Roots to life - Breathing your way through the birth

When I ask mothers what they expect out of a pregnancy course, many answer that they come to classes to be taught how to breathe! Isn't this strange when she has been breathing since the day she was born? What is the idea behind learning how to breathe for labour and birth?

Breathing is something we do naturally. Sure enough, our breathing is affected by our thoughts. We breathe differently when we are happy, sad, afraid, angry, impatient, etc. We do this unconsciously. It shows how our body and mind are connected. It is today known and widely accepted that many illnesses are mind-induced. This includes for example, hypertension. Learning the art of relaxation may positively affect a person who is otherwise tense. Throughout these articles, we have been discussing the importance of educating one's mind with regards to childbirth. Understanding how the body works, how it can be helped to work more effectively is the best way to diminish fear, definitely the number one obstacle towards a beautiful experience of the birth. It is known that many a problem arising in pregnancy and birth may be emotional or psychological. This happens most often when a mother feels vulnerable, weak, helpless and unable to find a solution to a problem.

Many studies have shown that in our everyday life, the state of being in control of a situation is what makes a person feel successful, such as at the place of work. Training is usually geared accordingly, so that one learns a job well and may be able to troubleshoot and solve problems to everybody's satisfaction. Unfortunately, perhaps due to lack of proper education, the home and the family are usually the place where parents feel least in control. For example, it is not easy for the otherwise successful manager to control his own toddler having a tantrum.

What is control and how does one get to be in control without being a dictator on others or on oneself? This is where the need to learn appropriate skills comes in. Using one's mind to change a perception is usually how it works. We have been doing this when we have been talking about childbirth. Childbirth is a natural event, catered for appropriately by mother nature, and has been successful since humanity was present on the planet. Having appropriate support and today highly qualified persons who are able to successfully solve problems that may arise, is a bonus which should help a mother face childbirth with more courage and determination. Feeling safe and well supported is what helps her work better.

When the basic needs for feeling safe are fulfilled, the mother may find ways to help herself. Choosing favourable positions and working with her body gives a better perception to the work of labour as opposed to the perceived "excruciating pain" she has been hearing about. Using her mind to take herself to beautiful surroundings during contractions is another skill she will surely find helpful. It is very empowering for the mother to be able to control a difficult situation with the power of her mind. This proves true not only during labour but even during various incidents she will come across as a mother. Practising at home with a supportive partner prepares her well for the day of the performance.

Visualisation, that is using the mind to create positive situations, is very effective. It is helped tremendously by patterns of breathing that go hand in hand to make relaxation more possible, even in difficult situations. Usually slow deep breathing or abdominal breathing is the one that is used most during contractions. Breathing deeply in through the nose, pausing for a few seconds, and then breathing out slowly through the mouth is the basic pattern. This is kept up until the contraction subsides, at most, after a minute. When breathing in, it is useful to imagine a cushion of air being inserted between the contracting uterus and the soft protruding belly. This gives the idea of softness around the hardening muscles which cushions them and so lessens the otherwise resulting pain.

Sometimes slow breathing is taught by counting numbers, but personally I find this to be too rigid. We all have different patterns of breathing, and I prefer the mother to breathe in her own comfort zone, rather than keep her breathing to somebody else's pattern, as this may cause her unnecessary tension. Her support person needs to be aware of this and help her accordingly without being too controlling.

Slow, deep breathing is usually effective throughout labour. When transition sets in, contractions are more difficult to control. This is when another pattern of breathing may prove helpful, especially with first-time mothers. It is known as quick breathing. Totally different to slow deep breathing, it is shallow and quick. There is a possibility that contractions become too overwhelming for the mother. This is shown by her pattern of breathing, which may become loud and deep, very much like a panic attack, often leading to hyperventilation. This needs to be avoided as the mother may become dizzy and the oxygen to the baby is diminished. The support person needs to help the mother regain control by making eye to eye contact while demonstrating the appropriate pattern. This is relatively easy if the mother and her partner have been learning and practising these techniques before the birth. Admittedly, these patterns of breathing are better shown and practised in a class, rather than read from a book.

At the end of transition, when dilatation reaches around eight to nine centimetres, the peak of a contraction may be felt as a pushing sensation, making the mother automatically hold her breath and push the baby out. This is caused by the baby's presenting part, usually the head. There is not much to hold the baby in, only a small rim of the cervix around the baby's head. When a contraction is pushing the baby down, the head is being pushed through, only to make the mother feel the need to help it even more. It is important that the mother does not push unless the midwife tells her she is fully dilated. This is not easy for the mother as the urge to push may be overwhelming and difficult to keep back.

Another useful pattern of breathing which helps this stage is "blowing candles". When a mother pushes, she needs to hold her breath. If she is required not to push, she needs to keep up her breathing, by seemingly blowing small candles on a cake. Keeping up this pattern prevents her from pushing and keeps her back from damaging the not-yet-fully-dilated cervix. The midwife helps tremendously with this difficult but happily short stage. She will guide the mother to keep up her breathing while she is taken to the delivery room where she will deliver her baby. Many mothers do not like being moved to another room at this point. Changing the mother's surroundings may affect her contractions, slowing them down until she orientates herself and feels safe again in the new surroundings. Because of this, some hospitals do not require this move, but encourage the mother to stay in the same room throughout labour, birth and the early postnatal period.

The stage when the mother is not yet fully dilated, but feels the urge to push, needs a lot of support and guidance, but can be achieved very successfully by the prepared mother. It will not be long before the midwife declares that the mother is fully dilated. This means that the cervix and vagina have now become one straight passage, and nothing comes in the way of the baby. This is the end of the first stage, and the start of the second stage, when the baby is slowly and surely pushed down the birth canal by the mother's efforts.

In the next and last article we shall tackle the birth of the baby and the mother's important role in helping her baby come into the world.

• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.