Spring 2014

For Obstetric and Paediatric Professionals in Ireland – Your Quarterly Newsletter

Welcome to our Spring 2014 edition of Mums, Babies & You.

We hope you enjoyed our last newsletter and your L’Occitane gift set. In this edition, we have a very informative article explaining the benefits and statistics behind yoga during pregnancy, written by a qualified midwife and pregnancy yoga teacher. Whilst pregnancy and childbirth are considered normal life events, during this time women undergo distinct physiological and emotional changes. It is becoming evident that the practice of yoga can assist women in reaching a state of mental and physical readiness for childbirth and beyond.

We held our 7th National Antenatal Seminar on Saturday 1st March in the Guinness Storehouse. It was a great success, and no doubt some of our readers managed to attend on the day!

We hope you enjoy this edition of Mums, Babies & You.
The Cow & Gate HCP Team

Yoga during pregnancy
Article by a Qualified Midwife and Pregnancy Yoga Teacher

The term ‘Yoga’ means ‘union’ and was originally developed several thousand years ago by hermits in North India as a means of stilling the mind. The practice of yoga is a multifaceted approach to exercise that includes physical stretching, mental centering and breath awareness1.

During the last 25 years the practice of yoga has become immensely popular throughout the world and Ireland is no exception to this trend with numerous yoga studios in operation countrywide, including the provision of pregnancy yoga classes in two maternity hospitals in Dublin. Whilst pregnancy and childbirth are considered normal life events, during this time women undergo distinct physiological and emotional changes. It is becoming evident that the practice of yoga can aDAN02752_spring2014_preg_woman_1ssist women in reaching a state of mental and physical readiness for childbirth and beyond. Yoga has many benefits for pregnant women as it increases flexibility, strength, circulation and balance. It helps women to become aware of their bodies and can help reduce many typical ailments of pregnancy such as back pain and insomnia1. Yoga is thought to alter the immune, endocrine, neurotransmitter, and cardiovascular function and improve psychological well being and physical fitness2. The studies looking at the impact of pregnancy yoga have shown encouraging results,suggesting that it may possibly benefit both the mother and the baby3.

Partaking in physical exercise during pregnancy was previously regarded as risky behaviour4. However, researchers have concluded that physical activity during pregnancy provides benefits for both mother and baby which outweigh the risks4,5. Recent Irish studies conclude that healthy pregnant women should be encouraged to exercise as it has been found that 19% of women were categorised as obese during the first trimester6. It has also been reported that 3 out of 4 women do not engage in the recommended amount of physical activity during pregnancy5.

In modern society there are many lineages of yoga and 3 yoga tools are commonly used: Asanas (poses); pranayama (control of breath) and meditation. These 3 principles are present in all variations of yoga but the emphasis is different for different types1. Pregnancy yoga is a gentle form of Hatha yoga which is the most common form of yoga in the western world. “Ha” refers to the sun and “tha” the moon and Hatha yoga has been called “yoking” yoga as it joins these two opposites together. The main principle of Hatha yoga is to practice asana (postures), in conjunction withpranayama (control of breath) and meditation.

 

The Benefits of pregnancy yoga

Physical benefits:

During pregnancy, the extra weight of the growing baby changes the postural dynamics of the body. This results in the natural curves of the spine adjusting to the additional weight in front of the body and as many women experience poor posture this results in pain, particularly in the lower back1. As pregnancy yoga focuses on improving women’s posture, it reduces the risk of developing back pain and can assist in alleviating lower back ache7. Physical exercise has also been found to be beneficial in the management of some pregnancy related conditions such as hypertension, diabetes, oedema, increased body weight and muscular skeletal discomfort4. In addition, as yoga improves physical strength and flexibility it can increase women’s stamina and fitness in preparation for labour and birth.

Psychological benefits:

Maternal stress and anxiety have been linked with adverse birth outcomes including preterm birth8 and has been reported as a significant factor in the onset of postpartum depression9. It has been suggested that maternal stress can alter the interuterine environment and affect fetal development during critical periods10 so it is therefore important to address maternal stress during pregnancy. Research has found that an integrative approach to stress reduction that includes mind–body practices including yoga during the perinatal period may help promote a healthier pregnancy and birth outcome11. This approach may also encourage qualities beneficial for promoting healthy parenting and overall positive child social-emotional development and physical health12. In addition, pregnancy yoga classes often offer a supportive environment in which pregnant women can share their experiences, which may help relieve feelings of anxiety. Yoga is not only a physical workout, it brings a greater self awareness to the woman, where she can nurture herself in a safe, warm and encouraging environment and take time out to enjoy being pregnant and connect with her unborn baby.

Preparing for labour:

Labour pain is complex and subjective, and is influenced by a multitude of factors including both emotional and physiological factors13. Research has shown that confidence, self efficacy and coping ability are necessary for a positive labour experience14. A Taiwanese study concluded tDAN02752_spring2014_preg_woman_2hat pregnancy yoga promotes women’s confidence in the birth process by imparting knowledge of postures, breathing and relaxation techniques for use during labour and birth. It also encourages women to recognise their body’s innate ability to grow and birth their baby, which increases their confidence in the labour process15. This view is supported by a systematic review of yoga for pregnant women which also concluded that yoga improves women’s quality of life and self efficacy and hence assists women to prepare for labour and birth3. From a physical perspective, the stretching exercises and pelvic floor exercises practised during pregnancy yoga can help increase fitness for labour and also prepares the muscles of the body for use during childbirth12. In addition, the breathing techniques used in yoga can teach women how to breathe during the physical challenge of labour17. A recent randomised controlled trial in Thailand examined the effects of a yoga programme on healthy first-time mothers during pregnancy and results show that women who practised yoga were found to have higher levels of comfort during labour and at two hours after labour. The women who practiced yoga also reported less labour pain and shorter labours than the other women in the control group16.

Guidance for healthcare professionals

It should be noted that whilst reviewing the literature for this article it was noted that some authors commented that methodological problems in published literature and an insufficient number of published trials on pregnancy yoga makes it difficult to draw a firm conclusion3,18. However, yoga’s many health beDAN02752_spring2014_preg_woman_3nefits and the lack of evidence that yoga is harmful in pregnancy or birth provide justification for encouraging interested women to incorporate yoga into their preparations for childbirth16. It is generally not recommended to practice yoga during the first trimester, and it is preferable to wait until at least 14 weeks gestation before commencing yoga practice. Pregnancy yoga is a gentle form of yoga and not all types of yoga are suitable for pregnant women. There are certain yoga poses that are not beneficial during pregnancy as they may inhibit blood flow to the uterus. In addition to this, as the hormone relaxin allows ligaments to soften during pregnancy, women tend to be more flexible than in a non-pregnant state which can allow women to over-stretch. To reduce the risk of injury, women are advised to attend a pregnancy yoga class that is led by a teacher who has trained as a pregnancy yoga instructor. Pregnant women should also consult with their midwife, GP or obstetrician before starting any exercise programme, as every pregnancy is unique.

 

 

Conclusion

  1. Pregnancy yoga improves physical strength and flexibility, which can increase stamina and fitness for labour.
  2.  Yoga postures strengthen and tone the pelvic floor muscles in preparation for labour, birth and beyond.
  3. Yoga encourages better posture, balance and coordination. Better posture can prevent and alleviate backache.
  4. Pregnancy yoga class provides a supportive environment, which encourages sharing of experiences with other women and reduces anxiety.
  5. Deep relaxation helps reduce fear, stress and tension. Being relaxed helps women be more intuitive during labour.
  6. Attending yoga classes promotes confidence in the birthing process as women have knowledge of postures, breathing and relaxation techniques for use during labour.
  7. Deep slow breathing ensures a good supply of oxygen for the woman and her baby plus breathing techniques can be used as a coping mechanism during labour.

 

References

  1.  Freedman F.A (2004) Yoga for Pregnancy Birth and Beyond. Turtleback Publishings. Bahamas.
  2. Wren A.A, Wright M.A, Carson J.W, Keefe F.J.( 2011) Yoga for persistent pain: new findings and directions for an ancient practice. Pain. 152(3),477–480.
  3. Curtis K, Weinrib A & Katz J. (2012). Systematic Review of Yoga for Pregnant Women: Current Status and Future Directions.Evidence-Based Complementary and Alternative Medicine.doi. 10.1155/2012/715942
  4. Melzer K, Schutz Y & Soehnchen N (2010) Effects of recommended levels of physical activity on pregnancy outcomes. American Journal of Obstetrics and Gynaecology. 202(3),266.e1–266.e6.
  5. Walsh J.M, McGowan C, Byrne J, McAuliffe F.M. (2011) Prevalence of physical activity among healthy pregnant women in Ireland. International Journal of Gynaecology and Obstetrics 114(2), 154-155.
  6. Fattah C,Farah N, Barry S, O’Connell N, Stuart B, & Turner M.J (2010) Maternal weight and body composition in the first trimester of pregnancy. Acta Obstetricia et Gynecologica Scandinavica 89, 952-955.
  7. Posadzki P & Ernst E.(2011), Yoga for low back pain: a systematic review of randomized clinical trials. Clinical Rheumatology.30(9),1257–1262.
  8. Dole N, Savitz D.A, Hertz-Picciotto I, Siega-Riz A.M, McMahon M.J & Buekens P (2003) Maternal Stress and Preterm Birth .American Journal of Epidemiology. 157(1), 14 – 24.
  9. Austin M.P & Leader L.(2000) Maternal stress and obstetric and infant outcomes: Epidemiological findings and neuroendocrine mechanisms. Australia New Zealand Journal of Obstetrics and Gynaecology.40,331–337.
  10. Fink N.S, Urech C, Isabel F,et al (2011) Fetal response to abbreviated relaxation techniques. A randomized controlled study. Early Human Development; 87(2),121–127.
  11. Beddoe A.E & Lee K.A.(2008) Mind-body interventions during pregnancy. Journal of Obstetric, Gynecological, and Obstetric Nursing. 37,165–175.
  12. Collins C . (1998) Yoga: intuition, preventative medicine and treatment. Journal of Obstetrics Gynaecology and Neonatal Nursing. 27(5), 563-568.
  13. Larkin P., Begley C.M. & Devane D. (2009) Women’s experiences of labour and birth: an evolutionary concept analysis. Midwifery 25, 49-59.
  14. Beebe K.R, Lee K.A, Carrieri-Kohlman V, Humphreys J.(2007) The effects of childbirth self-efficacy and anxiety during pregnancy on prehospitalization labor. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 36(5),410–418.
  15. Sun Y.C, Hung Y.C, Chang Y & Kuo S.C. (2010) Effects of a prenatal yoga programme on the discomforts of pregnancy and maternal childbirth self-efficacy in Taiwan. Midwifery. 26(6),e31–e36
  16. Chuntharapat, S., Petpichetchian, W., & Hatthakit, U. (2008). Yoga during pregnancy: Effects on maternal comfort, labor pain and birth outcomes. Complementary Therapies in Clinical Practice, 14(2), 105–115.
  17. Narendran S et al. (2005) Efficacy of yoga on pregnancy outcome. Journal of alternative and complimentary Medicine 11(2), 237-244.
  18. Field T. (2011) Yoga clinical research review. Complementary Therapies in Clinical Practice. 17(1),1–8.