Which of the following collections of risk factors would most likely result in damaging lacerations (including episiotomies)?

Question

1. A dark-skinned woman, who has had more than one pregnancy, going through prolonged second stage labor, attended by a midwife
2. A reddish haired mother of two, going through a breech birth
3. A dark-skinned first-time mother, going through a long labor
4. A first-time mother with reddish hair whose rapid labor was overseen by an ob-stetrician

Answer 1

4
1, 2, 3. Incorrect. Reddish haired women have tissue that is less distensible than darker-skinned women and so 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.
4. Correct. Reddish haired women have tissue that is less distensible than darker-skinned wom-en and so 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.