As teachers of yoga it is important to acknowledge and understand that modifications in practice may be necessary in many different phases of our students’ lives. When we consider function over form, as it relates to an individual’s specific phase of life, we can begin to recognise and acknowledge that modifications are imperative to our students safety and well-being. One such phase of life that yoga teachers must acknowledge and make modifications for their students individual practice is that of pregnancy. Here we look to highlight just some of the modifications and considerations that were covered in our most recent retreat for our 350YTT students of Personalised BioMedical Yoga.
Yoga Modifications for Pregnancy
Yoga is a great tool for pregnant women – before, during and after pregnancy. Apart from benefiting from the social aspects of joining a yoga class with other expectant mothers, yoga can help by calming the body emotionally and physically. Certain postures aid in keeping muscles supple and strong for the impending birth, relieving tension around the pelvic organs and perineal muscles.
Ujjayi breathing is helpful in relaxing the body and mind and is the best place to start. In the prenatal stage, postures that support the use of mula bandha (a physical perineal lock) help to bring awareness and control to the muscles of the perineal floor as well as the muscles higher up the pelvic floor that supports the bladder, vagina and rectum.
Yoga practice during the postnatal phase should be done very gradually over 2-3 months, then more regularly after that. Abdominal pressure from core work should be avoided, both prenatally and postnatally. During the two months postpartum students should be encouraged to practice at 80% when doing deep stretches (especially forward folds and backbends) as there are heightened levels of relaxin hormone.
Modifications to offer pregnant women in a class environment
Ujjayi pranayama is best for pregnant women. Avoid kapalabhati pranayama, bhastrika pranayama and any other breathing technique that has a belly pumping action or induces hyperventilation. Bhramari Pranayama (bumble bee breath or simple humming) can be introduced to help with labour and birth and is proven to help reduce pain both prior to and during labour. Avoid breath holds that are longer than two counts during pregnancy.
Minimise twisting to avoid pulling on the ligament that attaches to the uterus in the second and third trimesters. Keep twisting movements focused on the upper thoracic spine.
Be very careful with strong abdominal work or backbends as they may separate the linea alba in pregnancy and into post partum period. Linea alba separation is also referred to as Rectus Diastasis. The linea alba connects your pelvis to your ribcage. This is the weakest part of your core and will stretch or thin to make way for the baby. Stomach separation occurs when this fascia stretches or thins more than what is considered normal for your body. Navasana and Urdhva Dhanurasana are two examples of postures that should be avoided.
LYING ON THE BELLY
Unless a woman is ‘showing”, you are still able to instruct them to lay face down on their belly as the fetus is well protected in the early stages of pregnancy. This is not the case in the second and third trimester.
Focus on asanas with a pelvic focus and learn to engage the pelvic floor for longer term health of this region: Bridge Rolls whilst in Setu Bandhasana, Supta Baddha Konasana, Vajrasana, Virasana, Upavista Konasana, Gomukhasana, Ananda Balasana and Eka Pada Rajakapotasana.
PREPARING FOR LABOUR
Include daily squatting in the sequence to prepare the woman for active labour. If you add the Lion’s roar or Simha Mudra (wide open jaw and stick the tongue out long toward the chin) you will note that this will release the pelvic floor as you create the sound. Therefore, this should be implemented during all stages of the pregnancy to prepare the woman to let go during the active birth. Keeping attention on the strength of the pelvic floor and also knowing how to release it during labour is important. Releasing restriction and tightness in the jaw will help!
LYING ON THE BACK
During the second and third trimester students should pay attention to any numbness while laying on their back. As the weight of the baby will cause pressure on the vena cava, restricting blood flow to the mother’s heart, affecting blood supply to the foetus.
Incorporate hip opening postures and forward folds: Balasana (with wide knees to release pressure in the sacroiliac joint), Janu Sirsasana, Marichyasana A, Paschimotanasana with wide legs, Gomukhasana and Eka Pada Rajakapotasana Preparation but do keep the hip Bhandas switched on to avoid overstrain in the later stages of pregnancy.
CHAIR YOGA FOR THIRD TRIMESTER
In the later weeks of pregnancy become more familiar with using chairs to support a variety of standing and sitting postures such as Virabhadrasana and Malasana. Unless the student has a well-developed practice, avoid jolting the body by jumping into asanas.
For relaxation, try Viparita Karani with legs apart and straight up the wall, knees bent with bottoms of feet touchingElevate feet in Baddha Konasana. Raise the hips and legs onto a long bolster in Savasana. This can be done only in first and maybe second trimester, but not the third for long periods of time, if at all.
Science of Yoga during pregnancy
Even just one 20 minute session of yoga is shown to reduce hip, leg, back, lumbo pelvic pain, however 2 x per week makes quite a significant difference to both leg and lumbo pelvic pain.
Even 20 minutes of yoga is proven to reduce state anxiety and depression.
Longer term interventions of up to 20 weeks during 2nd and 3rd trimesters reduced: anger, state and trait anxiety, depression, stress.
Those practicing yoga report a higher level of comfort during the pregnancy and have lower levels of self reported pain throughout labour.
DURATION OF LABOUR
Yoga practice is shown to shorten the duration of labour, namely the active stages.
Yoga practiced during pregnancy showed that quality of life and interpersonal relationships were improved.
Yoga practiced during the last two trimesters tended to improve the gestational length, with the number of women experiencing preterm labour (before 37 weeks) significantly lower and with less complications.
Those who practiced yoga had significantly fewer complications and prenatal disorders such as: pregnancy induced hypertension, pre-eclampsia, gestational diabetes, and intrauterine growth restriction.
Yoga reduces active stage of labour time, increases birth weight for the baby equal to or more than 2500g. It reduces state anxiety, depression, anger, maternal stress. Yoga has been shown to improve confidence, self efficacy, and may reduce pain catastrophizing during labour; these skills tend to lower levels of self reported and observed pain. Studies have even shown that weekly yoga intervention is more effective than standard prenatal programs – however practice must be more than just “yoga as exercise”. Programmes that were proven to work incorporated: yogic philosophy, posturing, breathing, meditation and deep relaxation. Recommended yoga practices from numerous studies support gentle, specialised, modified asana that used props and focussed also on restoration. Iyengar yoga and Restorative Yoga are recommended. Do not choose physically demanding practices, strength based or heated yoga practice.
Happy Mother – Happy child.
It is very important that we as yoga teachers care for Mother’s and practice during pregnancy to reduce maternal stress for Mother and child.
Fetal exposure to maternal stress is a risk factor for adverse outcomes for programming of the nervous system and brain morphology of foetuses, infants and children. Maternal stress can lead to blunted cognitive functions (reduced brain volume), emotional and behavioural problems, even the development of attention deficit or hyperactivity disorder. It can also lead to lowered aspects of performance on executive function. So to regulate maternal stress we must consider the following: the hormone cortisol naturally increases in the later stages of pregnancy, and yet yoga practice can lower this naturally. Include side lying savasana daily in the routine to bring cortisol levels down. Focus more on the out breath to manage heart rate variability and lower cortisol levels in the bloodstream.
Heart rate variability is a valuable measure used to evaluate mental and physical health. Foetuses of mothers who had received an intervention of relaxation techniques in their yoga practice had higher long term heart rate variability than controls. This means that the Mother’s heart rate variability during pregnancy affects the foetus. Breathing and pranayama affect heart rate variability positively, but keep the breathing equal and stable during pregnancy, with a focus on a longer out breath without strain.
As with any yoga practice when, as teachers, we consider function over form as it relates to certain phases in our students’ lives, we find that we are able to provide not only a safe service, an effective service. As a yoga teacher, through attuned presence we connect to our students showing them a level of co-regulation that continually cultivates a sense of compassion and kindness – something that both mother and child shall always be in need of.