While performing a visual inspection of a woman in labor, you can see the umbilical cord at the vaginal opening. What should you do?

When observing the umbilical cord at the vaginal opening during labor, the immediate action should be to relieve pressure from the cord with your gloved fingers. This is crucial because the cord's appearance at the vaginal opening typically indicates a potential complication known as a cord prolapse, which can lead to cord compression. Cord compression can result in decreased blood flow and oxygen supply to the fetus, causing fetal distress.

By gently lifting the presenting part of the fetus away from the cord with your fingers, you help alleviate this pressure, potentially restoring proper blood flow and oxygenation to the fetus. This action can help stabilize the situation until more definitive care can be provided, such as preparing for an expedited delivery.

The other options, although they may seem tactical, do not directly address the immediate issue of relieving pressure on the umbilical cord. Massaging the uterus or elevating the lower extremities does not resolve the cord compression issue and may take critical time away from the necessary intervention. Placing the mother on her side may help with certain scenarios, but it does not provide the direct relief needed for the compressed cord situation. Therefore, focusing on relieving the pressure on the cord is the most appropriate and effective action in this emergent context.