The postpartum woman is experiencing heavy lochia and has required frequent fundal massage over the past 24- hour period.
Which of the following factors may have contributed to the uterine atony?

Choice A rationale
Unlabored irregular respirations are not typically associated with respiratory distress in a neonate. In fact, newborns naturally have irregular breathing patterns, which can range from fast and shallow to slow and deep.
Choice B rationale
Grunting is a common symptom of respiratory distress in neonates. This is an involuntary noise that a baby makes when exhaling. It’s the baby’s attempt to keep air in the lungs to help them stay open and filled with air.
Choice C rationale
While apneic periods (pauses in breathing) can occur in neonates, a 5-second pause is within the normal range. Apnea of concern in neonates, particularly those with respiratory distress, is usually defined as cessation of breathing for 20 seconds or longer, or a shorter pause if it is accompanied by a slow heart rate or low oxygen levels.
Choice D rationale
Nasal flaring, where the nostrils spread open during breathing, is another common sign of respiratory distress in neonates. It’s an indication that the baby is having to work harder to breathe.
Choice E rationale
Use of accessory muscles is a sign of respiratory distress in neonates. This means the baby is using additional muscles (other than the diaphragm and chest muscles) to breathe. This can be seen as indrawing or retractions, where the skin pulls in between the ribs or the neck sinks in with each breath.

Choice A rationale
After a birth complicated by shoulder dystocia, it is important to palpate the infant’s clavicles. This is because shoulder dystocia can lead to a clavicle fracture.
Choice B rationale
While encouraging the parents to hold the infant is generally a good practice, it is not the immediate action to take after a birth complicated by shoulder dystocia.
Choice C rationale
A complete newborn assessment is important, but the immediate action after a birth complicated by shoulder dystocia is to check for any injuries related to the difficult birth.
Choice D rationale
Giving supplemental oxygen is not the immediate action to take after a birth complicated by shoulder dystocia unless the baby shows signs of respiratory distress.