A breastfeeding woman develops engorged breasts at 3 days postpartum.
What action would help this woman achieve her goal of reducing the engorgement?

Choice A rationale: Primigravida

Primigravida (first-time pregnancy) is a known risk factor for preeclampsia. Studies show that nulliparous individuals (those who have never given birth before) have a higher likelihood of developing preeclampsia compared to multiparous individuals. The exact reason is not fully understood, but it is thought that immunological adaptation plays a role.

Choice B rationale: Age

Advanced maternal age (≥35 years) is a recognized risk factor for preeclampsia. This client is 36 years old, which places her in the higher-risk category. Older maternal age is associated with increased vascular dysfunction and underlying chronic conditions that predispose individuals to preeclampsia.

Choice C rationale: Type 1 diabetes mellitus

Type 1 diabetes mellitus significantly increases the risk of preeclampsia due to its impact on vascular health. Diabetes affects endothelial function and can cause chronic inflammation, both of which contribute to hypertension and proteinuria, hallmark symptoms of preeclampsia. Additionally, diabetes increases the risk of abnormal placentation, further raising the chances of hypertensive disorders in pregnancy.

Choice D rationale: Hemoglobin level

A hemoglobin level of 12.5 g/dL is within the normal range and does not contribute to an increased risk for preeclampsia. While anemia is sometimes associated with preeclampsia, a normal hemoglobin level does not raise concern in this case. Therefore, hemoglobin is not a risk factor for preeclampsia in this patient.

Choice A rationale

Walking and increasing fluid intake can often alleviate the discomfort associated with Braxton Hicks contractions. Movement can sometimes cause the uterus to relax, and adequate hydration helps maintain uterine irritability within normal physiological limits. Dehydration can sometimes exacerbate uterine contractions, so ensuring sufficient fluid intake is a prudent measure.

Choice B rationale

Timing contractions is more relevant when assessing for true labor. Braxton Hicks contractions are irregular and do not follow a consistent pattern of increasing frequency, duration, and intensity. Instructing the client to time them for 30 minutes may cause unnecessary anxiety and is not the primary intervention for discomfort relief.

Choice C rationale

Aspirin is not recommended during pregnancy, especially in the third trimester, due to potential risks to both the mother and the fetus, such as increased bleeding tendencies. Furthermore, aspirin would not address the physiological cause of Braxton Hicks contractions.

Choice D rationale

Going to the hospital is not indicated for irregular, non-painful Braxton Hicks contractions, especially at 36 weeks' gestation. Hospital visits are reserved for signs of true labor, such as regular, increasing contractions, rupture of membranes, or significant bleeding.