North American Registry of Midwives (NARM) Practice Exam

What happens to maternal hemoglobin levels during labor?

1. They decrease significantly

2. They increase slightly

3. They remain unchanged

4. They drop below normal

The correct answer is: They increase slightly

During labor, maternal hemoglobin levels often increase slightly due to hemodilution and the physiological changes occurring in the body. As labor progresses, there is a release of red blood cells from the maternal spleen and a shift of plasma volume, which can cause a relative concentration of hemoglobin even if there is no significant increase in the actual production of red blood cells. This slight increase is typically due to the mother’s increased fluid volume before labor, as well as the body’s compensatory mechanisms to maintain oxygen delivery to both the mother and the fetus during the stress of labor. Understanding this physiological response is crucial for midwifery practice, as it helps in monitoring the well-being of the mother during the labor process while considering her hemoglobin levels. It's important to note that while some may assume that hemoglobin can drop due to blood loss, labor typically involves a controlled environment where the body actively works to adapt to various stressors, which is why significant drops or a level below normal are not typically observed during this stage.