A laboring woman has received butorphanol intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of butorphanol on the neonate?

A. Caput succedaneum is a diffuse edema of the scalp caused by pressure during delivery. It is soft, may feel puffy, and crosses suture lines. It is usually present at birth and resolves within a few days, making this option inconsistent with the findings described.
B. Molding refers to the temporary shaping of the newborn’s head due to overlapping cranial bones during passage through the birth canal. It affects the overall head shape rather than causing a localized, raised, bruised area and does not present as a firm mass.
C. The anterior fontanelle is a normal anatomical structure located at the junction of the frontal and parietal bones. It is soft and flat or slightly sunken, not raised or bruised, and is not a pathological finding.
D. A cephalhematoma is a collection of blood between the skull and periosteum caused by birth trauma. It is typically firm, localized, appears within the first 24 hours after birth, and does not cross suture lines, which precisely matches the assessment findings described.

A. Ice application does not decrease lochia. Lochia is the normal postpartum vaginal discharge consisting of blood, mucus, and uterine tissue. Its flow is regulated by uterine contractions and involution, not by external cooling. Ice has no impact on the volume, color, or duration of lochia.

B. Ice does not provide a painful effect; rather, it provides a pain-relieving or numbing effect by slowing nerve conduction in the area. While clients may feel temporary numbness, the purpose is analgesia, not inducing pain. The cold temperature can help reduce discomfort from perineal trauma, such as lacerations, episiotomies, or swelling.

C. Decreasing edema is the primary purpose of applying ice to the perineum after vaginal delivery. Ice causes vasoconstriction, which limits blood flow to the tissues, thereby reducing swelling and inflammation. Edema is common in the first 24 hours postpartum, especially after traumatic births, large babies, or prolonged pushing, and can contribute to pain and discomfort. Applying ice also helps minimize hematoma formation and can improve the client’s comfort during the early postpartum period. Ice therapy is typically recommended for 15–20 minutes at a time in the immediate postpartum period for optimal effectiveness.

D. Ice does not cleanse the perineum. Perineal hygiene is maintained through separate interventions such as peri-bottle rinsing, sitz baths, or gentle cleansing with warm water. Ice therapy only addresses swelling and discomfort, not infection control or cleanliness.