You're being tested on your knowledge of basic skills. If you have the knowledge of skills necessary to handle different situations, that
is what makes you safe.
Remember, the test is not asking questions on any state-specific laws and rules, (the exam is a written test on midwifery theory
, your practical
skills are what you have actually done, documented by your preceptor) the answer will apply to the LM in Florida who suddenly finds herself with a surprise breech at 9 cm, and the CPM in Oregon where it is perfectly legal to attend a breech, and they're going to apply to the Boston midwife with a back-up hospital 4 minutes away, and the Montana midwife practicing where the closest hospital is 4 hours
away. Obviously, if you attemp to transport her to a hospital 4 hours away, at 9 cms, you're going to risk a car birth on the side of the road, which is decidedly LESS safe than continuing with the birth at home. There may
be a question where transporting a breech IS the correct answer (everyone gets a different version of the test), perhaps if Mom is 4 cms and you discover a little foot in her vagina, for example. They don't want to know if you can pick up a phone and call 911. They want to know you
have the knowledge of the skills necessary to manage a breech (or shoulder dystocia, or PPH....) at home if you
need to (even if in real life you DO call 911 and transport).
Now, if a question asks you if you discover a placenta previa in early labour....., the answer will of course be transport. That is not considered safe in any
situation, or in any state, no matter your skill level. But generally, the answer will not be transport, the answer will be what is appropriate management.
I hope I'm being helpful and not making you more stressed out.
I personally found the NARM to be rather easy. I finished both portions in less than an hour each and passed with a 98%. (I swear, I'm not trying to show off) I understood that the exam was testing my knowledge of midwifery theory, not my knowledge of my state laws, not what I would actually do in a real life situtation, with my skill level and my state laws to consider, but what is considered a working knowledge of good management skills