Which of the following statements by a client who is at 8 weeks of gestation and is Rh-negative indicates an understanding of the teaching about the Rho(D) immune globulin injection?

Choice A reason: Bladder distention indicates an adverse effect of epidural analgesia, as nerve blockade impairs bladder sensation, leading to retention. This is not a sign of effective pain relief but a complication requiring monitoring or catheterization to prevent urinary tract infections or bladder overdistension, per epidural side effect management.

Choice B reason: Reporting slight pressure with contractions indicates effective epidural analgesia, as it reduces pain while preserving some sensation, allowing awareness of labor progress. This reflects targeted nerve blockade, alleviating visceral pain via opioid and anesthetic action, aligning with the goal of balanced labor analgesia without complete sensory loss.

Choice C reason: Inability to move legs or feet suggests excessive epidural blockade, a complication rather than effective analgesia. Optimal epidurals provide pain relief with minimal motor impairment, allowing mobility. Complete paralysis risks prolonged recovery or injury, not reflecting the therapeutic goal of labor pain management, per anesthesia protocols.

Choice D reason: A 20 mm Hg systolic blood pressure decrease indicates hypotension, an adverse effect of epidural analgesia due to sympathetic blockade. This risks reduced placental perfusion, not effective pain relief. It requires intervention like fluids, contrary to the goal of stable analgesia with minimal maternal or fetal impact.

Choice A reason: Stating that rubella vaccination prevents breastfeeding is incorrect. The rubella vaccine, a live-attenuated virus, is safe for postpartum administration in non-immune mothers, as it does not significantly excrete in breast milk or harm the infant. Breastfeeding supports neonatal immunity through maternal antibodies, and this statement misrepresents vaccine safety and breastfeeding physiology.

Choice B reason: Repeating a rubella titer in the third trimester is unnecessary unless new exposure is suspected. A titer of 1:8 indicates susceptibility, requiring postpartum immunization, not repeated testing. Serological testing monitors antibody levels, but rubella immunity status typically remains stable during pregnancy unless infection occurs, making routine retesting scientifically unjustified in this context.

Choice C reason: Administering rubella immunization during pregnancy is contraindicated, as it is a live vaccine that poses a theoretical risk to the fetus. A titer of 1:8 indicates susceptibility, warranting postpartum vaccination. The immune system’s response to live vaccines could potentially cross the placenta, affecting fetal development, so immunization is deferred until after delivery.

Choice D reason: A rubella titer of 1:8 indicates susceptibility, as titers below 1:10 suggest insufficient antibodies to confer immunity. Rubella infection during pregnancy can cause congenital rubella syndrome, leading to fetal anomalies. This statement accurately reflects the need for postpartum immunization to protect future pregnancies, aligning with serological evidence and prenatal care guidelines.