Guidelines for Teaching Yoga to Pregnant Women
The new guidelines for teaching yoga to pregnant women were launched in February 2010 by Yoga Scotland (www.yogascotland.org.uk) These were written in conjunction with YogaBirth (www.yogabirth.org.uk) and, as a member of both organisations, I was invited to lead the project. In a previous article I summarised and introduced the background to these guidelines. Below follows a more in depth explanation of some of the recommendations.
Grounding, the Breath and the Pregnant Woman
Over millennia our bodies have evolved in the context of gravity and the downward force it exerts upon us toward the Earth. Hence we have developed a musculo-skeletal system that allows us to walk, run or jump when we wish. When this action is not required we can rest by releasing any tension simply by giving weight to our bones. We can do this when standing, sitting, lying down, inverted or resting on all fours. This is grounding.
The problem we face as yoga teachers is that many women choose to take up yoga for the first time when they are pregnant. If, as for many women today, their lifestyle has been predominantly sedentary, they may have developed certain habitual tendencies e.g. to tilt the pelvis in a particular way when standing or sitting, to be generally weak in their core muscles as a result of lack of attention to posture etc. The hormones of pregnancy and the added weight tend to exaggerate these tendencies which can in turn lead to stress and strain upon different joints causing discomfort and pain. Grounding and posture therefore are fundamental to a sound yoga practice.
When we stand grounded in Tadasana there is some tone in the abdominal muscles but this is part of the natural response to gravity. It is not artificially held (Blackaby 2009). The pelvis, the main weight bearing structure of the body, distributes the force through the bones of the legs so we can give weight to the feet – the heels, the inner and outer foot. The arches within the foot respond to create support which is mirrored within the diaphragms above, notably the pelvic and thoracic diaphragms. Tone is brought to the pelvic floor and breathing is distributed between the chest and the belly.
Once we start to tighten the belly and the pelvic floor deliberately, we begin to interfere with this natural process and breathing becomes less responsive to gravity. Through regular practice, yoga can change unhelpful habitual patterns of breathing. We begin to notice the more subtle shifts in our breathing as we move from each asana to the next (Blackaby 2009).
This is crucial for the pregnant woman. She needs to discover how the power of the breath can lead her, for example, from a state of rest in deep relaxation to a flowing movement with typical responsive breathing as the surges of energy from the womb signal the contractions of labour. Finally it is through the help of gravity that she will give birth.
Narrow versus Wide-Angle Standing: the dilemma
The wider stances seen in many of the standing asanas practised today in the West require closer scrutiny when considering the needs of the pregnant woman and her softer, heavier body. If we take the legs into a basic wide stride stance, we may see that for many people the wider the legs are taken apart, the further forward the pelvis has a tendency to tilt. This tendency resides in tension held in the pubofemoral ligaments and the pectineus muscles as the legs are taken wider (Blackaby 2005). For the pregnant woman whose pelvis will gradually tilt forward as her pregnancy progresses, this posture could lead to unhelpful compression of the lumbar spine with pressure on the nerves as they emerge from that part of the spine. Practising wide stance poses could actually increase the cause and symptoms of back pain in pregnancy.
If we then turn the feet in a wide stance, as for Virabhadrasana I, the anterior tilt may further increase, particularly if there is tension in the iliopsoas muscle. Tightness in this muscle is a common feature of a sedentary lifestyle where the hip remains flexed for prolonged periods in the sitting position. This version of Virabhadrasana could result in simply more lumbar compression.
More problems emerge from this posture as the woman attempts to draw the pelvis around to face the front leg leaving the back foot turned out. This sets up a twisting force through that back leg which in turn is transmitted through the knee joint. As the joints of pregnant women soften in response to the hormonal effects of pregnancy, this movement becomes particularly hazardous. Add to this the fact that grounding becomes increasingly more difficult the wider the legs are taken, we begin to see collapsing of the foot arch in the back foot, a situation which is hard to resolve until the stance becomes narrower.
A more sensible approach would be achieved by taking the feet a walking pace apart with both feet and pelvis facing in the same direction. Grounding is achieved more easily through the back foot and so the arch of the foot is able to retain its support. Any rotational forces within the knee joint are removed and in fact we now have a healthy stretch introduced to the Achilles tendon of the back leg, a stretch which is not present when the foot is turned out (Blackaby 2005). This healthy stretch is particularly helpful to the pregnant woman as it is one of the ways well known to physiotherapists and pregnancy yoga teachers of pre-empting and counteracting the uncomfortable and often painful leg cramps characteristic of pregnancy.
Warrior poses are synonymous with power and strength. Women can access these aspects of the pose in a practice that is both connected to the ground and the breath, while at the same time integrated with the response of the spine and the pregnant body. A safe practice evolves so that women can access the gentle confidence and feminine grace of a healthy pregnancy.
Helpline and Updates
We were very keen when we wrote these guidelines that they should be kept up to date in line with the evidence available. There is an e-mail Helpline that can be accessed to contact either myself firstname.lastname@example.org or Kay Kay.Millar@virgin.net . In pursuit of the very best we can offer pregnant women, we welcome your questions, your comments and your ideas.
For more information about how to train as a YogaBirth teacher, please visit www.yogabirth.org.uk or contact either Judy or Kay via the Helpline.