A multigravida at 40 weeks gestation is in active labor with contractions every 3 minutes lasting 60 seconds. She appears anxious and is breathing rapidly and shallowly. Which breathing technique should the nurse teach her first?

Scenario: Multigravida at 40 weeks in active labor (contractions every 3 min, lasting 60 sec) with anxiety and rapid, shallow breathing (hyperventilation).

Priority Nursing Action: Teach paced breathing (patterned-paced breathing) as the first intervention.

• Interrupts the hyperventilation cycle by establishing a conscious, rhythmic inhalation-exhalation pattern.
• Matches the intensity of active labor contractions, making it more sustainable than deep abdominal breathing.
• Prevents respiratory alkalosis, dizziness, and impaired fetal oxygenation.
• Provides a cognitive focus that reduces anxiety and enhances the patient's sense of control.

1. Positioning: Assist the patient into a comfortable, upright or side-lying position to facilitate diaphragmatic excursion.
2. Initial Breath: At the start of a contraction, instruct the patient to take a "cleansing breath" (a deep inhale through the nose and slow exhale through the mouth).
3. Rhythmic Pattern: Guide the patient to inhale slowly through the nose and exhale through the mouth at a rate slightly faster than resting but controlled (e.g., inhale for 2-3 counts, exhale for 2-3 counts). The pattern should feel like a gentle, rhythmic wave.
4. Focus Point: Encourage the patient to fix her gaze on a specific object or close her eyes and concentrate on the rhythm of her breath.
5. End of Contraction: Conclude with another cleansing breath to signal relaxation and release tension.
6. Between Contractions: Encourage normal, relaxed breathing and complete rest.

• If the patient reports tingling in fingers or around the mouth, or lightheadedness, the breathing rate is still too fast. Slow the cadence and consider coaching breath-holding for a few seconds at the end of an inhalation.
• Never instruct a patient to hold her breath during a contraction; this performs a Valsalva maneuver, which can cause fetal bradycardia.
• Transition to panting (short, rapid breaths) only if the patient has an urge to push before full cervical dilation.