Complementary Therapies in Clinical Practice 29 (2017) 213e219

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Complementary Therapies in Clinical Practice

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The effects of breathing techniques training on the duration of labor

and anxiety levels of pregnant women
Sevil Cicek, Fatma Basar*
Dumlupınar University, Kutahya School of Health, Department of Obstetrics and Gynecology Nursing, Kutahya, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To assess the effects of breathing techniques training on anxiety levels of pregnant women and
Received 11 September 2017 the duration of labor.
Received in revised form Materials and methods: The study utilizes a randomized controlled trial design. The pregnant women
13 October 2017
were divided into control (n ¼ 35) or experimental group (n ¼ 35) randomly. The experimental group
Accepted 16 October 2017
received breathing techniques training in the latent phase and these techniques were applied in the
following phases accordingly. The anxiety levels of pregnant women were evaluated three times in total.
Keywords:
The duration of labor was considered as the duration of the first stage of labor and the duration of the
Anxiety
Duration of labor
second stage of labor.
Breathing techniques Results: There were significant differences between the two groups regarding the mean State Anxiety
Inventory (SAI) and the mean duration of labor.
Conclusions: This study concludes that breathing techniques are an effective method in the reduction of
anxiety and influence the duration of delivery during labor.
© 2017 Elsevier Ltd. All rights reserved.

1. Introduction
Labor is a natural process that is often thought of as one of the
more painful events in human experience [1,2]. Women experience
stress, fear and anxiety during childbirth. Anxiety levels of preg-
nant women increase during labor and make it difficult to relax
[3,4]. Anxiety can cause tension in pelvic floor muscles, which play
key role in labor, and this muscle tension increases pain [5,6].
During delivery, excessive pain leads to increased fear, making a
woman more sensitive to pain. The concept of the fear-tension-pain
cycle arises [7,8]. Breaking this cycle is essential for having a posi-
tive labor and delivery experience [5]. In addition, anxiety causes
the release of stress hormones, which lead cortisol to release into
the general circulation. A high cortisol level causes a decrease in
uterine artery blood flow, which makes contractions to stop or slow
[9]. The decline in the efficiency of uterine contractions will
lengthen the duration of labor. A long labor may increase compli-
cations for the baby and mother [10].
There are many pharmacological and non-pharmacological ap-
proaches to decrease pain and anxiety both in antenatal period and
in the delivery process [11,12]. Non-pharmacological approaches
* Corresponding author.
E-mail addresses: sevil.cicek@dpu.edu.tr (S. Cicek), fatma.basar@dpu.edu.tr
(F. Basar).
are helpful to decrease the demand of medicines and to break the
anxiety-pain-fear cycle [13]. Breathing techniques are one of these
methods. Breathing techniques help the mother concentrate and
focus on breathing instead of her contractions during the labor,
provide an active participation in the birth, and develop internal
awareness of her body [6,10]. In addition, breathing helps to cope
with uterine contractions and to decrease anxiety [14,15]. In some
previous studies, breathing techniques were found to lead signifi-
cant declines in state anxiety, continuous anxiety and perceived
pain levels [16e22]. It is observed that during labor and delivery,
utilizing breathing techniques can help women to focus on other
things and to reduce their anxiety levels [2,3,7,22e25]. Moreover,
previous studies suggest that these techniques are effective in
shortening the duration of labor [10,26e28].
Breathing techniques are considered as the most effective, most
commonly known and most expected methods to be used in the
future [13,29]. These techniques can be taught either in the ante-
natal period or in the latent phase of labor [30]. In this regard, it is
important to provide instructions on breathing techniques to raise
awareness for midwives/nurses who work in delivery services and
to encourage them to teaching these techniques to pregnant
women [11,16]. Therefore, this research is conducted to assess the
effects of breathing techniques training on anxiety levels of preg-
nant women and the duration of labor.

https://doi.org/10.1016/j.ctcp.2017.10.006
1744-3881/© 2017 Elsevier Ltd. All rights reserved.
214 S. Cicek, F. Basar / Complementary Therapies in Clinical Practice 29 (2017) 213e219
2. Materials and methods
2.1. Design
The study utilizes a randomized controlled trial design.
2.2. Setting and participants
The study was conducted in the delivery room of Dumlupınar
University Kütahya Evliya Celebi Training and Research Hospital.
Sample acceptance criteria were: nulliparous women 18-35 years
of age who were 38e42 weeks pregnant with a single healthy fetus
in vertex position, expected to have spontaneous vaginal delivery,
without any pregnancy complications and in the early latent phase
of labor (0-1 cm).
2.3. Sampling and randomization
The study population consisted of 263 nulliparous women who
had applied for hospital delivery service a year prior to giving birth
to their first child, who had vaginal deliveries and who did not have
any communication problems. In this research, the sample size was
subdivided into two medium-sized independent groups. A t-test
was applied, obtaining a rate of 80% in the power test and an alpha
value of 0.05 with a 95% confidence level, which was calculated
using estimation G-Power Software version 3.0.10. Pregnant
women were randomly selected via a coin toss, and they were
assigned to either the experimental or control group. The pregnant
women were assigned alternately on one day to the experimental
group and on the other to the control group. Attention was paid for
the pregnant women who were taken into the practice at the same
time to be monitored in different rooms. Thus, 70 pregnant women,
35 for experimental group and 35 for control group, participated in
this study between March 2016 and November 2016.
2.4. Study subjects
2.4.1. Research hypotheses
H1. Breathing techniques training for labor decreases the anxiety
level of mothers.
H2. Breathing techniques training for labor reduces the duration
of labor.
2.5. Data collection tools
2.5.1. Personal information form
The personal information form includes questions regarding
socio-demographic and obstetric characteristics of pregnant
women such as age, education level, employment status, marital
status, gestational week and attendance to prenatal training cour-
ses, etc.
2.5.2. Labor observation form
The labor observation form was designed by researchers as a
result of a literature review to observe the duration of labor. It
consists of questions regarding the starting time of labor induction,
the duration of the labor, and the time of birth. A digital clock was
used for the duration of the births.
2.5.3. State Anxiety Inventory (SAI)
The State Anxiety Inventory (SAI) was used to measure anxiety
levels of pregnant women during labor. The scale was developed by
Spielberger et al., and translated into Turkish by Oner € and Le
Compte who also evaluated its reliability and validity between 1974
and 1977. SAI consists of 20 items that ask how a person feels now,
and reflects situational factors that may influence anxiety levels.
Responses are rated on a 4-point Likert scale and range from 1 (the
lowest-not at all) to 4 (the highest-severely). Scores range from a
minimum of 20 to a maximum of 80. The following guidelines are
used to interpret scores: 0-19: normal or no anxiety, 20-39: slight
anxiety, 40-59: moderate anxiety, 60-79: severe anxiety, 80: very
severe anxiety (panic) [31]. Test-retest reliability coefficients have
ranged from 0.94 to 0.96. In this study, SAI's Cronbach's alpha value
was calculated as 0.904 in the early latent phase (0-1 cm), 0.899 in
the late latent phase (4 cm) and 0.916 in the late active phase of
labor (8 cm) (>0.70).
2.6. Data collection method
Pregnant women were observed in the hospital until the de-
livery was completed. Face-to-face interviews were used for data
collection. Physicians, particularly midwives in the delivery service,
regularly evaluated cervical dilations of women from the beginning
of this study.
The mean anxiety scores of the pregnant women were calcu-
lated three times by SAI. The first evaluation was done when the
pregnant women arrived at the delivery service, in the early latent
phase (0-1 cm), prior to breathing techniques training for labor.
After breathing techniques were taught to participants, the second
evaluation was conducted in the late latent phase (4 cm), and a
third evaluation was conducted in the late active phase (8 cm). The
duration of the first stage (latent, active and transition phases) and
second stage of the labor was evaluated through the labor obser-
vation form.
2.7. Intervention
Lamaze breathing techniques were taught to pregnant women in
the experimental group and different kinds of breathing were
practiced with the pregnant woman for each labor phase. The
researcher has the instructor certification for breathing techniques.
The four stages of breathing in the Lamaze breathing model were
taught. In the first stage (normal, baseline breathing), you slowly
inhale through your nose and exhale through your mouth. Your
abdomen will remain fairly still, but you will feel your chest wall
move outward. In the second stage (slow-deep chest breathing), you
inhale through your nose to a count of 5 s and exhale through your
mouth with the same slow way in 5 s. The third stage (rapid-shallow
chest breathing) is called noisy breathing. Breathe without using
your abdominal muscles with your upper lungs. This breathing
pattern includes the cleansing breath and the rhythmic hee-hee-hoo
voices. Let the intensity of your contractions guide you in deciding if
and when to use light breathing. Accelerate and lighten your
breathing as the contraction increases in intensity. Breathe in and
out rapidly through your mouth. In the fourth stage (blowing-
abdominal breathing), breathe in and out through your mouth. This
is similar to rapid-shallow chest breathing; however, when you blow
out, imagine you're trying to almost blow a candle out. Blowing
should be rapid and shallow [32]. Lamaze breathing training was
given in four stages. The training lasted approximately 30 min.
However, this duration varied by the repetition of the training given.
There was no other intervention apart from daily hospital routine
checks to pregnant women in the control group. The pregnant
women in the experimental and control groups had no prior
knowledge about the breathing techniques and had not received any
training related to it. All the pregnant women who participated in
the study did not participate in the birth preparation training.
 S. Cicek, F. Basar / Complementary Therapies in Clinical Practice 29 (2017) 213e219 215

In the early latent phase (0-1 cm), personal information forms
and labor observation forms were filled and SAI was applied to the
pregnant women in the experimental and control groups.
Following that, in the latent phase, the first, second, third and
fourth levels of Lamaze breathing techniques were instructed to the
pregnant women in experimental group (n ¼ 35). After the in-
struction, the first and second levels of Lamaze were practiced
together with the pregnant women within the latent phase. In the
late latent phase (4 cm), SAI was re-applied to the pregnant women
in both groups, and the duration of the latent phase was recorded in
the labor observation form.
In the active phase, the third level of Lamaze was practiced
together with the pregnant women. In the late active phase (8 cm),
SAI was re-applied to the pregnant women in both groups, and the
duration of the active phase was recorded in the labor observation
form.
In the transition phase, the fourth level of the breathing tech-
niques was practiced with the pregnant women. Durations of the
transition phase were recorded in the labor observation forms for
the pregnant women in both groups. In addition, pregnant women
who were put on obstetric table after their cervical cerclage and
dilation completed, were supported for pushing. The duration of
the second stage of labor was recorded in the labor observation
form for the pregnant women in both groups. There were no other
interventions apart from daily hospital routine checks to the
pregnant women in the control group (n ¼ 35) (Fig. 1). During data
collection, there was no change in the daily running process of the
clinic, therefore all pregnant women were able to take their daily
routine cares and treatments. Of the experimental group, 14 preg-
nant women and 7 pregnant women in the control group gave birth
by cesarean section, and 1 pregnant woman from the control group
had a vacuum-assisted vaginal birth due to fetal distress and non-
progressive labor. In total, 22 pregnant women were excluded
from the research.
2.8. Data analysis
The data were analyzed using SPSS 20.0 software. Socio-

Pregnant women were randomly assigned to either the control or the experimental group.
Personal Information Form and Labor Observation Forms were filled.
Anxiety was assessed using SAI

Experimental Group (n=49) Control Group (n=43)

Latent Phase (0-4 cm) Latent Phase (0-4 cm)
st nd rd th
Breathing techniques training on the 1 , 2 , 3 , and 4 level. No special intervention.
st nd
Practicing the 1 - and 2 -level breathing techniques. Evaluation of anxiety levels and the duration of labor.

Evaluation of anxiety levels and the duration of labor. 5 pregnant women gave birth by cesarean section.

7 pregnant women gave birth by cesarean section.

Experimental Group (n=42) Control Group (n=38)

Active Phase (4-8 cm) Active Phase (4-8 cm)

Practicing the 3rd-level breathing techniques. No special intervention.

Evaluation of anxiety levels and the duration of labor. Evaluation of anxiety levels and the duration of labor.

7 pregnant women gave birth by cesarean section. 2 pregnant women gave birth by cesarean section.

Experimental Group (n=35) Control Group (n=36)

Transition Phase (8-10 cm) Transition Phase (8-10 cm)
th
Practicing the 4 -level breathing techniques. No special intervention.
Supporting the pregnant women to push the baby. Evaluation of anxiety levels and the duration of labor.
Evaluation of anxiety levels and the duration of labor. 1 pregnant women had a vacuum assisted vaginal

Experimental Group (n=35) Control Group (n=35)

Second stage of labor Second stage of labor
Evaluation of the duration of labor. Evaluation of the duration of labor.

Statistical analyses

Study Plan
Fig. 1. Study plan.
216 S. Cicek, F. Basar / Complementary Therapies in Clinical Practice 29 (2017) 213e219

demographic and pregnancy characteristics of the pregnant Table 1

women both in the experimental and control groups were Sociodemographic and obstetric history characteristics of the pregnant women.

compared by Chi square (X2) and fisher exact tests. A paired t-test Characteristics EG(n ¼ 35) CG(n ¼ 35) X2/t p
(t) was used to compare the mean SAI scores, the duration of latent, n % n %
active and transition phases and second stage of the labor. Results
Age (year)
were considered statistically significant at p < 0.05 and p < 0.001.
Mean ± SD 23.28 ± 4.1 22.40 ± 4.61 t ¼ 0.84 0.400
Education level
2.9. Ethical considerations Primary school graduate 4 11.4 6 17.1 1.91 0.590
Secondary school graduate 18 51.4 13 37.2
High school graduate 11 31.4 12 34.2
The purpose of the study was explained to each pregnant
College or higher education 2 5.8 4 11.5
woman and their consent was obtained. The research ethics com- graduates
mittee approval, dated 08.02.2016 and numbered 2015-KAEK-86/ Employment status
02-21, was obtained from Dumlupınar University Ethics Committee Employed 4 11.4 2 5.7 0.72 0.673
in Clinical Research, and the research permit dated on 07.03.2016 Not employed 31 88.6 33 94.3
Marital status
and numbered 38627517/605.99 was issued by the General Secre- Married 34 97.1 33 94.3 0.34 0.500
tary of the Turkish Public Hospitals Agency of Kütahya Province Single 1 2.9 2 5.7
under the Ministry of Health. Gestational week
Mean ± SD 39.17 ± 1.07 39.25 ± 1.09 t ¼ 0.33 0.741
Pregnancy intention
3. Results
Yes 30 85.7 33 94.3 1.42 0.428
No 5 14.3 2 5.7
During data collection, 92 pregnant women were randomly Attending a birth preparation class
assigned to the experimental and control groups. 22 pregnant Yes e e e e *
No 35 100 35 100
women were excluded from the research. The research was con-
ducted with 35 pregnant women in the experimental group and 35 *The number of participants was not enough to conduct statistical analysis.
women in the control group (Fig. 2). Both groups are similar in
terms of their socio-demographic and obstetric characteristics
(p > 0.05) (Table 1). housewives and 97.1% were married. 37.2% of the subjects in the
The mean age of the pregnant women was 22.80 ± 4.23 (EG: control group were secondary school graduates, 94.3% were
23.28 ± 4.11, CG: 22.40 ± 4.61). 51.4% of the subjects in the exper- housewives and 94.3% were married. The mean gestational week of
imental group were secondary school graduates, 88.6% were the pregnant women was 39. In addition, 85.7% of the subjects in

Enrollment Assessed for eligibility (n=92)

Excluded (n=0)
Not meeting inclusion criteria (n=0)
Declined to participate (n=0)
Other reasons (n=0)

Randomized (n=92)

Allocation

Allocated to experimental group (n=49) Allocated to control group (n=43)

Follow-Up

Lost to follow-up (n=14) Lost to follow-up (give reasons) (n=8)

Gave birth by cesarean section. Gave birth by cesarean section (n=7) and
vacuum assisted vaginal birth(n=1)

Analysis

Analysed (n=35) Analysed (n=35)

Fig. 2. Consort flowchart.

 S. Cicek, F. Basar / Complementary Therapies in Clinical Practice 29 (2017) 213e219
the experimental group, and 94.3% of the subjects in the control
group, described their pregnancy as ‘desired’. None of the subjects
from either group attended a prenatal training program (Table 1).
The mean SAI score in the early latent phase (0-1 cm) is
37.48 ± 3.12 in the experimental group, whereas it is 37.25 ± 4.53 in
the control group. There is no statistical difference between the
mean SAI scores in the early latent phases of both groups (t ¼ 0.24,
p > 0.05). The mean SAI score in the late latent phase (4 cm) in the
experimental group (38.00 ± 3.71) is lower than the mean SAI score
of control group (38.22 ± 2.85). However, there is no statistical
difference between the mean SAI scores in late latent phases of both
groups (t ¼ -0.28, p > 0.05). The mean SAI score in the late active
phase (8 cm) in the experimental group (38.88 ± 3.13) is lower than
the mean SAI score of control group (43.20 ± 3.31). The t-test depicts
a statistically significant difference in the mean SAI scores in the late
active phases among both groups (t ¼ -5.59, p < 0.001) (Table 2).
The mean duration of the first stage of labor in the experimental
group (679.85 ± 191.63 min) is shorter than in the control group
(1043.14 ± 262.13 min). There is a statistically significant difference
in the mean duration of the first stage of labor among both groups
(t ¼ -7.08, p < 0.001). When the mean duration of the first stage of
labor is compared according to phases, the mean duration of the
latent phase in the experimental group (403.71 ± 99.92 min) is
shorter than in the control group (658.71 ± 171.69 min). There is a
statistically significant difference in the mean duration of the latent
phase among both groups (t ¼ -8.11, p < 0.001). The mean duration
of the active phase in the experimental group (174.00 ± 69.90 min)
is shorter than in the control group (264.57 ± 164.74 min). There is
a statistically significant difference in the mean duration of the
active phase among both groups (t ¼ -2.86, p < 0.05). The mean
duration of the transition phase in the experimental group
(110.71 ± 79.62 min) is higher than in the control group
(101.42 ± 108.61 min). There is no statistical difference between the
mean duration of transition phases among both groups (t ¼ 1.10,
p > 0.05). The mean duration of the second stage of labor in the
experimental group (19.11 ± 12.49 min) is shorter than in the
control group (24.48 ± 16.32 min). However, there is no statistical
difference between the mean duration of the second stage of labor
among both groups (t ¼ -1.51, p > 0.05) (Table 3).
4. Discussion
Before the intervention, there is no statistical difference in the
early latent phase (0-1 cm) between the mean SAI scores among
Table 2
The mean SAI scores of pregnant women.
Labor phases EG (n ¼ 35) CG (n ¼ 35) t p
X±SD
X±SD
Early latent phase (0-1 cm) 37.48 ± 3.12 37.25 ± 4.53 0.24
Late latent phase (4 cm) 38.00 ± 3.71 38.22 ± 2.85 0.28
Late active phase (8 cm) 38.88 ± 3.13 43.20 ± 3.31 5.59
*Significant.
Table 3
The mean duration of labor/minutes.
Labor phases EG (n ¼ 35)
X±SD
First stage of labor (0-10 cm) 679.85 ± 191.63
Latent phase (0-4 cm) 403.71 ± 99.92
Active phase (4-8 cm) 174.00 ± 69.90
Transition phase (8-10 cm) 110.71 ± 79.62
Second stage of labor 19.11 ± 12.49
*Significant.
217
both groups (p > 0.05) (Table 2). This may be because the pregnant
women had just begun delivery and had not received any labor
training yet. Therefore, this is an expected result. Bastani et al. [16]
conducted a study to investigate the effect of applied relaxation
training, including breathing techniques, on reducing anxiety and
perceived stress among pregnant women in which both groups
were similar in terms of the mean SAI scores before the interven-
tion. It is observed that the mean anxiety scores of the pregnant
women in both groups increase during the labor process; however,
the increase in control group is higher than experimental group
(Table 2).
After the intervention, although the mean SAI score in the late
latent phase (4 cm) is lower in experimental group, there is no
statistical significant difference among both groups (p > 0.05)
(Table 2). This result suggests that the pregnant women have not
adopted breathing techniques training yet.
After the intervention, the mean SAI score in the late active
phase (8 cm) is significantly lower in the subjects in the experi-
mental group (p < 0.001) (Table 2). This difference may be due to
the increase in their adaptation to training and confidence in the
trainer. As cited in Smith et al. [33], Almeida et al. (2005) conducted
a study to determine the effects of breathing and relaxation tech-
niques on pain and anxiety during labor. They found that in the
active phase, anxiety levels of pregnant women in the experimental
group was lower than pregnant women in the control group. It was
emphasized that relaxation and breathing techniques are helpful to
experience lower anxiety levels during the labor process. In India, a
research study was conducted in 2015 to assess the effect of rapid
breathing on pain perception and anxiety levels during the first
stage of the labor. They stated that state anxiety levels of the
pregnant women in experimental group e who received breathing
techniques training e were significantly lower in the first evalua-
tion after 2 h of intervention and in the second evaluation after 4 h
of intervention [11]. The results of these studies are similar to our
findings.
There was no significant difference between the mean SAI
scores among both groups at the beginning of our study; how-
ever, a statistically significant difference was found among these
groups after the breathing training techniques were given to the
pregnant women in the experimental group, which indicated the
effectiveness of the training. Therefore, the H1 hypothesis of
“breathing techniques training for labor decreases the anxiety
level of mothers” was accepted within the limitations of this
study.
The duration of labor is shorter in the group that received
breathing techniques training (Table 3). The mean duration of the
first stage of the pregnant women in the experimental group is
significantly shorter than that of the pregnant women in the
control group (p < 0.001) (Table 3). Ciobanu et al. [3] conducted a
study to determine the role of directed or passive relaxation and
0.807 breathing exercises received in the third trimester, which sug-
0.773
<0.001*
gested that pregnant women who received training had a labor
duration (5 h 57 min) that was significantly lower than the control
CG (n ¼ 35) t p
X±SD
1043.14 ± 262.13 7.08 <0.001*
658.71 ± 171.69 8.11 <0.001*
264.57 ± 164.74 2.86 0.005*
101.42 ± 108.61 1.10 0.275
24.48 ± 16.32 1.51 0.135
218 S. Cicek, F. Basar / Complementary Therapies in Clinical Practice 29 (2017) 213e219
group which did not receive any training (8 h 55 min). Kaur et al.
[28] study to assess the effect of video on breathing exercises
during labor and duration of labor among the primiparous women
in which the experimental group of participants was shown a
video on ‘breathing exercises during labor’ before the onset of
labor. This study emphasized that a statistically significant dif-
ference was observed in the duration of the first stage of labor
with the mean duration (8 h 48 min) in the experimental group as
compared to the control group (9 h 48 min). The results of these
studies show similarities with our findings. In Canada, in a study
to assess the effectiveness of breathing techniques in the latent
phase of labor, the duration of labor (from regular contractions to
dilation) was 352 min for the subjects who did practice breathing
techniques, whereas it was 528.5 min for the subjects who did not
practice breathing techniques. Although the difference was more
than 2 h, it was stated that the difference was not statistically
significant [34].
When the mean durations of the phases of the first stage of
labor were compared, the mean durations of the latent and active
phases of pregnant women in the experimental group were
significantly shorter than in the control group (p < 0.001, p < 0.05).
However, there is no statistical significance in the mean duration
of the transition phase among both groups (p > 0.05) (Table 3). In
Iraq, in a study to assess the effect of breathing techniques applied
in the first stage of the labor in primiparous women, it was
found that the mean total of latent and active phases of the
group of subjects who did not practice breathing techniques
(4.185 ± 2.985 h) were longer than the group of subjects who
practiced breathing techniques (3.614 ± 2.334 h), but the differ-
ence was not statistically significant [35].
The mean duration of the second stage of labor in the study
group was shorter, but there was no significant difference in scores
between the experimental group and the control group (p > 0.05)
(Table 3). Ciobanu et al. [3] conducted a study to determine the role
of directed or passive relaxation and breathing exercises received in
the third trimester. The results showed that the duration of labor
was significantly reduced in women who practiced relaxation and
breathing exercises, as pregnant women from the experimental
group had a delivery duration (21 min) significantly shorter than
pregnant women from control group (who had 39 min of delivery
duration). Fahami et al. [27] discussed the effect of Lamaze practices
on the outcome of pregnancy and labor for women 24-26 weeks
into their pregnancy. Their findings showed that Lamaze practices
can decrease the duration of second stage of delivery. Kaur et al.
[28] conducted a study to assess the effect of video on breathing
exercises during labor and duration of labor among the primipa-
rous women, and they found that the mean duration of second
stage of labor was also significantly less (24 min) in experimental
group as compared to the control group (32 min). The results of
these studies are similar to ours.
It is found that the mean durations of that latent phase and
active phase of labor of pregnant women who received breathing
techniques training is significantly shorter than the pregnant
women in control group. Therefore, the H2 hypothesis of “breath-
ing techniques training for labor reduces the duration of labor” was
accepted within the limitations of the coverage.
5. Conclusions and implications for clinical practice
This study concludes that the breathing techniques are an
effective method in reducing both anxiety level and the duration of
labor. Therefore, it is suggested that healthcare professionals
working in delivery services be informed about these techniques
and promote these techniques with pregnant women.
6. Limitations
There are two limitations to the study. First, the research is
limited to nulliparous women, therefore, these results can only be
generalized for this sampling group. As such, studies should be
extended to include more participants and longer time periods.
Second, to speed up labor, the hormone oxytocin is used for the
induction of labor for almost every pregnant woman in the hospital
where this research was conducted. As it is not possible to inter-
vene routine checks in the hospital, the oxytocin induction was
applied to the pregnant women in both the experimental and
control groups. This may have influenced the duration of labor.
Conflict of interest
The authors declared no conflict of interest.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Authors' contribution
Sevil CICEK: Study design, data collection, data analysis, data
interpretation and drafting of the manuscript.
Fatma BASAR: Study design, data analysis, data interpretation,
critical revision of the manuscript and manuscript editing.
Acknowledgements
We would like to thank all the pregnant women who partici-
pated in this study and the healthcare personnel from the delivery
service. Also, we would like to thank Kalite Academic Tercume for
providing language support during the research.
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Sevil CICEK, MS, is an research assistant in Department of Obstetrics and Gynecology
Nursing at Dumlupınar University School of Health in Kutahya, Turkey.
Fatma BASAR, PhD, is an assistant professor in Department of Obstetrics and Gyne-
cology Nursing at Dumlupınar University School of Health in Kutahya, Turkey.