A laboring patient states to the nurse, "I have to push!" What is the next nursing action?
a. Contact the health care provider.
b. Examine the patient's cervix for dilation.
c. Review with her how to bear down with contractions.
d. Ask her partner to support her head with each push.
ANS: B
When the cervix is completely dilated, the head can descend through the pelvis and stimulate the Ferguson, or pushing, reflex. Cervical dilation must first be confirmed because premature pushing efforts may result in cervical edema and corresponding delay in dilation. Once complete dilation has been confirmed, the nurse can notify the health care provider. Teaching positioning and pushing efforts is accomplished once complete dilation has been confirmed.
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