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Free Practice Questions for Midwifery Licensing

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Exam Review

Key Facts: Midwifery Licensing Exam

70

Questions in the Written Part

Nursing Division — post-basic midwifery course page

2 parts

Written Paper, then MSR Simulation

Nursing Division — post-basic midwifery course page

60

Pass Mark for Post-Basic Licensing Exams

Nursing Division — examination results page

1,017 h

Post-Basic Course (373 Theory, 644 Clinical)

Nursing Division — post-basic midwifery course page

70+

Screening Exam Score Needed to Enrol

Nursing Division — post-basic midwifery course page

100

Practice Questions

OpenExamPrep Practice Bank

Midwifery in Israel is a post-basic qualification for registered nurses: after the 1,017-hour post-basic midwifery course, candidates sit a written licensing paper of 70 multiple-choice questions and then, about a month later, a station-based simulation examination at MSR at Sheba Medical Center. The pass mark for post-basic licensing examinations is 60. This 100-question set is independent English-language practice by OpenExamPrep across antepartum care, intrapartum care, obstetric emergencies, postpartum and neonatal care, and pharmacology and regulation.

Sample Midwifery Licensing Practice Questions

Try these sample questions to review concepts for the Midwifery Licensing exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 28-year-old primigravida presents at 12 weeks of gestation for first-trimester prenatal screening. Combined screening combines nuchal translucency (NT) sonography with maternal serum biochemistry. Which biochemical marker profile is most characteristic of fetal trisomy 21 (Down syndrome)?
A.Elevated free beta-hCG and decreased pregnancy-associated plasma protein A (PAPP-A)
B.Decreased free beta-hCG and elevated pregnancy-associated plasma protein A (PAPP-A)
C.Decreased free beta-hCG and decreased pregnancy-associated plasma protein A (PAPP-A)
D.Elevated free beta-hCG and elevated pregnancy-associated plasma protein A (PAPP-A)
Explanation: In first-trimester combined screening for trisomy 21, maternal serum free beta-hCG is significantly elevated (typically >2.0 MoM) while pregnancy-associated plasma protein A (PAPP-A) is markedly decreased (typically <0.5 MoM). When coupled with an increased fetal nuchal translucency measurement, this biochemical pattern provides a detection rate of approximately 85-90% for Down syndrome. Decreased levels of both markers are instead characteristic of trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome).
2During a routine first-trimester ultrasound at 12+3 weeks of gestation, the crown-rump length (CRL) is 58 mm and the nuchal translucency (NT) measures 3.8 mm. Which immediate clinical counseling and management pathway should the midwife recommend?
A.Reassure the patient that NT is normal below 4.0 mm and continue routine second-trimester care without referral
B.Refer for genetic counseling, high-resolution anatomy sonography, and diagnostic testing (chorionic villus sampling or amniocentesis)
C.Order an immediate emergency cesarean delivery preparation due to imminent fetal demise
D.Repeat the nuchal translucency ultrasound in 6 weeks during the second trimester
Explanation: A nuchal translucency measurement of 3.8 mm exceeds the 99th percentile cutoff (>=3.5 mm) for a CRL of 58 mm, signifying a substantially heightened risk for chromosomal aneuploidies (trisomies 21, 18, 13, and Turner syndrome), congenital heart defects, and genetic syndromes. The standard Israeli Ministry of Health clinical guideline mandates referral for comprehensive genetic counseling, offering diagnostic testing via chorionic villus sampling (CVS) or amniocentesis with chromosomal microarray, as well as specialized fetal echocardiography. An enlarged NT cannot be measured in the second trimester because the posterior nuchal space physiologically resolves after 13+6 weeks.
3A 32-year-old woman at 10 weeks of gestation requests information regarding cell-free DNA (cfDNA / NIPT) screening. Which counseling point regarding cfDNA is clinically accurate under Israeli prenatal screening guidelines?
A.A negative cfDNA result completely guarantees the birth of a chromosomally normal neonate without false negatives
B.cfDNA is a diagnostic test that definitively replaces the requirement for amniocentesis in high-risk pregnancies
C.cfDNA is a highly sensitive screening test for common trisomies, but positive results require diagnostic confirmation via CVS or amniocentesis
D.cfDNA can accurately detect neural tube defects such as anencephaly and open spina bifida
Explanation: Cell-free DNA (cfDNA/NIPT) analyzes placental trophoblast-derived DNA fragments in maternal circulation and has a sensitivity and specificity exceeding 99% for trisomy 21. However, because it is a screening tool rather than a diagnostic modality, false positives occur (especially in low-risk populations), necessitating invasive diagnostic confirmation via CVS or amniocentesis prior to making irreversible reproductive decisions. Furthermore, cfDNA does not screen for neural tube defects, which still require maternal serum alpha-fetoprotein (MSAFP) evaluation and ultrasound.
4In Israel, routine maternal serum screening in the second trimester (triple test / 'Seker Cheroni') evaluates three biochemical markers between 16 and 20 weeks of gestation. Which marker elevation is specifically indicative of an increased risk for open neural tube defects (fetal spina bifida or anencephaly)?
A.Alpha-fetoprotein (AFP)
B.Unconjugated estriol (uE3)
C.Human chorionic gonadotropin (hCG)
D.Inhibin A
Explanation: Elevated maternal serum alpha-fetoprotein (MSAFP >=2.0-2.5 multiples of the median [MoM]) reflects transudation of fetal serum protein across exposed neural membranes directly into the amniotic fluid and maternal circulation, serving as the primary biochemical screening marker for open neural tube defects (myelomeningocele, anencephaly) and ventral abdominal wall defects (gastroschisis, omphalocele). Conversely, low MSAFP levels are associated with trisomy 21 and trisomy 18. Unconjugated estriol and hCG are evaluated for aneuploidies rather than neural tube defects.
5A 36-year-old multigravida with a history of two prior spontaneous early miscarriages presents at 8 weeks. What baseline maternal screening investigations are routinely recommended at the initial antenatal booking visit according to Israeli Ministry of Health guidelines?
A.Complete blood count, blood typing and Rh antibody screen, rubella IgG, hepatitis B surface antigen, syphilis serology, and urinalysis with culture
B.Full maternal thrombophilia panel, immediate diagnostic amniocentesis, and daily non-stress testing
C.Serum CA-125 level, 24-hour urine copper excretion, and cervical cerclage assessment
D.Pelvic computed tomography (CT) scan and routine prophylactic ampicillin therapy
Explanation: Standard Israeli Ministry of Health antenatal booking protocols require a complete blood count (CBC) to screen for anemia and thrombocytopenia, ABO blood group typing and Rh(D) alloantibody screen, rubella immunity serology, hepatitis B surface antigen (HBsAg), syphilis serology (VDRL/RPR or treponemal EIA), and clean-catch urinalysis with urine culture to detect asymptomatic bacteriuria. Routine thrombophilia workups or invasive procedures are not indicated without specific clinical criteria such as recurrent pregnancy loss (>=3 consecutive losses) or documented thromboembolism.
6At 22 weeks of gestation, a woman undergoes a targeted late anatomy ultrasound (סקירת מערכות מאוחרת). The sonographer identifies an isolated single umbilical artery (two-vessel umbilical cord). What is the primary clinical significance of this finding?
A.It is an absolute indication for emergency delivery within 24 hours to prevent fetal cord accidents
B.It carries an increased association with renal and cardiovascular anomalies and warrants careful anatomical assessment and serial third-trimester fetal growth scans
C.It guarantees the presence of lethal renal agenesis (Potter sequence) in all cases
D.It requires immediate cessation of all oral nutrition and hospital admission for maternal parenteral nutrition
Explanation: A single umbilical artery (SUA) results from aplasia or atrophy of one umbilical artery and occurs in approximately 0.5-1% of singleton pregnancies. While often an isolated benign variant, SUA is associated with an increased incidence of congenital renal and cardiovascular malformations, as well as fetal growth restriction (FGR). Standard practice involves detailed targeted sonographic anatomical survey, fetal echocardiography if indicated, and serial ultrasound biometry in the third trimester (28-32 weeks) to monitor fetal growth.
7A sonographic assessment of amniotic fluid volume is performed at 34 weeks of gestation. Which quantitative ultrasound finding confirms the clinical diagnosis of oligohydramnios?
A.Amniotic fluid index (AFI) of 14 cm
B.Single deepest vertical pocket (DVP) measuring less than 2.0 cm or AFI less than 5.0 cm
C.Single deepest vertical pocket (DVP) measuring greater than 8.0 cm
D.Amniotic fluid index (AFI) between 8.0 cm and 18.0 cm
Explanation: Oligohydramnios is sonographically defined as an amniotic fluid index (AFI) <5.0 cm or a single deepest vertical pocket (DVP) <2.0 cm free of fetal parts and umbilical cord loops. Oligohydramnios in the third trimester mandates comprehensive clinical evaluation for rupture of membranes, uteroplacental insufficiency, fetal renal abnormalities, or post-term gestation. Conversely, a DVP >8.0 cm or AFI >24-25 cm defines polyhydramnios.
8In a 32-week pregnancy complicated by fetal growth restriction (estimated fetal weight below the 3rd percentile), umbilical artery Doppler interrogation demonstrates absent end-diastolic flow (AEDF). What physiological mechanism explains this Doppler waveform?
A.Markedly elevated vascular resistance within the placental tertiary villous capillary bed
B.Accelerated fetal blood flow through the ductus venosus due to fetal polycythemia
C.Complete occlusion of the maternal uterine arteries by amniotic fluid debris
D.Physiological reduction of fetal cardiac afterload during deep fetal rapid-eye-movement sleep
Explanation: Normal umbilical artery Doppler waveforms exhibit low vascular resistance with continuous forward blood flow throughout cardiac diastole. When >=60-70% of the placental tertiary villous vascular bed is obliterated (as seen in severe placental insufficiency and preeclampsia), downstream placental resistance escalates markedly, causing diastolic velocity to diminish, flatten (absent end-diastolic flow - AEDF), or eventually reverse (reversed end-diastolic flow - REDF). AEDF is an ominous sign of severe fetal hypoxemia and acidosis requiring intensive surveillance or delivery.
9A 30-week pregnant woman with Rh(D) negative blood and no prior anti-D prophylaxis presents with high titers of maternal anti-D alloantibodies (indirect Coombs titer 1:64). Which Doppler parameter is the primary non-invasive modality to detect moderate-to-severe fetal anemia?
A.Peak systolic velocity of the fetal middle cerebral artery (MCA-PSV) greater than 1.5 MoM
B.Resistive index of the descending thoracic aorta below 0.2
C.Pulsatility index of the maternal uterine artery below the 5th percentile
D.Amniotic fluid index measurement
Explanation: In Rh(D) alloimmunized pregnancies, fetal hemolysis leads to anemia, reducing blood viscosity and triggering a hyperdynamic circulatory response with elevated fetal cardiac output. Measurement of the peak systolic velocity in the fetal middle cerebral artery (MCA-PSV) using Doppler ultrasonography has replaced invasive amniocentesis (amniotic fluid delta-OD450); an MCA-PSV >1.5 multiples of the median (MoM) predicts moderate-to-severe fetal anemia with high accuracy, indicating the need for diagnostic cordocentesis and intrauterine fetal blood transfusion.
10A complete Biophysical Profile (BPP / Manning score) is performed on a 38-week fetus. The ultrasound examination over 30 minutes shows 2 episodes of fetal breathing lasting 35 seconds, 4 discrete body movements, full flexion and extension of the limbs, and a deepest amniotic fluid pocket of 3.5 cm. The non-stress test is reactive. What is the total BPP score and clinical interpretation?
A.10/10, normal reassuring profile with low risk of chronic fetal asphyxia
B.6/10, equivocal score requiring repeat testing within 24 hours
C.4/10, abnormal score indicating immediate delivery
D.8/10, deducting points for excessive fetal breathing movements
Explanation: The standard Manning Biophysical Profile evaluates five parameters over 30 minutes, awarding 2 points for each normal criterion and 0 points for abnormal: (1) Reactive NST (2 pts); (2) Fetal breathing movements (>=1 episode of rhythmic breathing lasting >=30 seconds = 2 pts); (3) Gross body movements (>=3 discrete body/limb movements = 2 pts); (4) Fetal tone (>=1 episode of active extension with return to flexion = 2 pts); and (5) Amniotic fluid volume (>=1 vertical pocket >=2 cm = 2 pts). All 5 criteria are fulfilled, yielding a perfect score of 10/10, which confers a reassuring fetal status with an extremely low false-negative rate (<1 per 1,000 within one week).

About the Midwifery Licensing Exam

The Israel Midwifery Licensing Examination (בחינת רישוי ממשלתית במיילדות) is the statutory qualifying examination established under the Midwives Ordinance (פקודת המיילדות) and the Public Health Regulations (Nursing Practitioners) 5749-1988 (תקנות בריאות העם (עוסקים בסיעוד)). Administered by the Nursing Division of the Ministry of Health, the examination certifies Registered Nurses who have completed the rigorous accredited Post-Basic Midwifery Course (קורס על-בסיסי במיילדות). The qualification confers full statutory authority to independently manage normal pregnancy, labor, and physiological delivery, administer authorized obstetric pharmacotherapy, identify early maternal-fetal deterioration, execute lifesaving emergency procedures, and conduct neonatal resuscitation. The official examination is administered in Hebrew; this practice question bank is an independent English-language multiple-choice study adaptation prepared by OpenExamPrep for academic revision and is not an official translation of the governmental examination pool.

Exam sponsor: Ministry of Health — Nursing Division (מינהל האֲחָיוּת) with MSR, Israel Center for Medical Simulation. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two-part government examination for graduates of the post-basic midwifery course (קורס על-בסיסי במיילדות): a written licensing paper of 70 multiple-choice ('American-style') questions, followed about a month later by a simulation licensing examination at MSR, the Israel Center for Medical Simulation at Sheba Medical Center, Tel Hashomer. The simulation examination rotates through stations: a mannequin/simulator performance station, a simulation with an actor, a debrief station on that simulation, and a computerised station analysing a clinical situation presented on video or audio.

Time Limit

Not published by the Nursing Division

Passing Score

60 (Nursing Division pass mark for post-basic course licensing examinations)

Exam / Certification Fees

Set by the Nursing Division; see the Nursing Division payments pages

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Antepartum Care & Fetal Assessment

Prenatal risk stratification, routine antenatal biochemical and ultrasound screening, biophysical profiles, non-stress testing (NST/CTG interpretation), gestational diabetes screening, hypertensive disorders of pregnancy, and maternal infectious disease screening (GBS, CMV, Toxoplasmosis, Rubella, Hepatitis B).

25%

Intrapartum Care & Normal Delivery Management

Labor stages and cervical progression dynamics, WHO labor care guide / modified Friedman partogram, cardinal movements of labor, intrapartum electronic fetal monitoring (FIGO/ACOG Category I, II, III CTG guidelines), non-pharmacological labor support, epidural analgesia management, and active management of the third stage of labor (AMTSL).

25%

Obstetric Complications & Emergency Management

Postpartum hemorrhage (PPH) recognition, 4Ts etiology, medical and surgical tamponade protocols, shoulder dystocia management (HELPERR mnemonic), preeclampsia with severe features, eclampsia seizure management with magnesium sulfate protocols, overt and occult umbilical cord prolapse, amniotic fluid embolism (AFE), and uterine rupture.

15%

Postpartum Care & Neonatal Resuscitation

Physiological puerperium involution, lochia progression, perineal tear assessment and repair (1st to 4th degree classification), neonatal resuscitation protocol (NRP 8th edition algorithm: warm, dry, stimulate, PPV, chest compressions, epinephrine), 1-minute and 5-minute Apgar scoring, neonatal hypoglycemia protocols, hyperbilirubinemia assessment, and early breastfeeding initiation.

10%

Midwifery Pharmacology, Ethics & Israeli Health Directives

Obstetric pharmacology (oxytocin, methylergonovine, carboprost tromethamine, misoprostol, nifedipine, labetalol, magnesium sulfate), controlled substance regulations (pethidine/meperidine handling), Ministry of Health Director-General Home Birth Directives (חוזר מנכ"ל לידות בית), Patient Rights Act 1996 (חוק זכויות החולה), informed consent in labor, and statutory documentation standards.

Preparing for the Midwifery Licensing Exam

What You Need to Know

  • Passing score: 60 (Nursing Division pass mark for post-basic course licensing examinations)
  • Assessment: Two-part government examination for graduates of the post-basic midwifery course (קורס על-בסיסי במיילדות): a written licensing paper of 70 multiple-choice ('American-style') questions, followed about a month later by a simulation licensing examination at MSR, the Israel Center for Medical Simulation at Sheba Medical Center, Tel Hashomer. The simulation examination rotates through stations: a mannequin/simulator performance station, a simulation with an actor, a debrief station on that simulation, and a computerised station analysing a clinical situation presented on video or audio.
  • Time limit: Not published by the Nursing Division
  • Exam / certification fees: Set by the Nursing Division; see the Nursing Division payments pages Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Midwifery Licensing: Suggested Study Strategy

1Master the HELPERR mnemonic for shoulder dystocia in sequence: Call for Help, Episiotomy evaluation, Legs flexed (McRoberts), Suprapubic Pressure, Enter rotational maneuvers (Rubin/Woods), Remove posterior arm, Roll to all fours (Gaskin).
2Memorize the precise dosing, administration routes, contraindications, and monitoring parameters for PPH uterotonics: Oxytocin (first-line IV infusion), Methylergonovine (contraindicated in hypertension/preeclampsia), Carboprost / Hemabate (contraindicated in active asthma), and Misoprostol (sublingual/rectal).
3Know the exact NRP 8th edition algorithm steps and timeframes: initial evaluation within 30 seconds, positive pressure ventilation (PPV) initiated within 60 seconds if heart rate is below 100 bpm or gasping/apneic, MR. SOPA ventilation corrective steps, and chest compressions (3:1 ratio) if heart rate remains under 60 bpm despite effective PPV.
4Understand the Israeli legal framework: Patient Rights Act 1996 provisions regarding informed refusal, emergency medical intervention without consent under statutory committee approval, and mandatory notification protocols for clinical adverse events.
5Practice multi-factorial clinical decision-making on partogram progress: differentiating prolonged latent phase from active phase arrest (no cervical dilation progress for >=4 hours with adequate contractions or >=6 hours with inadequate contractions and oxytocin).

Frequently Asked Questions

What is the structure and passing mark of the Israel Midwifery Licensing Examination?

It has two parts. The written licensing paper consists of 70 multiple-choice questions. About a month later candidates sit the simulation licensing examination at MSR, the Israel Center for Medical Simulation at Sheba Medical Center, rotating through a mannequin/simulator station, a simulation with an actor, a debrief of that simulation, and a computerised station analysing a clinical situation on video or audio. The Nursing Division's pass mark for post-basic licensing examinations is 60.

What are the prerequisites to sit for the Israeli Midwifery Licensing Exam?

Candidates must be registered nurses (RN) licensed by the Israeli Ministry of Health Nursing Division holding an academic degree (BSN), have completed at least 1-2 years of clinical bedside experience, successfully graduate from an accredited 1-year Post-Basic Midwifery Program (קורס על-בסיסי במיילדות), and present a verified logbook documenting the completion of at least 40-50 supervised vaginal births and clinical rotations across antepartum wards, delivery suites, and neonatal nurseries.

What clinical guidelines are tested for intrapartum fetal heart rate monitoring?

The examination tests current international consensus guidelines, specifically the FIGO and ACOG three-tier cardiotocography (CTG) classification system: Category I (Normal / physiological, reassuring baseline 110-160 bpm, moderate variability, absence of late/variable decelerations), Category II (Indeterminate / suspicious, requiring conservative intrauterine resuscitation and close surveillance), and Category III (Abnormal / pathological, absent variability with recurrent late decelerations, bradycardia, or sinusoidal pattern requiring immediate delivery preparation).

What are the statutory requirements for home births under Israeli Ministry of Health circulars?

Under Ministry of Health Director-General Circular 2012/17 (and subsequent updates), planned home births may only be attended by a licensed midwife or obstetrician with at least three years of active hospital delivery room experience. The woman must be at low obstetric risk (singleton, cephalic presentation, 37+0 to 41+6 weeks, no prior uterine scars, normal placenta location) and reside within a maximum 30-minute transit time to the nearest acute obstetric hospital.

Is this OpenExamPrep question bank an official Ministry of Health exam translation?

No. The official licensing examinations are formulated and conducted in Hebrew by the Nursing Division. This practice bank is an independent English-language educational adaptation developed by OpenExamPrep to help candidates master core clinical concepts, pharmacology calculations, and regulatory guidelines in a structured, four-option MCQ format.

When is the exam offered and what is the registration fee?

The Nursing Division schedules the post-basic licensing examinations and publishes each date; the invitation appears in the healthcare professionals portal about two weeks beforehand. Fees are set by the Nursing Division and shown on its payments pages. Candidates who score 58-59 on a computerised knowledge station or computerised case-management station may appeal.