Breath to cope

Lilian Karanja, a Lamaze instructor at Aga Khan University Hospital discusses breathing as a coping strategy you can apply for easier labour.

Breathing
A childbirth experience can either be positively or negatively over whelming for a woman. Good breathing techniques contribute towards a positive experience as it helps both you and the baby to get the required oxygen during labour and most importantly, it helps you to relax.

Breathing has been scientifically proven to have a positive impact on the process of pregnancy, labour and birth. Childbirth educators have different names for the various breathing techniques, however the techniques are similar.

In the past, breathing techniques were a set of rigid rules, currently the trend is on making them flexible, individualized and focused on following the movement of the body, lungs and encouraging more breathing awareness hence a strategy that enhances relaxation.

The idea is to work with your body and relax as completely as possible during a contraction while using the breathing techniques. Techniques should be modified to your preference.

How to breathe
Breathing through the nose helps in humidifying and filtering the air with the mucous membrane, gives you a calming effect. If you breathe through the mouth, you miss this effect. Our bodies are designed in such a way that under normal breathing, we achieve a balance between the oxygen and carbon dioxide in our blood. Depending on the activities we do, our bodies are able to adjust by increasing the amount of air we take either by breathing faster or more deeply. This ensures that our cells have the amount of oxygen required to perform, while getting rid of waste gases like carbon dioxide.

Panic can lead to a switch from nose to mouth breathing, characterized by shallow, short, rapid sharp gasps (panting). This makes one lose carbon dioxide faster than it is produced, a condition known as hyperventilation. In normal situations, your body cannot sustain this for long leading to exhaustion. During labour, one needs to conserve energy as much as possible.

Panic breathing has more negative effect of making you light headed, dizzy and tense. You may also experience some numbness and a tingling sensation of the extremities (for example, your fingers and toes). To avoid this, cover your mouth and nose with your hands as you breathe.
Pregnant women require 10 to 20 percent more oxygen which necessitates a 10 percent increase in the amount of air inhaled and exhaled in one cycle hence one tends to breathe more deeply and frequently.

Cleansing breath
Cleansing breath is an exaggerated deep breath done by breathing in through the nose and out through the mouth. It is recommended before and after a contraction. A cleansing breathe allows enough oxygen to get to the baby. This deep breath is a signal that warns you that a contraction
is beginning. So concentrate on breathing, focusing and relaxation. After the contraction, taking another cleansing breathe will help you to relax as you wait for the next contraction. The more relaxed you are the more you will be able to cope in labour.

Focal point breathing
Focus your attention on something in the room. Choose a point that enhances your concentration and helps eliminate distractions. Avoid something like a clock, as it will serve as a reminder of how long the contraction is lasting instead of calming you. Focal point breathing will help you to continue breathing easily, quietly and evenly. Make sure you relax completely as you let your body go limp with each exhalation.

How to breathe during labour

Paced breathing
Paced breathing has been scientifically proven to decrease pain and reduces responses to stressful stimuli. It is encouraged to use this breathing pattern for as long as possible during labour as it makes you more relaxed and allows more oxygen into your system, which is very necessary for pushing.

How to pace breathe
o Take a cleansing breath at the beginning of a contraction.
o Continue to breathe evenly in and out with slow, easy abdominal breaths.
o Your pace should be approximately half that of your normal breathing rate.
o When relaxed, the slow paced breathing occurs naturally.
o You may choose to breath in and out through the nose or mouth or in any combination.
o If you choose to use your mouth breathing in, you are then required to take plenty of fluids to moisturize your mucous membrane due to the drying effect.
o Do not confine the breathing movement to either chest or abdomen as it will hamper your ability to relax.

This breathing pattern becomes less effective as labour progresses and you will need to change to modified breathing.

Modified breathing
Generally, the respiration rate increases when work becomes more physical and/or emotionally demanding so as to get the required oxygen. Pay more focus to the rate and rhythm as this helps in decreasing your perception of the pain.
Your breathing rate should not exceed twice your normal breathing rate. Keep it light and relaxed, at your own comfort level, not confined to the throat or moving your entire chest wall vigorously. This pattern must be learnt and practiced to be effective. Again you may decide to use your mouth or nose.

Patterned breathing
The breathing is similar to modified breathing pattern. It is used as need be to maintain a sense of relaxation and control. It is characterized by a rhythmic pattern and an exhalation at regular intervals.

How to pattern breathe
o Take a ‘cleansing’ breath at the beginning of a contraction.
o Continue breathing in the pattern Breath-Breath-Breath-Blow. Blowout softly at regular intervals after breathing like you are blowing a candle.
o The pace may increase as needed but should not exceed twice the normal breathing rate.

Pain during labour is as a result of the pain receptors in the uterus responding to two things: Diminished oxygen supply and stretching of the uterine muscles, which occurs when you tense up during a contraction. Using appropriate breathing techniques can go a long way in helping you alleviate your pain. This pattern is helpful during transition (as explained earlier in Pregnant Issue 18). Decision to change from paced to patterned entirely depends on you.

The rule of thumb is to change when the previous breathing pattern no longer helps. Listen to your body keenly; it will guide you on this aspect.

These patterns ensure adequate oxygen for you and the baby during labour. Breathing techniques might sound easy on paper. However, attending childbirth classes will help you master them. Your childbirth educator will instruct you and your partner on coping strategies. The classes prepare you intellectually, physically, emotionally and psychologically.

END: PG20/52-53