A nurse is caring for a newborn 4 hours after their birth.
Which of the following findings should the nurse report to the provider?

Choice A rationale

Consistent crying is considered a late cue of hunger in a newborn. Crying, a complex physiological and behavioral response, requires a high expenditure of energy and is an indication that the newborn is already significantly distressed by hunger and needs to be fed immediately to avoid excessive agitation and difficulty latching.

Choice B rationale

The rooting reflex involves the newborn turning their head toward any stimulation of their cheek or mouth and opening their mouth, which is an innate physiological response critical for locating the nipple. This is a primary early hunger cue, indicating the newborn is ready and searching for a food source, initiating feeding efforts.

Choice C rationale

Sucking motions, such as rapid, repetitive sucking on the lips, tongue, or anything near the mouth, are direct early behavioral manifestations of the newborn's innate physiological need for nourishment. This action is a preparatory step for feeding, indicating readiness for oral intake and satiation of hunger.

Choice D rationale

Hand-to-mouth movements are a key early hunger cue, demonstrating the newborn's increasing drive to seek oral stimulation and food. This behavior is part of the newborn's reflexive self-soothing and exploratory repertoire, signaling a rising level of hunger before the onset of overt distress or crying.

Choice E rationale

The Babinski reflex is a normal neurological response in infants where the great toe extends upward and the other toes fan out when the sole of the foot is firmly stroked. It is a primitive reflex related to neurological development and is not an indicator of hunger or feeding readiness.

Explanations

Fetal presentation The fetus is in a left occiput anterior (LOA) vertex presentation, which is the most favorable position for vaginal birth. LOA allows for optimal alignment of the fetal head with the maternal pelvis, facilitating descent and rotation during labor. Malpresentations such as breech or transverse would be unfavorable, but vertex LOA is considered ideal. Therefore, this finding is favorable for vaginal delivery at 42 weeks gestation.

Cervical findings The cervix is described as closed and thick, which is unfavorable for vaginal birth. At 42 weeks, the cervix should ideally be effaced and dilated to allow for labor progression. A closed, thick cervix indicates that the cervix has not ripened, which may necessitate induction with cervical ripening agents such as prostaglandins or mechanical methods. Thus, this finding is not favorable for vaginal birth readiness.

Uterine contraction pattern The client reports only occasional mild uterine contractions, which is not favorable for vaginal birth at 42 weeks. Effective labor requires regular, strong contractions that cause progressive cervical dilation and effacement. Occasional mild contractions are insufficient to initiate or sustain active labor. At this post-term stage, the absence of an adequate contraction pattern suggests that induction may be required. Therefore, this finding is not favorable.

FHR The fetal heart rate is 150/min, which falls within the normal baseline range of 110 to 160 beats per minute. This indicates adequate fetal oxygenation and no evidence of tachycardia or bradycardia. A normal FHR is a favorable finding for vaginal birth, as it reflects reassuring fetal status. Continuous monitoring remains important, but this specific finding supports safe progression toward vaginal delivery.