A nurse is assisting with the care of a client who is in labor.
The client's labor is difficult and prolonged and she reports a severe backache.
Which of the following factors is a contributing cause of difficult, prolonged labor?

Rationale for Choice A:

Having the client pant during the next few contractions is not appropriate at this time. While panting can be a helpful

breathing technique during earlier stages of labor, it is not recommended when the client feels the urge to push.

Panting can actually delay the progress of labor by preventing the client from bearing down effectively.

It is important to allow the client to push when she feels the urge, as this will help to facilitate the descent of the fetal head and

progress labor.

Rationale for Choice B:

Helping the client to the bathroom to empty her bladder is not the priority action at this time. While a full bladder can

sometimes interfere with labor progress, it is more important to assess the perineum for signs of crowning before taking the

client to the bathroom.

If the fetal head is crowning, it is crucial to avoid any unnecessary delays in delivery.

Rationale for Choice C:

Assisting the client into a comfortable position is important for labor progress, but it is not the priority action at this time.

Assessment of the perineum for signs of crowning takes precedence, as it will guide the nurse's subsequent actions.

Once crowning is confirmed, the nurse can then help the client into a position that facilitates pushing, such as squatting, semi-

sitting, or side-lying.

Rationale for Choice D:

Assessing the perineum for signs of crowning is the most appropriate action for the nurse to take in this situation.

Crowning is the term used to describe the appearance of the fetal head at the vaginal opening.

It is a definitive sign that the client is in the second stage of labor and that delivery is imminent.

By assessing for crowning, the nurse can confirm the progress of labor and prepare for the delivery of the baby.

Choice A rationale:

Umbilical cord compression is a serious condition that can deprive the fetus of oxygen and nutrients. It can occur during labor

due to various factors, such as excessive fetal movement, a long umbilical cord, or decreased amniotic fluid.

Key signs of umbilical cord compression include:

Variable decelerations: These are abrupt decreases in the fetal heart rate (FHR) that vary in duration, depth, and timing. They

are often caused by cord compression, as the compression temporarily reduces blood flow to the fetus.

Late decelerations: These are delayed decreases in the FHR that occur after the peak of a uterine contraction. They can also be

a sign of cord compression, as the compression can impair placental blood flow.

Loss of FHR variability: This refers to a decrease in the normal fluctuations of the FHR. It can be a sign of fetal distress,

including cord compression.

Immediate action is crucial when umbilical cord compression is suspected. The nurse should:

Notify the provider immediately.

Change the mother's position: This can help relieve pressure on the cord. Common positions include:

Lateral positioning (lying on the side)

Trendelenburg position (lying on the back with the head tilted down)

Knee-chest position (kneeling with the chest on the bed)

Administer oxygen to the mother: This can increase fetal oxygenation.

Prepare for possible interventions: These may include amnioinfusion (infusing fluid into the amniotic sac to increase fluid

volume), internal fetal monitoring, or cesarean delivery.

Choice B rationale:

Head compression is a common occurrence during labor as the fetal head descends through the birth canal. It usually does not

require intervention unless it causes significant changes in the FHR or other signs of fetal distress.

Choice C rationale:

Maternal opioid administration can affect the FHR, but it is not typically a cause for immediate concern unless there are

significant changes in the FHR or other signs of fetal distress. The nurse should continue to monitor the FHR closely and report

any concerns to the provider.

Choice D rationale:

Lateral decelerations are not a recognized pattern of fetal heart rate decelerations. The correct term for decelerations that

occur after the peak of a contraction is "late decelerations."