Breathing Techniques

Are effective in producing relaxation and pain relief through the use of controlled
breathing to reduce the pain experienced through a stimulus-response conditioning.

Lamaze Breathing Patter Levels

This pattern may also be called slow, deep breathing or slow paced breathing. During the
breathing movements only the chest moves. The woman inhales slowly through her nose.
She moves her chest up and out during inhalation attacked. She exhales through pursed
lips. The breathing rate is 6-9 breaths a minute.

First Level (Slow Paced)- Pattern begins and ends with a cleansing breath(in through the
nose and out through pursed lips). While inhaling through the nose and exhaling through
pursed lips,slow breaths are taken, moving only the chest. The rate should approximately
6-9/minute or 2 breaths/15 seconds. The coach or nurse may assist by reminding the
woman to take a cleansing breath, and then breaths could be counted out if needed to
maintain pacing. The woman inhales as someone counts “one one thousand, two one
thousand . Exhalation Begins and continues through the same count.

Second Level (Modified paced)

This pattern is also called the shallow or modified-paced breathing. The woman begins
with a cleansing breath and at the end of the cleansing breath she pushes out a short
breath. She then inhales and exhales through the mouth at a rate of about four breaths
every 5 seconds. This pattern can be altered into a more rapid rate that does not exceed 2-
2.5 breaths every second.

Pattern Begins and ends with cleansing breath. Breaths are then taken in and out silently
through the mouth at approximately 4breaths/5 seconds. The jaw and entire body need to
be relaxed. The rate can be accelerated to 2-2 1/2 breaths per second. The rhythm for the
breaths can be counted out as “one and two” with the woman exhaling on the numbers
and inhaling on and.

Third Level (Pattern paced)

This is also called pant-blow or pattern based breathing. It is similar to modified-paced
breathing except the breathing is punctuated every few breaths by a forceful exhalation
through pursed lips. A pattern of four breaths maybe used to begin. All breaths are kept
equal and rhythmical. As the contraction becomes more intense, the woman may adjust
the pattern as needed to 3:1. 2:1 and finally 1:1.

Pattern begins and ends with a cleansing breath. All breaths are rhythmical, in and out
through the mouth. Exhalations are accompanied by a “hee” or “hoo” sound in a varying
pattern, 2:1, which begins as 3:1 (hee hee hee hoo) and can be changed to 2:1 (hee hee
hoo) or 1:1 (hee hoo) as the intensity of the contraction changes. The rate should not be
more rapid than 2-2 1/2 breaths per second. The rhythm of breaths would match a “one
and two and” count.
Abdominal breathing cues
The abdomen moves outward during inhalation downward exhalation. The rate remains
slow with approximately 6-9 breaths/ minute.

Quick Method
When the woman has not learned a particular method and is in active phase of labor, the
nurse may teach her a combination of two patterns. Abdominal breathing may be used
until labor is more advanced. Then a more rapid pattern consisting of two short blows
from mouth followed by a longer blow can be used.

In abdominal breathing, the woman moves the abdominal wall upward as she inhales and
downward as she exhales. This method tends to lift the abdominal wall off contracting
uterus and thus may provide some pain relief. The breathing is deep and rhythmical. As
transition approaches, the woman may feel the need to breath more rapidly. To avoid
breathing tpp rapidly, which may occur with deep abdominal breathing, the woman can
can use the pant-pant-blow breathing pattern.

Hyperventilation
Occurs when a woman breathes very rapidly over a prolonged period of time.
Hyperventilation is the result of an imbalance of oxygen and carbon dioxide.

Anxiety
An excessive degree of anxiety decreases a woman’s ability to cope with the pain.
Wuitchik (1989) found that women in the latent phase of labor who were experiencing
increased level of anxiety about safety and their ability to cope were much more likely to
describe their pain as “horrible” or “excruciating”.

They were more likely to have FHR declarations in labor, a slow second stage, and/or
cesarean birth, and more likely to need pediatric assistance for neonatal resuscitation at
birth.

Client Teaching
Providing information about the nature of the discomfort that will occur during labor is
important.Stressing the intermittent nature and maximum duration of the contraction can
be most helpful.

The woman con cope with pain better when she knows that a period of relief will follow.
Describing type of discomfort and specific sensations that will occur as labor progresses
helps the woman recognize these sensations as normal and expected when she does
experience them. A thorough explanation of surroundings procedure, and equipment
being used also decreases anxiety, thereby reducing pain.

Promote For Change In Positions (Ambulation and Position Changes)

Changing position frequently (every 30 minutes or so)-- sitting, walking, kneeling and
using birthing ball-- helps relieve pain. Position changes also may help to speed labor by
adding benefits of gravity and changes to the shape of the pelvis. Swaying from side to
side, rocking or other rhythmic movements may also be comforting, if labor is
progressing slowly, ambulating may speed it up again. Upright position such as walking,
kneeling forward, or doing the lunge on the birthing ball give most women a greater
sense of control and active movement than just lying down.

Research reports profound effect on uterine activity and efficiency. Allowing the woman
to obtain a position of comfort frequently facilitates a favorable fetal rotation by altering
the alignment of the presenting part with the pelvis. As the mother continues to change
position based on comfort, the optimal presentation is afforded (Gildert & Harmon,2003).
Supine and sitting positions should be avoided, since they may interfere with labor
progress and can cause compression of the vena cava.

Labor Support
Involves offering sustained presence to the laboring woman by providing emotional
support, comfort measures, advocacy, information and advice, and for the partner. This
continuous presence can be provided by a woman’s family, a midwife, a nurse, a doula or
anyone else close to the woman. A support person can assist the woman to ambulate,
reposition herself, and use breathing techniques.

Help Empower Woman

Most women want to feel in control of what is happening to them during labor in order to
be able to face this big event in their life. They accomplish this by stating their
preferences, breathing with contractions, and changing their position to the one that
makes them most comfortable. Help each woman express her feelings in her own way or
in the way that works best for her.

Offer Support
Support needs to come from health care personnel as well as a woman’s individual
support person. There is no substitute for personal touch and contact as a way to provide
support during labor. Patting an arm while telling a woman she is progressing in
labor,brushing away a wisp of hair from her forehead, and wiping her forehead with cool
cloth.Effective support can make the difference in helping a woman feel able to continue
with labor.

Respect Contraction Time

Do not interrupt a woman who is in the middle of breathing exercises during labor to
perform a procedure or ask questions.Instead of interrupting, allow her to finish breathing
with her contraction, the ask questions or announce what procedure needs to be done.

Once her concentration is disrupted, she will feel the pain of the contractions and, if she
has been successfully using breathing exercises to reduce the pain, suddenly feeling the
full force of the pain becomes worse, causing her to doubt her ability to breath
constructively in the face of the next contraction.
Promote Voiding and Bladder Care
A full bladder or bowel can impede fetal descent, so encourage a woman to void, if
possible, at least every 2 to 4 hours during labor. The reason you need to remind a woman
to void during labor is because she may mistakenly interpret the discomfort of a full
bladder as part of the sensations of labor.

Respect And Promote The Support Person

Be certain to admit a woman’s support person to the birthing area along with the woman
and encourage him/her to remain with the woman throughout the birt because having
someone familiar with her during labor helps to counteract the sensation everything is
new and uncertain.