title: Effect of Breathing Technique of Blowing on the Extent of Damage to the Perineum at the Moment of Delivery: A Randomized Clinical Trial.
abstract: BACKGROUND
  One of the important tasks in managing labor is the protection of perineum. An important variable affecting this outcome is maternal pushing during the second stage of labor. This study was done to investigate the effect of breathing technique on perineal damage extention in laboring Iranian women.
  
  
  METHODS
  This randomized clinical trial was performed on 166 nulliparous pregnant women who had reached full-term pregnancy, had low risk pregnancy, and were candidates for vaginal delivery in two following groups: using breathing techniques (case group) and valsalva maneuver (control group). In the control group, pushing was done with holding the breath. In the case group, the women were asked to take 2 deep abdominal breaths at the onset of pain, then take another deep breath, and push 4-5 seconds with the open mouth while controlling exhalation. From the crowning stage onward, the women were directed to control their pushing, and do the blowing technique.
  
  
  RESULTS
  According to the results, intact perineum was more observed in the case group (P= 0.002). Posterior tears (Grade 1, 2, and 3) was considerably higher in the control group (P= 0.003). Anterior tears (labias) and episiotomy were not significantly different in the two groups.
  
  
  CONCLUSIONS
  It was concluded that breathing technique of blowing can be a good alternative to Valsalva maneuver in order to reduce perineal damage in laboring women.
authors.affiliation: Student of Midwifery in Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Zohre
authors.initials: Z
authors.lastname: Ahmadi
authors.affiliation: School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Torkzahrani
authors.affiliation: Senior Lecturer Preparation for Child Birth, Director of Midwifery Services Center Member of the National Committee to Improve Maternal Health, Tehran, Iran.
authors.forename: Firouze
authors.initials: F
authors.lastname: Roosta
authors.affiliation: Department of Biostatistics, Faculty of Paramedical Sciences Shahid Behesht University of Medical Sciences, Tehran, Iran.
authors.forename: Nezhat
authors.initials: N
authors.lastname: Shakeri
authors.affiliation: Assistant Research Professor of Social Determinant of Health Research Center of Alborz University of Medical Sciences, Karaj, Iran.
authors.forename: Zohre
authors.initials: Z
authors.lastname: Mhmoodi
keywords: Breathing technique of blowing; delivery; laboring women; pelvic floor muscle; perineal lacerations