During early active labor, a patient demonstrates rapid shallow breathing and paresthesias. What should the nurse do?

• A. Notify the provider.
• B. Help her breathe into a paper bag.
• C. Administer oxygen via nasal cannula.
• D. Tell her to slow her breathing.

Answer: (B)

Rapid shallow breathing during labor often indicates hyperventilation, which blows off carbon dioxide and causes respiratory alkalosis. This shift lowers hydrogen ion concentration and can lead to tingling and numbness in the hands and around the mouth—paresthesias.

Having the patient breathe into a paper bag allows her to rebreath some of the expired carbon dioxide, increasing CO2 levels back toward normal and reversing the alkalosis. As CO2 returns to the blood, symptoms like paresthesias diminish and overall comfort improves. This approach directly corrects the underlying imbalance rather than just addressing the symptom of rapid breathing.

Giving oxygen won’t fix the CO2 deficit and can mask the problem without correcting it, and telling her to slow her breathing is supportive but not as effective as rebreathing in the moment. Notifying the provider would be considered if symptoms persist or there are other concerns, but the immediate corrective action for hyperventilation with paresthesias is to rebreath expired air.