There are two primary breathing patters for pushing that women use to move the baby down the birth canal. The first pattern is more natural and incorporates an exhalation during the strong physical work of pushing. Exhaling during a strenuous action is a technique used by athletes to prevent injury. For many women, this first pattern is sufficient. Other women need to push more forcefully to make any progress. The second pattern, which incorporates breath holding, limits the time the breath is held. Long breath holding and forceful pushing, called the Valsalva maneuver, is not recommended, since it can cause your blood pressure to drop and thus decrease the amount of oxygen your baby receives.
Gentle pushing is the preferred method of helping the baby down the birth canal. As the contraction begins, take relaxing breaths until you feel the urge to push.
Then inhale deeply to expand your lungs, tuck your chin onto your chest, purse your lips, and exhale slowly and steadily as you bear down using your diaphragm. When you need to take another breath, lift your head, inhale slowly while continuing to maintain some pressure against the uterus, tuck your chin, and exhale through your mouth as you bear down. Repeat this pattern until the contraction ends. When the contraction is over, take several relaxing breaths and try to completely relax your body until the next contraction begins. (See Figure 5.6).
Breath Holding While Pushing
Pushing while holding your breath, also known as the modified Valsalva maneuver, is used by women who need to apply more force to help their baby in the trip down the birth canal. As the contraction begins, take relaxing breaths until you feel the urge to push. Then inhale deeply, let a little air out, tuck your chin, hold your breath, and bear down using your diaphragm. Directing the air downward, rather than holding the air in your cheeks, reduces the tension in your face and neck, and lessens your chance of breaking small blood vessels in your face and in the whites of your eyes.
While you hold your breath and push, your partner should count slowly to 6 to pace your effort. When he reaches 6, ease the breath out slowly to maintain abdominal pressure and to keep your diaphragm down on top of the uterus. Straighten your neck and inhale again, let a little air out, hold, tuck your chin, and push while your partner counts. Repeat the pattern as many times as needed during the contraction. When the contraction ends, gradually stop pushing as you exhale slowly. Take 1 or 2 relaxing breaths and relax completely. (See figure 5.7).