The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous client 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. Semi-sitting or lithotomy position increases the likelihood of perineal lacerations.
2. Short pushes during the expulsion of the head decrease the likelihood of perineal lacerations.
3. Perineal massage has been shown to decrease the need for episiotomy in primiparous clients.
4. Pulling back on the legs while pushing tightens the perineal tissue, which in turn increases the likelihood of perineal lacerations.

Nursing

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