A nurse is caring for an adolescent with spina bifida who is paralyzed from the waist down. Which of the following client statements should alert the nurse to the need for further education?

Choice A rationale
Cervical dilation is a key sign that labor has begun. During labor, the cervix dilates to allow the baby to pass through the birth canal. This is a physical change that can be measured during a pelvic exam.
Choice B rationale
Pain above the umbilicus is not typically a sign of labor. During labor, contractions are usually felt as a tightening or cramping in the lower abdomen or back.
Choice C rationale
Brownish vaginal discharge can occur during pregnancy and is not necessarily a sign of labor. If the discharge is heavy, or accompanied by other symptoms such as pain or cramping, it should be evaluated by a healthcare provider.
Choice D rationale
The presence of amniotic fluid in the vaginal vault, also known as “water breaking,” can be a sign that labor is imminent. However, it does not confirm that labor has begun, as it can occur before the onset of contractions and cervical dilation.

Choice A rationale
Limiting noise and interruption in the delivery room can help create a calm environment, which can be beneficial for both the mother and the newborn. However, this is not the priority action for promoting maternal-infant bonding.
Choice B rationale
Encouraging parents to touch and explore the neonate’s features can help foster a connection between the parents and the newborn. This tactile stimulation can also be comforting for the newborn. However, this is not the most immediate action to promote maternal-infant bonding.
Choice C rationale
Placing the neonate skin-to-skin on the client’s chest is the priority action. Skin-to-skin contact immediately after birth helps regulate the newborn’s temperature, heart rate, and breathing. It also promotes breastfeeding and bonding.
Choice D rationale
Placing the neonate at the client’s breast can promote breastfeeding, which can enhance maternal-infant bonding. However, this is not the first action to take. The priority is to establish skin-to-skin contact.