Normal Labor and Delivery: Stages of Labor, Imminent Delivery, Delivery Steps, and Cord Care Practice Questions

25 multiple-choice questions on Normal labor and delivery: stages of labor, imminent delivery, delivery steps, and cord care for paramedic and EMT students, from Chapter 42 (Obstetrics). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The first stage of labor begins with regular contractions and ends when:

   1. A. The infant's head crowns
   2. B. The cervix is fully dilated
   3. C. The infant is fully delivered
   4. D. The placenta is delivered
   Show answer

   Answer: B. The cervix is fully dilated

   The first stage is the dilation stage, ending at full dilation of about 10 cm. Crowning occurs during the second stage, which ends with the birth of the infant.

2. The second stage of labor is the interval from:

   1. A. Onset of labor to full cervical dilation
   2. B. Delivery of the infant to placental delivery
   3. C. Rupture of membranes to onset of labor
   4. D. Full dilation to delivery of the infant
   Show answer

   Answer: D. Full dilation to delivery of the infant

   The second stage, the expulsion stage, runs from full dilation until the baby is born, and it is when delivery in the field becomes likely. Birth to placental delivery is the third stage.

3. The third stage of labor ends with:

   1. A. Delivery of the placenta
   2. B. Delivery of the infant
   3. C. Full cervical dilation
   4. D. The first newborn breath
   Show answer

   Answer: A. Delivery of the placenta

   The third stage runs from the birth of the infant to delivery of the placenta, normally within about 30 minutes. A placenta that has not delivered by then should not be pulled out by traction.

4. Thinning and shortening of the cervix during labor is called:

   1. A. Dilation
   2. B. Crowning
   3. C. Effacement
   4. D. Lightening
   Show answer

   Answer: C. Effacement

   Effacement describes the cervix thinning out, while dilation describes it opening to about 10 cm. Lightening is the earlier drop of the fetus into the pelvis in the weeks before labor.

5. A 28-year-old gravida 3, para 2, at 39 weeks has contractions every 2 minutes lasting 60 seconds and says she needs to move her bowels. You see the head at the vaginal opening during a contraction. You should:

   1. A. Load her quickly and drive with lights
   2. B. Have her cross her legs to delay birth
   3. C. Hold the head back until you arrive
   4. D. Prepare to deliver on scene
   Show answer

   Answer: D. Prepare to deliver on scene

   Crowning, a strong urge to push, and close contractions in a multipara mean delivery is imminent, and birth in a moving ambulance is riskier than on scene. Holding the head back or crossing the legs can injure the infant.

6. You are called to a woman at 40 weeks who says she is in labor. Which finding is the most reliable sign that delivery is imminent?

   1. A. Rupture of the membranes
   2. B. Passage of the mucous plug
   3. C. Crowning of the presenting part
   4. D. Regular contractions every 10 minutes
   Show answer

   Answer: C. Crowning of the presenting part

   Crowning means the presenting part is at the vaginal opening and birth will occur soon. Membranes may rupture hours before delivery, so that alone does not mean birth is about to happen.

7. During labor, a woman's urge to have a bowel movement usually means:

   1. A. She needs a bedpan before delivery
   2. B. The fetus is pressing low in the birth canal
   3. C. Her bowel has been compressed by the placenta
   4. D. Labor has stopped and will resume later
   Show answer

   Answer: B. The fetus is pressing low in the birth canal

   Pressure of the presenting part on the rectum produces the sensation of needing to defecate, a sign that delivery is near. Letting her go to the toilet risks delivery into it.

8. For a field delivery, appropriate personal protective equipment includes gloves, a gown, and:

   1. A. Eye and face protection
   2. B. A surgical cap and shoe covers
   3. C. A paper mask without eye cover
   4. D. A second pair of gloves only
   Show answer

   Answer: A. Eye and face protection

   Delivery involves large amounts of blood and amniotic fluid that may splash, so eye and face protection are required. During a respiratory outbreak, a mask on the patient if tolerated and a respirator for the provider add protection.

9. During an outbreak of a respiratory virus, which step is recommended to reduce disease transmission during a field delivery?

   1. A. Wear eye protection but no mask
   2. B. Limit the number of providers present
   3. C. Delay drying the newborn to limit contact
   4. D. Separate the newborn from the mother at once
   Show answer

   Answer: B. Limit the number of providers present

   Keeping only the needed providers in the room, using full PPE, and masking the patient when she can tolerate it reduce exposure. Eye protection without a mask leaves your own airway exposed. Drying and warming the newborn are not delayed, and routine separation of mother and newborn is no longer recommended; the mother can stay with her infant using masking and hand hygiene.

10. As the head delivers, you should place gentle pressure on it with your palm in order to:

    1. A. Check for a cord around the neck
    2. B. Help the head rotate to the side
    3. C. Speed delivery of the head
    4. D. Prevent an explosive delivery
    Show answer

    Answer: D. Prevent an explosive delivery

    Gentle palm pressure on the head controls its exit and reduces the risk of perineal tearing and injury to the infant. The goal is to slow and guide delivery, not speed it. The check for a nuchal cord comes after the head is out, and the head rotates to the side on its own as the shoulders line up.

11. After the head delivers, your next step is to:

    1. A. Feel for a cord around the neck
    2. B. Pull the head to free the shoulders
    3. C. Cut the cord before the shoulders
    4. D. Wait 5 minutes before going on
    Show answer

    Answer: A. Feel for a cord around the neck

    Check for a nuchal cord by sliding a finger along the neck as soon as the head delivers. Pulling on the head to free the shoulders can injure the brachial plexus.

12. To deliver the shoulders, you should gently guide the head:

    1. A. Upward for the top shoulder, then downward
    2. B. Sideways back and forth until they deliver
    3. C. Downward for the top shoulder, then upward
    4. D. Toward the mother's back with firm traction
    Show answer

    Answer: C. Downward for the top shoulder, then upward

    Gentle downward guidance delivers the anterior shoulder from under the symphysis, and gentle upward guidance then delivers the posterior shoulder. Firm traction risks nerve injury.

13. After delivery, routine suctioning of the newborn's mouth and nose is:

    1. A. Needed for every infant within 10 seconds
    2. B. Done by deep suction of the stomach
    3. C. Done before checking for a nuchal cord
    4. D. Reserved for obstruction or secretions
    Show answer

    Answer: D. Reserved for obstruction or secretions

    Current newborn guidelines advise suctioning only if secretions block the airway or the infant needs positive-pressure ventilation. Routine deep suction can cause bradycardia from vagal stimulation.

14. As the head delivers, you see that the amniotic sac is still intact and covering the infant's face. You should:

    1. A. Leave it intact until the body delivers
    2. B. Tear the sac open with your fingers
    3. C. Suction the mouth through the membrane
    4. D. Cut the cord before opening the sac
    Show answer

    Answer: B. Tear the sac open with your fingers

    An intact sac over the face blocks the first breath, so tear or puncture it with your fingers, pull it away from the nose and mouth, and wipe or suction only if secretions obstruct the airway. Leaving it in place until the body delivers risks the infant inhaling against the membrane or fluid. A suction catheter cannot clear the mouth through an intact membrane. Cutting the cord first removes the infant's only oxygen supply before breathing has begun. (Caroline, normal delivery; Limmer and O'Keefe, Emergency Care, childbirth.)

15. For a vigorous term newborn, current guidelines recommend clamping the umbilical cord:

    1. A. After a delay of at least 60 seconds
    2. B. Within 5 seconds of the shoulders delivering
    3. C. Before the infant takes the first breath
    4. D. As soon as the infant begins to cry
    Show answer

    Answer: A. After a delay of at least 60 seconds

    The 2025 AHA/AAP neonatal guidelines recommend deferring cord clamping for at least 60 seconds in newborns who do not need immediate resuscitation (ACOG's 2020 opinion gives at least 30 to 60 seconds); the extra placental blood improves iron stores and the circulatory transition. Clamping within seconds of the shoulders delivering removes that benefit. Clamping before the first breath is a misconception; the first breaths happen while the cord is still pulsing, which is when the transfusion helps most. A cry shows the infant is vigorous, which is the reason to wait, not to clamp. A newborn who needs resuscitation should not have care delayed for cord management. (AHA/AAP 2025; ACOG CO 814.)

16. When the cord is ready to be cut, you should:

    1. A. Cut first, then place a single clamp
    2. B. Tie it with a shoelace and then cut it
    3. C. Place two clamps and cut between them
    4. D. Cut it with one clamp on the placenta side
    Show answer

    Answer: C. Place two clamps and cut between them

    Two clamps several centimeters apart, with the cut between them, prevent bleeding from both the infant and the placental ends. Cutting flush against the abdomen leaves no stump to clamp or check for bleeding.

17. After the cord is cut, you notice the stump is bleeding. You should:

    1. A. Place another clamp next to the first
    2. B. Remove the clamp and start again
    3. C. Pack the stump with sterile gauze
    4. D. Apply firm pressure over the infant's abdomen
    Show answer

    Answer: A. Place another clamp next to the first

    If the cut end oozes, place a second clamp next to the first on the infant's side; even a small blood loss is significant for a newborn. Removing the clamp would let the stump bleed freely.

18. You delivered an infant 10 minutes ago and are waiting for the placenta. Which sign suggests the placenta has separated and is about to deliver?

    1. A. The uterus becoming soft and boggy
    2. B. Lengthening of the cord with a small gush
    3. C. A sudden, sharp increase in contraction pain
    4. D. A sudden fall in maternal heart rate
    Show answer

    Answer: B. Lengthening of the cord with a small gush

    Lengthening of the cord, a gush of blood, and the uterus rising and becoming firmer and rounder signal separation. A soft, boggy uterus after delivery is the warning sign of atony and hemorrhage.

19. While waiting for the placenta to deliver, you should:

    1. A. Pull firmly on the cord to speed it up
    2. B. Push hard on the top of the uterus
    3. C. Allow it to deliver without traction
    4. D. Reach inside to separate the placenta
    Show answer

    Answer: C. Allow it to deliver without traction

    Traction on the cord can tear it or invert the uterus, a life-threatening emergency, so let the placenta deliver spontaneously. Transport if it has not delivered within about 30 minutes or there is heavy bleeding.

20. After the placenta delivers, you should:

    1. A. Discard it safely at the scene
    2. B. Leave it attached to the newborn's cord
    3. C. Give it to the family to keep
    4. D. Bag it and bring it to the hospital
    Show answer

    Answer: D. Bag it and bring it to the hospital

    Hospital staff examine the placenta to confirm that it is complete, because retained fragments cause hemorrhage and infection. Discarding it removes the evidence they need.

21. After a field delivery, you estimate the mother's blood loss. Blood loss after a normal vaginal delivery is usually less than about:

    1. A. 50 mL
    2. B. 150 mL
    3. C. 500 mL
    4. D. 2,000 mL
    Show answer

    Answer: C. 500 mL

    Losing up to about 500 mL is expected and is well tolerated because of the increased blood volume of pregnancy. Losing more than that, or any loss with signs of shock, should be managed as postpartum hemorrhage.

22. Five minutes after the placenta delivers, you can help the uterus contract and reduce bleeding by:

    1. A. Encouraging the newborn to breastfeed
    2. B. Having the mother walk around the room
    3. C. Laying her flat with legs together
    4. D. Applying cold packs to the perineum
    Show answer

    Answer: A. Encouraging the newborn to breastfeed

    Nipple stimulation from breastfeeding releases oxytocin, which contracts the uterus. Laying her flat with her legs together does not stimulate contraction.

23. After a field delivery, a small perineal tear is bleeding steadily. You should:

    1. A. Suture the tear before transport
    2. B. Pack the vagina tightly with gauze
    3. C. Leave it alone and focus on the newborn
    4. D. Apply pressure with a sanitary pad
    Show answer

    Answer: D. Apply pressure with a sanitary pad

    Firm pressure with a sanitary pad over the perineum controls most tear bleeding until a physician can repair it. Packing the vagina is not a field treatment and may hide ongoing hemorrhage.

24. Some EMS systems carry misoprostol for postpartum hemorrhage. Unlike oxytocin, it can be given:

    1. A. By IM injection into the thigh
    2. B. By mouth, under the tongue, or rectally
    3. C. By slow IV infusion diluted in normal saline
    4. D. Intranasally, using an atomizer
    Show answer

    Answer: B. By mouth, under the tongue, or rectally

    Misoprostol is a prostaglandin tablet that is stable at room temperature and can be given by mouth, sublingually, or rectally, which makes it useful when IV access or refrigerated oxytocin is not available. It has no IV, IM, or intranasal form; IM injection and IV infusion are oxytocin routes. Like oxytocin, it must never be given before all infants are delivered.

25. A mother at 39 weeks begins to deliver in the back seat of a car. The best way to position her is:

    1. A. On her back with knees bent and spread
    2. B. Standing upright with legs slightly apart
    3. C. On her right side with both legs straight
    4. D. Seated upright with legs crossed together
    Show answer

    Answer: A. On her back with knees bent and spread

    A semi-reclined position with hips flexed and knees spread gives access to the perineum and support for the infant. Crossing the legs to delay birth can harm the fetus.