Final answer:
During the transition phase of labor, feeling the urge to have a BM at the peak of contractions is normal, and the client may be assisted to the bathroom or provided a bedpan. Devin is advised to return home as she is not in active labor, and for Janine, Pitocin is administered to facilitate labor progression.
Step-by-step explanation:
The question pertains to the management of a client who is in the transition phase of labor, feeling the urge to have a bowel movement (BM) at the peak of contractions. The most appropriate response would be to help the client to the bathroom if it is safe to do so, or to provide a bedpan if the client's mobility is compromised or the healthcare provider advises against moving to the bathroom. Instructing the client to hold off until after delivery may not be practical, as the sensation of needing a BM can be due to the baby's head pressing on the rectum, mimicking the urge to defecate, which is a normal part of the pushing stage. Administering an antiemetic is not relevant to the sensation of needing a BM.
In the case of Devin, who is 35 weeks pregnant and experiences diffuse, mild contractions, the advice to return home is given because her cervical mucus plug is still intact and there is no cervical dilation, indicating that she is not yet in active labor. Early labor is characterized by the cervix beginning to efface and dilate to about 10 cm, which is necessary for the eventual expulsion of the baby and placenta.
For Janine, at 41 weeks pregnant and experiencing mild contractions without significant cervical dilation, the administration of synthetic oxytocin (Pitocin) is to facilitate labor progression, as her labor is not advancing naturally. Pitocin is used to restart and maintain contractions, aiding in the progression to stage two of labor, where the baby is expelled from the uterus.