Midwives & Doulas: Coaching Breathing for Labor and for Life

In one short lesson, midwives and doulas can extend their already powerful influence on birth outcomes to improving the entire life of the mother.   It is something that you already support women with: breathing.  With a little knowledge and practice, you can take the power of diaphragmatic breathing and extend the benefits of your services to include: joint pain relief, speedy postpartum tummy recovery, core stability and the foundations for rehabilitations like C-sections, diastasis and pelvic girdle pain / sacroiliac (SI) joint dysfunction.  This one addition to your coaching allows you to offer greater service to your clients, which puts you in demand and earns you referrals and a very successful birth business.

I can tell you from my personal experience as an educator in the perinatal fitness world that proper diaphragmatic breathing activation is consistently the single most important concept that I teach to clients and fitness professionals around the world.

As a midwife or doula, it’s likely that you are already teaching breathing as a way for your moms to make it through childbirth with focus and calmness.  Whether it’s the meditative focus, the energetic field enhancement, or some other physiological shift of the body, deep breathing is effective and you know that it is the foundation of all childbirth preparation courses.

Breathing affects much more than just labor and delivery, however.  Breathing is also the foundation of one’s core, as well as one’s electromagnetic field generation, parasympathetic stress relieving response, and cellular nutrient/toxin exchange. Sub-optimal breathing is a major stress to the body.

As it turns out, it is likely that your client isn’t breathing properly¹, meaning that she doesn’t optimally breathe with her primary breathing muscle, the diaphragm.  To assess your client, ask her to take 10 deep breaths while standing or seated.  According to biomechanics scientists, you should visibly see her belly, sides and back of her ribs expand for the first two-thirds of her breath.  The breath should also look like the muscles in her midsection are inspiring it. What you will usually see—in all but the best yogis, singers or musicians—is the faulty pattern of her chest and shoulders rising dominantly.  And if her breath fills this way now, then you can be assured that this neural pattern is what her brain is choosing for all of her activities, from childbirth to exercise to doing the dishes to sitting before you in each and every prenatal appointment.

The problem with faulty breathing is that it is literally straining to the musculo-skeletal system about 20,000 times per day (the approximate number of times that the average person breathes each day).  Consider now that the diaphragm muscle is top of the totem pole in human muscle function, just like the heart muscle.  Imagine for a moment what would happen if your heart wasn’t quite strong enough to pump blood effectively through the body? First, the brain would say, “I’m going to die if I don’t find a work-around ASAP,” and then a chemical stress response would initiate.  Second, the brain would do everything in its power to activate secondary helper muscles, effectively placing strain up and down the entire kinetic chain.  That’s what happens when diaphragmatic breathing is not optimal.

Have you ever had a prenatal mom suffering aches and pains? How about tension headaches or feeling over stressed? These are just a few shorter-term results of over straining the secondary respiratory muscles all day long, every day. And you can keep sending her to get a massage, sure, but if you want to solve the root of the problem, strengthen her diaphragm.

The diaphragm is the primary “inner unit” core muscle, as many fitness professionals today are now learning.  And as the saying goes, you are only as strong as your weakest link.  In practice, most fitness moms are doing “core” exercises, but never actually optimizing their core.  (You can burn the abs all you want, but if your diaphragm doesn’t work in synchronous harmony, you’re just burning calories while perpetuating a faulty motor program.  And this directly worsens conditions like diastasis and pelvic girdle pain / SI joint dysfunction.  In fact, doing abdominal exercises with a dysfunctional core inner unit can cause one’s midsection to expand, rather than flatten).

In other words, a strong diaphragm allows for a strong core, which can foundationally solve or prevent a lot of problems. Proper diaphragmatic core function equates to proper muscle alignment and posture as well as optimal shock absorption properties. This equals less strain on the joints, and less likelihood of experiencing mal-alignment issues like pelvic girdle pain and SI joint dysfunction.

And proper diaphragmatic core function also results in a speedy postpartum tummy recovery for your clients. Here’s another saying:  “Use it or lose it.”  Your prenatal client can tone her abdominal muscles 20,000 times each day, every time she breathes. Not only does this usually elicit better function of the abdominal muscles for skeletal stability, but her tummy muscles will know how to return after her newborn arrives.  Add that to your marketing materials and watch how business picks up for you.


Inner Workings of the Core and Diaphragm

To make a simple point on a potentially complex topic, imagine a core pump in which the diaphragm and the transverse abdominis (TVA) muscles work in harmony.  When the diaphragm contracts, it shortens and moves lower into the abdominal cavity (this is why the tummy and ribs will appear to fill with air).  But while this is happening, the TVA muscle must expand or lengthen (which will either be an eccentric contraction, or a relaxation of the TVA muscle).


Doula BreathingMuscles of the Core’s “Inner Unit”

Then during exhalation, the diaphragm relaxes and returns to its original rest position, allowing the TVA to concentrically contract and return to a flat(ter) tummy position.  This TVA shortening acts as the very important corset of the body, one that supports the spine while lifting anything from a couch to your client’s one-day-old infant.

What has fitness instructors trigger-happy these days is the concept of drawing in the TVA, for better and for worse. What is starting to happen is that this kind of “fitness core awareness” often adds to further shut off the diaphragm as the woman is taught to suck in the mid-section. More and more, fitness minded people are unknowingly preventing their diaphragm from traveling into the abdominal chamber with a full range of motion, literally reinforcing faulty core mechanics, muscle imbalances, and dysfunction all over the body.

Where C-section rehabilitation comes into play is primarily due to the fact that a C-section cuts the TVA muscle and other fascia in the area below the navel and above the pubis bone.  Severed muscles mean that neural signal no longer travels optimally to the area below the scar, for example.  The foundation for re-teaching this neuromuscular connection is to access the Core Breathing Belly Pump™, same as the aforementioned solutions.


Accessing the Core Breathing Belly Pump™

Here is a conceptual four-step approach that may allow you to add services like joint pain relief, speedy postpartum tummy recovery, core stability and the foundations for rehabilitations like C-sections, diastasis and pelvic girdle pain / sacroiliac (SI) joint dysfunction to your business.

  1. First, educate your client on the importance of the diaphragm-TVA pump mechanism, perhaps even hand them this article.
  2. Second, teach diaphragm muscle activation by coaching her how to breathe deeply and primarily into the belly and ribs without over-using the chest and shoulders.  Don’t hurry past this phase.
  3. Third, after she is proficient in diaphragmatic breathing, coach her how to gently activate her TVA when she exhales.
  4. Fourth, remind her to practice this “Core Breathing Belly Pump™” as often as she can think about it—at stop lights, doing the dishes, on the phone, when exercising, etc.  Remind her that she is re-programming a neuromuscular pattern, and that she has about 20,000 opportunities each day with which to practice.

If you are eager for a few more specifics, here is a 5-minute sequence of exercises/positions that you can follow with your clients when you meet with them.  It will not likely be appropriate to use all eight of these exercises at each meeting. Instead, you’ll use the few that seem intuitively most needed for her progression from easy to difficult, and you’ll make sure that she correctly activates her diaphragm and TVA core pump.  It’s not what she does; it’s how she does it.  Your best way of knowing if your client is ready to progress is (1) that you see her inhalation fill her belly/ribs and you see her belly get smaller when she exhales, and (2) your client feels like she understands what her objectives are and feels like she is improving.

  1. Beginner:  Supine Deep Diaphragmatic Inhalations
  2. Beginner: Supine TVA Exhalations
  3. Beginner: Supine Core Breathing Belly Pump™ with alternating tiny knee lifts (bent knees starting position, should seem very easy—this is just for programming the core breathing to initiate the leg movement)
  4. Intermediate: Quadruped “Horse” Hands & Knees position using Core Breathing Belly Pump™
  5. Intermediate: Side Plank from the knees using Core Breathing Belly Pump™
  6. More Challenging:  Seated/Standing Deep Diaphragmatic Inhalations
  7. More Challenging: Seated/Standing TVA Exhalations
  8. More Challenging: Seated to standing (squatting) while synchronizing the Core Breathing Belly Pump™
  9. Apply Core Breathing Belly Pump™ to all activities of daily life

Notes for the Pre & Post Natal Professional:

  • Generally teach competency in diaphragmatic inhalations before progressing to TVA exhalations, as this will help ensure that the diaphragm does not remain underactive.
  • Generally move from the horizontal positions to the vertical positions, as this will be an easier progression for your clients to learn.  (Most people are chest breathers in their upright daily activities, but will be able to breath more diaphragmatically when they lie down.  This is likely due to upright association with stressful habits and patterns that elicit chest breathing whereas lying down tends to associate with relaxation and parasympathetic dominance.
  • Supine positions can cause lightheadedness in some clients, make sure you make her aware of that and let her know that it is OK to move out of the position if she needs (or not participate in the supine position at all).

Now you have the information to take breathing as one of your basic teachings as a midwife or doula and really knock it out of the park.  Teaching a few of these basic principles to your pre and post natal clients will not only enhance their experience of breathing during childbirth itself, but it will lay a foundation for an easier, safer, and more empowering pregnancy altogether.  In addition, you will be teaching your client tools to bounce back fast into her pre-pregnancy body, a service that many women will be searching for and spending money on.  And last but not least, you will be giving your clients a tool that they can use for the rest of their lives whenever they are feeling over stressed, have a back ache or just want to play with their kids and grandkids a little longer and with more vitality and ease.


¹ Fit For Birth experience is that about eight or nine out of every ten perinatal women fail breathing assessments.
James Goodlatte is the founder of Fit For Birth, where corrective exercise and progressive education techniques are used to educate Pre and Post Natal Fitness and Wellness Instructors all over the world. The mission of the company is to help professionals become pre and postnatal leaders who heal families by inspiring the use of natural solutions to free families from unnecessary infertility, mechanized childbirth, and chronic disease in our infants.  You can find out more about their flagship course, the Pre & Post Natal Corrective Exercise Specialist, at www.GetFitForBirth.com.  

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