Health Promotion and Maintenance
7. A client who is a 38-year-old multipara had an epidural during her last labor for pain control. She and her husband have chosen to decline any medication during this labor and delivery and ask an RN to help them achieve this goal. To best assist them during the second stage of labor, which action should be taken by the RN?
. Perform vigorous perineal massage to decrease pain during delivery.
. Encourage patterned breathing to decrease pain during delivery.
. Encourage strong pushing between contractions.
. Inform the couple about progress toward delivery and all procedures.
Test-Taking Tip
Remember the stages of labor and that the correct coaching for a woman who is pushing (second stage of labor) is different than during the first stage of labor.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Implementation; Cognitive Level: Application; Client Need/Subneed: Health Promotion and Maintenance/Ante/Intra/Postpartum and Newborn Care
Health Promotion and Maintenance
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Answer 1 is incorrect because vigorous perineal massage does not decrease pain during delivery; gentle perineal massage may be used by some practitioners to decrease perineal tearing. Answer 2 is incorrect because the second stage of labor is the pushing stage and coaching with patterned breathing is used to decrease pain during the first stage of labor. Answer 3 is incorrect because pushing should be performed during the peak of the contractions, not between, to enhance progress toward delivery. Answer 4 is correct because keeping the couple informed decreases anxiety, increases confidence in their ability to cope with an unmedicated labor and delivery, and helps accomplish their goals.