The Spring (20.2) issue of the Journal of Perinatal Education is already upon us, and this month's Continuing Education Module is by our own Judith Lothian, PhD, RN, LCCE, FACCE.

In her article, Lamaze Breathing: What Every Pregnant Woman Needs to Know, Dr. Lothian reviews the history of the Lamaze organization and its initial focus on breathing-as-pain-reduction. Describing the birth of the Lamaze method, when Marjorie Karmel brought her experience birthing with Dr. Fernand Lamaze in Paris, France, to the United States and subsequently paired with Elizabeth Bing to form ASPO (now Lamaze), Lothian states:

"...conscious relaxation and controlled breathing [were used] to manage the pain of contractions, avoiding the need for drugs."

Lothian goes on to suggest that Lamaze's focus on breathing as a pain reduction strategy, in all its simplicity, tended to "work" well at the time because, "in those years, labors routinely started, continued, and ended naturally. Intravenous fluids, continuous fetal monitoring, and epidurals were not part of typical labor. The cesarean rate was 6%."

And yet, as we all know, the labor and birth environment here in the US has become more complicated since the early 1960s when the Lamaze approach to labor and birth first took hold.

In my childbirth education classes, when discussing breathing and relaxation techniques, I often find myself asking for a show of hands: "How many of you in this class have ever participated in an athletic activity before?" Most, if not all hands, typically rise. The line of questioning further unfolds like this:

"What happens when you find yourself going from walking...to jogging...to running...to sprinting? What does your heart begin to do? What about your breathing pattern?" The answers, of course, are that heart rate and breathing increase to match the body's level of effort.

Then my questioning continues.

"What kind of breathing pattern occurs when you hurt yourself, such as stubbing your toe, spraining an ankle, hitting your thumb with a hammer?" The answer, of course, is no surprise again: your breathing automatically changes: perhaps you suck in a quick breath, hold your breath, or take a series of long, deep breaths while adjusting to the pain of the injury. Alterations in breathing happen naturally.

Members of the hiking/mountain climbing arena may be familiar with the guidance about breathing touted by the famed mountaineer, writer, and founder of National Outdoor Leadership School, Paul Petzoldt, in his book, The New Wilderness Handbook (Petzold, Ringholz, 1984). Petzoldt described using rhythmic breathing to control the hiker's pace and thereby prevent the need for auxiliary oxygen (even at high altitude) as well as avoid potential complications of altitude sickness such as hallucinations, headaches and faulty decision making.

Conscious breathing, as it turns out, really isn't just a "Lamaze thing," after all.

Birth, of course, is neither an injury nor a trek up K2 (though, it might feel like the latter at times). It is a normal event in the continuum of a woman's lifespan. However if we, as childbirth educators, help our students tap into the natural ways their bodies already can and do utilize altered breathing - be it during exercise, athletics or injury - then we can more easily convince expectant parents that they already know how to use breathing as a pain-coping technique.

Lothian's article goes on to described how, since the '60s, Lamaze has moved away from "prescribing" particular breathing methods and, instead, encourages women to tap into comfortable and yet purposeful breathing patterns that feel right to the individual. Moving from strict guidelines which suggest the "one right way" to breathe during labor and birth, a more organic, nimble and responsive approach to breathing-as-pain-reduction (and distraction) is urged.

And yet, there are practices out there, which many women find helpfully applicable to labor and birth, which do combine specific breath work with specific intention.

A friend of mine, Gloria Overcash, teaches both Kundalini and Khalsa Way prenatal yoga classes. During a recent class for members of our local birth network, Gloria introduced us to some of the breathing methods she teaches her students, along with the purpose behind the methods. Here are some of her insights:

"The science of breathing, known in yoga as Pranayama, is incredibly useful for pregnant women in a variety of circumstances. A simple, long deep breath can bring one back to the center in the most chaotic of times."

Here, I think of the usefulness of a calming, purposeful breath to help a laboring woman relax during a vaginal examination, during the insertion of an IV catheter, if needed, or following the conclusion of a contraction.

"There are a number of breathing exercises I teach in my prenatal classes to support mental and emotional balance," says Overcash, who recommends practicing breathing techniques in a cross-legged, seated position, or in a chair with a straight spine. "The chin is tucked slightly. The eyelids are closed and the eyeballs are rolled up, focusing on the "third eye," also known as the brow point, between the eyebrows. This 'drishti,' or eye focus, stimulates the pituitary gland, the 'master gland,' regulating the secretion of the thyroid, adrenal and reproductive glands while also increasing a mother's intuition."

When addressing use of the breath for relaxation during the active phase of labor, Gloria suggests, "Women in the active phase of birthing are encouraged to breathe naturally and consciously, creating a rhythmic focus which helps facilitate relaxation and a meditative state while also providing needed energy."

Lothian does a fantastic job outlining the progress Lamaze has made over the past fifty years teaching women about the labor process and methods of relaxation and pain-coping. Summarizing the journey of her article, and of Lamaze International, in general, Lothian states:

"Although many women continue to think of Lamaze as 'breathing,' it is no longer the hallmark of Lamaze. The six Lamaze Healthy Birth Practices (2009) are the foundation of Lamaze preparation for birth and reflect the evolution of the Lamaze approach to childbirth, one that incorporates a more complete understanding of the physiology of labor and birth and the danger of interfering in the natural physiologic process of birth without clear medical indication."

As always, Lamaze members can access the entire JPE on-line for free, and Springer Publishing also makes the Table of Contents as well as a couple select articles (including the one featured here) free to the general public. To complete the continuing education modules based on JPE articles, go here.

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