Amaryllis Hager--Prenatal Yoga Final Paper

Amaryllis Hager

4/27/12

Yoga: Theory, Culture and Practice

Laura Douglass

Prenatal Yoga; Theory, Culture and Practice

Theory

            Prenatal yoga has been recommended by medical professionals, childbirth educators, psychologists and experienced yoga practitioners because it promotes the relaxation response, and helps to maintain both muscle tone and flexibility throughout pregnancy. Yoga also tackles one’s limitations his or her mind and body through difficult postures which require mental strengths and skills, which can be beneficial in childbirth preparation (Samuels, 1987, p. 39). Relaxation is one of the most important elements of pregnancy and childbirth, because complications most often arise from the fear-tension-pain cycle in labor (Sears & Sears, 1994, p. 62). Yoga is a wonderful way for pregnant women to cultivate relaxation in everyday life. As Samuels put it, “Pregnancy is a time when a woman seeks to experience an internal calmness, the relaxing elements of yoga postures and Savasana (relaxation pose) appear helpful in this goal” (1987, p. 40). Prenatal yoga teachers as well as childbirth educators preach relaxing, breathing techniques, positive language, empowerment and education (Israel, 2010, p. 15). Judith Lasater, a psychologist and physical therapist, describes hatha yoga as an appropriate activity during pregnancy to physically prepare for, and to facilitate childbirth. “Being in touch with and sensitive to inner states is an important part of yoga, pregnancy and birth” (Samuels, 1987, p.40).

             In partnership with these benefits, yoga has been seen to correlate with better birth outcomes. According to Dr. Tiffany Field, “Yoga has been used effectively during pregnancy to reduce the incidence of preterm births and low birth weight” (Field, 2008, p. 29). While a woman is practicing prenatal yoga, the relaxation response which is coexistent with the meditation aspect of yoga lowers stress hormones in the blood, which therefore contributes to the health and wellness of the infant (Beddoe, 2007, p. 27).Not only are there positive effects for the mother, but the infant also benefits from the mother’s yoga practice and increased overall physical and mental health. In another study, trials of prenatal yoga have reported both “positive maternal and neonatal outcomes, such as reduced back pain, lower anxiety levels, decreased labor pain, higher birthweight babies, less intrauterine growth retardation, and fewer preterm deliveries compared with women who did not practice yoga” (Battle, 2010, p. 353). In fact, in a 2005 study, one group of pregnant women, from 18 to 20 weeks’ gestation until delivery, practiced yoga for 60 minutes a day. Another group of pregnant women walked 60 minutes per day for the same time period, and was compared to the yoga group. The yoga group experienced fewer complications during pregnancy, including both intrauterine growth retardation and pregnancy-induced hypertension. This group also had better neonatal outcomes, including higher birth weight and a lower incidence of preterm labor” (Field, 2008, p. 29).

            In another study done in 2008, sixty-six pregnant women were split into two equal groups; one which underwent six one-hour yoga classes during the same weeks gestation (28, 30, 32, 34, 36 and 37), and the other which was asked to practice yoga in a more informal setting, at home, two or more times a week for 10-12 weeks. The control group was given a diary of their practice, a video tape and a booklet for home study, whereas the experimental group was given a structured class with instruction on postures, chanting, breathing, yoga relaxation and meditation. The results of the study concluded that the experimental group experienced significantly higher maternal comfort than the control group both during labor and two hours post-delivery. The experimental group also experienced a significantly shorter first stage labor (Robertshawe, 2009, p. 81).

            A third study which was a randomized controlled study of 102 normal pregnant women was conducted in 2010 to compare the quality of life and interpersonal relationships of pregnant women who participated in yoga classes to those who received standard antenatal exercise practices during the same period. The study showed that “integrated yoga interventions can significantly improve the quality of life of pregnant women in the physical, psychological, social and general health domains” (Rakhshani et al., 2010, p. 1451). The study found some interesting benefits that surpassed physical health and relaxation. According to Rakhshani et al., “compared to the non-yoga group, the integrated yoga interventions helped the subjects in developing a sense of belonging, wanting more influence on their environment, and desiring more warmth and closeness” (2010, p. 1452).

            Yoga is an incredibly helpful tool to use in preparation for childbirth. Hatha yoga combines many of the basic elements of psychoprophylaxis, which is something that is taught in childbirth classes for coping strategies in labor. Psychoprophylaxis is a method of mental training to reduce the perception of pain in childbirth using the gate control theory of pain and other relaxation techniques. Utilizing these mental and physical skills is often crucial in order to surpass the pain in labor, and this type of cognitive restructuring is also essential in yoga in order to assume some of the uncomfortable physical positions (Samuels, 1987, p. 40). According to Israel, “For anyone who has practiced yoga, you know that you must listen to your body, and when you do that, you can also learn to soften around your discomfort and even settle into it, often accepting the discomfort and learning from it” (2010, p. 15). In addition to the physical benefits of yoga, the practice of pranayama (conscious breathing) contributes to better psychological affects during labor, which enables the “letting go” so crucial in childbirth. For example, during an intense stretching pose in yoga, the student is taught to surrender all physical tension and “let go.” This concept of “letting go,” innate in many yoga practices, is vital in labor, and cultivating this cognitive process in pregnancy will help the woman in labor (Samuels, 1987, p. 41).  

Culture

            In order to adequately research and report the “culture” of prenatal yoga, it is important to have an understanding of the word culture and its meaning in several contexts. The World English Dictionary’s sixth definition of culture is “the attitudes, feelings, values and behavior that characterize and inform society as a whole or any social group within it,” which is the definition which will be assumed. In America’s Western, primarily Caucasian, middle class culture in an urban area, there are still many sub-cultures in which prenatal yoga exists, such as the difference between prenatal yoga offered at a Hindu temple vs. a hospital. In the same way, in India there is also a plethora of sub-cultures in which yoga exists; to say that yoga in India is the same everywhere in India would be a falsity. Due to these vast differences, there is a wide range of prenatal yoga that can be found in the world.

            The cultural and medical understanding of pregnancy in India, found in the Caraka Samhita (an early Ayurvedic text on internal medicine), is an interesting one when compared with Western culture. According to the text, the formation of an embryo is derived from the following five sources: mother, father, soul, wholesomeness and rasa (digestive product of the mother’s food). (Rhodes, 1997, p. 24). This is very different from Western medicine’s theory on conception, where there is no legitimate role of a soul or consciousness. Just as the understanding of conception and pregnancy is variant in both cultures, the understanding of prenatal care is also very different. According to Rhodes, in India, the dominant discourse is that the practice of prenatal yoga significantly improves the health and well-being of the mother and fetus. “The importance of the mother’s health and physical nurturance is included in this ancient writing with acknowledgement of wholesomeness and rasa as necessary for full development” (Rhodes, 1997, p. 25). Prenatal care is very different in India than it is in the West, where standard prenatal care includes allopathic values such as regular doctor’s visits, taking prenatal vitamins, and cultivating stress-reduction techniques.

            In the West, a culture rich in stress, anxiety and depression (Battle,2010, p. 353), women carry these mental fixations into their pregnancy. Some women even develop depression in their pregnancy, especially if their pregnancy was unplanned, or happened under unfortunate circumstances. Antenatal major depression is a prevalent condition, which is difficult to treat considering that pregnant women are not advised to take medications in pregnancy (Battle, 2010, p. 353). Alternative and complementary therapies appeal to some pregnant women because they are less likely to have negative side effects and harm their baby. Prenatal yoga is used to treat mild to moderate depression during pregnancy, because the practice is based in enhancing one’s well-being (Battle, 2010, p. 353). Due to clear evidence that prenatal anxiety predicts postpartum depression, (Beddoe, 2007, p. 35), it possible that by reducing anxiety in pregnancy through yoga may lessen the incidence of postpartum depression.

            The high prevalence of psychosocial stress in Western culture has an immense impact on maternal health. In fact, according to Rakhshani et al.,

                        “Maternal psychological stress has been associated with reduced placental perfusion and endothelial dysfunction, which are known as the main causes of many   pregnancy complications, including intrauterine growth restriction, pregnancy-induced           hypertension, and preeclampsia”(Rakhshani et al., 2010, p. 1447).

These complications are among the most serious prenatal complications in pregnancy, which lead to more complicated births, higher incidents of cesarean births and overall less favorable birth outcomes (Battle, 2010, p. 353). Prenatal yoga, a system of philosophy and practice aimed at improving mental, physical and spiritual well-being by practicing postures, breathing and meditation in pregnancy, is known to reduce maternal stress and therefore lower the rates of pregnancy complications such as those listed above (Battle, 2010, p. 353). In addition to contributing to more positive birth outcomes, prenatal yoga practice is also posited to favorably impact pain tolerance during labor. (Reis, 2011, p. 32). Studies on animals have revealed that prenatal maternal stress affects pregnancy outcome and results in early programming of various systems of the body with permanent changes in neuroendocrine regulation as well as a change in the offspring’s behavior (Narendran, 2005, p. 237). When the body is under stress, it releases a hormone called cortisol which is essential in stimulating the sympathetic nervous system, however when this hormone is released in excess, there are many potential harmful effects on the body, such as experiencing an excess of stress and anxiety. The major parts of the female reproductive organs (the endometrium, myometrium and ovaries) are rich in receptors for corticotrophin releasing hormone and cortisol receptors, which is potentially why stress may lead to poor reproductive outcomes (Narendran, 2005, p. 243).

            A study was done at Brown University in Providence, Rhode Island, which surveyed a group of women (who had, for one reason or another, been seeking treatment at a psychiatric day hospital) about their interest in trying prenatal yoga as a complimentary treatment. Perinatal women from diverse racial, ethnic, and socioeconomic backgrounds were given a brief anonymous survey asking women whether or not they would be interested in trying prenatal yoga, and to endorse reasons that might motivate them to do so. Out of the 250 pregnant and postpartum women who participated, eighty-three percent reported having an interest in trying prenatal yoga. Most of the women who reported an interest (sixty-two percent, to be exact) had never before taken a yoga class, and therefore based their interest or non-interest on the standard definition of Prenatal Yoga, which was presented (Battle, p. 353). From this study, alone, it appears that the culture within a particular hospital in Providence, Rhode Island, saw value in trying prenatal yoga.

            It is understood that yoga was “discovered” in India, and part of the dominant discourse in America around yoga is that yoga is not “authentic” unless Indian culture is implicated. Interestingly enough, in 1991 at a conference sponsored by Unity in Yoga International in Costa Rica, there was a debate among yogis as to which culture actually “discovered” yoga—India or South America (Rhodes, 1997, p. 9). According to Rhodes, yoga-like postures are part of our archetypal heritage as human beings. As a matter of fact, this postulation “may find substantiation in the ultrasound picture of a fetus in a yoga-like posture, described by Ianniruberto and Tajani” (Rhodes, 1997, p. 10). Although American culture recognizes the roots of yoga as an exclusively Indian cultural tradition, it is important to note that parts of this ancient tradition are part of our archetypal ancestry. Because infants find themselves assuming yoga asanas in the womb and these postures are essential to physiological development (Rhodes, 1997, p. 10), pregnant women who practice yoga may, therefore, pass a wealth of body awareness and knowledge through the neuro-musculature to the infant (Rhodes, 1997, p. 11).

Practice

            According to Reis, Although the practice of prenatal yoga varies according to style and ritual, the philosophical basis of yoga is described in the form of eight limbs or steps: “yama (ethical principles), niyama (discipline and self-purification), asana (postures), pranayama (rhythmic breath control), pratyahara (emancipation of the mind from the dominance of the senses and external foci), dhyans (meditation), and Samadhi (loss of the sense of separate existence; possessing a universal spirit)” (Reis, 2011, p. 22). In the West, the prenatal yoga practice that has developed typically includes a series of specific postures targeting specific muscle groups helpful for pregnant women integrated with structured breathing and meditation (Reis, 2011, p. 22).

            It is important to address the benefits of practicing yoga for the pregnant woman’s body, specifically. A woman’s body changes tremendously in the nine months that she is pregnant. The woman’s center of gravity shifts downward, which can produce instability and back pain for some women. By the end of the nine months of pregnancy, the uterus has expanded from the size of a pear to the size of a watermelon, holding a baby that is approximately seven pounds. The body has created an entirely new organ, the placenta, which is a large frisbee-sized organ weighing a little over a pound that is attached to the inside of the uterus and brings nutrients to the unborn fetus. The uterus has expanded into the abdominal cavity, pushing all organs in the abdominal cavity over to a smaller space. The woman’s spine takes a more exaggerated “S” shape as she may develop moderate to severe lordosis in her lower back in order to compensate for her large belly in the front of her body. Both the uterus and breasts gain about three pounds each in pregnancy. The woman’s blood volume increases by about thirty percent, constituting for a whopping four extra pounds, and extra-cellular fluid constitutes for about six extra pounds. Lastly, a woman’s fat stores increase, but this varies widely woman to woman (most women gain between 5 to 10 pounds in extra fat storage) (Stillerman, 2008). In a very short period of time, a woman’s body changes from the body she has always known, to a large-bellied, completely different body. This has a huge effect on pregnant women, because her perception of herself (self image, body image, role changes, etc.) as well as her sense of “self” in her own body, changes dramatically in such a short period of time, which can be positive or negative, depending on the woman’s perception of herself. The practice of yoga addresses these changes in the body and works to adjust this postural alignment by strengthening particular muscles, depending on the particular asanas in the practice. Yoga reaches specific groups of muscles in the back, and strengthening muscles that contribute to the pregnancy “waddle”, which is a result from the loosening of the pelvic joints and ligaments (Samuels, 1987, p. 40).

            Reis states that there are “a number of studies that support the health promotional benefits of yoga practice. The findings affirming the positive effects of yoga practice suggest that it is an ideal path to promote optimism, health and well-being during pregnancy” (Reis, 1987, p. 35-36). A prenatal yoga practice can look very different depending on the teacher, the specific asanas present, the environment and the location and culture of where the class is held. For example, a low-cost prenatal yoga class at a hospital in a poorer part of New York with an inadvanced teacher would be a very different experience than a yoga class in a wealthy town in France with a world-renowned Yoga teacher. Here is a snapshot of the flow-through of a prenatal yoga class, as shown by Rakhshani et al.’s study: short lecture topic (15 mins), asanas, such as tadasana, ardhakati-chakrasana, trikonasana, vajrasana, vakrasana, siddhasana, baddakonasana, upavistakonasana, squatting, viparita and ardha-pavanamuktasana (15 mins), pranayama and meditation (10 mins) such as nadishiddhi, sheetali, bharamari, nadanusandhana, and om meditation, and lastly, the class ended with DRT, or deep relaxation technique (10 mins) (Rakhshani et al., 2010, p. 1449).

            The asanas, or postures, are a very important element in the practice of yoga. According to Munger, while pregnant women in America may be interested in practicing yoga, it can be difficult to find the time. As Munger put it, “Unfortunately, at the stage we need yoga most, when our bodies and minds are in need of balance, we rarely find the time” (2008, p. 116). If women are educated about the benefits of prenatal yoga for both the mother and infant, women may be more inclined to practice yoga.

References

Battle, C. L., Uebelacker, L.A., Howard, M. & Castaneda, M. (2010). Prenatal Yoga and             Depression During Pregnancy. Birth:Issues in Perinatal Care, 37(4), 353-354.

Beddoe, A.E. (2007). Mindfulness-based yoga during pregnancy: A pilot study examining             relationships between stress, anxiety, sleep and pain. University of California, San           Francisco. Proquest Dissertations and Theses.

Beyer-Nelson, K. K. (2001). Developing a Prenatal Hatha Yoga Program for Integration with       Existing Hospital-Based Childbirth Education Classes. International Journal of Yoga             Therapy,(11), 49-60.

Coe, W. (2020). Prenatal Yoga. Midwives Magazine, 50. Retrieved from     <http://go.galegroup.com/ps/i.do?id=GALE%7CA224933816&v=2.1&u=les_main&it=r        &p=AONE&sw=w>.

Culture. (n.d.). In World English Dictionary.Retrieved from             <http://dictionary.reference.com/browse/culture>.

Field, T. (2008). Pregnancy and Labor Alternative Therapy Research. (Cover Story). Alternative   Therapies In Health & Medicine, 14 (5), 28-34.

Israel, A. L. (2010). Prenatal Yoga and Childbirth Education: A Response to Tracy Posner’s         Birth Story. Journal of Perinatal Education, 19(2), 3-15. 

Munger, D.L. (2008). Yoga Prenatal and Yoga for Mother & Baby DVDs. International Journal Of Yoga Therapy,(18), 116.

Narendran, S. Nagarathna, R., Narendran, V., Gunasheela, S., & Nagendra, H. (2005). Efficacy   of Yoga on Pregnancy Outcome. Journal of Alternative & Complementary Medicine,    11(2), 237-244.

Posner, T. (2010). The Most Amazing 24 Hours. Journal Of Perinatal Education 19(1), 4-7.

Rakhshani, A., Maharana, s., Raghuram, N., Nagendra, H. R., & Venkatram, P. (2010). Effects    of Integrated Yoga on Quality of Life and Interpersonal Relationships of Pregnant        Women. Quality of Life Research, 19(10), 1447-1455.

Reis, P.J. (2011). Prenatal Yoga Practice in Late Pregnancy and Patterning of Change in Optimism, Power, and Well-being. East Carolina University. ProQuest Dissertations and    Theses,             <http://lesley.ezproxy.blackboard.com/login?url=http://search.proquest.com/docview/872  089468?accountid=12060>.

Rhodes, J.M. (1997). Aware beginnings: Body Language and Birth Memory Through the Lens of the Ancient Practice of Yoga Asana. The Union Institute. ProQuest Dissertations and   Theses,             <http://lesley.ezproxy.blackboard.com/login?url=http://search.proquest.com/docview/30    4463669?accountid=12060>.

Samuels, K. L. (1987). An Examination of Childbirth Training: Changes in Self-Efficacy,   Anxiety, and Body Image. California School of Professional Psychology-Los Angeles.             ProQuest Dissertations and Theses,             <http://lesley.ezproxy.blackboard.com/login?url=http://search.proquest.com/docview/303  476025?accountid=12060>.

Sears, W., & Sears, M. (1994). The Birth Book: Everything You Need to Know to Have a Safe       and Satisfying Birth. Boston: Little, Brown & Co.

Stillerman, E. (2008). Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum          Bodywork. St. Louis, Mo.: Mosby/Elservier.