North American Registry of Midwives (NARM) Practice Exam

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If a woman misses three OC pills, what action is recommended?

  1. Continue with the remaining pills without any precautions

  2. Take all missed pills immediately and resume regular schedule

  3. Use a back up method of contraception for seven days

  4. Throw away the remaining package and start a new one

The correct answer is: Throw away the remaining package and start a new one

When a woman misses three oral contraceptive (OC) pills, the recommended action is to use a backup method of contraception for seven days in addition to continuing the remaining pills. This is crucial because missing multiple doses increases the risk of ovulation, which diminishes the effectiveness of the contraception. Continuing with the remaining pills without precautions does not adequately reduce the risk of unintended pregnancy after missing three consecutive pills. Taking all missed pills immediately could lead to an overdose or increased side effects since the hormonal levels may rise too rapidly. Starting a new pack without finishing the current one could also disrupt the hormonal balance and is not necessary unless the instructions specify a break. Therefore, the safest approach is to use a backup contraception method to ensure protection while resuming the OC regimen.