes to improve practice.
Sample questions from this domain
Three of the 22 questions in this domain, with the reasoning. The full set is in the question bank.
When helping a client decide where to give birth, the midwife's role is best described as:
- A. Deciding the safest setting and informing the client
- B. Recommending the hospital in every case
- C. Discussing the advantages, risks, and requirements of each birth setting so the client can make an informed choice ✓
- D. Avoiding the topic to prevent anxiety
Why: The midwife facilitates the client's decision by discussing the advantages and risks of different birth sites, their requirements, and how to prepare and equip them — supporting informed, autonomous choice.
A midwife encounters a clinical situation not covered by her written practice guidelines. The most appropriate action is to:
- A. Refuse to act and end the visit
- B. Consult per her protocols and legal scope, and refer or transfer if the situation exceeds that scope ✓
- C. Proceed however she thinks best, ignoring protocols
- D. Ask the client to decide the clinical management alone
Why: Midwives practice within a legal and regulatory framework and written protocols. When a situation exceeds guidelines or scope, the professional response is consultation, referral, or transfer.
The primary purpose of peer review after an adverse maternal or neonatal outcome is to:
- A. Satisfy the client's family
- B. Learn from the case and improve future practice and safety ✓
- C. Avoid documentation
- D. Assign personal blame
Why: Peer review is a quality-improvement process: midwives examine cases of morbidity or mortality to identify lessons and improve safety, not to assign individual blame.
Full access from $59 — all 450 questions with explanations, three timed mock exams, flashcards and the study guide. One-time, no subscription.
PowerExams is an independent study resource, not affiliated with, endorsed by, or sponsored by the North American Registry of Midwives (NARM) or the Midwives Alliance of North America (MANA). All questions are original; no real exam items are reproduced. NARM does not publish a passing cut score, and nothing here predicts a pass or fail result.