FCOG-1217
A 30-year-old primigravida was admitted to the hospital in active labor. On admission, her cervix was 7 cm dilated and 100% effaced. She received epidural anesthesia and proceeded to complete cervical dilation with fetal head at +3 station within a few hours.Patient who has been pushing for 4 hours is exhausted now and says she cannot feel her contractions, nor knows when to push because of the epidural anesthesia.Patient had no complications during the pregnancy and has no chronic medical conditions. Estimated fetal weight by Leopold maneuvers is 3.4 kg (7.5 lb), patient’s vital signs are normal and fetal heart rate tracing is category 1.Tocodynamometer indicates contractions every 2-3 minutes and a repeat cervical examination shows complete cervical dilation with the fetal head at +3 station, in the left occiput anterior position with no molding or caput. Among the following, which is considered the best next step in management of this patient?