You know that _________ promotes bonding, helps infant maintain their temperature and promotes involution.

The Apgar score is calculated based on five criteria, each scored from 0 to 2:

1. Heart rate

   • 0 = Absent
   • 1 = Below 100 beats per minute ✅
   • 2 = 100 or more beats per minute

2. Respiratory effort

   • 0 = Absent
   • 1 = Slow, irregular ✅
   • 2 = Good, crying

3. Muscle tone

   • 0 = Limp
   • 1 = Some flexion of extremities ✅
   • 2 = Active motion

4. Reflex irritability (response to stimulation, e.g., suctioning)

   • 0 = No response
   • 1 = Grimace ✅
   • 2 = Crying, active withdrawal

5. Color

   • 0 = Blue, pale
   • 1 = Body pink, extremities blue
   • 2 = Completely pink

Apgar Score Calculation:

• Heart rate: 1
• Respiratory effort: 1
• Muscle tone: 1
• Reflex irritability: 1
• Color: 0

Total Apgar Score: 4

A score of 4 suggests the newborn is in distress and requires immediate medical intervention, such as oxygen support and further assessment.

A) Apply ice to the perineal area for the first 12-24 hours:
Applying ice to the perineal area in the first 12-24 hours after delivery is a common intervention for promoting comfort, especially for lacerations or episiotomies. The cold helps to reduce swelling and inflammation, and it numbs the area, providing pain relief. Ice also helps to constrict blood vessels, reducing blood flow to the affected area, which can prevent excessive bleeding and promote healing.

B) Apply warm packs to the perineal area for the first 24-48 hours:
Warm packs are generally not used in the first 24-48 hours after delivery for a laceration. Heat can increase blood flow, which is not ideal immediately after birth when the risk of swelling and bleeding is higher. Typically, warm packs are more beneficial after the first 48 hours to improve circulation and promote healing. Therefore, this is not the best intervention in the immediate postpartum period for a labial laceration.

C) Encourage sitz baths at least twice a day:
Sitz baths are highly effective for postpartum comfort, particularly for perineal trauma such as lacerations or episiotomies. A sitz bath helps to cleanse the area and promote relaxation, reducing discomfort. It also enhances circulation to the perineum, which can speed up healing. Encouraging sitz baths at least twice a day is a helpful intervention for postpartum care and is appropriate for a labial first-degree laceration.

D) Use a topical antiseptic cream or spray on the perineal area:
While topical antiseptics may help reduce infection risk, they are generally not necessary for most first-degree lacerations, especially if they are uncomplicated. In fact, overuse of antiseptics or antibiotic creams can irritate the sensitive tissue in the perineal area and delay healing. The focus should be on keeping the area clean and dry, using gentle care. Therefore, this intervention is not typically recommended for a labial laceration.

E) Obtain an order for an indwelling urinary catheter:
An indwelling urinary catheter is usually only needed in specific cases, such as when a woman is unable to void postpartum due to perineal trauma, epidural anesthesia, or bladder retention. In the case of a labial first-degree laceration, there is no indication for an indwelling catheter unless the woman is unable to void on her own. The best approach is to encourage frequent voiding and assist with comfortable positioning.