The greatest danger to the perineum comes from a too rapid advance of the head; hence, the nurse retards the delivery by putting the woman on her side where she can not bear down so successfully, and instructs her to cry out with her pains. She may also delay the labor by holding the head back with a clean pad until the vulva stretches to its fullest capacity. The rules which the doctor follows in protecting the perineum as the head advances, may be thus summarized. 1. Deliver the patient on her side. 2. Maintain flexion of head. 3. Delay extension of the head. 4. Give chloroform to retard delivery and to prevent precipitate delivery. 5. Deliver between pains, if possible, by Ritgen’s maneuver (modified). 6. Do episiotomy, if necessary. =Perineorrhaphy.=—Lacerations of the perineum occur in about 30 per cent of all primiparas and in from 10 to 15 per cent of multiparas. They occur when the child is large or too rapidly delivered, and when the orifice is small or the tissues inelastic. For convenience, the lacerations of the perineum are divided for description into three degrees. The _first degree_ involves only the fourchette and a small portion of the mucosa. It is rarely more than one-half an inch in depth and requires no attention except cleanliness by the nurse. The _second degree_ may tear a variable distance into the perineal body, sometimes so deeply as to expose the sphincter ani. It is usually on one side, but may appear on both sides, and be accompanied by prolongations into the vagina. The _third degree_ passes through the sphincter and sometimes well up the rectal wall. This is also called a complete tear. The lacerations of the perineum which require sutures should be attended to _at once_ unless the patient’s condition is critical. In such cases the repair may wait from twelve to twenty-four hours. For this operation the nurse will assemble and boil for fifteen minutes: 2 pairs of scissors. 2 tissue forceps, one with teeth and one without. 1 bull-dog forceps. 3 artery forceps. 6 needles, 3 full and 3 half-curved. 1 dressing forceps. 1 needle holder. Suture material of catgut and silkworm gut should be ready in sterile containers. The catgut should be the twenty-day chromicized, No. 3 and 4. Even then the strands are quickly absorbed when the lochial secretions flow over them. Silkworm gut is better, but hard to remove from the vagina; hence it is customary to use catgut inside the vagina and silkworm gut for the sutures outside.