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Teaching Prenatal Yoga - Part 1

As a Yoga teacher, one must extrapolate as how to adapt Prenatal Yoga 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.

I have been teaching Prenatal Yoga for over twenty seven years. In my experience as a Yoga teacher and Yoga teacher trainer, I’ve found most Yoga teachers are 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.


EXERCISE DURING THE FIRST TRIMESTER

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. But 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. 

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.

PHYSIOLOGICAL CHANGES IN PREGNANCY

Heart and Circulatory System

The entire circulatory system must change radically during pregnancy. As soon as the fertilized egg implants, the cells that 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 an 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. Due to this shifting of the pelvic structure, joints within the pelvis may become unstable, resulting in the relatively common problems of sacroiliac (sacroiliac joint is a firm, small joint that lies at the junction of the spine and the pelvis) and pubic pain.

EXERCISE DURING PREGNANACY

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:
• Reduced maternal weight gain
• Less maternal discomfort and injury
• Less need for pain relief in labour and delivery
• Decreased need for episiotomy (surgical incision to increase the vaginal opening during delivery)
• Decreased need for surgical intervention (C-section, forceps or vacuum delivery)
• Increased rate of term delivery (less likelihood of going past due date)
• Increased relaxation and positive mental attitude
• Enhanced immune function
• Increased energy levels
• Faster recovery after delivery

HOLISTIC APPROACH OF YOGA

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.

HOW YOGA HELPS

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 at any time 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 should be practiced. Encourage good posture.

Constipation

Progesterone, one of the hormones that increases dramatically in pregnancy, causes relaxation of smooth muscle tissue, including the intestines. Preparatory Exercises Pt 2 & Energy block Postures (Read my article “Yogic Home Work”) 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. Preparatory Exercises Pt 2 & Energy block Postures (Article “Yogic Home Work”), Surya Namaskara.

Headaches

Often due to muscle tension and anxiety. Preparatory Exercises Pt 1( Article “Yogic Home Work”), tranquillizing and balancing Pranayamas, Yoga-nidra and Meditation

Insomnia

Regular Asana practice, tranquillizing and balancing Pranayamas, Yoga nidra and Meditation

Rhinitis (Running 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.

First Trimester

Breast Tenderness

Asanas involving lying down on stomach may be uncomfortable; such Asanas may be avoided

Fatigue

Encourage Pranayama practices, Yoga-nidra, adequate fluid intake, small and frequent meals.

Morning Sickness

Adequate fluid intake, small and frequent meals

Second Trimester

Round Ligament Pain
This feels like a ripping sensation when rolling over. Support the belly.

Second & Third Trimester

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 expanding breath capacity Pranayamas

Carpal Tunnel Syndrome
Due to increased fluid retention and compression of nerve in wrist. Preparatory Exercises Pt 1 (Article “Yogic Home Work”) for hands. Spread fingers widely and ground the whole palm to distribute weight in arm. Do weight bearing Asanas.

Hip Soreness
Preparatory Exercises Pt 1, 2, Energy Block Postures (Article “Yogic Home Work”) & hip stretching Asanas.

Haemorrhoids
Due to pelvic congestion and straining if constipated. Energy Block Postures (Article “Yogic Home Work”) and Ashwini Mudra.

Pubic Bone Pain
Hip stretching Asanas.

Sweating
Due to increased blood flow to skin. Reassure.

Third Trimester

Backache
Gentle backward bending Asanas, Yoga-nidra, and encourage good posture.

Edema and Swelling
Preparatory Exercises Pt 1, adequate fluid intake.

Fatigue
Preparatory Exercises Pt 1, Pranayama, Yoga- nidra and Meditation.

Heartburn
Progesterone relaxes cardiac sphincter. Tadasana, Tiryaka Tadasana, encourage frequent, small meals and papaya enzyme.

Leg Cramps
Preparatory Exercises Pt 1, adequate fluid intake, and Yoga-nidra

Sciatica
Preparatory Exercises Pt 1, 2 & Energy Block Postures, 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 Mudra.

Varicose Veins
Due to increased pressure in pelvis- Preparatory Exercises Pt 1, Parvatasana and Kandharasana.

Courtesy: Dr. Rita Khanna

Aum Shanti