By Birth & Baby University · Last updated: October 2026 · 3 min read
Breathing is probably the most commonly taught labor coping tool, and it is often described with confidence: slow breathing reduces pain, lowers adrenaline, speeds labor. The trials are small, the techniques vary and the strongest claims are not supported. This article summarizes the evidence and what it means for teaching.
Key takeaways
- A 2017 randomized trial of 250 women found slightly lower pain scores and a shorter second stage with breathing exercises, but the pain difference was small.
- A 2023 meta-analysis found breathing exercises shortened second stage in trials of 1,418 participants, but the review’s methods and trial quality limit certainty.
- A 2024 meta-analysis of mind-body methods found large reductions in pain for hypnosis and mindfulness, with breathing skills one of six categories studied, and hypnosis and mindfulness did not reduce epidural use.
- Breathing instruction in antenatal classes was associated with greater self-efficacy and sense of control, with inconsistent evidence across studies.
What the research says
A randomized trial in the second stage
A randomized trial of 250 women compared one session of breathing exercise training and use during second stage with no training. Mean pain scores were 88.2 in the intervention group and 90.5 in the control group (P < 0.001), and second stage was shorter in the intervention group. First-minute Apgar scores did not differ. The pain difference was only about two points on the study’s visual analog scale, and the study was in one setting with an unblinded intervention, so the trial supports a small effect at most.
Pooled evidence on labor duration
A 2023 systematic review and meta-analysis of trials published between 2005 and 2022 (1,418 participants) concluded that breathing exercises shortened the second stage of labor. The review included randomized and quasi-experimental studies and was the first of its kind on this outcome. It reported that techniques and comparison conditions varied, which makes it hard to say which breathing approach works.
Breathing within broader mind-body approaches
A 2024 meta-analysis of 24 trials grouped interventions into hypnosis, mindfulness, breathing skills, muscle relaxation, guided imagery and therapeutic touch. Hypnosis and mindfulness showed large reductions in pain intensity (SMD -1.45 and -1.22) but did not reduce epidural use, and heterogeneity was very high (I2 above 90%). All categories were associated with shorter labor, and mindfulness was associated with fewer cesareans (RR 0.46, 95% CI 0.21 to 0.97) and less fear of childbirth. The authors called for more rigorous trials. The breathing-only category was not singled out as showing a large effect in the abstract.
Learning breathing in antenatal classes
A 2022 systematic review of 10 studies found that antenatal classes with skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support (specifically epidural), and memory of labor pain, with no effects on neonatal outcomes. The authors rated the quality of evidence as inconsistent because classes included many different components, so the effect of breathing alone cannot be separated.
What this means for doulas
- Present breathing as one coping tool among several. Evidence supports possible modest benefits for pain, sense of control and self-efficacy, not guaranteed relief.
- Avoid prescriptive patterns. The research does not identify an ideal rhythm, and rigid breathing rules can add pressure.
- Do not claim effects on hormones or labor speed. Trials point to possible shorter second stages, but with weak methods and inconsistent techniques.
- Combine with other support. In the meta-analysis, several mind-body approaches helped, which fits a menu approach.
Putting the evidence into practice
- Teach two or three simple patterns (slow nasal inhale with longer exhale, sighing out, humming) and let clients experiment and choose.
- Rehearse during pregnancy so the skill feels familiar, since self-efficacy was the most consistent benefit.
- During labor, breathe with the client when they want you to, and drop the pattern if it adds stress.
- If a client feels dizzy, tingly or panicky while breathing quickly, encourage a slower rhythm and tell the nurse if symptoms persist.
The bottom line
Breathing techniques are safe and may modestly help with pain, confidence and sometimes second stage, but the evidence is thin and uneven. Doulas serve clients best by teaching flexible options and avoiding promises about hormones or speed.
This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work.
Sources and further reading
- Yuksel H, et al. Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. Journal of Integrative Medicine 2017. Read the source
- Issac A, et al. Effectiveness of breathing exercise on the duration of labour: a systematic review and meta-analysis. Journal of Global Health 2023. Read the source
- Wang R, et al. Effectiveness of mind-body interventions in labour pain management during normal delivery: a systematic review and meta-analysis. International Journal of Nursing Studies 2024. Read the source
- Leutenegger V, et al. The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review. BMC Pregnancy and Childbirth 2022. Read the source
Teaching and coaching breathing is part of childbirth education and doula practice. See the options on the For Doulas page.
More for professionals: the Professionals Blog.
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