The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous patient states: "I can reduce the likelihood that I'll tear or need an episiotomy if I:
1. "Push in a semi-sitting position."
2. "Make sure I push long and hard."
3. "Begin regular perineal massage."
4. "Pull back on my legs when pushing."
3
Rationale 1: The semi-sitting or lithotomy position increases the likelihood of perineal lacerations.
Rationale 2: Short pushes during the expulsion of the head decrease the likelihood of perineal lacerations.
Rationale 3: Perineal massage has been shown to decrease the need for episiotomy in primiparous patients.
Rationale 4: Pulling back on the legs while pushing tightens the perineal tissue, which in turn increases the likelihood of perineal lacerations.
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