Do Breathing Exercises Work? Why Today’s Lamaze Is Not Your Ma’s Lamaze

The BBC is reporting on a new study about the effects of childbirth education classes that emphasize breathing and relaxation techniques. The headline, “Natural birth classes questioned” stands to fuel an already troubling trend that has more women skipping childbirth classes altogether.

Before we get swayed by headlines, let’s take a look at the study itself. This randomized controlled trial was conducted in Sweden with roughly 1,000 couples who attended four 2-hour sessions of childbirth education classes in the third trimester of pregnancy. It compared two different types of classes. The “standard” class gave equal time to childbirth topics as well as early parenthood and newborn care skills. The “natural birth” class did not cover early parenthood or newborn care, spending that time on relaxation breathing exercises instead. Seventy percent of the women actually used the breathing exercises in labor. The women who took the natural birth class were just as likely to have an epidural (52% in both groups) or give birth by cesarean surgery (20% versus 21%) compared with the women who took the standard classes. Likewise, there were no differences in the memory of labor pain at three months, whether the women reported positive birth experiences, and whether the women or men rated their parenthood experience positively.

There is plenty that this study does not tell us:

  • The study tells us nothing about the value or effectiveness of childbirth classes themselves. The study did not include a group that had no childbirth education.
  • The study tells us nothing about the use of other interventions, such as induction of labor, continuous electronic fetal monitoring, pitocin augmentation, or episiotomy. It is not surprising that the study does not report on these outcomes, because information about the indications for and side effects of interventions were not included in either type of childbirth class.
  • The study does not tell us at what point in labor women got epidurals. Some adverse effects of epidurals, including fevers (which can lead to antibiotic use and separation of the mother and baby after birth) and possibly cesarean surgery, are more likely when epidurals are given early in labor. If breathing and relaxation exercises enable a woman to delay getting an epidural, they might offer some health benefit after all. 
  • The study does not tell us what other pain relief methods were available to laboring women. It is possible that breathing exercises are more effective when used in combination with other methods, such as immersion in water, continuous doula support, or position changes.

Despite these limitations, the study provides important evidence that breathing techniques alone may not be enough to change women’s experience of childbirth, or their exposure to potentially harmful interventions. This trial, which is “all about the breathing,” reminds us that childbirth education shouldn’t be. Lamaze has known this for years, moving away from teaching a particular method or technique and toward educating women about how to achieve safe and healthy birth outcomes. The Six Lamaze Healthy Birth Practices form the foundation for optimal safety and wellbeing. If women are deprived of these basic elements of care – or don’t know about them – the labor experience becomes unnecessarily complex, not to mention more painful. Today’s Lamaze can simplify the process by teaching women how their bodies work, how to achieve greater comfort and control, and how to keep the process as safe and healthy as possible.

Citation: Bergstrom, M., Kieler, H., & Waldenstrom, U. (2009). Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG An International Journal of Obstetrics and Gynaecology, doi 10.1111/j.1471-0528.2009.02144.x.

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  1. avatar
    PfB Teri
    | #1

    To see the original study, it is posted on Debby Amis’s blog at http://www.thefamilyway.com Debby also has wise words about this research which is certainly grabbing headlines. AARRGGH!

  2. | #2

    You’re right. In the UK (unlike here) the medical journals are free access. The study is here. And I second the recommendation to The Family Way blog for another analysis and some wise thoughts on what makes for good childbirth education.

  3. | #3

    GREAT post. It’s refreshing to see someone able to break down a study like this and point out what the study is really about. :-)

  4. | #4

    Thank you so much for addressing this study. It has been popping up in my Google Alerts like crazy! What stood out to me in the article was the emphasis on breathing techniques. There is a lot more to childbirth education than that and if that is all the “natural birth” classes had to offer, no wonder the results were what they were. I appreciated the point that Debby made in her blog post about this as well that the women were randomly assigned to either group, indicating that they did not have a strong interest in natural birth (if they did, why risk being assigned to the non-natural birth classes!), so that perhaps the personal investment element was missing.


  5. | #5

    Great post! So many people just look at the headlines rather than the actual study. Thank you for putting this out Amy!

  6. avatar
    Linda Middlekauff
    | #6

    This study was so simplistic and as such very misleading as others have pointed out. As a very longtime nurse and LCCE, I’d like to add to the thoughts of others that knowledge of the process of labor and how to depend on the physical & emotional signs the laboring mom shows is a helpful tool in determining progress in labor in spite of what dilation and effacement show. This can give the laboring mom & her partner the determination to “keep going”. Another aspect in addition to comfort measures, activity, etc. is knowledge of keeping hydrated & regular urination to prevent some complications. Thorough explanation of interventions, their uses, side effects, and alternatives is a must. How to raise concerns to the medical professional is also important. There are so many essential components required for optimal outcome in each labor situation. For the students who avail themselves of all of this and do their part as well, the outcomes have the best potential for both mom, her partner, and her baby.

  7. | #7

    I used Lamaze breathing for all three of my births.it help me in some parts of my labor.my husband was my birth coach and supporting me threw my birth and my decision to use meds when need to be.my midwife helping me threw the labor. even Lamaze breathing help me when I had my C-section with my first baby it was emergency situation.my last baby I used Lamaze breathing all 19 hours of labor with my son .he weighed 9 pounds 22 inch long.

  1. | #1

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