How to Breathe in Pregnancy and Postpartum
“I’m cleared! What exercises can I do first?!”
Breathe. I remember leaving my first Pelvic Floor PT appointment thinking, “wait, all she wants me to do is breathe?” I was so confused. How could breathing be part of my Return to Fitness programming? Wasn’t I breathing already? I had tons of questions. I quickly discovered in future sessions that breathing, moving, and trying to do everyday tasks in my postpartum body felt and looked different. In many ways I had to (re) learn how to breathe and move my body.
“Learning how to breathe correctly is the single most important thing you can do to keep your core intact during pregnancy and to help heal your body post baby.” - Expecting & Empowered
My goal today is to:
Introduce you to your “Core system.”
Learn how to take a full 360° degree umbrella breath.
Practice how to integrate that breath with a pelvic floor contraction (connection breath).
Understand common breathing dysfunctions and what to look for in your own body.
Let’s get started! :)
Meet Your Core Team
Your inner core “team” is made up of four muscles: diaphragm, transverse abdominis, pelvic floor, and multifidus. As Julie Wiebe notes, these four muscles work together, “like gears in a machine” to stabilize our body as we move throughout the day and during exercise. They are designed to activate to stabilize the center before any other muscle group in the body turns on (Hodges PW, and Richardson CA. 1997). For example, before you swing your arm, elements of your core turn on first. Crazy right?!
Pelvic Floor: Your Pelvic Floor is a powerhouse! The set of muscles and connective tissue sit at the base of your inner core inside your pelvis. So yes, they just happen to be near our lady parts. But, your pelvic floor deserves just as much attention and love as other muscles in your body. Your pelvic floor provides support for all of the organs that lay above it (like an awesome hammock!) and also helps maintain continence. As a crucial player in our central stability system (core), the pelvic floor MUST be considered when approaching core training. As Julie Wiebe notes, your pelvic floor is the “secret ingredient to a flat belly, keeping backs and hips strong and pain free, and helping you have great sex.” Who doesn’t want that? :)
Diaphragm: Your “breathing muscle.” The dome shaped muscle that forms the roof of the inner core and is located at the base of the ribs. We train the diaphragm with the rest of the inner core via breathing (more on that coming up). Every time we inhale and exhale our diaphragm is working!
Transverse Abdominis: The TA muscle is the front wall of your inner core, as well as the deepest layer of the abdominal muscles with fibers that run laterally across the abdomen. When the muscles contract the belly pulls inward. They are often referred to as the “corset muscles.”
Multifidus: The multifidus is the back wall of the inner core. These are deep muscles along the spine and are most developed (largest) in the low back area. From experience these are super difficult to find and isolate.
What happens during a “normal” breath?
During a normal breath your pelvic floor and diaphragm work as one awesome team. As we take a breath in the diaphragm draws air into our lungs, and pushes our insides down south. In response, the pelvic floor lengthens and descends. The abdominal muscles lengthen and expand outwards slightly in order to make room for the contents and increase in pressure.
Inhale: Expansion
Exhale: Compression
Inhale → Diaphragm descends, rib cage and tummy expand, and pelvic floor and transverse abdominis (TVA) lengthen down and out. This downward movement increases pressure in the abdominal cavity. Pressure isn’t a bad thing. It helps stabilize the spine and trunk.
During the inhale you should see expansion laterally, on the front (chest expansion and a little belly movement) and posteriorly. An umbrella opening and closing is a helpful visual since an umbrella expands in a 360 degree fashion.
Exhale → Diaphragm contracts upwards, pelvic floor recoils (much like a rubber band) and TVA is drawn inward. The system is in constant motion as you inhale and exhale all day long. When functioning properly, it moves like a piston, as described by Julie Wiebe.
Pregnancy tends to make the pattern described above a bit challenging. As the baby grows and the diaphragm becomes squished, breathing can become more laborious. The ribs flare to make space for added abdominal contents (hi baby) and pressure, which makes it more challenging for the diaphragm to ascend back up on exhalation.
That’s why it’s so important to start practicing early in your pregnancy, so you’re a pro by the time a big head is wedged against your rib cage :)
Why is this important?
Diaphragmatic breathing is a relationship between the diaphragm and pelvic floor. When the two are coordinating optimally they work together to adjust pressure within the abdominal cavity. Our ability to manage pressure plays a role in things like incontinence, healing a diastasis recti, pelvic organ prolapse, or pain in other areas of the body as other superficial muscles try to compensate (e.g. shoulder, hip, knee, back). Breath is pretty powerful.
Let’s Practice Diaphragmatic Breathing
Settle in to a comfortable position. Rest your head on a pillow to keep your neck muscles calm.
Inhales are soft, controlled, and through the nose. Sense your back, sides, and chest inflating with air. Think belly, then chest.
Inhales should be soft and quiet. Go for a 3-4 second count.
You can place your hands on your rib cage for feedback, or use a small band or scarf gently around the rib cage for feedback. Send air into the band.
Exhale audibly out the mouth. Softly for a 4-8 second count. Envision a soft “haaa” exhalation like you are fogging up a mirror with your breath. Allow the ribs to gently melt towards the floor below you.
Putting it all together: Connection Breath
The Connection Breath takes our breath one step further, integrating a pelvic floor contraction (kegel). Oftentimes with kegels there is a big focus on generating tension, but understanding how to release tension is just as important, both in pregnancy and postpartum. Practicing the connection breath will help you practice how to gain and release tension in the abdominals and pelvic floor, thereby helping regain tone throughout your entire core.
How to perform the Connection Breath: The connection Breath can be done sitting or standing, lying on your back with knees bent, or side lying, which is typically where I like to start. I find it easier to feel the connection and expansion of the rib cage on the inhale breath. On the inhale, focus on your 360° degree umbrella breath, allowing your pelvic floor to fully relax. On the exhale, breathe air “out” of your ribcage, belly, and the base of your pelvis. I find it helpful to add an audible sound. On the exhale gently contract the pelvic floor (20% max effort). Your TVA should follow the pelvic floor contraction and “pull” inwards. Jessie Mundell describes the full sensation using the terms: Scoop, Lift, and Pull.
Scoop: On the exhale breath think of a scooping sensation in your pelvic floor, gaining tension from back to front (anus to pubic bone). On the inhale breath, relax and release the opposite direction, from front to back.
Lift: Think of your Pelvic Floor as an elevator. On the exhale, find tension from the base of your pelvis to the crown of your head, slowly lifting up two floors, then release. Important: On your release focus on bringing yourself back to zero before restarting (ground floor). It can be common to stay at a level one or two, holding a bit of tension in the Pelvic Floor. But, allow yourself to fully relax.
Pull - Take a moment to find your hip bones on the front side of your body. Imagine there’s a wire connecting those two bony points together - the two sides of your pelvis. On the exhale breath feel those two bones pull close, feeling a sensation of the hip bones drawing together. You should feel a gentle pull in across the belly, and the skin should pull taut (like a trampoline) beneath your fingers. If you notice a bulge, reset. This may be a sign you are overdoing it. I like to incorporate the connection breath in a dynamic warm-up, but you can also practice throughout the week with 1-3 sets of 8-10 reps. You may find it’s pretty relaxing too :) Now that you know how to breath, I also wanted to also talk briefly about common breathing patterns so you can self-check.
Paradoxical breathing (backwards)
“Backwards breathing” is very common, especially among athletes (of all ages) and/or pregnant women as the baby takes up more space. By backwards breathing I’m referring to inhales moving UP into the neck and shoulders instead of down towards the abdominal cavity. You are essentially “pulling” air in. This breathing strategy utilizes the smaller, weaker muscles in your neck and shoulders, which often leads to tension in the upper body.
One quick tip: I want you to focus on relaxing your abs before you start your breath. It’s very common for women AND athletes to “suck in,” “pull belly button to spine,” or “brace/contract their abs” all the time. We have a cultural obsession with “strong abs" :) But, let your belly go. You can even place your hands on your belly as you practice your breathing.
Belly Breathers
Belly breathing happens where there is a lot of movement in the belly with every inhale, but very little movement through the rib cage. The goal is to increase awareness of movement through the rib cage. Breathing into the belly a bit is okay, but we don’t want ALL the air out on the midline.
Quick tip: Set up in a position where you are “blocking” off your belly. I love something like a rockback position, which essentially forces air into the posterior side of the ribcage. Belly breathing may be a strategy because you are unable to get air into other areas of the rib cage.
Once you have mastered your 360° umbrella breath, connection breath, and become more aware of different breathing tendencies, we can start integrating breath with movement in our everyday activities and in exercise. know this was a TON of information on breath, but it’s so important to understand and practice. With small adjustments we can help minimize pain and dysfunction, both now and in the future!
Questions? Comment below or send along a message anytime. I also have a FREE resource on my website that introduces breathing during the early postpartum period.
xoxo,
Erica