Is breathlessness in pregnancy normal?

Very commonly yes — around three quarters of pregnant women report it, and it often starts in the first trimester because of hormonal changes to respiratory drive rather than because of the bump. Sudden or severe breathlessness, or breathlessness at rest, is different and needs assessing.

Can I do breathing exercises while pregnant?

Slow nasal breathing, long exhales and rib-focused breathing are appropriate. Avoid breath holds, the Control Pause, strong reduced-breathing training and any rapid technique — those are contraindicated in pregnancy.

Why does it get worse lying down?

Lying flat raises the diaphragm further and increases central blood volume. Side-lying with support, and raising the head of the bed, is usually enough. Breathlessness that only happens lying down, or that wakes you, should be mentioned to your midwife or doctor.

Breathless in pregnancy: what is normal, and what is not

You are twelve weeks in and getting breathless talking. Later it is stairs, and then lying down. Everybody says it is normal, which is mostly true and not a reason to ignore the versions that are not.

Do this now

Make room, three minutes

3 minutes

Sit tall, or side-lying with a pillow under the bump. Not flat on your back.
Mouth closed. Breathe in through the nose and aim the breath sideways into the lower ribs rather than down into the belly.
Feel the ribs widen. Out slowly, a little longer than in.
Three minutes, small and unforced. As pregnancy progresses the ribs are where the room is.
Then stand and roll the shoulders back once. Posture gains you more space than technique does.

Run it with a timer

Why it starts in the first trimester

Progesterone increases respiratory drive early in pregnancy, so you breathe more and arterial carbon dioxide falls by design — a mild, normal respiratory alkalosis that helps carbon dioxide cross from the baby to you. The subjective result is breathlessness, and the fact that it precedes any mechanical change is why the bump does not explain it. Around three quarters of pregnant women report it.

Then the mechanics change too

Later on, the diaphragm sits higher and the ribcage has to work differently. Tidal volume rises substantially while the rate barely changes, and the lower ribs take on more of the movement. This is why the breath aimed sideways into the ribs works better in the third trimester than the belly-breathing instruction that suits everyone else.

Which breathing practices are appropriate

Slow nasal breathing, long exhales and the three-part breath are all fine and useful. What to avoid in pregnancy: breath holds, the Control Pause measurement, reduced-breathing training to strong air hunger, and any forceful or rapid technique. Those are contraindicated here, and the reason is simply that deliberately altering carbon dioxide in pregnancy is not something to experiment with.

What changes it, over a week

Daily
Three to five minutes of slow rib-focused nasal breathing, sitting tall or side-lying.
All day
Nasal breathing. Pregnancy rhinitis is common and makes the nose feel blocked — saline rinses are safe and often enough.
Sleep
Side-lying with a pillow supporting the bump, and the head slightly raised if reflux is part of it.
Avoid
Breath holds, Control Pause measurement, strong reduced-breathing practice, and any rapid or forceful technique.

When this is not a breathing pattern

See a clinician — promptly, and before assuming any of this applies to you — if any of these describe you:

Sudden or severe breathlessness, breathlessness at rest, or breathlessness with chest pain — call for urgent assessment
Calf pain or swelling in one leg, or coughing blood — possible clot, seek care immediately
Breathlessness with a headache, visual changes, upper abdominal pain or swelling of hands and face — possible pre-eclampsia, same-day assessment
Palpitations with dizziness or fainting
Any asthma that is worsening in pregnancy — this needs prompt review, because undertreated asthma is riskier than the medication

This page is education, not medical advice, and no part of it is a diagnosis. Full disclaimer.

Questions people ask

Is breathlessness in pregnancy normal?: Very commonly yes — around three quarters of pregnant women report it, and it often starts in the first trimester because of hormonal changes to respiratory drive rather than because of the bump. Sudden or severe breathlessness, or breathlessness at rest, is different and needs assessing.
Can I do breathing exercises while pregnant?: Slow nasal breathing, long exhales and rib-focused breathing are appropriate. Avoid breath holds, the Control Pause, strong reduced-breathing training and any rapid technique — those are contraindicated in pregnancy.
Why does it get worse lying down?: Lying flat raises the diaphragm further and increases central blood volume. Side-lying with support, and raising the head of the bed, is usually enough. Breathlessness that only happens lying down, or that wakes you, should be mentioned to your midwife or doctor.

What this page is built on

— Hegewald & Crapo, 2011, Clinics in Chest Medicine — respiratory physiology in pregnancy
— Jensen et al., 2005, Respiratory Physiology & Neurobiology — progesterone, ventilation and dyspnoea in pregnancy
— Traditional: the three-part yogic breath and antenatal breathing practice, long used for the rib-focused breath that late pregnancy requires

Named by author and year. The DOIs live in the journal.

Put a number on it

Most of what is on this page tracks one measurement: the Control Pause. It takes sixty seconds, needs no account, and it is the thing that tells you whether any of this is working.