A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?

Choice A reason:

The woman in early labor with contractions every 5 minutes lasting 40 seconds each does not require the immediate discontinuation of the oxytocin (Pitocin) infusion. Early labor is characterized by mild and infrequent contractions as the cervix begins to dilate and efface. Choice B reason:

The woman in active labor with contractions every 30 minutes lasting 60 seconds each also does not warrant immediate discontinuation of the oxytocin (Pitocin) infusion. Active labor typically involves regular and stronger contractions as the cervix continues to dilate and the baby progresses downward.

Choice C reason:

The woman in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each does not require immediate cessation of the oxytocin (Pitocin) infusion. These contractions are within the expected range for active labor and may be considered normal.

Choice D reason:

The woman in transition with contractions every 1.5 minutes lasting 95 seconds each should have the oxytocin (Pitocin) infusion discontinued immediately. Transition is the most intense phase of labor, characterized by rapid and strong contractions as the cervix completes dilation. Prolonged and frequent contractions during this phase can lead to uterine hyperstimulation, which can compromise fetal oxygenation and result in fetal distress. Discontinuing the oxytocin infusion is necessary to reduce the intensity and frequency of contractions, ensuring better fetal well-being during this critical phase of labor.

A. The woman had a vacuum-assisted birth. While vacuum-assisted births can cause perineal trauma, the specific orders for ice packs, sitz baths, and stool softeners are more directly related to an episiotomy, which involves a surgical incision that requires careful postpartum care.

B. The woman is a gravida 2, para 2. This information indicates the woman's obstetric history but does not directly correlate with the need for perineal ice packs, sitz baths, and stool softeners. These orders are more specific to perineal trauma or surgical intervention.

C. The woman has an episiotomy. An episiotomy involves a surgical cut made at the opening of the vagina during childbirth, which can cause significant perineal pain and swelling. The orders for perineal ice packs, sitz baths, and stool softeners are intended to manage pain, reduce swelling, and prevent constipation, which can be particularly uncomfortable with perineal stitches.

D. The woman received epidural anesthesia. While epidural anesthesia is a common pain management technique during labor, it does not necessitate the use of perineal ice packs, sitz baths, or stool softeners postpartum. These orders are more indicative of perineal trauma or surgical intervention such as an episiotomy.