A 22-year-old woman visits the clinic requesting birth control.
Her medical history includes dysmenorrhea, irregular menstrual cycles, and menorrhagia.
She smokes half a pack of cigarettes daily and reports being sexually active with multiple partners.
Which birth control method is most appropriate for this client?

Choice A rationale

Persistent feelings of sadness that are pervasive and interfere with daily functioning, coupled with severe fatigue that goes beyond typical postpartum tiredness and a marked loss of interest in activities, including bonding and caring for the newborn, are key indicators of postpartum depression. These symptoms are more intense and prolonged than the emotional lability often seen in the postpartum period.

Choice B rationale

Feeling anxious about the baby's well-being is a common experience for many postpartum individuals as they adjust to parenthood. As long as this anxiety does not impair their ability to care for the baby effectively, it is more likely a component of normal postpartum adjustment rather than indicative of postpartum depression.

Choice C rationale

Experiencing occasional mood swings and irritability is typical during the postpartum period due to hormonal shifts, sleep deprivation, and the significant life changes associated with a new baby. These fluctuations are usually transient and less severe than the persistent sadness and loss of interest seen in postpartum depression.

Choice D rationale

Feeling overwhelmed and having difficulty sleeping are common challenges for new parents due to the demands of newborn care. While these symptoms can contribute to or exacerbate postpartum depression, they are not solely indicative of it unless accompanied by persistent sadness, severe fatigue, and a loss of interest in activities.

Choice A rationale: Assist the patient onto her left side

Positioning the patient on her left side helps improve uteroplacental blood flow by reducing compression of the inferior vena cava. This can enhance oxygen delivery to the fetus and mitigate late decelerations.

Choice B rationale: Assist with a vaginal exam for cord prolapse

Cord prolapse occurs when the umbilical cord slips ahead of the presenting fetal part, leading to variable decelerations rather than late decelerations. Since late decelerations indicate placental insufficiency rather than cord prolapse, this intervention is not necessary.

Choice C rationale: Discontinue the oxytocin infusion

Oxytocin is used to stimulate contractions, but excessive contractions can lead to uteroplacental insufficiency, causing late decelerations. Discontinuing oxytocin reduces uterine stress and improves fetal oxygenation.

Choice D rationale: Administer oxygen at 10 L/min via nonrebreather face mask

Providing high-flow oxygen increases maternal oxygenation, which in turn enhances fetal oxygen delivery. This intervention is a standard response to late decelerations.

Choice E rationale: Notify the health care provider

Late decelerations suggest fetal distress due to uteroplacental insufficiency, requiring urgent evaluation and possible escalation of care, such as intrauterine resuscitation or expedited delivery.

Choice F rationale: Stop the magnesium sulfate

Magnesium sulfate is administered for seizure prevention in preeclampsia and does not directly contribute to late decelerations. Therefore, stopping magnesium sulfate is not necessary in this situation.