IRCT2014092819310N1 IRCT 2014-10-18 Vice Chancellor for research of Shahid Beheshti University of Medical Sciences Effect of pushing with breathing techniques on perineal statue and delivery outcome in nulliparous in Kamali hospital in Karaj Effect of pushing with breathing techniques on perineal statue and delivery outcome in nulliparous in Kamali hospital in Karaj 2014-09-19 anticipated 166 Complete https://irct.ir/trial/17295 interventional Randomization: Randomized, Blinding: Not blinded, Placebo: Not used, Assignment: Parallel, Purpose: Prevention. N/A delivery. Intervention 1: The intervention group used breathing techniques from completing dilatation until fetus exit this means that with every contraction every muscle in their body starting to relax, by breathing deeply through the nose and blowing abdomen simultaneously .then while the abdominal muscles are contracted, they carry out a deep breath through half open mouth or through nose .after that they take a deep breath again and expiration with all strength over half-open mouth during 5-4 seconds and then after re breathing ,the next force will be started until the contraction ends. At the end of the contraction, two deep abdominal breathing was done (with an open glottis). This trend continued until the head of neonate is going to exit. At this time people took a deep breath and start to blow for 3-2 seconds . Intervention 2: In control subjects using Valsalva maneuver for pushing in the second stage. This means that initially took a deep breath and hold it for 10 seconds and proceed with straining to have a closed glottis.