Yesterday in the NICU I donned my N-95 mask, my gloves, my hair covering, my shoe coverings, then my plastic blue gown because we are out of the paper, slightly more breathable gowns. I stepped up to the isolette, called the baby’s mother on the ipad and waited for her to answer. The service is poor in the windowless NICU, deep in the interior of the hospital. The black screen flickered as the baby’s mom’s face appeared. The dark circles under her eyes revealed the sleepless night you would expect of a COVID positive mom who gave birth to a pre-term baby four days ago. The anxiety and worry in her eyes began to wain, as I placed the ipad upside down on top of the incubator so that through the marvel of technology, she could gaze down at her peacefully sleeping three pound baby. As emotion overcame her, I reminded her to breathe. I did not want her to go into a coughing fit, exacerbating her COVID and hurting her C-section incision. Eventually her breathing returned to normal, and she was able to continue admiring her baby from afar.
The heat of the plastic gown and mask in the 75 degree NICU began to overwhelm me and it was time to remind myself to breathe. Slowly and methodically in my nose and out my mouth, I took deep breaths to keep myself grounded and in the moment.
How often do we tell our patients to breathe? During exercise, ADL’s, walking, stress management… How often do you remind yourself to breathe?
When I first started teaching yoga, sometimes I felt silly constantly reminding the yogis to breathe. Of course they are breathing. But something about hearing the word “breathe” just makes us more intentional about that inhale and exhale. It becomes more purposeful and cleansing as we focus on the breath coming in and going out. I used to work with children with Postural Orthostatic Tachycardia Syndrome (POTS) in a POTS clinic and one of the most important things I taught them every day was to breathe. I taught them to place a hand on their lower belly below their belly button and another hand on their chest. I encouraged them to take in a nice deep breath so they felt the abdomen extend first, then their chest rise next. This brings the air all the way to the lower belly. Then I instructed them to exhale at half the speed of the inhale. Then we began to slowly count. Four counts for the inhale, eight counts for the exhale. I taught them to exhale through pursed lips, as if they are blowing out candles on their birthday cake. We repeated this for several minutes until their heart rate slowed and they began to feel calm and relaxed. This form of diaphragmatic breathing allows the lower belly to apply pressure to the intestines, where the calming hormone, serotonin is released from. The pressure releases the serotonin, tricking the body into calming as the serotonin runs through the bloodstream, counteracting the stress hormone, cortisol.
These deep, cleansing, diaphragmatic breaths are invaluable to our patients and to us as practitioners as well. Do it now for practice. One hand on your lower belly, one hand on your chest. Deep inhale through your nose. Feel your lower belly expand, then feel your chest slowly rise. Exhale slowly through your pursed lips. Do it again. Do it again. Feel the calm wash over you. Now tuck this away in your bag of tricks. Noone has to know you are doing it. Use this breathing technique throughout the day to keep your blood flowing with optimal oxygen and serotonin, keeping you calm and grounded. It sounds simple, but there is a lot to be said for this simple breath.
Cortisol wreaks havoc in our bodies, increasing sugar in our bloodstream, altering immunity, suppressing digestion, increasing tension in our muscles, and disrupting almost all of our body’s natural processes. Long term effects of increased cortisol can result in anxiety, depression, digestive problems, headaches, heart disease, sleep problems, weight gain and memory and concentration impairment. Let’s not get to this place. Let’s address it in the moment. Breathe...just breathe.