A primipara tells the nurse, "My afterpains get worse when I am breastfeeding.”. What is the most appropriate nursing response?

Choice A rationale Afterpains, which are intermittent uterine contractions following childbirth, are generally less intense in a primipara (first baby) because the uterine muscle tone is usually stronger and the uterus is less stretched than in multiparous women. In multiparas, repeated stretching leads to decreased muscle tone, requiring stronger contractions to achieve hemostasis and involution, thus causing more intense afterpains. Normal involution sees the fundus descend about 1 cm per day. Choice B rationale Although changing position can sometimes offer comfort, it does not address the underlying physiological cause of the afterpains experienced during breastfeeding. The intensification of pain is a direct hormonal response related to the sucking stimulus, not primarily a positional issue. Non-pharmacological interventions like warmth or massage might offer minor relief, but the hormonal action is dominant. Choice C rationale Suckling stimulates the posterior pituitary gland to release oxytocin, a potent uterotonic hormone. Oxytocin causes strong, coordinated contractions of the myometrial smooth muscle cells, which helps compress blood vessels at the placental site (aiding hemostasis) and promotes uterine involution (return to its pre-pregnant state). These strong contractions are perceived as afterpains. Choice D rationale While non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen are often appropriate for afterpain relief, aspirin is generally avoided postpartum due to its potential to interfere with maternal-newborn clotting factors, increasing the risk of bleeding, and its theoretical association with Reye's syndrome in infants if passed through breast milk. Pain management should be tailored and safe.