Some physicians prefer not to repair perineal tears until some days after labor, contending that the congestion of the soft parts immediately after delivery is not favorable to a satisfactory union. When the repair is made subsequently, therefore, the nurse prepares as she would for any perineal operation, performed independently of labor. Repairs are not often postponed for more than a few days, since long delayed or neglected attention frequently gives rise to gynecological disorders, such as descensus or prolapse of the uterus. =Episiotomy.= Some obstetricians prefer to anticipate a perineal tear by making an oblique incision, usually on one or both sides, extending downward and outward from the margin of the vaginal outlet down into the perineum. This operation is termed episiotomy, and the incision is sutured after labor just as a tear would be. It is the belief of those who perform this operation that the clean-cut incision heals more satisfactorily than an irregular tear, and that by directing the incision to the side, away from the median line, the integrity of the rectal sphincter is preserved, even though the perineum tears beyond the end of the incision, when distended during the birth of the head. =Breech Extraction.= In some cases of breech presentation, particularly among primiparæ, it is necessary to assist nature in the delivery of the child in order to save its life. Complete anesthesia is usually necessary at such times and the patient is preferably on a table or at the edge of the bed in a lithotomy position. In the majority of cases, no effort is made toward assistance until the body is born as far as the umbilicus, partly because of the difficulty of taking hold of the child securely before that time, and partly because the perineum is not likely to be fully distended, in which case a serious tear would probably result. But after the body has been extruded as far as the umbilicus, it is usually considered imperative to complete the delivery within eight minutes to save the child from asphyxiation, due either to pressure on the cord between the head and pelvic brim, or to premature separation of the placenta. The baby’s feet or legs are grasped by a towel to prevent slipping, and downward traction is made on the body until the tips of the scapulæ appear at the outlet. During this procedure the nurse may be called upon to make pressure on the uterus with the idea of keeping the baby’s head flexed forward; preventing the arms from becoming extended upward above the head and also to help in expelling the child.