A multiparous client is bearing down with contractions and crying out, The baby is coming! Which immediate action should the nurse implement?

• A. Obtain a precipitous delivery tray.
• B. Visualize the perineum for bulging.
• C. Call the healthcare provider for a STAT delivery.
• D. Instruct the client's partner to stay for the delivery.

Answer: (B)

In the second stage of labor, the immediate priority is to assess whether crowning is occurring so you know how imminent the birth is and how to support it. Visualizing the perineum for bulging lets you quickly determine if the widest part of the head is beginning to emerge. If you observe bulging or crowning, you can anticipate the delivery, position yourself to protect the perineum, and guide the baby out more smoothly, reducing the risk of tearing and injury. This quick assessment also helps you decide whether to call for additional help or equipment, but the first step is to confirm whether birth is moments away by noting the perineal bulge.

Precipitous delivery trays aren’t the immediate move here because you want to confirm the situation on the ground and provide perineal support first. While contacting the provider may be appropriate if there are signs of complications or if the birth is imminent, you start with visualizing for bulging to gauge how to proceed. Instructing the partner to stay isn’t the critical action in that moment; the focus is on recognizing crowning and preparing for delivery with appropriate perineal support.