A 22-year-old primigravida visits the antepartal clinic in her third month of pregnancy. She has had diabetes mellitus for the past 7 years.
During the visit to the clinic, the nurse and patient discuss diabetes mellitus and pregnancy.Which comment by the patient would indicate a need for further instruction?

The correct answer is choice D. Wear a supportive bra.This will help suppress lactation and reduce the discomfort of engorgement.

The other choices are wrong because:

• Choice A. Manually express colostrum as necessary.This will stimulate milk production and prolong engorgement.

• Choice B. Apply hot compresses to the breasts.This will increase blood flow and swelling in the breasts and worsen engorgement.

• Choice C. Massage the breast tissue surrounding the areola.This will also stimulate milk production and prolong engorgement.

Normal ranges for breast engorgement are not applicable as it is a subjective experience that varies among women.However, some signs of engorgement include firm, tender, swollen breasts, flat or inverted nipples, and low-grade fever.Engorgement usually resolves within 24 to 36 hours after it begins.

A transverse lie means that the baby is lying sideways across the uterus, instead of head-down or breech.

This position makes vaginal delivery impossible and increases the risk of umbilical cord prolapse, which can compromise fetal oxygen supply.Therefore, a cesarean delivery is indicated for a fetus in a transverse lie.

Choice A is wrong because having extremely slender hips does not necessarily mean that a woman cannot deliver vaginally.

The size and shape of the pelvis, not the external appearance, determines the adequacy of the birth canal.A trial of labor may be attempted for women with borderline pelvic measurements.

Choice C is wrong because fetal hyperactivity is not a reason for a cesarean delivery.

Fetal movements may vary depending on the time of day, maternal activity, maternal blood sugar level, and other factors.Fetal well-being can be assessed by fetal heart rate monitoring and biophysical profile.

Choice D is wrong because having a posterior cervix does not indicate the need for a cesarean delivery.

A posterior cervix means that the cervix is tilted toward the back of the uterus, which may make cervical dilation slower and more painful.However, with adequate contractions and maternal pushing, the cervix can move to an anterior position and allow vaginal delivery.