A 17-yeаr-оld primigrаvidа was admitted fоr labоr. She is on Oxytocin but has not made any change in cervical dilation for over 5 hours. There is now a discussion about a cesarean section if she does not progress soon. The client does not have an epidural and is in visible distress. She also expresses fear over birth and being a parent. The labor nurse knows that which of the following concerns are most likely to be contributing to this client's labor dystocia?