When individuals achieve doula certification, they learn different breathing patterns their clients can use through labor and delivery. Different women will have different preferences on which pattern of breathing they prefer for breathing through contractions. Some women will prefer to breath deeply, using their diaphragm to fill their abdomen. Others prefer shallow, lighter breathing, only inhaling enough air to fill their chest. Regardless of the breathing pattern patients prefer, the ultimate goal is to find a pattern that will have a calming and relaxing effect.

Different patterns of breathing will be used at different stages throughout the labor and delivery process. Learning about different patterns of breathing will allow each contraction to be used productively.

There are many benefits that come with learning patterned breathing prior to labor. These benefits can include:

• Breathing will become an automatic response to pain
• Mothers will remain in a more relaxed state, allowing them to respond more positively at the onset of pain
• Steady rhythm of breathing can be calming during labor
• Provides mothers with a sense of well-being and control
• Increased oxygen provides more strength and energy for both the mother and the baby
• Brings purpose to each contraction, making them more productive through the labor process

How to Practice Patterned Breathing

It is a good idea to practice patterned breathing prior to going into labor so mothers are prepared. Some of the best ways to prepare are to practice while sitting in traffic jams, at the onset of a headache, or while doing household chores. Have your mothers try to incorporate breathing patterns into their daily routine so it comes easily when it’s necessary.

Incorporating Patterned Breathing into Labor

How to Begin Teaching Your Moms:

At the onset of each contraction, remember to take a deep, cleansing, relaxing breath. This will help to sharpen focus, along with providing extra oxygen for the baby, muscles, and uterus.

Breathing Through the First Stage of Labor:

Slow Breathing:

Start with slow breathing when contractions are intense enough that mom is no longer able to walk or talk through them without having to pause and catch her breath. Continue to breath slowly as long as it is helpful. When it is no longer helpful, switch to a different pattern that is more relaxing.

1. Start by taking an organizing breath—a big sigh as soon as a contraction begins. Release all tension in the body while breathing out.
2. Find something to focus attention on other than the pain.
3. Slowly start to inhale through the nose, exhaling out the mouth.
4. On every exhale, work to relax a different part of the body.  

Light, Accelerated Breathing

Most mothers will feel the need to switch to a variation of light accelerated breathing at some point during the active phase of labor. It is best to use the intensity of the contractions as a guide to determine when it is best to switch your breathing pattern. The distinguishing features of light, accelerated breathing will include breathing in and out rapidly through the mouth, at a rate of about one breath per second. Additionally, this type of breathing will be shallow and light, inhales should be quiet while exhales are clearly audible.

1. Start by taking an organized breath—big sigh at the first sign of a contraction. Release all tension, going completely limp all over upon exhale.
2. Focus your attention on something other than the contraction.
3. Slowly inhale through the nose, exhaling out the mouth. As contractions increase in intensity, accelerate and lighten the breathing. Try to keep the mouth and shoulder relaxed as much as possible.
4. As contractions reach their peak, the breathing rate should also increase. At this point, breath in and out through the mouth lightly. Keep the breathing shallow and light, at a rate of approximately, one breath per second.
5. When the contraction ends, take a final breath, exhaling with a sigh.

Variable or Transitional Breathing

A variation of light accelerated breathing, this particular breathing pattern is often referred to as either “pant-pant-blow” or “hee-hee-hoo” breathing. The difference between the two different types of breathing patterns is that this one combines light shallow breaths with periodic longer or more pronounced exhalation. Most often, the variable breathing pattern is used during the first stage of labor, or when the mother is feeling overwhelmed, is unable to relax, is in despair, or is exhausted.

1. Take an organizing breath to relax the entire body as the body exhales.
2. Focus all of the attention on either a partner or another focal point in the room.
3. Breath through the mouth, taking light, shallow breaths at a rate of 5-20 breaths every 10 seconds throughout the contraction.
4. Following every second, third, fourth or even fifth breath, try to blow out a longer exhale. If needed, try to verbalize this longer exhale with a “who” or “puh” sound.
5. At the end of the contraction, take one or two more deep, relaxing breaths.

Breathing to Control Pushing

Breathing patterns can also be used to help prevent the mother from pushing at the wrong time. It is not uncommon during both stages of labor for the laboring mother to want to push or bear down at the wrong time. As a result, most women are tempted to hold their breath during these particularly difficult and painful moments. The best way to avoid this is to continually breath in and out by raising the chin and blowing or panting. When this happens, it prevents any additional pressure or pushing being applied to the baby other than what your body is already doing.

Breathing Patterns for Second Stage of Labor

Expulsion Breathing

This particular breathing style should only be used after the cervix has fully dilated and the second stage of labor is underway.

1. Take an organizing breath.
2. Shift your focus to the baby moving down and out or another positive image.
3. Let your contraction guide the breathing, accelerating or lightening the breath as needed for comfort. When the urge to push becomes too strong to resist, join in. Take a deep breath in, tucking the chin to the chest, curling the body while leaning forward. Hold the breath while bearing down, or slowly exhale with a grunt or moan.
4. When the contraction ends, relax the body and take one or two calming breaths.

Knowing the different breathing patterns can be useful as your client brings new life into the world. If you have recently received your doula certification and have been hired as part of a soon-to-be mother’s birthing team, review these breathing patterns and walk your mother through the breathing patterns and the benefits of each.