Answer: D - Directed pushing increases the risk that a mother will need an assisted delivery. If she is holding her breath it may look as if the fetus is in distress due to changes in heart rate, so intervention to deliver the baby quickly may be needed, which might include instrumental delivery. The use of positions that work with gravity, such as squatting, standing, and kneeling, aid in fetal descent as well as in stretching the perineum. If one position is not working or is causing increased pain, the mother should be encouraged to change positions. Exhale pushing keeps the mother, uterus, and baby well-oxygenated and works with the body's natural urges to deliver the baby. Supporting the perineum as it stretches provides a physical restraint to prevent tearing, and helps ease the baby's head past the tissues, alleviating the need for an episiotomy.
