A. Early labor (0 to 5 cm)

1) Deep, relaxing breaths, in through the nose, out through the mouth. Think about blowing away the contraction.

B. Active labor (5 to 8 cm) and transitional labor (8 to 10 cm)

1) Howt: Short, faster, rhythmic breathing. Use high chest muscles to inhale and exhale. Inhale on "How,'' begin exhale on ~ and finish exhaling on ''t.'' Accentuate ''t'' on exhale to avoid buildup of carbon dioxide and risk of fainting. Start and finish with a deep, relaxing breath.

2) Howt breathing requires some practice. It also requires concentration to maintain in labor during a contraction, reducing the woman's ability to concentrate on fear or pain. The brain's response to fear and pain can cause a reduction in blood flow to the uterus (physiologic fight-or-flight reaction).

C. Panting (10 cm)

1) Panting breaths are best described as being like an overheated canine. These are used to help control the actual delivery.

D. Pushing (10 cm): DO NOT TRULY PUSH DURING PRACTICE!   ONLY PUSH WHEN OB PROVIDER INSTRUCTS YOU TO DO SO!

1) Take a deep, relaxing breath in and out at first feeling of contraction beginning. Inhale deeply and hold, while bringing chin down to chest.

2) Push while holding your breath, using the same muscles as those you use to have a bowel movement. (Use of the abdominal muscles is ineffective.)

3) Attempt to hold breath while pushing to the count of 10. Release breath and quickly repeat entire process. Attempt to get three pushes with each contraction.