Which collection of risk factors most likely would result in damaging lacerations (including episiotomies)?
a. A dark-skinned woman who has had more than one pregnancy, who is going through prolonged second-stage labor, and who is attended by a midwife
b. A reddish-haired mother of two who is going through a breech birth
c. A dark-skinned, first-time mother who is going through a long labor
d. A first-time mother with reddish hair whose rapid labor was overseen by an obstetrician
ANS: D
Reddish-haired women have tissue that is less distensible than that of darker-skinned women and therefore may have less efficient healing. First time mothers are also more at risk, especially with breech births, long second-stage labors, or rapid labors in which there is insufficient time for the perineum to stretch. The rate of episiotomies is higher when obstetricians rather than midwives attend births.
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