A woman who is 6 cm dilated has the urge to push. What will the nurse instruct the woman to do during the contraction?

Choice A rationale Breathing into a brown paper bag is a technique occasionally used to manage hyperventilation, which causes an excessive loss of CO_2 and resultant respiratory alkalosis. Instructing a woman who feels the urge to push, especially one only 6 cm dilated, to do this would not address the issue of cervical trauma risk associated with premature pushing and is not a standard breathing technique for labor. Choice B rationale Rapid-paced breathing (often called "pant-pant-blow") is a distraction technique primarily used during the transition phase (8-10 cm dilation) or to resist the urge to push before full cervical dilation to prevent cervical edema or lacerations. While appropriate for resisting an urge, simply stating "rapid-paced breathing" lacks the specificity of the short, blowing breaths needed for managing this intense urge. Choice C rationale Holding the breath and pushing is a directed or closed-glottis pushing technique appropriate only after the cervix is fully 10 cm dilated. Pushing prematurely at 6 cm can lead to cervical edema, lacerations, or swelling, which can impede or prevent further dilation. Additionally, sustained breath-holding can reduce oxygen saturation and lead to fetal hypoxia. Choice D rationale Blowing in short breaths (or panting) is the most appropriate instruction to manage the premature urge to push at 6 cm dilation. This technique involves an open glottis and uses the abdominal muscles to counteract the downward pressure without generating the sustained, forceful pressure required for actual expulsion, thereby reducing the risk of cervical injury while the cervix finishes dilating.