Is your pregnant client holding her breath?

By teaching your pregnant client how to use her breath effectively during training, and simulating some physiological challenges of labour, you can help her prepare for childbirth, writes women’s health expert Dianne Edmonds. 

THE QUICK READ 

• Training your clients to use breathing and stretching sequences helps give them the opportunity for physical and mental preparation for labour and birth 
• Ways to train include using breathing through the holding of a deeper squat, through counting of repetitions in strength and resistance training, and during stretches 
• Pointing out to clients any patterns of tension observed in their shoulders, neck or jaw and giving the instructions to move these areas can help them become aware of the effects of stress and tension held in the body 
• Breathing out during labour gives women something to focus on, and reduces the build-up of muscle tension (tension can’t build up as much when breathing out) 
• Remind clients to use and enhance the skills that they have developed during training sessions. 

For over 25 years I have been teaching pregnant women to focus on their breath out as a strategy for relieving tension and coping with contractions during the first stage of labour. During the global pandemic, however, I have noticed myself holding my breath on a number of occasions. As the impact of the pandemic and restrictions continues, it affects a pregnant woman’s support networks, particularly those with family and friends living interstate or internationally. For many, their stress response is heightened, even before they go into labour. This may reduce their stress resilience and their ability to cope with the challenges of labour and birth, as well as alter their reserves postnatally for meeting the demands of a new baby.  

Kylianne Farrell, founder of Move for Mental Health and a Gidget Foundation Ambassador, reported that there had been a 50% increase in requests for help from pregnant and postnatal women since the pandemic, highlighting the need for building the strength of support systems for women. 

The role of the fitness professional

The benefits of regular exercise during pregnancy are known to increase energy and enhance mood and sleep. Improved muscle tone, strength and endurance can help women have more energy for labour. This, in turn, may help reduce the effects of fatigue during labour, the duration of which varies considerably between women. 

In addition, specific mental training and preparation may help women to better cope with labour, using recognised tools in antenatal preparation for birth programs, including relaxation and breathing awareness. 

Fitness professionals are well positioned to teach and coach pregnant clients how to use the breath effectively during training, whether their sessions are face to face or online. Breathing out is a focus during strength and resistance training, and during stretch and relaxation exercises. By teaching a woman to shift her focus during training to the breath (or breath control), she can learn to use this as a tool in the later stages of pregnancy and labour. 

Breathing training for the first stage of labour

As women transition into the later stages of their pregnancy, their focus often shifts to the safe delivery of their baby. This includes starting to prepare for labour and birth. 

In first stage, the uterus contracts to open and dilate the cervix (the opening of the uterus), in preparation for second stage where the baby moves down the birth canal. 

Contractions of the uterus are felt by the pregnant woman and vary from between 30–45 seconds in early labour, to 60–90 seconds as labour progresses. Contractions become stronger as labour advances, and the intervals between them reduce in duration. 

Clients are used to being cued to work with their breath when training, stretching, undertaking weights and resistance work, and doing relaxation or releasing work. With pregnant clients, consider using training times in 30–90 second intervals when designing programs, in order to mimic the durations of ‘work’ (contractions) and intervals during labour. 

Squat training

During squatting, bring your clients awareness to tension that they may be holding in their shoulders or jaw. Point out tension signs, and highlight that she can drop her shoulders down or unclench her teeth. 

During a squat, the focus on the breath out is normally performed during the press up or down. Around the 8th to 12th rep, reinforce the client’s focus on the deliberate breath out, as the effort increases, and relate this to training for labour. 

A squat hold for 30–60 seconds is another opportunity to train mentally for the birth, by getting the client to focus on how to use breathing out as a tool for dealing with contractions. A sustained squat simulates the length of time of a contraction. Repetitions can be added for trained clients, providing they feel no pelvic floor pressure. Check there is no discomfort in their back, pelvis or lower abdominal area or their knees. 

This training can also enhance her ability to assume upright birthing positions that will enable her to benefit from the effect of gravity during labour, if she chooses. 

Relaxation training

Relaxation training using the law of reciprocal inhibition is one method that can be used in active positions with your clients, such as in the case of squat training, focusing on pulling the shoulders down and relaxing the jaw if tension is noted in response to a stressor. 

Body tension is a typical response to stressors. If the body is holding excessive muscle tension when labour is initiated, it can be more tiring and can result in the release of more adrenaline and cortisol. This may inhibit the progression of labour and extend the birth process. 

Reciprocal inhibition is described as the spinal process of inhibition of a motor neuron pool when the antagonistic motor neuron pool is activated. This principle is used in the Mitchell Method of physiological relaxation sequence, whereby women are advised to move key points in their body away from the position of tension. 

A simple explanation for clients is: there is automatic relaxation of the opposite muscle to the one being used. For example, when a ball is kicked or the leg extended, the hamstrings need to automatically relax, otherwise it would tear. We can use this ‘law’ in the body to enhance physiological relaxation in times of stress. 

For use during labour, the body can be moved quickly into what is called ‘a position of ease’ such as 4-point kneeling leaning over a Swiss ball, and deliberately releasing muscle tension by lowering the shoulders, loosening and stretching out the fingers and relaxing the legs into a comfortable position. Use three key phrases of ‘low shoulders’, ‘fingers long and soft’, and ‘feet resting’ while getting into a position quickly, and then cue the focus on breathing out during a contraction in the first stage of labour. 

This technique can also be used for postnatal mums during breastfeeding, as excess tension may interfere with the let-down of breast milk. A mum holding a baby and feeling tension through her shoulders can lower them down, and then deliberately focus on breathing tension out of her body. If she has been rushing, or her mind is distracted, breathing out is a strategy that allows the mind to focus and calms the nervous system. This may assist with relaxation prior to feeding the baby. 

Stretching to train breathing awareness

In preparing for labour, stretching can be used to release stress and tension and is especially effective when combined with a skillfully focused breath out. 

Stretches can also enable a client to mentally attend to instructions when practicing a labour breathing sequence, and help them to feel what it is like to get into that zone of focus for the length of a contraction. Regular stretching also helps women to release the tension associated with daily stressors. 

During a sustained stretch, both awareness of tension holding patterns and focusing on a releasing breath out can be highlighted to clients. 

During a side flexion stretch, question what area in the body is affected with the breath out. Is it the rib area, through the lats, or the obliques? Are shoulders elevated –and cuing therefore needed to deliberately lower them before or during a stretch? 

Do they feel more release as they focus on 3–5 elongated breaths out? 

During a rotation stretch, where is the stretch felt? Tension held in the body over a period of time can cause an upper chest breathing pattern with increased use of accessory muscles in the front of the neck. An opening up rotation stretch, may bring the restriction to the client’s awareness and should be encouraged to be performed daily to manage the buildup of tension. 

Rotation in sidelying is another option. Breathing out with each rotation for 8–10 repetitions with each set lasting 30–45 seconds can serve as an opportunity to practice breathing awareness for the same length of time as an early contraction.

Hamstring stretches

A focused breath out during a hamstring stretch seated on a ball (photo 4), or seated on the floor and leaning forward (photo 5), is another opportunity to train breathing awareness as a tool that can be used during labour. Holding a stretch longer allows the client to feel and focus the intention to release muscle tension while consciously breathing out. 

Hamstring, adductor and calf stretches improve flexibility, which will increase the ease for the client to transition into various positions for the second stage of labour. Upright positions, such as supported squatting, sitting or on all fours, expand the dimensions of the bony pelvis, which is suggested to facilitate the birthing process.

Childs pose sequence

A good sequence for combining stretching and focused breathing is the yoga asana ‘balasana’ or child’s pose (photo 6). 

Instruct the client to:

• from a seated or kneeling position on the floor, gently move into child’s pose 
• hold the position and focus on the breath out
  let the breath in come naturally 
• deliberately breathe out tension from the body 
• become aware of any jaw clenching and, if tension is being held, unclench their teeth and lower their jaw and refocus on the breath out 
• take 5 more breaths out, unless they need to move out of the pose for reasons of comfort (precaution: there should be no pain or discomfort in the hips, back or pelvic joints or in the lower abdominal wall or pelvic floor area) 
• move into 4-point position, stretch one calf muscle and focus on a long-extended breath out 
• repeat for the other side. 

Labour is a uniquely demanding experience for women, both physically and mentally. By guiding your pregnant client to harness the power of focused breathing, you can help her face it with increased confidence and a greater sense of control.

CHEC K OUT NETWORK’S FEMALE-FOCUSED FITNESS COURSES 

Dianne has created pregnancy-related CEC courses available exclusively in Australia through Network.

Network also has a range of other female-focused ongoing education courses for fitness professionals.

Click here to view all Women’s Health-related courses.

REFERENCES & FURTHER READING

• Clarkson, Suzy (2014).  Fit for Birth and Beyond: The guide for women over 35.(pp 162, 191-193) Exisle Publishing Limited, New Zealand and Australia. 
• Gizzo, S., Gangi, S.D., Noventa, M., Bacile, V., Zambon, A., & Nardelli, G.B. (2014). Women’s Choice of Positions during Labour: Return to the Past or a Modern Way to Give Birth? A Cohort Study in Italy. Biomed Research International. 638093. 
• Guszkowska, M. (2014). The effect of exercise and childbirth classes on fear of childbirth and locus of labor pain control. International Journal of Anxiety, Stress and Coping. Vol 27, Issue 2, p 176-189. 
• Lawrence, A., Lewis, L., Hofmeyr, G.J., Dowswell, T., & Styles, C. (2009). Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 15(2). CD003934. doi: 10.1002/14651858.CD003934.pub2. 
• Michel, S.C., Rake, A., Treiber, K., Seifert, B., Chaoui, R., Huch, R., Marincek, B., & Kubik-Huch, R.A. (2002). MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions.  American Journal of Roentgenology. 179 (4): 1063 – 7. 
• Miquelutti, M.A, Cecatti, J.G. and Makuchll, M.Y. Developing strategies to be added to the protocol for antenatal care: An exercise and birth preparation program. CLINICS 2015;70(4):231-236 
• Salt, V.L., & Kerr, K.M. (1997). Mitchell’s Simple Physiological Relaxation and Jacobson’s Progressive Relaxation Techniques: A comparison. Physiotherapy. 83(4), 200-207. 
• Exercise benefits source: https://americanpregnancy.org/health-fitness/exercise-during-pregnancy-5451 
• Reciprocal inhibition definition: Electrophysiologic Evaluation of Movement Disorders* Mark Hallett, in Aminoff’s Electrodiagnosis in Clinical Neurology (Sixth Edition), 2012, Chapter 20. 

Dianne Edmonds 

A physiotherapist based in an obstetric GP clinic, Dianne is a course creator, Women’s Health Ambassador for Australian Fitness Network and the Director of The Pregnancy Centre. She has worked in women’s health and fitness for 25 years and was integral in the development of the Pelvic Floor First resources.

• Bio

Network

Network is an education subscription service that offers a broad range of upskilling courses for fitness and wellness professionals. Established in 1987, Network has played a pivotal role in the continual evolution of the fitness industry.