A client asks the nurse, "What can I do to avoid an episiotomy during birth?" Which responses should the nurse give? (Select all that apply)
a. "Using the lithotomy position during pushing may be beneficial."
b. "Using prolonged breath-holding when pushing may help stretch the tissue."
c. "Beginning at 36 weeks, a daily 10-minute perineal massage may help stretch the tissue."
d. "Using an open glottis technique when pushing can promote gradual perineal stretching."
e. "Delaying pushing until the urge is felt can gradually distend the soft tissues of the pelvic floor."
ANS: C, D, E
Daily perineal massage and stretching by the woman from 36 weeks until birth has been shown to reduce the risk for perineal trauma during birth. Pushing with an open glottis technique rather than prolonged breath-holding when pushing promotes gradual perineal stretching. Delaying pushing until the urge is felt gradually distends the soft tissues of the pelvic floor. An upright position while pushing promotes gradual stretching of the woman's perineum, not the lithotomy position.
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