A nurse is caring for a patient in the latent phase of labor who is requesting an epidural for minor labor pains.
The nurse encourages the patient to delay the epidural because she knows that walking and frequent position changes in labor can help to do which of the following? Select all that apply.

Choice A rationale

While many inductions of labor are performed for medical reasons, such as preeclampsia or post-term pregnancy, not all are. Elective inductions, performed for non-medical reasons, are also common, although they are associated with certain risks. The decision to induce labor is a medical one, but the indication is not always strictly medical, making this statement inaccurate.

Choice B rationale

A trial of labor (TOL) is a term used specifically for patients who have had a prior cesarean section and are attempting a vaginal delivery. It is also known as a TOLAC (Trial of Labor After Cesarean). Induction of labor is a broader term and refers to stimulating contractions before the spontaneous onset of labor. The two terms are not synonymous.

Choice C rationale

Induction of labor is a process initiated by methods like oxytocin infusion or prostaglandin gels. Internal and external version are procedures used to change the fetal presentation (e.g., from breech to cephalic) and are not methods for initiating labor. These procedures may be followed by induction, but they are not the induction methods themselves.

Choice D rationale

The Bishop score is a scoring system used to predict the likelihood of a successful induction of labor. It assesses five components: cervical dilation, effacement, consistency, position, and fetal station. A higher Bishop score (typically 8 or greater) indicates a more favorable cervix and a greater chance of successful induction, making this a crucial assessment tool.

Choice A rationale

Suprapubic pressure involves applying downward pressure just above the pubic bone on the mother's abdomen. This maneuver is used to dislodge the anterior fetal shoulder, which is wedged behind the symphysis pubis. The pressure helps to adduct the fetal shoulder, reducing its diameter and allowing it to pass beneath the pubic bone.

Choice B rationale

MacBeth's maneuver is not a recognized obstetric maneuver for resolving shoulder dystocia. Recognized techniques for this emergency include McRoberts maneuver, suprapubic pressure, and Gaskin's maneuver. The lack of a scientific basis or formal obstetric recognition makes this a non-viable option for clinical practice.

Choice C rationale

Fundal pressure, or applying pressure to the top of the uterus, is contraindicated in cases of shoulder dystocia. This action can further wedge the fetal shoulder against the symphysis pubis, increasing the risk of fetal injury, such as a brachial plexus injury, or causing uterine rupture. It is a dangerous and ineffective maneuver.

Choice D rationale

McRoberts maneuver is a first-line intervention for shoulder dystocia. It involves hyperflexing the mother's hips and bringing her thighs toward her abdomen. This position straightens the sacrum relative to the lumbar spine, which rotates the symphysis pubis cephalad, widening the pelvic inlet and allowing the anterior shoulder to pass more easily.