RESULTS	Compared with the control group , women in the study group experienced a lower incidence of perineal and cervical lacerations ( P < 0.001 ) ; reduced use of the Kristeller maneuver ( P < 0.001 ) ; shorter duration of the second stage of labor ( P < 0.001 ) ; less psychologic and physical fatigue ( P < 0.001 ) ; fewer maternal requests for cesarean delivery during labor ( P < 0.001 ) ; fewer vacuum extractions ( P < 0.01 ) ; and fewer cesarean deliveries ( P < 0.02 ) .\