In which order would paced breathing techniques be used as a client progresses through labor?

Believe it or not, your due date will be here before you know it, and the third trimester is the perfect time to start practicing relaxation and breathing techniques that you'll use during childbirth.

Even if you have already decided to have an epidural or opioids to relieve pain — or if you change your mind about natural childbirth and ask for pain medication midway through your delivery — these techniques can help you manage any discomfort you do feel and actively participate in your baby's birth. Use these techniques, in addition to those you learn in childbirth class, to teach yourself to work with your body and make labor easier on yourself and your baby.

These techniques may be especially useful in early labor. If your baby is moving and you haven't broken your water, stay at home for early labor.

RELATED: Early Labor Symptoms: How to Recognize the Signs

One of the best ways to relax during labor is to learn to isolate different muscle groups in your body. Your uterus must contract to push the baby down and retract the cervix over the baby's head. If other muscles are tight during contractions, you're wasting energy and oxygen. By learning to relax the rest of your muscle groups, you can focus on allowing most of your oxygen to travel to your uterus.

To learn how to relax your body during contractions, work with your partner or labor coach. Prop yourself up against the pillows in your bed or lie on your side. Starting with your toes and moving up toward your head, focus on relaxing each individual set of muscles in your body.

Have your coach issue different commands, one at a time, asking you to contract different muscle groups. For instance, if your coach says, "Contract your left arm," raise that arm and make a fist. Your coach should check to see that the rest of your body is relaxed by lifting different parts of your body. They should feel heavy and loose in his hands. Then have your coach say, "Relax your left arm." You should focus on letting that arm fall slowly until it's heavy enough for him to feel the weight of it in his hands.

The goal here is to learn how to relax your entire body while one muscle contracts. Ideally, during early labor your coach will be able to help you relax your entire body when your uterus is contracting. How long you will be able to keep doing this throughout labor depends on how skilled you are at relaxing your muscles and the type of labor you are having.

RELATED: 8 Ways to Manage Labor Pain

No matter what your birth experience, breathing techniques can help make it faster and easier. Practicing them for several weeks before your delivery can delay or eliminate the need for pain medication during childbirth. You will no doubt learn Lamaze or other breathing techniques if you take a childbirth class.

Although there are variations, the point of most of these exercises is to teach you to focus your energy and work with your body as your baby makes her way into the world.

RELATED: Labor Pain Explained: Stages, Symptoms and Pain Relief

Once labor contractions get so regular or intense that you have to stop a conversation or halt your activities, it's time to start your paced breathing. Practice paced breathing techniques every day, starting at least 2 months before your due date:

• Take a deep breath to fill your lungs completely and exhale it.
• Channel your energy by focusing on one spot on the wall, ceiling, or floor (depending on your position).
• When your coach says, "Contraction begins," take 5-10 deep breaths for a minute. As you inhale, place your hands on the lower part of your abdomen and stroke gently upward toward your ribs. As you exhale, let your hands glide back down. Massaging the uterus during a contraction can help ease the discomfort, much like massaging a cramp in your leg. Your coach should count out a minute in 15-second intervals so that you can track the time and peak of each contraction: "15, 30, 45, 60."
• Breathe normally when your coach says, "Contraction ends."
• Practice your paced breathing exercises in all of the basic labor positions — sitting in a chair, reclining on pillows, lying on your side, standing, and kneeling against a large ball or bed.

RELATED: 10 Ways to Ease Contractions Without Drugs

In active stage 1 labor — when your cervix has dilated about 5 centimeters — the slow, deep breaths of paced breathing may no longer be enough to get you through a contraction. Then it's time to modify your paced breathing to keep up with the pace and intensity of labor.

Practice modified paced breathing, starting at least 6 weeks before your delivery date. Doing it daily will help you master conditioned responses to your labor coach's commands:

• Take a deep, relaxing breath.
• When the coach says, "Contraction begins," start with your slow breathing. Accelerate your inhale-exhale pattern as the contraction builds and peaks, using faster, lighter breathing. It will help if your coach counts out each contraction for a minute, "15, 30, 45, 60 seconds," so that you'll know when to start slowing your breathing again. Generally your contraction will peak around 30 seconds, and you can slow your breathing after that.
• There is no one right time to start modified breathing, or one right pace. Generally you'll be breathing at twice your normal rate. The important thing is that your breathing should be regular, and you should take in the same amount of air that you exhale. If you feel light-headed, that means you're breathing in more oxygen than you're exhaling; if you find that your breaths are shallow, you're probably letting out more air than you're inhaling.
• You may still find that massaging your uterus, as described on the previous page, helps you keep time and get through the contraction. However, some women find the extra sensation too overwhelming and have to stop at this point. Ask your partner to massage your thighs or back instead.

RELATED: Stages of Labor: What to Expect When You Give Birth

The point of controlled breathing during transition and second-stage (also called "expulsion") labor is to keep yourself from bearing down and pushing — no matter how much you might want to — until the doctor or midwife tells you that your cervix is fully dilated and ready.

You'll feel a lot of pressure in your rectum, almost as if you need to move your bowels, and you'll need to use some special breathing to distract yourself from wanting to answer this call to push your baby into the world. This is important because if you push too soon you may have more swelling and tearing of your cervix.

Try the following techniques:

• When your coach says, "Contraction begins," take a deep breath; then pant several times.
• When your coach says, "Urge," instead of exhaling in one breath, imagine a candle in front of your face. Make an "O" with your mouth and try to blow it out.
• Repeat this pattern of breathing several times for each urge to push. Many educators describe this pattern as "six pants, one blow" so that you're saying something like "hee, hee, hee, hee, hee, hee, who!" Blowing air outward makes it impossible to strain downward to push your baby out.
• When it's time to push, you're going to use your entire body to bear down with your uterine contractions, so take deep breaths and lean into the contraction.
• Bear down with all your might, slowly exhaling and grunting or groaning as you tighten your abdominal muscles and exert more pressure on your diaphragm. Visualize your baby moving downward and assume a position that will work with gravity instead of against it.
• Don't push or bear down between contractions. Use that opportunity to rest and wait for the next urge.
• Practice these pushing breaths in the different labor positions to choose the ones that feel most comfortable for you. But don't push — it's way too early!

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