Family-Centered Maternity Care

Chapter 82 Family-Centered Maternity Care




Clinical Case Problem 1 A 22-Year-Old Primigravida Comes for Her First Prenatal Visit


A 22-year-old woman comes to your office at 10   weeks of gestation for her initial prenatal visit. She has been referred to you by friends who are your patients. She would like you to be her physician, to deliver her baby, and then to care for her child. Her uterus feels 10   weeks by size on bimanual examination, and her blood pressure is 100/70   mm Hg. All other aspects of the initial complete physical examination are normal.



Select the best answer to the following questions




1. The patient asks you about birth plans during her initial visit and inquires as to your attitudes toward pregnant couples who wish to participate in decision-making for the conduct of labor and delivery. How would you respond?


a. birth plans are not a good idea; usually something goes wrong and the couple is disappointed

b. birth plans are not a good idea; they frequently lead to unresolved guilt in the couple

c. birth plans should be avoided; perinatal morbidity and mortality are usually increased

d. birth plans are an excellent idea; everything always goes according to plan

e. birth plans are a good idea; they involve the couple in the planning for their baby’s delivery and can be an important part of the prenatal, postnatal, and postpartum care

2. On the next prenatal visit, the couple wishes to discuss your feelings concerning a number of issues. The first issue is electronic fetal monitoring (EFM). The couple is aware that in some hospitals and with some physicians, continuous EFM during labor is standard procedure. Which of the following statements regarding continuous routine EFM is true?


a. the perinatal mortality rate in laboring patients who undergo continuous EFM is lower than in those who do not

b. the perinatal morbidity rate in laboring patients who undergo EFM is lower than in those who do not

c. the incidence of cesarean section in laboring patients undergoing EFM is not statistically different from that of those who do not

d. there is no significant difference in perinatal outcomes between those patients who undergo EFM and those who do not

e. the incidence of admission to the intensive care nursery is greater for those infants who do not undergo EFM

3. The couple then asks you about routine ordering of ultrasound studies in pregnancy. Which of the following statements regarding the routine use of ultrasound examination in pregnancy is false?


a. routine prenatal ultrasound examination has been shown by U.S. studies to be justified from a cost-benefit standpoint

b. repetitive studies by independent researchers have not found any consistently adverse effects of obstetric ultrasound examination on perinatal outcome

c. first-trimester ultrasound examination for gestational age assessment should be performed for patients scheduled for elective repeated cesarean section

d. vaginal bleeding in pregnancy should be assessed by ultrasound examination

e. a size-date discrepancy in fundal height of 3   cm or more is an indication for obstetric ultrasound examination

4. The couple inquires about the routine administration of intravenous (IV) fluids during labor. Concerning this issue, which of the following statements is false?


a. the use of routine IV fluids does not limit ambulation in the first stage of labor

b. if epidural analgesia is to be administered, an IV line must be in place

c. if the first stage of labor is prolonged, an IV line should be in place to prevent dehydration

d. if a patient has a history of a severe postpartum hemorrhage, an IV line should be established

e. none of the above statements is false

5. The patient tells you it is important to her that she have a “natural” delivery and does not want any narcotics or medications that will “hurt the baby.” How do you respond?


a. many women think they do not want narcotics or an epidural, but most change their mind

b. intravenous narcotics are totally safe and have no complications

c. epidural analgesia is no longer associated with any complications and is completely safe

d. massage, standing in a warm shower, alternating position, and walking with intermittent monitoring can all be used to decrease the need for pain relief during labor

e. leave that decision to the doctor

6. Which of the following statements regarding epidural analgesia is true?


a. maternal hypertension is a common side effect of epidural analgesia

b. high spinal anesthesia is one of the most serious complications of epidural analgesia

c. unintentional dural puncture occurs in 10% of attempted epidural analgesia

d. prolongation of all stages of labor by epidural analgesia has been established

e. fetal bradycardia is seen consistently with epidural analgesia

7. The couple has some specific requests that they add to their birth plan at the 36-week visit, suggested by a friend. Which of the following would not be advisable?


a. having the patient’s mother present for support

b. allowing the father to cut the umbilical cord

c. putting the baby to breast before giving vitamin K and eye ointment

d. allowing all birth plan actions to take place regardless of any unexpected emergencies

e. delaying 30 seconds to clamp the umbilical cord

8. The couple’s final question concerns “routine episiotomy.” They have been told that the medical profession is “cut happy” and that most episiotomies are unnecessary. Which of the following statements regarding routine episiotomy is true?


a. episiotomy pain may be more severe and last longer than the pain from perineal lacerations

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Family-Centered Maternity Care

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