Childbirth has long term implications in a woman's life. Explain how Yoga can help improve not only the quality of particular pregnancies but also the well being of women beyond childbirth.
Introduction
In this essay, I will explore the experience of childbirth in the 21st century and the implications of undertaking pregnancy yoga in this context. I believe that the benefits can be considered as physical, emotional and spiritual and I will examine each of these. I will then look at how the skills learned during pregnancy yoga can benefit a woman beyond pregnancy.
Childbirth in the 21st century
I believe that, for many Western women giving birth in the 21st Century, their experience of pregnancy can easily be one of a medicalised and increasingly commercialised pregnancy, which prepares them to anticipate a medicalised labour and birth and a particular vision of life with a baby, dictated and designed by the manufacturers of baby products.
On arriving at the doctor’s surgery to discuss her pregnancy, a woman will be given a package of pregnancy information, most of which is sponsored by major commercial companies. There will be some information provided about breastfeeding but usually very little that will reassure her that pregnancy and birth are natural and that her body has been designed for this purpose. This is confirmed by Robertson, who states that “It is sometimes argued that modern women have lost the ‘art’ of giving birth” and “The current medicalisation of birth encourages women to forsake their own resources and embrace technology and external guidance during labour”. Robertson (1994) p. 101.
Yet, more and more women who have previously had a medicalised birth experience seek a different experience during subsequent pregnancies. Some of these opt for a home birth and those who choose to give birth again in hospital often plan to avoid or minimise medical interventions. “Tragically, previous bad hospital experiences often motivate women to have subsequent babies at home.” Wesson (1990) p. 18.
Throughout pregnancy, medical interventions are presented by doctors, midwives, the media and anecdotally as normal practice rather than processes which a woman can opt for or against. Information given to pregnant women about preparation for childbirth tends to focus on pain relief, again with relatively little information being given to non-pharmacological methods of pain relief, let alone to ‘natural childbirth’ without pain relief or interventions. “The process of surrender of the mother’s power and control over her birth begins as soon as the pregnancy is confirmed, if not earlier. [This] undermines the woman’s trust and confidence in her own body and her own power.” Balaskas (1993) p. 19.
I believe that undertaking pregnancy yoga can act as a counter-balance to this medical and commercial view of pregnancy, which is commonly accepted as the norm, by showing pregnancy to be an important but entirely normal and natural part of a woman’s life. It can reaffirm a woman’s self-belief in her own abilities to carry and birth a child; can help her gain physical skills to assist with any discomforts of pregnancy and labour and can help her develop baby-nurturing skills for the post-natal period.
Becoming part of a pregnancy yoga group can provide emotional support and can highlight the importance of effective support from a birth partner during labour. It can also reawaken and reaffirm within each woman the spirituality of pregnancy and of simply being a woman. The benefits that yoga brings can last throughout pregnancy and birth, through the post-natal period and on for the rest of life, becoming life skills which can transform and support a woman.
Physical benefits
Yoga involves at its core body awareness, which is crucial during pregnancy when there are so many physical changes that a woman’s body goes through.It is well acknowledged that good body awareness is a key factor in women having the confidence to give birth. “Midwives may feel called to strengthen the woman’s body awareness and trust in self.” Ayerle et al (2005) p. 193.
Robertson (1994), p. 149, states that “Participating in exercise offers an ideal way for women to become more aware of their pregnant bodies and there are important benefits to be gained from exercise during pregnancy”. Interestingly, this positive view of the benefits of undertaking physical exercise contrasts with the more circumspect guidance on exercise in pregnancy, funded by NICE as guidelines for the NHS,which states only that “In an RCT that compared babies born to women who continued regular exercise during pregnancy with women who did not exercise regularly during pregnancy, no differences in neurodevelopmental outcomes at one year of age were reported.” National Collaborating Centre for Women’s and Children’s Health (2003) p. 45.
The report concludes only that “Pregnant women should be informed that beginning or continuing a moderate course of exercise during pregnancy is not associated with adverse outcomes”.
It is highly concerning that women are being advised not only that exercise during pregnancy may carry no risks but that it may bring about no benefits. Official guidance includes little if any acknowledgment that forms of exercise such as pregnancy yoga can be highly beneficial. The experience of the women that I have encountered who have given birth after attending Birthlight Yoga classes for between 6 and 24 weeks before giving birth is that pregnancy yoga brings about many benefits.Even if this were provided only to be a placebo effect [which I personally doubt strongly], the fact that women who attend Perinatal yoga classes report that they feel they had an improved birth experience is a good enough reason to positively encourage attendance at such classes.
For some women, their needs may extend beyond body awareness as they may need help to accept and adjust to their pregnancy. I believe that Western society portrays pregnancy almost as an illness and an abnormal state of being, which leads women to fear it and to search for methods of control. A woman who cannot accept the changes that early pregnancy can bring may struggle more to accept labour and childbirth. “A woman who is resisting and fighting her body can never enjoy the tussle of labour. She lies in stoic endurance, taut with anxiety, determined not to give in, or chooses to obliterate the sensations of birth with drugs. She retreats from the overwhelming reality of the childbirth experience”. Kitzinger (2004) p.150.
For many women, their greatest fear about labour and childbirth is the potential pain and the loss of control. Sheila Kitzinger states that “One effect of the desanctification of birth is that a woman is left helpless in the face of fear and pain. The guarantee of an epidural as soon as she gets through the hospital door may be the only thing that makes birth bearable.” Kitzinger (2000), p. 91.
Pregnancy yoga classes can provide an opportunity for each woman to consider her physical strengths and abilities, to think about her pain threshold and to make an informed choice about pain relief methods. Although there may be no direct discussion about pain relief during classes, one of the benefits of regular attendance at a pregnancy yoga class is that women build up stamina and endurance. Women who return to classes with their babies will invariably discuss their choice of pain relief methods and may be able to present the advantages and disadvantages of the methods that they considered or tried. Above all, the power of breathing can be used as a way to control and welcome the pain of contractions and yoga classes reinforce this gently and regularly.
Discussion about breathing and the power of the breath form an essential part of each yoga class. The importance of being in tune with one’s own breath cannot be over-emphasized. “The way you breathe is closely connected with the rhythm to which your body adapts itself in labour. If you can harmonise your breathing with the contractions of the uterus… you will find it very exhilarating”. Kitzinger (2004) p.115.
Breathing is one of the simplest and yet most important tasks that our body accomplishes. “To breathe is to be in accord with creation, to be in harmony with the Universal, with its eternal motion”. Leboyer (1975), p.46.Yet the teaching of breathing techniques, as applied in some antenatal classes, can be detrimental. “Applying an unnatural breathing pattern is an intervention that carries the risk of disturbing blood chemistry… Promoting ‘the breathing’ also suggests that women’s bodies will not be able to manage this function automatically during labour, potentially undermining her confidence in her body’s own ability to give birth.” Robertson (2002) p. 16.
It is important that, rather than being taught breathing as a technique, women are helped to focus on their breathing and their body’s own ability to adapt breathing as circumstances dictate. “It is not necessary to learn any special breathing techniques for labour and birth, when breathing should be free and spontaneous. However, to be able to concentrate on the ‘breath’ – the source of all life – can help you to get through the most difficult times in your labour.” Balaskas (1994) p.32.
Pregnancy yoga classes offer the opportunity to practise different forms of breathing, for example, deep abdominal breathing, ‘cafetière’ breathing and‘candle’ breathing, which can then be called upon, almost subconsciously, when needed. My one-to-one student was greatly relieved when I explained to her that she could fit a movement to her breath, rather than vice versa, as she had found some exercises taught to her by a midwife during a previous pregnancy to be almost impossible as she couldn’t harmonise her breath with the movement. She visibly relaxed when I explained that she could take her own time and listen to her own body.
I have heard many women relating their birth experiences who have made comments like “I just remembered to keep breathing as I had done in yoga class and that helped.” During my own labour, my husband and I focussed on breathing together through every contraction and I found that I was able to let the breath flow with the contraction, listening to my own body, and without even considering the need for any outside intervention or pain relief.
A skill which can be taught very effectively in pregnancy yoga classes is that of toning the pelvic floor. It is essential to begin pelvic floor exercises early in pregnancy and they can be incorporated into every class, with women being shown a variety of different positions to adopt in which to carry them out. The yoga method of pelvic floor exercises focuses on the hammock of muscles which make up the pelvic floor. Once again, this contrasts with the ‘medical’ approach to the pelvic floor which can focus only on one set of muscles, without really explaining to women why such exercises are necessary and without providing advice on how to carry out exercises correctly.
Practising pelvic floor exercises sitting backwards over a chair, with a flannel placed beneath the perineum, or sitting on a birth ball can allow women to really understand the connection between what they are being asked to do and the groups of muscles that are involved. They can focus on the birth canal and begin to think about their birthing muscles, reinforcing for themselves the belief that women’s bodies are designed to give birth.
Yoga classes can also give women the confidence to make choices about medical interventions and pain relief, rather than accepting without question what is presented to them by medical staff. “Most of the women that I teach… manage to give birth instinctively without drugs or interventions. However, those that do choose or need to avail themselves of pain relief or obstetric support usually do so from a position of inner power and feel content that this was appropriate in their situation and circumstances.” Balaskas (1993) p. 13.
Women attending a pregnancy yoga class regularly may have the opportunity to hear more ‘natural birth’ stories than other women. In fact, many women may give birth without even having heard a genuine birth story or having heard only tales of what can go wrong during labour. I attended Birthlight classes for twenty-three weeks during my first pregnancy and, at the time of writing this essay, have attended classes again since the eighteenth week of my second pregnancy. I have heard more than twenty birth stories from women returning to Birthlight classes and have been struck by how many women have managed to have what I would term a ‘natural birth’, without interventions or pharmacological pain relief. Many of these women have attributed this to their yoga classes, which provided them with both the physical skills and the confidence to have their desired birth.
“Women know how to give birth. A woman who is encouraged to be instinctive and to tune in to her body during labour can discover exactly what she needs to do to make labour easier for herself and the baby.” Robertson (1994), p. 101.
The practice of yoga allows a woman to trust her instincts and her intuition, to make decisions for herself, even about which exercises she takes part in and which positions she adopts. By teaching pregnancy yoga as a series of flowing movements, which can be varied to suit each woman, we give out the message that the woman herself knows what is best for her. We can explain how micro-movements can be just as effective as larger movements and can offer different exercises for different stages of pregnancy, constantly encouraging each woman to make choices for herself. As teachers, we give her confidence in her ability to make decisions for herself, knowing that this will help her to have the self-assurance to make important decisions during labour and birth.
Relaxation, which is a key part of pregnancy yoga classes, offers both a time for self-reflection, which may be the only time a woman takes all week to focus purely on her own needs, and a time for bonding with her baby. It is important to note that not all women will appreciate a focus on the baby during this time. “It is distressing for some women who dislike being pregnant – like an invasion from outer space. They may picture the baby as a parasite clinging to them or an enemy within.” Kitzinger (2004) p.78.
Relaxation sessions offer a chance to both unwind and to draw the woman’s focus inwards. “The aim of [relaxation] exercises is to help a woman understand herself and her body better… There is nothing to escape from, nothing to deny, nothing she cannot face.” Kitzinger (2004) p.95.
Yoga classes provide women with practical skills to deal with the discomforts of pregnancy, to cope with labour and to handle their babies after birth. In a qualitative study into women’s well-being during their pregnancy, researchers reported that “The participants reported a continuum of typical physical complaints during pregnancy... Surprisingly, some women report severe physical symptoms or pain yet do not feel compromised in their well-being. Depending on her body awareness, a woman is able to react to various symptoms of her body and make herself feel at ease by appropriate self-care. By way of their body sensations, some feel they know what is good for their baby”. Ayerle et al (2005) p. 189.
In the same vein, Balaskas comments that “Problems such as tiredness, back pain, nausea, anxiety, headaches and many other common complaints of pregnancy may be eased by practising yoga and often they may disappear altogether.” Balaskas (1993) p. 28. By offering women a simple way of easing discomforts, and by providing an explanation about the source or cause of discomforts, we can help women to accept the physical changes that accompany the growth of the baby.
Many yoga practices can be carried out during labour, can help with positioning of the baby, and with helping labour to progress. Yoga classes can provide an opportunity to use ‘props’ such as birth balls, which women may not be familiar with, but which are extremely useful during labour. “[The birth ball] enables women to adopt upright positions that evidence informs us helps to shorten labour and reduce the sensation of pain. The ball addresses the balance and culture around how women labour and birth their babies. Inevitably many women come to the delivery suite having never seen
[a birth ball] before but will be willing to use it if it suggested sensitively and pro-actively” Shallow (2003) p. 28 – 29.
Yoga classes can also provide ideas for upright birth positions, challenging the traditional (as-seen-on-TV) image of women labouring on their backs. Women can practise squatting, a practice which is rarely carried out in the everyday life of Western women but which is useful for opening the pelvis and for stretching the perineum. Positions can be practised which can speed up or slow down labour, as needed, and there can be some discussion about how to use gravity to help a baby’s birth.