There are many prenatal yoga books currently on the market, but most of these are geared toward an individual learning how to do yoga at home. As a yoga teacher, one must extrapolate how to adapt this to a yoga class. This becomes a particularly difficult task for those teachers who are not teaching prenatal yoga, but have a pregnant student in their regular class. Also, in reviewing this literature, I was amazed and sometimes appalled at the contradictory and illogical information that exists regarding yoga and pregnancy.
Partly this is a result of considerable controversy over the safety of exercise during pregnancy, and partly due to paternalistic attitudes regarding pregnancy. Traditionally physicians were men, and when advising women they have advocated that pregnancy is a time to “take it easy”. Knowing that pregnancy alters all physiological systems, this was perhaps a safe medical approach, but was not based on actual research. In terms of yoga during pregnancy, the same paternalistic attitudes have existed as yoga has historically been predominantly a male endeavour. This, coupled with the fact that pregnancy and childbirth were essentially taboo subjects within Indian culture, has resulted in an equally precautionary approach.
As women began to take more control of their bodies and health in the 1970s, they began to question if the safe approach was the best approach. In the 1980s, as research began to demonstrate the many health benefits of a regular exercise program, pregnant women began to ask their physicians why this didn’t apply to them. Some physicians began to modify their answer, saying that pregnant women could do whatever exercises they had done prior to pregnancy, but the majority still took the cautious approach. The fact is that until recently few scientific studies have been done to document the effects of exercise in pregnancy.
I have been teaching prenatal yoga for over seven years. Prior to this I was a nurse anaesthetist for 25 years, the last five doing obstetrical anaesthesia exclusively, covering labour and delivery for two 24-hour shifts per week. I taught anaesthesia for eight years in a nurse anaesthetist training program and also taught anaesthetic management of labour and delivery to midwifery organizations.
In my experience as a yoga teacher and yoga teacher trainer, I’ve found most yoga teachers somewhat fearful of dealing with pregnant students. My purpose in writing this article is to provide yoga teachers with enough information to put their minds at ease when teaching a pregnant student within a regular yoga class.
Nearly all prenatal yoga books recommend minimal, if any, exercise during the first trimester of pregnancy, and many recommend stopping in late pregnancy. Although many women will not feel like exercising during the first weeks of pregnancy due to fatigue or nausea, there has been no scientific evidence to support the necessity for restricting exercise during this time, or any other time.
In Exercising Through Your Pregnancy, Dr James F. Clapp, III, has conducted, reviewed and documented 15 years of research surrounding this issue. In general he has found that most of the medical concerns regarding exercise and pregnancy were related to the possibility of increasing body temperature, reduced delivery of oxygen and nutrients to the placenta and baby, and mechanical stress. Through his research he has shown that the physiological effects of exercising in pregnancy were not what might be anticipated. Instead of being a possible detriment to the mother and foetus, the physiological changes of pregnancy were actually enhanced by exercise. The combination of exercise and pregnancy results in an increased ability of the pregnant woman to adapt to the stress of pregnancy, as well as any other unanticipated medical problems that might arise during labour and delivery.
Heart and circulatory system: The entire circulatory system must change radically during pregnancy. As soon as the fertilized egg implants, the cells that will become the placenta begin to send signals that cause a dramatic increase in hormonal secretions. One of the first systems required to adapt to pregnancy, the circulatory system must increase its capacity by about 40%. This increase is necessary to support the developing foetus, ensuring adequate oxygen and nutrients, and to support the mother through the blood loss of delivery. Hormonal secretions cause the blood vessels to dilate, and the volume of blood must increase to fill the system. In early pregnancy, this expansion results in relative dehydration that may manifest as waves of fatigue, nausea, sweating and dizziness, especially with sudden positional changes.
Respiratory system: In general, lung function is improved during pregnancy, both by increased depth of breathing and by an improved ability of the body tissues to take up oxygen. Increases in progesterone secretion stimulate deeper breathing by the mother, but may result in a quicker feeling of breathlessness on exertion. This is normal and does not have any detrimental effects on either the mother or the foetus. On average, there is a 40–50% increase in the amount of air a pregnant woman breathes.
Temperature regulation: Pregnancy increases the metabolic rate by 15–20%. Therefore, heat production by the body is increased. Many women feel as though they have an internal furnace. The ‘glow of pregnancy’ is often the result of the pregnant woman’s body regulating her temperature through dilation of the skin blood vessels to dissipate heat. Heat is also lost through the increase in ventilation (breathing) and the increased ability of pregnant women to sweat. All of these mechanisms help prevent overheating during exercise.
Muscles, ligaments and bones: A pregnant woman’s weight normally increases by 15–25%. This increase, along with an enlarging abdomen and a changing centre of gravity, results in mechanical stress on the muscles, ligaments and bones. In addition, a hormone called relaxin softens ligaments and cartilage. Relaxin, produced by the placenta, is secreted to allow the pelvis to expand, providing space for the enlarging foetus. It also changes the contour of the pelvic opening in preparation for birth. Unfortunately, due to this shifting of the pelvic structure, joints within the pelvis may become unstable, resulting in the relatively common problems of sacroiliac and pubic pain.
Exercise during normal pregnancy is not only safe, but should be encouraged. Current studies done on women engaged in sustained, vigorous, aerobic exercise have demonstrated many benefits of exercise during pregnancy including:
Yoga offers a holistic approach to pregnancy more than any other form of exercise, because yoga is more than exercise. As discussed, pregnancy is a time of drastic change physiologically, but as we know in yoga there cannot be physiological changes without affecting the other dimensions of the self. Pregnancy can be a time of great upheaval and emotional adjustment, but it can also be a wonderful opportunity for introspection. Yoga offers practices and a philosophy that will allow the pregnant woman to integrate the physical, energetic, mental and spiritual dimensions in a manner that will enhance her ability to be a mother.
Generally, pregnancy occurs in younger women. Most have not spent much of their life managing any kind of health related problems or needing to contend with some form of chronic illness that may come with ageing. They are young and healthy with a “no pain, no gain” mentality. Once pregnant, they begin to experience many bodily changes and some of the common discomforts of their condition. This may be the first time they’ve had to consider someone else’s needs before their own. With the ever-increasing level of hormones, their ability to adjust to these changes fluctuates greatly. By practising yoga, the expectant mother learns to adapt mind and body in a way that will help her through her pregnancy, prepare her for labour and delivery, and assist her in the years ahead.
Yoga asanas provide a non-stressful form of exercise that strengthens and stabilizes the muscles and joints. Asanas teach pregnant women to coordinate breath and movement, to move with awareness and to improve posture and balance.
Pranayama practices help balance energy, create calmness and stabilize emotions. Pranayama improves focus and it encourages pratyahara, abilities that will be greatly needed in labour and delivery. The practices also restore prana that is being used to support the new life growing within.
Yoga nidra and meditation provide relaxation, restoration of energy, and develop pratyahara. Meditation develops awareness and intuition. The senses of the infant are evolving and it is experiencing the bodily rhythms, movements and feelings of its mother. It is a partner in the pregnancy and meditation can help provide a bridge of intuitive awareness between mother and child.
Overall, the goal of yoga in pregnancy should be santosha, or contentment. Yoga stretches the body and mind into acceptance. This is a time to honour oneself, to truly experience the moment. Life will never again be the same. The illusion of predictability is gone.
In addition, the discipline of yoga will help prepare for the discipline of motherhood. Developing a daily sadhana should be encouraged. After all, motherhood will be a daily practice. There will be endless karma yoga involved, and as a mother serves her child, devotion will make her a bhakta.
Yoga can provide the means for a woman to become a mother.
It is normal in pregnancy to experience many different aches and pains, feelings and sensations. Some of these are minor annoyances while others create considerable distress. As a yoga teacher, it is important to know what is normal and how yoga can help relieve these symptoms or at least help in their management. Pregnant students often feel uncomfortable in a regular yoga class because they are unsure if the teacher understands how to modify practices. They may pose questions about something they are experiencing to ‘test’ whether the teacher has enough knowledge. The following are common occurrences during pregnancy and when they are most likely to occur, along with some general suggestions.
Breast enlargement. The average woman increases 2 cup sizes. This increase in size creates stress in the neck and shoulders, and encourages slouching. Asanas to loosen and strengthen the neck and shoulders. Encourage good posture.
Constipation. Progesterone, one of the hormones that increases dramatically in pregnancy, causes relaxation of smooth muscle tissue, including the intestines. Pawanmuktasana (PMA) 2 & 3, and spinal twists.
Eye dryness and vision changes. Due to hormonal changes. Eye exercises, palming and trataka.
Faintness and dizziness. The vascular system doesn’t react quickly to position changes and often there is relative dehydration. During asana, move slowly from sitting to standing. Limit length of time for standing asana practice. Encourage adequate fluid intake.
Gas and bloating. Due to sluggishness of intestinal tract. PMA 2 & 3, surya namaskara.
Headaches. Often due to muscle tension and anxiety. PMA 1, tranquillizing and balancing pranayamas, yoga nidra and meditation.
Insomnia. Regular asana practice, tranquillizing and balancing pranayamas, yoga nidra and meditation.
Rhinitis (runny nose). Swelling of the mucus membranes due to the increased blood volume and hormones. Neti.
Weepiness and emotional instability. Regular sadhana, especially pranayama, yoga nidra and meditation. Encourage expression, not suppression of feelings.
Breast tenderness. Asanas lying prone may be very uncomfortable.
Fatigue. Encourage pranayama practices, yoga nidra, adequate fluid intake, small and frequent meals.
Morning sickness. Adequate fluid intake, small and frequent meals.
Round ligament pain. This feels like a ripping sensation when rolling over. Support the belly.
Abdominal muscle separation. This is a linear bulge along the mid-abdomen when the abdominal muscles are engaged. Corrects after pregnancy.
Breathlessness. Due to increased progesterone. Encourage honouring of limitations, expanding breath capacity pranayamas.
Carpal tunnel syndrome. Due to increased fluid retention and compression of nerve in wrist. PMA 1 for hands, spread fingers widely and ground the whole palm to distribute weight in arm weight bearing asanas.
Hip soreness. PMA 1, 2 & 3, hip stretching asanas.
Haemorrhoids. Due to pelvic congestion and straining if constipated. PMA 3, and ashwini mudra.
Pubic bone pain. Hip stretching asanas.
Sweating. Due to increased blood flow to skin. Reassure.
Backache. Gentle backward bending asanas, yoga nidra, and encourage good posture.
Edema and swelling. PMA 1, adequate fluid intake.
Fatigue. PMA 1, pranayama, yoga nidra and meditation.
Heartburn. Progesterone relaxes cardiac sphincter. Tadasana, tiryaka tadasana, encourage frequent, small meals and papaya enzyme.
Leg cramps. PMA 1, adequate fluid intake, and yoga nidra.
Sciatica. PMA 1, 2 & 3, gentle backward bending asanas, avoid unsupported forward bending, and do yoga nidra.
Urinary incontinence. Due to weak pelvic floor muscles and weight of baby. Kandharasana, moola bandha and vajroli.
Varicose veins. Due to increased pressure in pelvis. PMA 1, parvatasana and kandharasana.
Part 2 of this article will be printed in the next issue