Breathing During Labor: How to Work With Your Body
Learning HOW to breathe during labor can be an extremely valuable tool to utilize both when riding the waves of contractions and when ready to push. There are several different techniques and ways to utilize the breath through labor and birth, but this blog post is going to focus on two specific breathing techniques in particular to allow the body to relax through contractions and have productive pushes.
Breathing Through Contractions
The purpose of a contraction is to prepare the body for birth, and depending on your response to those contractions, you can either FIGHT the contractions, or work WITH the contractions.
Fighting the contractions would look like holding your breath, tensing up, clenching your jaw, tightening your fists and just overall feeling tight and tense throughout your body. Working with the contractions would look like breathing through each surge, relaxing your jaw, relaxing the muscles throughout your body and overall allowing the contraction to do what it’s meant to do!
There is a specific breathing technique that can really optimize each contraction, and not just allowing you to ride the wave of each surge, but to power through them, to feel strong through each one, and that technique is known as 1:2 ratio breathing.
How to Perform 1:2 Ratio Breathing
When thinking about 1:2 ratio breathing, it’s important first to understand the typical contraction intensity and sequence. Usually, a surge will start, it will rise in intensity, hit a peak, and then start to decrease. If you can picture a simple drawing of a mountain or an inverted V, that’s essentially what a contraction looks like on paper. Of course, everyone is different and experiences contractions differently, but for the most part, that’s what you can expect!
The typical response from our body during a contraction is to signal for the sympathetic nervous system to kick in and trigger that “fight or flight” response. However, learning to properly utilize your breath during a contraction can actually trigger the parasympathetic response to activate and allow our body to instead “rest and digest” to get through those surges and allow our body to feel more relaxed.
So, here’s how it works!
The 1:2 ratio means that the inhale should be half as long as the exhale. A good rule of thumb is to try a 4 second inhale, followed by an 8 second exhale. If this feels unnatural or too long for you, you can always reduce to 3 seconds in, 6 seconds out. Again, each person is different and you want to choose what feels RIGHT for you.
Essentially, as you start to feel the surge kick in, you will take that 4 second inhale in, followed by a nice long 8 second exhale and continue along in that pattern until the contraction has decreased and you are back at baseline. As you are breathing, focusing on counting and really putting all of your attention to your breathing can really be beneficial. If you can, also focusing on feeling your muscles, particularly your pelvic floor, relax, open up and accept each contraction with the knowledge that each contraction is helping you get closer to your baby’s arrival! One of my favorite visualizations for this pelvic floor relaxation is seeing it as a flower opening up with each surge.
This breath work pairs beautifully with movement as well! Body sways are a nice rhythmic movement that you can use with each purposeful breath and comes naturally for a lot of women when working through surges. If movement and being upright isn’t an option, laying down or sidelying positions are great too…you really just want to listen to your body and go with what feels the best to you during those surges!
Breathing During Pushing
There are different ways that breath work can be utilized during the pushing phase and different philosophies on what is best. When considering what is “best”, you really have to determine what that means to you. Some may think that having a short amount of time pushing to get the baby out quickly and safely is best, while others take into consideration how a quick birth experience can affect the mother’s pelvic floor and overall well-being of the surrounding tissues. With that in mind, there are two common types of push breathing to be aware of and understand the purpose for each - closed glottis and open glottis.
closed glottis pushing
Closed glottis is often referred to as “purple pushing”, since you are holding your breath and essentially bearing down. The term closed glottis is in reference to the throat being closed and the breath being held during the push aka a valsalva.
Pushing in this way allows you to use an excessive amount of pressure from the held breath to forcefully bear down onto the pelvic floor. Now, this may sound like it’s exactly what you are wanting to do when you’re trying to push a baby out, but this is actually discouraged by many due to that excessive amount of pressure on the perineum and vaginal walls, as well as the decrease in oxygen and blood flow to the uterus and even baby. ACOG has also recently made a committee opinion on this stating “When not coached to breathe in a specific way, women push with an open glottis. Each woman should be encouraged to use her preferred and most effective technique.” (1) Furthermore, other labor and delivery professionals state that, “Traditional breath holding for 10 seconds should be discouraged, and women should be encouraged to ‘do what comes naturally.’” (2)
Think about it this way…if you hold your breath and push really hard right now, what naturally happens? Typically we end up tensing our jaw, our fists, our abs, and ultimately, our pelvic floor activates! When you push your tongue to the roof of your mouth, what do you feel in your pelvic floor? A slight lift or tensing, right?! This is another example of how tension in the jaw/mouth can cause tension in the pelvic floor.
Purple pushing also puts a lot of strain on the abdomen and the pelvic floor and increases intra-abdominal pressure significantly! This can contribute to increased diastasis issues going into the postpartum (*). Overall, the recommendation is for the woman to push as it feels natural, and to not be forced or coached into “breath holding” if it does not feel right.
Oftentimes, when you’re in the moment and surrounded by professionals, it can feel hard to self-advocate, especially if it’s going against what you’re being told to do. Let this be a reminder that your intuition and what you are feeling in your own body is JUST as important, and should be taken into consideration when you’re doing something as important as birthing your baby.
open glottis pushing
Open glottis is essentially the exact opposite of closed glottis. Instead of closing the throat and holding your breath, with open glottis the throat will stay open and you will actually utilize your breath downward to assist the body to do what it naturally wants to do during breathing.
Typically, when you breathe in, your diaphragm drops down to allow for the lungs to expand with air. With the diaphragm dropping down, that facilitates our intra-abdominal pressure to also move down to the base of our core which is the pelvic floor. In order for the pelvic floor to accept that pressure, it actually will mimic the response of the diaphragm and also drop down, relax and in a sense, open up! The way that our body works naturally is a really important concept to understand so that we can then take that information and utilize it to our benefit during pushing.
So, when thinking about this idea of breathing allowing pressure to move down, this is where the term “down breathing” comes from. Down breathing is PURPOSEFULLY using our breath to move pressure down towards the uterus and vaginal opening and to allow the pelvic floor to open up naturally instead of forcibly.
When thinking about the way this breathing looks, think about it as a longer, slower and more purposeful breath that can oftentimes be accompanied with a “mooing” or “groaning” sound. For reference, this SHOULDN’T look like how you might blow out birthday candles.
How to Perform Down Breathing
Again, down breathing is what we can do with our breath to assist allowing the uterus to push down to get the baby out. That pressure downward is what you may feel when you get that pushing sensation or urge to push! And remember, your body is DESIGNED to push baby out and we can use the breath to ASSIST what it is already naturally doing for you. If you have an epidural, if possible, try to make sure the epidural is TOO strong to where it takes away the pressure sensation so you can feel this sense of pushing!
So, how might this look?
Down breathing starts with a quicker breath IN. Remember, the breath in is what moves that pressure downward, which is what we want! Then we use a very purposeful exhale, focusing on feeling that inhale breath go downward and instead of just immediately expelling it out our mouths.
Sometimes a “moo” or low groan noise can accompany this, which is completely normal and can feel very natural to some women! We can also utilize our core and upper abs to assist the uterus as it feels right, as long as we aren’t tensing/squeezing the pelvic floor while doing this. (Why it’s important to practice during pregnancy…see below for how!)
One way to practice this is when having a bowel movement - I know, I know, but hang with me here! In order to have a successful bowel movement, the pelvic floor also must be relaxed and able to allow stool to be expelled (which can’t happen if the pelvic floor is taut/tense). This is exactly what we need in order to birth a baby as well! So, you can really mimic and practice this breathing while having a bowel movement in the same way that you want to do while having a baby! No straining, but intentional breath downward.
Once the contraction is done, remember to take a break, resume normal breathing and focus on allowing yourself to recover for the next push!
Breathing and Pregnancy
If learning how to utilize your breath to assist the pelvic floor during labor has intrigued you, make sure to sign up for my FREE mini course, “Pregnancy Breathing Series”. This is a 3-part pregnancy breathing series that will cover the different types of breathing you can utilize when engaging your core, relaxing your pelvic floor or breathing during labor. Click here to sign up and receive access to the mini course immediately!
And lastly, if you’re looking for support throughout your pregnancy that goes beyond breathing, make sure to click the button below to learn more about my Mind Body Core Prenatal Program! This program will walk you step-by-step through each stage, phase and trimester to fully support you through your pregnancy. All the details of the Prenatal Program, Core/Mobility Program and Labor Prep Program are just a click away!