During pushing, the fetal head is crowning. To prevent perineal lacerations, the nurse should:

• A. Stretch the perineal tissues with sterile gloved fingers
• B. Apply warm compresses to the perineum
• C. Perform an immediate episiotomy
• D. Use forceps to assist delivery

Answer: (A)

During crowning, the goal is to protect the perineum by guiding and yielding the tissues with the presenting part. Gentle, controlled stretching of the perineal tissues with sterile gloved fingers as the head crowns helps the tissues stretch progressively rather than tear abruptly, reducing the risk of perineal lacerations. This perineal support keeps delivery smooth and minimizes severe tearing.

Warm compresses can aid relaxation and comfort, but they don’t replace the protective effect of manual perineal stretching during crowning. An episiotomy isn’t routinely used to prevent tears and carries its own risks, so it isn’t a default preventive measure. Instrumental delivery with forceps is an intervention reserved for specific indications and should be performed by a clinician, not as a preventive measure during crowning.