Breathing Techniques for First-Stage Labor

Purpose of Breathing Techniques.

• Provide oxygen to mom and baby. If the muscles are well-oxygenated, they can function more effectively, while creating less pain stimuli.
• Relaxation: Relaxation is important, because pain impulses are perceived more quickly when anxiety is present;  anxiety and tension also increase the body’s production of adrenaline. Adrenaline causes blood vessels to constrict, reduces oxygen to the muscles which causes pain, and decreases the production of oxytocin, thus slowing labor. Rhythmic breathing promotes physical relaxation by reducing muscle tension, and promotes emotional relaxation by reducing anxiety.
• Distraction: Breathing techniques provide a means for distracting the woman from the pain of labor, giving her “something to do” and something to focus on other than the contraction. The nerve fibers which carry the messages of labor pain to the brain move more slowly than the nerve fibers which carry pleasurable stimuli; thus, if brain cells are kept pre-occupied with breathing techniques, fewer pain messages are perceived.
• There are two major schools of thought on breathing techniques, and which style works for you will depend on your personality and normal coping styles. The Bradley method emphasizes relaxation, working in harmony with the body, ‘tuning in’ to contractions, and slow abdominal breathing throughout labor. No other breathing techniques are taught, as the woman is encouraged to follow her instincts. The Lamaze method emphasizes an intellectual understanding of labor, an external focus of attention, and distraction with patterned breathing techniques. This style is appropriate for women and couples who need a sense of being in control, and is most comfortable with a list of what to do and when to do it.

The Cleansing Breath.

• How to: At the beginning of each contraction, take a deep breath in through your nose, bringing in new energy for the contraction, then exhale it through the mouth, releasing tension, sighing on the exhale, if desired. Welcome the contraction, remembering that each contraction brings you closer to the time when your baby will be born. When a contraction ends, take another deep cleansing breath, perhaps also yawning or stretching. Release the tension of the contraction, and relax.
• When to use: No special breathing techniques are necessary in early labor, when you’re still easily distracted from focusing on contractions. Begin using breathing techniques when you can no longer walk and talk during contractions, and no longer want to be distracted between contractions. Once you begin using these techniques, the cleansing breath can be used throughout the rest of labor on each contraction.
• Benefits: Welcoming breath gives both mother and baby an extra boost of oxygen, serves as a signal to relax and focus, and informs partner and support people that a contraction has begun. Closing breath serves as a release, informs support people that contraction has passed, and serves as a reminder to relax between contractions.

Slow, Relaxed, Abdominal Breathing.

• How to: Inhale slowly through your nose, allowing your belly to expand first, then your chest. (When your belly expands,  your diaphragm lowers, and creates more space for your lungs to expand into). Exhale slowly through your mouth, pursing your lips to prevent mouth dryness.
• Frequency: Slow and relaxed, about half your normal rate. 6-9 breaths per minute.
• When to use: Some women use only this breathing method throughout the entire labor. Some women find that at some point in labor, they get tense and can no longer relax with this technique, and use other patterns and variations described below.
• Benefits: Relaxing, slow, and effortless. Many women find that breathing slowly can induce a sense of peacefulness and safety that helps to release tension.
• Practicing before labor: This breathing can be practiced at any time: while driving, while reading or watching TV, at work, during times of stress, etc. It is beneficial not only during labor, but in all of life. More on abdominal breathing.

Light Breathing, a.k.a. Hee-Hee Breathing

• How to: Inhale and exhale through the mouth. Lips are relaxed, with a slight smile. On exhale, make a soft “hee” sound. Breathing is shallower than in slow breathing.
• Frequency: Approximately one breath per second.
• When to use: When you can no longer relax during contractions, and tension persists despite using deep breathing. Let your instincts guide when you switch to light breathing.
• Benefits: Helps with relaxation, distracts attention from contraction.
• Practicing: It’s very important to practice this technique until you become comfortable with it, and can use it for two minutes without feeling out of breath.
• If you begin to feel lightheaded or dizzy, take a deep cleansing breath, and start over again. If necessary, rebreathe your air by cupping your hands over nose and mouth, or breathing into a paper bag.
• Practice in various positions: sitting, side-lying, standing, hands-and-knees.
• In order to remember to practice this breathing technique, and the others below, set up a cue for yourself. For example, every time you’re at a red light, do hee-hee breathing. During every TV commercial, do hee-blow.
• Tip: if your mouth feels very dry during this breathing, try touching the tip of your tongue to the roof of your mouth.

Hee-Hee-Blow Breathing

• How to: Similar to Hee-Hee Breathing, except you do 1 to 5 “hee” breaths, followed by a blow. The blow is a deeper, slightly slower breath, and you relax more with it.
• As always, begin and end contraction with a cleansing breath.
• When to use: When Hee-Hee Breathing isn’t enough. Helpful during transition.
• Benefits of patterned hee-hee-blow: Provides a rhythm to breathing. (Some women nod their heads in rhythm to the ‘beat’ of this breathing.) Helps to avoid hyperventilation. The blow breath helps to release tension.
• Practicing: Find the number of breaths that work best for you. Some women do three “hees” with every contraction, others find more or less “hees” to be most helpful.

Variable Hee-Blow Breathing

• How To: Partner randomly chooses a number of breaths to be done before each blow: 2, 3, or 4. For example, he holds up three fingers, mom does three hees, then he closes fist to show her to blow, then he holds up two fingers, etc. If mom doesn’t like watching his fingers, he can also say a number, or hold the fingers on her arm where she can feel them, but doesn’t need to look.
• When to Use: Best as a “take-charge” routine during transition. The birth companion can use when the mother is feeling out of control and panicky. Establish eye contact with her, and guide her through breathing until she is focused again.
• Benefits: Distraction. Woman focuses on partner and on counting the breaths.
• Practicing: Practice with partner.

Combining Techniques

You should always use the most basic technique possible, using the least effort required to manage each contraction. This will help prevent fatigue, and also help avoid the sensation of having already pulled in “all the big guns” too early on, leaving you with no new resources later in labor. Use slow, relaxed breathing whenever possible.

When you feel like a basic technique is no longer enough to manage the peak of the contraction, then start doing one of the later techniques, but only over the peak of the  contraction. Use slower, more relaxed breathing at the beginning and end of contraction.

Use the intensity of your contraction to guide you. For example, begin a contraction with a deep, cleansing breath. Use slow, relaxed breathing as long as it is helpful, switching to hee-hee breathing or hee-hee-blow over the peak of the contraction, returning to slow, deep breathing as soon as you are able. Take a cleansing breath at the end of the contraction.

Breathing Techniques for Second-Stage Labor

How to Avoid Pushing, if necessary.

How to: Lift your chin, and arch your back a little. Either: Breathe deeply, relaxing your body. Or: Pant, blowing lightly. Some people recommend visualizing a feather, and blowing just enough to keep the feather bouncing up and down in the air above your lips.

When to use: If you are experiencing the urge to push, and your caregiver has told you that it is too early to begin pushing, or that there is some need to stop pushing temporarily.

Benefits: This breathing will not prevent your uterus from pushing, and it generally won’t take away the urge to push. However, it does keep you from adding your voluntary strength to a pushing effort.

Breathing for Birth

Breathing the baby out: Breathe in deeply, then on exhale, gently push downward with abdominal muscles, while visualizing the baby moving down and out. It may help to grunt or vocalize while exhaling. Continue this pattern through the contraction.

Pushing the baby out: During a contraction, when the urge to push becomes irresistible, then hold breath for five to seven seconds, while pushing. Then breathe deeply in and out again until the urge to push becomes strong. Repeat through contraction.

“Purple” pushing: In the past, some caregivers recommended holding your breath and pushing for as long as possible before coming up for air. However, this can cause a reduced oxygen supply to the fetus, and is not recommended.

Sources: Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler, 2001. Family-Centered Maternity and Newborn Care by Celeste R. Phillips, 1996. “Teaching Breathing Techniques in the 90’s” by Jill Janke, IJCE, May 1992. “Breathing Techniques” by Carla Reinke, R.N., M.N., Birth Education Northwest. Methods of Childbirth by Constance Bean, 1990.

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