The nurse is teaching a pregnant patient about true labor contractions.
The nurse evaluates that the patient understands the explanation when which statement is made?

Choice A rationale

A fetus in the left sacroanterior (LSA) position has its sacrum, or buttocks, pointing toward the mother's left side and toward the front of her pelvis. The fetal heart is typically located in the fetal chest, and with a breech presentation (sacrum first), the fetal heart is located higher in the uterus, often above the umbilicus, which explains why the nurse hears the fetal heart rate in that location.

Choice B rationale

A fetus in the left occipitoanterior (LOA) position has its occiput, or back of the head, pointing toward the mother's left side and toward the front of her pelvis. In this vertex presentation, the fetal head is typically in the lower uterine segment, and the fetal heart would be heard below the mother's umbilicus, not above it.

Choice C rationale

A fetus in the right occipitoanterior (ROA) position has its occiput, or back of the head, pointing toward the mother's right side and toward the front of her pelvis. Similar to LOA, this is a vertex presentation. The fetal heart is typically heard below the mother's umbilicus and on her right side, not above it and on her left side.

Choice D rationale

A fetus in the right occipitoposterior (ROP) position has its occiput, or back of the head, pointing toward the mother's right side and toward the back of her pelvis. This is also a vertex presentation. The fetal heart would be heard below the mother's umbilicus and on her right side, not above it and on her left side.

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.