Breathing exercise,Labor pain,labor time,Labor pain management,Visual analogue scale,Randomized controlled trial," /> Breathing exercise,Labor pain,labor time,Labor pain management,Visual analogue scale,Randomized controlled trial,"/> Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: A randomized controlled trial
Search JIM Advanced Search

Journal of Integrative Medicine ›› 2017, Vol. 15 ›› Issue (6): 456-461.doi: 10.1016/S2095-4964(17)60368-6

• Research Article • Previous Articles     Next Articles

Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: A randomized controlled trial

Hilal Yuksela, Yasemin Cayira, Zahide Kosanb, Kenan Tastana   

  1. a Department of Family Medicine, Ataturk University Faculty of Medicine, Erzurum 25070, Turkey
    b Department of Public Health, Ataturk University Faculty of Medicine, Erzurum 25070, Turkey
  • Received:2017-04-28 Accepted:2017-06-27 Online:2017-11-15 Published:2017-11-15
  • Contact: Yasemin Cayir, MD, Associate Professor. E-mail:


 Some research exists on the effect of non-pharmacological approaches for labor pain relief. However, there is limited information about effectiveness of breathing exercises in pregnant women to reduce maternal pain during labor.


To determine whether breathing exercises for pregnant women during the second stage of labor have beneficial effects on maternal pain, duration of labor, and the first-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores.

Design, Setting, Participants and Interventions

This randomized clinical trial involved 250 pregnant women, who were randomly divided into two groups: intervention group (IG; n = 125) and control group (CG; n = 125). IG received one session breathing exercise training and performed breathing exercises during the second stage of labor versus the CG that did not receive any breathing exercise training.

Main Outcome Measures

The effects of breathing exercises on maternal pain were determined by Visual Analogue Scale (VAS), duration of the second stage of labor, and the first-minute APGAR scores.

Results: The mean age of the participants was (23.2 ± 4.2) (range: 18 to 42) years. Both IG and CG had similar baseline characteristics in terms of age, education level, occupation, and smoking (P > 0.05). The mean VAS scores of IG and CG were (88.2 ± 6.3) and (90.5 ± 7.0), respectively (P < 0.001). The duration of the second stage of labor was (369.6 ± 92.0) s for IG and (440.7 ± 142.5) s for CG (P < 0.001). The mean first-minute APGAR scores were (8.84 ± 0.50) for IG and (8.73 ± 0.89) for CG (P > 0.05).


Based on this study, breathing exercises with deep inhalation and exhalation in pregnant women are effective in reducing the perception of labor pain and shortening the duration of the second stage of delivery. Therefore, we recommend breathing exercises as an effective modality for labor pain management and shortening the duration of labor.

Trial Registration

This study is registered on the website of ( with the number of NCT03066973.

Key words: Breathing exercise, Labor pain, labor time, Labor pain management, Visual analogue scale, Randomized controlled trial

1 Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol.2011; 205(3): 262.e1- 262.e8.
2 Boaviagem A, Melo Junior E, Lubambo L, Sousa P, Aragão C, Albuquerque S, Lemos A.The effectiveness of breathing patterns to control maternal anxiety during the first period of labor: a randomized controlled clinical trial.Complement Ther Clin Pract. 2017; 26: 30-35.
3 Adams ED, Bianchi AL.A practical approach to labor support.J Obstet Gynecol Neonatal Nurs. 2008; 37(1): 106-115.
4 Stjernholm YV, Petersson K, Eneroth E.Changed indications for cesarean sections.Acta Obstet Gynecol Scand. 2010; 89(1): 49-53.
5 Akarsu RH, Mucuk S.Turkish women’s opinions about cesarean delivery.Pak J Med Sci. 2014; 30(6): 1308-1313.
6 Saleh AM, Dudenhausen JW, Ahmed B.Increased rates of cesarean sections and large families: a potentially dangerous combination.J Perinat Med. 2017; 45(5): 517-521.
7 Kuczkowski KM.Labor pain and its management with the combined spinal-epidural analgesia: what does an obstetrician need to know?Arch Gynecol Obstet. 2007; 275(3): 183-185.
8 Simkin P, Bolding A.Update on nonpharmacologic approaches to relieve labor pain and prevent suffering.J Midwifery Womens Health. 2004; 49(6): 489-504.
9 Smith CA, Collins CT, Crowther CA, Levett KM.Acupuncture or acupressure for pain management in labour. Cochrane Database Syst Rev.2011;(7): CD009232.
10 Miquelutti MA, Cecatti JG, Makuch MY.Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial.BMC Pregnancy Childbirth. 2013; 13: 154.
11 Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev.2012; (3): CD009234.
12 Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D, Stroup DF.Improving the quality of reporting of randomized controlled trials. The CONSORT statement.JAMA. 1996; 276(8): 637-639.
13 WMA declaration of Helsinki Serves as guide to physicians.Calif Med. 1966; 105(2): 149-150.
14 Ahmadi Z, Torkzahrani S, Roosta F, Shakeri N, Mhmoodi Z.Effect of breathing technique of blowing on the extent of damage to the perineum at the moment of delivery: a randomized clinical trial.Iran J Nurs Midwifery Res. 2017; 22(1): 62-66.
15 Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev.2015; (10): CD009124.
16 Simpson KR, James DC.Effects of immediate versus delayed pushing during second-stage labor on fetal wellbeing: a randomized clinical trial.Nurs Res. 2005; 54(3): 149-157.
17 Yildirim G, Sahin NH.The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women.Pain Res Manag. 2004; 9(4): 183-187.
18 Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. Hypnosis for pain management during labour and childbirth. Cochrane Database Syst Rev.2016; (5): CD009356.
19 Henry DE, Cheng YW, Shaffer BL, Kaimal AJ, Bianco K, Caughey AB.Perinatal outcomes in the setting of active phase arrest of labor.Obstet Gynecol. 2008; 112(5): 1109-1115.
20 Anarado A, Ali E, Nwonu E, Chinweuba A, Ogbolu Y.Knowledge and willingness of prenatal women in Enugu Southeastern Nigeria to use in labour non-pharmacological pain reliefs.Afr Health Sci. 2015; 15(2): 568-575.
21 Lothian JA.Lamaze breathing: what every pregnant woman needs to know.J Perinat Educ. 2011; 20(2): 118-120.
22 Bankowski JB, Hearne AE.John Hopkins gynecology and obstetric handbook. Ankara: Atlas Kitapçılık. 2005.
[1] Chiung-Hui Huang, Mei-Ling Yeh, Fang-Pey Chen, Daphne Wu. Low-level laser acupuncture reduces postoperative pain and morphine consumption in older patients with total knee arthroplasty: A randomized placebo-controlled trial. Journal of Integrative Medicine, 2022, 20(4): 321-328.
[2] Maryam Azimi, Hanieh Niayesh, Mahboobeh Raeiszadeh, Sedigheh Khodabandeh-shahraki. Efficacy of the herbal formula of Foeniculum vulgare and Rosa damascena on elderly patients with functional constipation: A double-blind randomized controlled tria. Journal of Integrative Medicine, 2022, 20(3): 230-236.
[3] Ubiratan Cardinalli Adler, Maristela Schiabel Adler, Ana Elisa Madureira Padula, Livia Mitchiguian Hotta, Amarilysde Toledo Cesar, José Nelson Martins Diniz, Helen de Freitas Santos, Edson Zangiacomi Martinez. Homeopathy for COVID-19 in primary care: A randomized, double-blind, placebo-controlled trial (COVID-Simile study). Journal of Integrative Medicine, 2022, 20(3): 221-229.
[4] Xin Wang, Wen-juan Song, Yi Ruan, Bing-chu Li, Can Lü, Nian Huang, Fan-fu Fang, Wei Gu. Core muscle functional strength training for reducing the risk of low-back pain in military recruits: An open-label randomized controlled trial. Journal of Integrative Medicine, 2022, 20(2): 145-152.
[5] Meng-zhu Zhao, Chen Zhao, Shuang-shuang Tu, Xu-xu Wei, Hong-cai Shang. Evaluating the methodology of studies conducted during the global COVID-19 pandemic: A systematic review of randomized controlled trials. Journal of Integrative Medicine, 2021, 19(4): 317-326.
[6] Si-chun Gu, Jie Zhou, Qing Ye, Can-xing Yuan. Pingchan granule for depressive symptoms in Parkinson’s disease: A randomized, double-blind, placebo-controlled trial. Journal of Integrative Medicine, 2021, 19(2): 120-128.
[7] Jie Wu, Shu-wei Duan, Hong-tao Yang, Yue-yi Deng, Wei Li, Ya-ni He, Zhao-hui Ni, Yong-li Zhan, Shan Lin, Zhi-yong Guo, Jun Zhu, Jing-ai Fang, Xu-sheng Liu, Li-hua Wang, Rong Wang, Nian-song Wang, Xiao-hong Cheng, Li-qun He, Ping Luo, Shi-ren Sun s, Ji-feng Sun, Ai-ping Yin, Geng-ru Jiang, Hong-yu Chen, Wen-hu Liu, Hong-li Lin, Meng Liang, Lu Ma, Ming Chen, Li-qun Song, Jian Chen, Qing Zhu, Chang-ying Xing, Yun Li, Ji-ning Gao, Rong-shan Li, Ying Li, Hao Zhang, Ying Lu, Qiao-ling Zhou, Jun-zhou Fu, Qiang He, Guang-yan Cai, Xiang-mei Chen. Efficacy and safety of Shenyankangfu Tablet, a Chinese patent medicine, for primary glomerulonephritis: A multicenter randomized controlled trial. Journal of Integrative Medicine, 2021, 19(2): 111-119.
[8] Xian Wang, Xuan Yin, Xiu-tian Guo, Yan Wang, Wen-qi Jin, Ai-jun Mao, Lixing Lao, Zhang-jin Zhang, Jie Zhang, Shi-fen Xu. Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: A randomized controlled trial. Journal of Integrative Medicine, 2020, 18(6): 492-498.
[9] Sherman Gu, Arthur Yin Fan. Controversial conclusions from two randomized controlled trials for acupuncture's effects on polycystic ovary syndrome or in vitro fertilization support. Journal of Integrative Medicine, 2020, 18(2): 89-91.
[10] Gerli E.G. Herr, Fábio Goulart da Silva, Francisco José Cidral-Filho, Fabricia Petronilho, Lucinéia Gainski Danielski, Mariana Pereira de Souza Goldim, Afonso Shiguemi Inoue Salgado, Franciane Bobinski, Daniel Fernandes Martins, Eliane R. Winkelmann. Effects of the use of bioceramic wraps in patients with lower limb venous ulcers: A randomized double-blind placebo-controlled trial. Journal of Integrative Medicine, 2020, 18(1): 27-.
[11] Xin-yu Yue, Zhuo-qi Feng, Xi-yi Yu, Jia-min Hu, Xiao-Jing He, Shi Shu. Fire-needle acupuncture for upper limb spastic paralysis after stroke: Study protocol for a randomized controlled trial. Journal of Integrative Medicine, 2019, 17(3): 167-172.
[12] Pádraic J.Dunne, Julie Lynch, Lucia Prihodova, Caoimhe O'Leary, Atiyeh Ghoreyshi, Sharee A. Basdeo, Donal J.Cox, Rachel Breen, Ali Sheikhi, Áine Carroll, Cathal Walsh, Geraldine McMahon, Barry White. Burnout in the emergency department: Randomized controlled trial of an attention-based training program. Journal of Integrative Medicine, 2019, 17(3): 173-180.
[13] Ya-ru Huangfu, Wei Peng, Bao-jun Guo, Zhi-fu Shen, Li Li, Shi-wei, Liu, Hui Zheng, You-ping Hu. Effects of acupuncture in treating insomnia due to spleen-stomach disharmony syndrome and its influence on intestinal microbiome: Study protocol for a randomized controlled trial. Journal of Integrative Medicine, 2019, 17(3): 161-167.
[14] J.M. Oliver-Baxter, H.S. Whitford, D.A. Turnbull, M.J. Bond. Effects of vitamin supplementation on inflammatory markers and psychological wellbeing among distressed women: A randomized controlled trial. Journal of Integrative Medicine, 2018, 16(5): 322-328.
[15] Parunkul Tungsukruthai, Preecha Nootim, Wiwan Worakunphanich, Nareerat Tabtong. Efficacy and safety of herbal steam bath in allergic rhinitis: A randomized controlled trial. Journal of Integrative Medicine, 2018, 16(1): 39-44.
Full text



[1] Fu-rong Du , Bin Zhang. Study on English translation for rhetoric devices in Neijing; intertextuality and synecdoche. Journal of Chinese Integrative Medicine, 2010, 8(12): 1207-1210
[2] Mei-jun Lü, Hui-yong Zhang, Zhe Zhang, Guan-lin Yang. Measurement of health-related quality of life in coronary heart disease: A review. Journal of Chinese Integrative Medicine, 2011, 9(12): 1277-1285
[3] Hua-fa Que, Han-jun Tang, Lin-yang Wang, Hong-yu Dai, Shi-yun Zhang, Hai-guang Qin, Xiao-dong Liu, Huan-yu Xiang, Zhen Zhang. Study on wound healing mechanism of replenishing qi and dissipating stagnation therapy for chronic skin ulcers. Journal of Chinese Integrative Medicine, 2005, 3(3): 243-246
[4] Wen-hui Ma, Xiao-hong Sun. Discussion of time and space differentiation of three-yin and three-yang in Shanghan Lun. Journal of Chinese Integrative Medicine, 2005, 3(4): 257-259
[5] Dong Yang, Shi Jian-rong. Biological research evaluating the Chinese medical theory of the association of the kidney with the ears. Journal of Chinese Integrative Medicine, 2012, 10(2): 128-134
[6] Xiao-hui Sun, Sheng Liu . External Chinese medical therapy for pain associated with hyperplastic disease of the breast: Study protocol of a randomized, double-blind, multicenter, controlled trial. Journal of Chinese Integrative Medicine, 2012, 10(4): 384-389
[7] Hai-bo Yu, Cheng-en Pan, Wu-jun Wu, Si-hai Zhao, Hui-feng Zhang. Effects of resveratrol on matrix metalloproteinase-9 expression in hepatoma cells. Journal of Chinese Integrative Medicine, 2008, 6(3): 270-273
[8] Xiao-long Wei, Rui Feng, Zhi-qing Zhao, Zai-ping Jing. Efficacy of Chinese herbal medicine Mailuo Shutong Granule and Hirudoid cream for chronic venous disorder-induced pigmentation in lower extremities: A prospective, randomized controlled trial. Journal of Chinese Integrative Medicine, 2011, 9(8): 866-870
[9] Hui Han , Li-min Wu , Ming-xiang Han, Wen-ming Yang , Dao-jun Xie , Zhao-hui Fang , Dan-chen Chu , Fang Fang . Effects of Chinese herbal medicine Shenxiong Yujing Granule on regeneration of neural cells in rats with diabetes-associated cerebral ischemia. Journal of Chinese Integrative Medicine, 2012, 10(10): 1140-1148
[10] ZG Li. Comparative study on WHO Western Pacific Region and World Federation of Chinese Medicine Societies international standard terminologies on traditional medicine: An analysis of the Causes of Diseases (Part 2). Journal of Chinese Integrative Medicine, 2009, 7(4): 383-388