A patient is more likely to require an episiotomy if she is?

The correct answer reflects a common practice in obstetric care regarding the second stage of labor. When a patient is asked to stop pushing, it can lead to increased pressure in the birth canal, particularly as the baby continues to descend. This increased pressure and potential for rapid delivery can make it more likely that an episiotomy may be necessary to facilitate a controlled delivery and prevent severe perineal tearing.

While the other choices center around certain labor management techniques, they don't inherently increase the likelihood of requiring an episiotomy as directly. For example, laboring in a lateral side-lying position can actually be beneficial for fetal positioning and may minimize perineal trauma. Advising a patient to push harder can lead to increased distress for both mother and baby if not balanced properly, but it does not directly contribute to the need for an episiotomy. Directing a patient to breathe through contractions may help in managing pain and reducing strain on the perineum, thereby also not correlating with a higher episiotomy rate.

Therefore, the context involving the management of pushing during the second stage of labor gives insight into why the need for an episiotomy might arise when the patient is instructed to stop pushing.