Which instruction given by the nurse to a woman in first stage of labour?

NORCET 3 - 2022 (Shift-1)

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

The first stage of labor is characterized by cervical effacement and dilatation, from 0 to 10 cm.
The primary goal during this stage is to allow the cervix to dilate fully without the mother actively pushing.
The instruction to 'Push after full cervical dilatation' is a key piece of anticipatory guidance. It educates the woman on what to expect and helps her conserve energy for the second stage.
This instruction helps manage the premature urge to push by providing a clear timeline and goal, empowering the patient and reducing anxiety.

Option A: This is a correct but incomplete instruction. It tells the woman what not to do but doesn't provide the context of when pushing will be appropriate. Options A and C are nearly identical, making them weak choices in a single-best-answer question.
Option B: This is a dangerous instruction. Lying flat on the back (supine position) can cause supine hypotensive syndrome, where the uterus compresses the inferior vena cava, reducing blood flow to the heart and the fetus.
Option C: Similar to option A, this is a correct but incomplete instruction. Premature pushing can lead to cervical edema, tears, and maternal exhaustion. However, the best instruction provides a complete plan.

Visual 1: Diagram - A chart illustrating the four stages of labor, showing cervical dilatation (0-10 cm) in the first stage and the expulsion of the fetus in the second stage. This will visually separate the 'no pushing' and 'pushing' phases.
Visual 2: Infographic - A simple 'Do's and Don'ts' list for the first stage of labor. 'Do's' would include changing positions, breathing techniques, and staying hydrated. 'Don'ts' would include pushing before full dilatation and lying flat on the back.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management and patient instruction during the first stage of labor to guide bedside assessment, documentation, and the next nursing action.
The nurse's role in labor is to coach the mother effectively to ensure a safe delivery for both mother and baby.
Preventing premature pushing is critical to avoid complications such as cervical lacerations, prolonged labor, and fetal distress from reduced uteroplacental perfusion.
Proper positioning is a key nursing intervention to promote comfort, facilitate labor progress, and prevent complications like supine hypotension.

How to Approach the Question

First, identify the core of the question: What is the correct nursing instruction for the first stage of labor?
Recall the physiological goals of each stage of labor. The first stage is for cervical dilatation (0-10 cm); the second stage is for pushing and delivery.
Evaluate each option against the goals of the first stage.
Eliminate option B ('To lie flat on the bed') as it is known to be harmful (risk of supine hypotension).
Compare the remaining options. Options A and C ('Do not push...') are essentially identical, which often indicates they are distractors in a well-formed question. They are correct but negative commands.
Option D ('Push after full cervical dilatation') provides positive, anticipatory guidance. It tells the woman the correct plan of action, which is a key part of patient education and coaching during the first stage.

Concept Tested & Keywords

Concept Tested: Nursing management and patient instruction during the first stage of labor.
Stem keywords: nurse, instruction, first stage of labour
Lead-in keywords: Which

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