A nurse is reviewing the medical records of four clients who are pregnant and planning to have a vaginal birth after cesarean (VBAC).

Which of the following clients has the highest risk of uterine rupture during labor?

The correct answer is choice C. Interdependent.According to Mercer’s theory of maternal role attainment, the interdependent phase is when the mother redefines her relationship with her older child and integrates the new baby into the family.She also reestablishes her role in society and resumes her pre-pregnancy activities.

Choice A is wrong because dependent is the first phase of maternal role attainment, when the mother is focused on her own needs and recovery after childbirth.She relies on others for support and guidance.

Choice B is wrong because dependent-independent is the second phase of maternal role attainment, when the mother begins to take charge of her own care and learns how to care for the baby.She seeks information and validation from health professionals and experienced mothers.

Choice D is wrong because independent is the fourth and final phase of maternal role attainment, when the mother has a strong sense of identity and competence in her maternal role.She develops her own style of mothering and feels confident and comfortable with her baby.

Advanced maternal age is a risk factor for preterm labor, which occurs when regular contractions begin to open the cervix before 37 weeks of pregnancy.

Preterm labor can lead to premature birth, which can have serious health consequences for the baby.

Choice B is wrong because full-term gestation is not a risk factor for preterm labor.Full-term gestation means that the pregnancy lasts between 39 and 40 weeks, which is the ideal duration for the baby’s development.

Choice C is wrong because absence of medical or obstetric complications is not a risk factor for preterm labor.Some medical or obstetric complications that can increase the risk of preterm labor include urinary tract infections, high blood pressure, bleeding from the vagina, placenta previa, diabetes and blood clotting problems.

Choice D is wrong because lack of uterine contractions before 37 weeks of gestation is not a risk factor for preterm labor.Uterine contractions are a sign of preterm labor, not a cause of it.

Some other risk factors for preterm labor that the nurse should include in the discussion are:

• Previous preterm delivery or preterm labor

• Multiple gestation (twins, triplets or more)

• Abnormalities of the reproductive organs, such as a short cervix

• Ethnicity (African American and American Indian/Alaska Native mothers have higher rates of preterm birth than white mothers)

• Age of the mother (women younger than 18 are more likely to have a preterm delivery)

• Tobacco use and substance abuse

• Short time period between pregnancies (less than 18 months)