Which fetal position may cause the laboring patient increased back discomfort?

Correct Answer: B

Rationale: The correct answer is B: Left occiput posterior. In this position, the baby's occiput is towards the mother's back, leading to increased back discomfort during labor. The baby's position can put pressure on the mother's sacrum and lower back, causing more pain. Choices A, C, and D do not involve the baby's occiput being posterior, so they would not result in the same level of back discomfort.

Correct Answer: D

Rationale: The correct answer is D because excessive pain in labor can lead to increased maternal stress, which may result in decreased placental perfusion, compromising oxygen and nutrient delivery to the fetus. This can have serious implications for the baby's well-being. Choices A, B, and C are incorrect because excessive pain in labor does not necessarily lead to a more rapid labor, has an effect on the labor outcome by potentially impacting placental perfusion, and is not considered a normal occurrence that should be disregarded.

Correct Answer: C

Rationale: The correct answer is C: Epidural anesthesia. At 8 cm cervical dilation, the patient is in active labor and close to delivery. Epidural anesthesia is the safest method as it provides effective pain relief without affecting the baby's central nervous system. Narcotics can pass through the placenta and affect the baby's breathing. Spinal block may cause a sudden drop in blood pressure. Breathing and relaxation techniques may not be sufficient at 8 cm dilation. Epidural anesthesia is the most appropriate for pain management in this scenario.

Correct Answer: A

Rationale: The correct answer is A: epidural block. Epidural anesthesia in labor is considered the safest for the fetus because it does not directly affect the baby's central nervous system. It provides effective pain relief for the mother while minimizing the risk of medication passing to the fetus. It also allows for adjustment of the dose as needed during labor. Summary of why other choices are incorrect: B: Pudendal block is a regional anesthesia technique that primarily provides pain relief to the perineum and does not affect the fetus directly. C: Local infiltration anesthesia is limited in its coverage and may not provide adequate pain relief during labor. D: Spinal (subarachnoid) anesthesia may lead to a rapid and significant drop in blood pressure, affecting fetal oxygenation and require careful monitoring.

Correct Answer: A

Rationale: The correct answer is A: Right occiput posterior fetal position during labor. This position can lead to intense back pain and prolonged labor, affecting pain perception. A posterior position can put pressure on the sacrum and cause increased discomfort. In contrast, choices B, C, and D do not directly impact pain perception during labor. Choice B, Bishop score of 10, indicates favorable conditions for labor progress but does not necessarily affect pain perception. Choice C, Gynecoid pelvis, refers to a common pelvis shape that may facilitate labor but does not directly influence pain tolerance. Choice D, Absence of Ferguson's reflex, is related to the ability to push effectively but is not directly linked to pain perception.