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RC: Hello everyone. This is Liz Harvey coming to you from our studios in New York City where we are dedicated to bringing you cutting edge interviews from many of the leading industry professionals across the US. In today’s episode, we are speaking with Stephanie Heintzeler. Stephanie is a German educated midwife, a U.S. educated doula, an acupuncturist and a certified lactation counselor. She is known as the New York doula.

Stephanie has delivered over 1,200 babies and has experience with twins, triplets, breach babies and water births. She also works with newborn parents in their post-partum stage and holds classes and seminars for moms and dads to be. With a wealth of experience and knowledge in her field, Stephanie Heintzeler is widely considered to be one of the top doulas in the country. She is also a contributing member of our national network of industry professionals.

Today we are going to talk about a very important topic:

Breathing Techniques for Labor

RC: Hello Stephanie. How are you today?

Stephanie Heintzeler: I’m very well thank you.

RC: Well thanks for joining me.

Why is it important to learn proper breathing techniques for labor?

Stephanie Heintzeler: Breathing techniques are really important during labor because that’s the only one thing actually that a mother has during labor. Pain is overwhelming. What is happening around her is very overwhelming in terms of medical team or going to a hospital or having IV fluids. So everything can be very stressful and a good breathing technique can help tremendously to stay relaxed. If the mother stays relaxed, the birth continues to go much better. We have less interventions. We have a better blood flow for the baby and generally less pain so mothers really notice that it helps them there. Sometimes they got laboring, for example, they have a doula with them, so they start laboring at home and I’m not there, and they learned a little bit but then they start laboring and I’m on my way but I’m not there yet, so once I’m there, they suddenly get what it means to breath properly until the contractions, then they feel so much better.

Are there different breathing techniques for the different phases of labor?

Stephanie Heintzeler: Funny, in the beginning the parents often use what they have learned in class and even during labor, early labor, they practice the breathing and they breathe in and out slowly, in and out, in through the nose and then out through the mouth, and they feel it doesn’t really do anything, when it’s early labor like that, a contraction every eight minutes, so they’re like, “Okay, whatever. We’ll just do it,” but then the contractions pick up and they go into so called active labor, and suddenly the mom’s like, “Whoa, this is the only thing I can actually use.” Suddenly she’s breathing much deeper so for the partner and the doula, it’s we work much more and closer with the mother in labor and the breath is mainly being used during the contraction and in between it is more about relaxation and remembering to let go of anything that tensed up during the contraction.

The breath becomes deeper but at some point when active labor is really intense, the mother might feel nothing works anymore, like she can’t even do any breathing techniques. She can’t do, you know, breathing in and breathing out, so then we use the techniques that are a little more guided. We use counting with the contraction, with like the peak, we count up to ten and then down to zero. We use vowels, so she’s breathing in and then she’s breathing out with an aaaaaa, then she’s breathing in and breathing out with an o, breathing in, breathing out with a u, and the partner, birth partner, is with the mother and reminds her which vowel to use, and that’s something that many moms really love in active labor because they have something, they sort of think about it, the need to follow someone and at the same time using vowels opens the pelvic drawer so birth goes much better.

Once transition happens, transition is a pretty intense stage in labor, sometimes moms even feel they have a little bit of an urge to push, so then we need to avoid that because you don’t want to push against the cervix that is not completely open yet, so we need more guidance again, and then sometimes we use shorter breaths, so to really help the mother to not like breath all the way deep in her pelvis when in fact she has this urge to push, so then we use sometimes panting, which we can also use for pushing, when she cannot push yet but there’s certain panting techniques, like you don’t want to get dizzy and you just don’t have a proper breathing technique.

Then, for pushing, it’s another breath again, that you kind of hold the breath and then here and there you breathe out and push at the same time, so it’s really yeah, there are very different breathing techniques and finding out every mother is different, so sometimes we need to try things out. We need to see what works best with this kind of contraction because you know, if it works for half an hour and then I notice the contraction changes, and then I know it won’t work anymore, so then we need to switch. We need to focus on something else.

Then, the other thing is, how alert is the mother. Is she still with me? Can she ask me questions in between contractions, which is the case in the beginning of labor but then later on, you give as little input as necessary because she won’t be able to take a whole explanation. I can’t be like, “Well, do this, do that, breathe here and position there,” you really need to give two sentences and then the mother knows what to do because there is only so little time between the contractions.

Is it possible to provide more oxygen for the baby during these breathing techniques?

Stephanie Heintzeler: In the end, nobody really knows but what we know is that yes, but because the mother feels better, so if she breathes deeply and is relaxed, that means the body is relaxed. That means there’s better blood flow throughout her body and therefore there is better blood flow for the uterus and placenta, and then baby, so it does really help. We’ve certainly had births where, especially as a midwife, where maybe I didn’t know the mother. I needed to connect with her first and she was all overwhelmed and didn’t breathe at all. She’s like completely out of it and holding her breath and maybe even screaming, and you know, and the baby wasn’t well either. I could see that, so in that case the goal is really to relax the mother. Yes, she’ll get some oxygen like on a mask but she needs to also breathe. She needs to breathe deeply and relax the body to give more blood flow to her placenta and that makes a huge difference.

The main thing is that all the moms say they just have a better connection with the baby when they breathe because the body is more relaxed so they feel the movement. If the mother is really tense, uptight and she doesn’t breathe and she doesn’t really know what the baby’s doing, then she gets more stressed, and then the baby gets distressed as well versus when she’s more relaxed and the baby is, you know, she has a connection to the baby and there’s better blood flow towards the baby, she really feels a huge difference.

Do some women try to hold their breath during labor and is this ever okay?

Stephanie Heintzeler: Yeah, not so much. Yes, some moms try to hold their breath. For the labor part, until the cervix is fully open, it is very important to breathe. Holding the breath, some really they get into pain and then they’re like, ah, ee … They’re kind of, you see the shoulders going up and it’s like, “well, hmm,” that’s not ideal because again, it hurts much more. The baby doesn’t get a lot of flow. She’s not very relaxed. It does happen sometimes, especially when contractions change or the water breaks. I had a mom last week, she was standing and she was breathing beautifully and then her water broke and suddenly the baby shifted and pushed against the cervix much more because that little bubble was gone, and she had a sudden urge to push and she wasn’t really open yet but the urge was there, so all the breathing techniques didn’t work anymore, so she did hold her breath because she didn’t really know what to do. In that case, I moved her back onto the bed and put in the hands and knees position, so she had less pressure and also used another technique so that helped her.

It does happen because moms also forget but the goal for every nurse, every doula, every midwife, every obstetrician is to keep breathing and keep the flow.

How do women remember all these techniques when it comes time to labor?

Stephanie Heintzeler: The most important with, to take a child birth class, where you practice those breathing techniques, and practice at home so you don’t forget. Hire a doula, that would be the key for me because I see it and even for the partners, it’s not only they forget, it’s also they can’t do this for eighteen hours in a row, so we alternate. You need another person who knows how to correct the mother when she doesn’t really know what to use. If you don’t want to hire a doula, just write it down. We write things down, some nurses in the delivery room they know about techniques but not all of them and it also depends on how much time they have to go over it but yeah, the main thing is take a class, practice, hire a doula.

RC: Thank you so much, Stephanie. We appreciate all your time and help today.

Stephanie Heintzeler: Thanks for having me.

RC: For our listeners across the country, if you are interested in speaking with Stephanie Heintzeler, please visit www.thenewyorkdoula.com or call 917-399-2031 to schedule an appointment and on behalf of our entire team, we want to thank you for listening and we look forward to bringing you more top quality content from our country’s leading industry professionals.