10 Prenatal & Postnatal Yoga Presumptions
1. Deep hip stretches are the key focus in Prenatal Yoga!
Although the focus is to prepare expectant mothers for labour and delivery by stretching and opening tight muscles in the hips, it’s important to understand about the powerful hormone known as relaxin.
Relaxin is produced by the ovaries, which causes the ligaments in the pelvis to soften and stretch during pregnancy and widens the cervix for expansion during delivery.
To focus only on hip opening poses in prenatal yoga can actually create more damage than good, as the ligament are pliable and unstable due to several hormonal releases. Teachers need to encourage mothers to stay in a safe range of motion and practice the deeper hip openers with awareness.
An asana practice changes drastically week-to-week so it's important for teachers to cue mothers to stay about 70% of their natural range of motion, to ensure safety within the pelvic ligaments. The focus should be then to strengthen muscles that are weak, like the gluteals and adductors to aid in delivery rather than a focus on deep hip openers or just ‘stretching’ This focus on strengthening the supporting muscles will also aid in the stability and recovery of the pelvic floor muscles, which is an important focus in postpartum healing.
2. Belly down backbends are safe in early stage of pregnancy because you can’t see the belly bump.
This couldn’t be further from the truth. As soon as a woman know’s she’s pregnant, belly down backbends are best to be avoided. Belly down backbends consist of dhanurasana (bow), shalambhasana (locust), bhujangasana (cobra), bhekasana (frog), naraviralasana (sphinx)
The developmental stage during the 1st trimester (4-12 weeks) is as follows.
The embryonic period is one of the most important as the brain, spinal cord, heart and other organs begin to develop. The embryo is made up of three layers.
The Ectoderm, the outmost layer of development consists of the skin, central and peripheral nervous system, eyes, inner ears and connective tissues.
The Mesoderm, the middle layer of development make up the heart and the beginning stages of the circulatory system, bones, muscles and kidneys.
The Endoderm, the innermost layer of development consisting of the lungs, intestines and bladder.
In month two (5-8 weeks) the umbilical cord has already begun to circulate blood and nourishment to the fetus.
In month three (9-12 weeks) the baby begins to develop facial features such as the eyes (eyelids remain fused), outer ears, nose and mouth. Ligaments, including the arms and legs start formation and bones begin to take shape. The spine strengthens; the brain, liver, kidneys, bloodstream and digestive system are in their earliest stage of development.
I’d say the first trimester, the one in which no one really knows a mother is expecting, is the most crucial in development. Unfortunately, the risk miscarriages are more prevalant during this delicate stage, especially if there is a problem with development in the fetus. I’m not saying that belly down backbends will create a miscarriage, all I’m saying is why would you want a mother lying on her stomach with all her weight pressing onto the belly when the greatest developmental stage of the fetus is being created?
Not only is the lower abdomen quite tender and sensitive due to the shift in hormones; to lie on the stomach leaves mothers with an overwhelming feeling of discomfort.
Just because the pregnancy is undetected or unseen doesn’t mean that theses positions are suitable. It’s best to recommend Setu Bandhasana over a bolster or with a block under the sacrum for more relief and to keep the belly soft and organic without compression.
3. Yoga asana should be seated, creating awareness and cultivating breath control!
Being an expectant mother myself and teaching prenatal, I was always aware of a teachers expression when I would walk into a ‘regular’ class and the sheer look of terror across the face of the instructor. I was recommended when in doubt to practice Marjariasana (Cat), Bitilasana (Cow) or Baddha Konasana (bound angle pose) throughout the entire class. Those teachers that knew me would leave the modifications up to me in the hopes that I wouldn’t ask for an alternative pose. Not knowing what was best, they assumed I should stay seated and focus on my breath, practicing the same three poses for 90 minutes.
A pelvic floor therapists once asked me, “why do prenatal yoga teachers focus on seated hip openers, don’t they understand the marathon these mothers are about to endure during childbirth?” I couldn’t agree with her more. Standing poses are a wonderful addition to a prenatal yoga class that help to strengthen weakened leg muscles and gluteals and create stamina and stability. Indeed, laboring is exhausting both mentally and physically so it’s just as imperative to build strength in the legs needed to endure the pushing stage than it is to stretch some of the tighter hip muscles.
To create an balanced prenatal yoga sequence, hip opening poses, standing positions mixed with mindful meditation, breath control (pranayama) and pelvic floor exercises altogether can create a overall sense of confidence, strength and stability a laboring mothers needs to focus on the journey ahead.
4. Abdominal stretches help to stretch the tight muscles of the abdominals!
Yikes. I was recently in a class where an instructor encouraged a mother 28 weeks pregnant to practice Ustrasana (camel). She looked absolutely stunning in the pose and seemed to do so with much ease but as I stood there a bit perplexed as all I could see was her Diastasis Recti worsening. I asked her if it was comfortable and she said, ‘not really’.
Here’s something very few expectant mothers and teachers are not aware of and it needs to be paid more attention too. The connective tissues in-between the Rectis Abdominis seperate, pulling the abdominal wall apart to create room for the growing uterus, known as Diastasis Recti. Not only can women not engage the rectis anymore, they simply have no control over the separation.
Poses like ustrasana (camel), navasana (boat), urdhva dhanurasana (upward bow), setu bandhasana (little bridge), urdhva mukha svanasana (upward dog) and virbhadrasanan 1 (warrior 1) are not recommended during the 2nd trimester of pregnancy and will enhance the separation. The reason being is that the obliques will pull the rectis abdominis further apart.
Not to mention, it’s can cause a pulling or tearing sensation in the ligaments supporting the uterus, which is known as the round ligament. It just does not feel good.
Why is this detrimental to women’s health? During the postpartum stage, this separation can plaque a mother with instability issues within the core that won’t necessarily heal. If the separation is more than 4 finger-widths apart, physiotherapy is recommended. If not, pelvic pain and instability will increase, which will affect the stability of the lower back as well, later in life while in menopause the weakness can result in prolapse.
In Postnatal Yoga, the above poses shouldn’t be taught until 4 months postnatal and only after wearing an abdominal belt for 6-8 weeks after birth.
5. Encourage mothers to engage their rectis abdominis or ‘navel to spine”!
As mentioned above, women can no longer engage the rectis abdominis, mostly because of their beautiful baby pushing against the abdominal wall. As well, the sensation of this engagment may cause lower ligament cramping. The most powerful abdominal muscles to an expectant mother that will help create strength and stability are the Transverse Abdominis. These muscles act like a corset supporting your internal organs and are essential for maintaining good posture and lumbar support as well, help strengthen the pelvic floor muscles. To engage these muscles, imagine trying to zip into a tight fitting pair of pants, you'll feel the lower belly pull towards the medial line of the body – hold this engagement for however long is possbile or during the duration of poses where the pelvis tips forward creating lardosis in the spine.
Women in general need to focus on engaging these abdominal muscles in their yoga practice in addition to mula bandha.
6. Lunges are awesome when pregnant!
Really? Have you ever tried to get into a lunge when you’re 33 weeks pregnant? First, modifications need to be encouraged to comfortably move an expectant mother into a lunge with ease and grace. Using momentum from the hips and shoulders over wrists to step the foot outside of the hand. Second, the knee on the floor is a tender and may require a blanket to kneel on. Third, lunges are great for stretching the hip flexors, primarily the psoas, but again, is this the best recommendation for expectant mothers? Because of relaxin and the instability within the ligaments of the hips, lunges need to be subtle with the cue of hugging the thight towards each other to engage the gluteals versus the lunging forward.
It’s best for teachers to instruct mothers to stay at 70% of their maximum versus going for the depth of the pose. Which is why a yin practice while pregnant for a mother who was already quite pliable can be dangerous. Women who are pliable before and during pregnancy need to direct their focus on strengthening vs. stretching.
The more open your hips the easier for delivery? I believe this to be true but if a mother is starting yoga for the first time while in her 2nd trimester is this going to guarantee she has an easier delivery? No, but the preparation will definitely help. More importantly, it’s the awareness within and her ability to connect to areas in her body and trust that will be the most powerful influence in the laboring process.
7. Avoid stretches lying on your back!
The reason mothers are encouraged to avoid laying on their back while pregnant is due largely to the amount of pressure on the inferior vena cava (IVC). THE IVC is the main blood vessel that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart in mothers. It runs along the vertebrae column on the right side and can be compromised more so during the 3rd trimester because of the excess weight gain.
There are many stretches that can relieve issues within the back and hip, open the chest and shoulders and can create stillness helping to calm the nervous system. It’s best to recommend no more than 2-3 minutes at a time lying on the back, taking a break in-between by having mothers lie on their left side. Those that feel nauseous or light headed can take a block underneath the head or elevate using a bolster. Restorative poses like Supta Baddha Konasana (supine bound angle) is a great addition and helps mothers relieve tightness in their shoulders, releases pressure off the diaphgram and open the hips. Most mothers will need to cross the bolsters adding in elevation and taking the extension out of the back.
In savasana, recommend laying on their left side to promote better circulation but there isn’t any harm if they choose to lay on their right side or on their back (more than 26 weeks, prop a blanket underneath their right hip). Savasana is usually taught for 8-10 minutes so the pressure for the minimal time spent is not going to be detrimental to either mother or the baby’s health, unless they have a medical condition.
8. Inversions are dangerous while pregnant!
YES AND NO! Yes, they certainly can be for mothers who have no previous experience balancing on their hands or forearms. The majority of mothers who enroll in prenatal yoga have very little experience, which also means they have very little awareness; for this reason I would never teach hand or forearm balances in my prenatal classes.
This is only my opinion based on my own experience and teaching prenatal yoga for 8 years but the answer is NO, they are not dangerous for mothers who have a strong practice. I only recommend the practice of inversions while pregnant to mothers that have a previous practice and the upper body strength to do so. They must move close to the wall for further support as the weight shift changes our perception of gravity and we don’t want to risk a fall.
Some precautions for pregnancy concerns such as placental previa, risk of hyper or hypotension and any mother complaining of shoulder or wrist injuries should avoid inversions (with the exception of adho mukha svanasana (downward facing dog), which is considered a semi-inversion and is quite safe).
The benefits of inversions while pregnant can help cure backache, constipation, fatigue, shortness of breath as the baby moves away from the diaphragm. Inversions promote blood circulation to the uterus, increases blood flow to the head and neck, stabilize the thyroid, pituitary and pineal glands, create space in the pelvic cavity for the baby to move and relieves pressure off the legs, which may help to prevent varicose veins.
The practice of poses such as sirsasana (headstand), adho mukha svanasana (downward facing dog) would probably be the safest and most comfortable as sarvangasana (shoulderstand) tends to put a lot of pressure on the diaphragm due to the compression of the neck and the heaviness in the breasts.
All inversion should be removed from a mothers practice around 30 weeks or when the baby has ‘dropped’ into the pelvis.
9. Pelvic pain will be greatly reduced by practicing prenatal yoga!
I wish this statement were true. Mothers often comes to class and describe a deep, stabbing pain in the pubic region making it difficult for them to walk, cross their legs or even take their legs apart. They come to class in the hopes that I can take this pain away and unfortunately, I cannot. I believe yoga cures a lot of physical, mental and emotional discomforts and disturbances but not all.
This pubic pain is a condition referrred to as Pubis Symphysis Disorder (PSD) or Dysfunction and for all intents and purposes, it’s completely normal during pregnancy. The pubic symphysis is a thick, fibrous cartilage which joins together the two ilium bones in the pelvis. In conjunction with the hormone relaxin, which will loosen the cartilage, the separation occurs in late term pregnancy allowing the pelvic bones to become more flexible during delivery.
Most teachers make the assumption that stretching the hip will help decrease the pain but it’s strengthening poses mothers need to create stability. I usually recommend a hip girdle or band that mothers can wear around the hips to reduce the separation or a band around the lower abdomen that place less pressure on the pubis and support the abdomen. In conjunction with a yoga practice, this would be most suitable for comfort.
Encouraging a mother suffering from PSD to take shorter stances in standing poses (virbhadrasana 2) and wide angled hip stretches (prasarita padottanasana) and keep the focus on strengthening the legs and gluteals will help to relieve a bit of the pressure. Squatting poses supported would be ok (resting against the wall), but painful if unsupported (malasana).
10. Surya namaskars are a great addition to a postnatal class!
The quick, sudden and jumping motion required to flow through a sun salutation can be quite challenging for new mothers. Most postnatal classes in North America start at 6 weeks postpartum, which in my opinion is too early. Not only are mothers receiving very little sleep, they are also malnourished. They lack overall upper body strength and most are still recovering from their birth, whether it be a caesarean or vaginal birth.
If they’ve had a vaginal birth, there may still be postpartum bleeding, swelling and overall discomfort, as with a caesarean birth, 12 weeks is the minimum amount of time recommended by their Dr. The incision may not have completely healed and because the surgery has cut directly through the transverse abdominis, there is a huge lack of instability in the core and pelvic floor muscles.
Despite what most people think, just because you’ve had a caesarean section, doesn’t mean a mother will avoid the beauty of incontinence. Incontinence affects 40% of mothers while pregnant due to the pressure on the pelvis and pelvic floor. The weight bearing is the same regardless of which way a mother has given birth. When the baby descends into the pelvis, the pressure increases causing more instability on the pelvic floor muscles that aid in support of the pelvic organs like the bladder.
Jumping through, even large steps forward can make mothers 'pee a little', it may be embarrassing for many but it’s incredibly common and should hold some compassions and a teacher's understanding. If incontinence continues after a year with very little control, encourage mothers to seek a pelvic floor therapist to help palpate the appropriate muscle for support. No amount of mula bandha is going to help a mother if she isn’t aware of which muscle is unstable.
I usually recommend new mothers return to a yoga practice 3 months postpartum. At this stage mothers are more rested, stronger, focused and have healed from the birthing process. Babies are generally more relaxed in an unknown environment and the classes are taught with a bit more ease.
I’ve had many women over the years comes to class 4 – 10 days after giving birth to their first and I’ve sent them home to rest. We’re culturally the only society that returns to physical exertion so quickly after childbirth. Most countries in the East encourage mothers to only bond with baby and rest for the first 4 months of postpartum. This is very evident in our society where postpartum depression is at an all-time high with one out of every three mothers suffering alone. Everywhere else it’s less than 1%. We need to heal from the inside out….
As teachers, we have an obligation to teach yoga asana safely to mothers and with modifications and adaptations for each trimester. I taught prenatal yoga for 3 years before experiencing pregnancy myself. I was fascinated, even with my experience as a doula, to learn that my previous assumptions about the mobility of mothers was completely incorrect. I didn't teach with as much awareness instead, I taught based on assumptions.
I encourage teachers who haven’t experience pregnancy as of yet and who are teaching prenatal/postnatal classes to enroll in a program such as Mamata to teach with knowledge and confidence. If you don’t choose a prenatal yoga certification program, look into a birth support or doula training in your local area to understand the anatomical and physiological changes during pregnancy, the precautions and most importantly, what's safe during pregnancy and postpartum.
Prenatal yoga classes have a profound impact on the impending labor and delivery so the focus should be more to prepare for this journey ahead so mothers can tap into their own divine strength, wisdom and awareness to birth consciously.