Pre & Postnatal

How to Breathe in Pregnancy and Postpartum

Learning to Breathe

“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. 

Barre3Childare

“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: 

  1. Introduce you to your “Core system.”
  2. Learn how to take a full 360° degree umbrella breath.
  3. Practice how to integrate that breath with a pelvic floor contraction (connection breath).
  4. 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?!

Inner Core Canister
                    Image courtesy of Brianna Battles

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 incorporated into core work. 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 by breathing correctly (more on that coming up). 

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. 

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. On this inhale breath you should see movement through the belly, not a “sucking in.” 

Breathing
                        Image: Girls Gone Strong

Inhale → Diaphragm descends, rib cage and tummy expand, and pelvic floor and transverse abdominis (TVA) lengthen down and out.

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, PT. 

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. 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 in your rib cage 🙂 

Why is this important? Your diaphragm is part of your awesome inner core team, and if it’s not working properly, it loses connection with the entire central stability team. This is when mama may experience incontinence, pressure, a large diastasis recti, 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. 

Diaphragmatic Breathing

For a full breath, start by taking a long, slow breath in through your nose. As you inhale, your stomach should rise and your ribs expand to the sides. We often refer to this as a 360° umbrella breath, thinking about how an umbrella opens up on all sides. With rib cage expansion we also incorporate front and back movement. You should feel your rib cage push out gently into your hands and your belly gently rise. Allow your abdomen and pelvic floor to relax and expand. On the exhale, breathe out all your air and allow your belly to come back gently towards center. 

One technique I learned from Jessie Mundell is to wrap a light resistance band around your rib cage, right around your bra line. With your inhale breath, focus on breathing into all sides of the band. Sometimes the bit of feedback can help. 

Note: Postpartum you may find it challenging to breathe into one side of your rib cage in particular. This great video from Expecting & Empowered has a few tips on rib angle correction. I also recommend consulting a PT for individual guidance. 

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. Doing a million crunches will not train the whole 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 (20-30% 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. 

Chest Breathing

“Chest breathing” is very common, especially among athletes (of all ages) and/or pregnant women as the baby takes up more space. Why can chest breathing be problematic? Chest breathing utilizes the smaller, weaker muscles in your neck and shoulders, which often leads to tension and pain in the upper body. Chest breathing also doesn’t allow for your diaphragm and pelvic floor to work as a coordination system. 

How do you know if you’re a chest breather? A good clue is body positioning and alignment. A chest breather often finds themselves in a bell “run up” position, as described by Julie Wiebe. This means your chest is pointed up towards the sky, which often results in breathing in the shoulders and upper chest, with very little movement in the belly (middle photo). 

FindNeutralSpine

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. Julie wrote an interesting post talking more about the increased pressure that may come along with a “strong core” here. Similarly to squeezing a balloon in the middle, the air in the balloon needs to shift up, out the top, or down at the bottom. In your own body this may result in altered breathing patterns, breath holding, and reduced respiratory capacity. The pelvic floor may not be able to sustain the pressure, which may result in incontinence (women AND men). I’ve also personally found a pelvic floor contraction very difficult to achieve in the bell rung up position. 

chest breather
            Image: Julie Wiebe

The first step with chest breathing is to be aware of it and to focus on alignment of your rib cage. More on finding neutral here.  The next step is to practice your full 360° umbrella breath. Start lying down, propping your head up on a pillow or with a towel. Place your hand on your chest. Relax your abdomen on your umbrella inhale. As chest breathers there isn’t a ton of space for the inhale, so really focus on that expansion in your neutral position. On your exhale, breath out like you are breathing out through a straw, allowing all the air to leave your body. Your abdomen should rise and fall to follow your breath. 

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. A belly breather tends to be in what Julie Wiebe describes as a “bell rung down” position, meaning the rib cage is actually positioned downward. Posture tends to be a bit more slouched, with butt tucked under and rib cage positioned behind the low back (this can be very exaggerated or barely noticeable). 

The goal is to increase awareness of movement through the rib cage. 

Step One: Focus on drawing air into your whole chest. Use the air to open the rib cage like an umbrella, around all sides. You want to find some movement through the rib cage, with only a gentle rise in the abdomen. Relax on the exhale. 

Step Two: A great place to start is with small inhales, especially if you are having trouble finding movement. Only inhale as far as you can without feeling a big belly rise. 

Step Three: On your exhale breath, pretend like you’re blowing out through a straw. 

Practice laying down on a firm surface, with a pillow propped behind your head. Start with 10 deep umbrella breaths. 

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. Post coming soon!

I 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. 

xoxo,

Erica

One quick note: Although my focus is on pregnancy and postpartum, dysfunction is not limited to women who have had children. This video interview with Julie Foucher & Julie Wiebe goes into more detail on core function and athletes (men too). 

 

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