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Middlesex-London Health Unit

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Breath Awareness1

Pregnant people around the world practice Pam England's breath awareness1 in preparation to work with the pain of labour and birth. Breath awareness is simply bringing your full attention to your breathing. This mindfulness “technique” when practiced everyday helps you relax and empower you in labour. It can also be used in many of life’s stressful situations related to being pregnant and parenting.

Your breathing is already perfect! Trust that your body knows how to breathe for you in labour. You don't need to try to change it. To practice breath awareness, find a quiet space when you have 5 – 10 minutes and simply notice when your breath begins and when it ends. Notice if your breath is deep/shallow, cold/warm, long/short, soft, or tight.

Ideas That Will Help You Focus on Your Breathing:1


Imagine one of the following with each breath:

  • A rose and its fresh smell while breathing in and gently blow out birthday candles as you breathe out.
  • A soft pink balloon inflating as you breathe in and slowly deflating as you breathe out.
  • Your pelvis or cervix gently opening, bigger than your baby.
  • The colour of your breath.
  • Waves rising onto shore with your inward breath and falling away with your outward breath.
  • Your favourite flower opening up as you breathe in and closing as you breathe out.

Using your senses:


  • Place your hands on top of your abdomen and feel where your breath goes in your body. Vary your hand placement to below your abdomen and then to your sides. Most pregnant individuals feel their breathing more at the sides.
  • Place your hand in front of your mouth - approximately 3 inches away, then 6 inches away, then 9 inches away and feel your breath.
  • Wet the inside of your hand, proceed as above, and feel the cool breath on your hand.
  • Have your labour support person lay their hands on your chest or abdomen and match their breathing to yours.


  • During practice sessions, breathe loudly enough so your labour support person can hear you and breathe with you. This helps your partner be in tune with you while you are in labour.
  • At the beginning of your contraction, take a deep breath, loud enough for you, your partner and/or other support person to hear your breath. In labour, this louder breath will alert everyone in the room to the fact that you are having a contraction and the focus should be on you. You can then continue with your breath awareness as a distraction and help you to work with the pain.


  • To practice, blow soap bubbles slowly and watch them float away. (Not for use in hospital)
  • You can also hold a piece of “tissue” in front of your mouth and watch it move as you inhale and exhale.


  • Hold a cotton ball dabbed with a small amount of Lavender or any other fragrance that is safe for use in pregnancy. Hold it 6 inches away, then 9 inches away and notice the smell as you breathe in. (Not for use in hospital)

Using Your Senses to Your Advantage in Labour1

  • Your labour pain will seem much less intense when you use outside sights, sounds, smells and sensations to enhance your breath awareness. The perception of pain lessens as you give equal attention to other sensations around you as well as to your breath.
  • To practice this, begin by lowering your eyes and notice your first outward breath. Use breath awareness as you do the following:
    • Notice what you see, but don’t look around.
    • Notice what you hear, but don’t listen for anything in particular.
    • Notice what is touching you and what you are touching.
    • Notice what you smell, but don’t look for a particular scent.
Breath Awareness pie chart

Using all your senses puts pain into perspective. With equal awareness of all sensations, you don’t feel pain as intensely.

Practice Before Labour Begins1

To help breath awareness become a natural response to stress or pain, it’s important to practice breath awareness daily through your pregnancy. Try using it during a quiet moment in your day or with any daily stressful experiences (e.g., traffic jams).

For a more ‘real’ pain experience, practice breath awareness while holding several ice cubes** in your hand for increasing periods of time - 30 seconds, 1 minute, 1 1/2 minutes (max) with 1 minute’s rest in between to imitate contractions. This is a great exercise to do with your partner as they can practice their support techniques and you can discover what is most effective for you.

**Please note: If you have Raynaud’s Syndrome or any circulatory problems, you should not use the ice exercise.

Additional Information

For more information, visit the Birthing From Within website at:

Date of creation: February 19, 2015
Last modified on: February 12, 2024




1England, P., & Horowitz, R. (1998). Birthing from within: An extra-ordinary guide to childbirth preparation. Albuquerque, N.M: Partera Press.