No epidural? Pain management and alternative tips – Part 5: Yoga, Mindfulness and Breathing Techniques

Photo courtesy of Clare Island Yoga Retreat Centre, Mayo, Ireland www.yogaretreats.ie

Science now broadly recognises that the practice of yoga, which includes breathing exercises and meditation, can “actually reverse the physiological signs of stress [and can] provide dramatic and lasting pain relief in a variety of conditions” (Diane Post, MD – Harvard Health Publications)

During pregnancy, a woman’s body changes on several different levels. There are the physical, or more visible changes, and there are the internal changes, such as hormonal and emotional ones. The process of growing another human being means that women are constantly connected to this developing life and all of the changes that it brings.

Many medical professionals and birth educators recommend antenatal pregnancy yoga classes for women after the first trimester (around 14 weeks) as a means of preparation for pregnancy, labour and birth. Yoga has been practiced for over 3000 years and has become more popular in the West over the last 100 years. The use of yoga and its inherent focus on mindfulness for both clinical and non-clinical populations has increased substantially the last decade. It is widely recognised as a form of mind-body medicine that integrates an individual’s physical, mental and spiritual components to improve aspects of health, particularly when they are related to stress or perceived pain (Atkinson and Permuth-Levine, 2009).

A broad translation and definition of the Sanskrit word yoga is ‘to unite’ and “to work towards a unified experience of the self and improved health” (Salmon et al., 2009; Curtis et al., 2012). Yoga is a comprehensive system of practice that encompasses physical movement, breathing exercises, concentration, mindfulness and meditation. The evidence to support the many benefits of prenatal yoga include a reduction in maternal stress levels, reduction of pregnancy related pain, improved quality of sleep during pregnancy and improved overall birth outcomes. While there is limited data to support non-pharmacologic pain relief in childbirth, studies support the use of yoga and relaxation techniques as providing a “modest analgesic benefit to women in labor” (Arendt et al., 2013).

Photo courtesy of www.purplecircleyoga.com

The physical postures in antenatal yoga classes focus on stretching and toning the body in preparation for labour and birth. These are modified and adapted for each woman as she transitions from the first trimester to the third trimester. For example, the first trimester (up to 14 weeks) will focus on restorative postures and gentle breathing techniques while the second and third trimester will focus on postures that are suitable for building strength and preparing for labour and birth. The difference between a regular yoga class and a prenatal yoga class is that there is an element of childbirth education taught to help connect women with their developing babies and with their instinctual selves. While the yoga postures, often referred to as ‘meditation in action’, prepare women physically for giving birth, it is the awareness of the body, mind and breath that truly helps women to build confidence and trust in themselves to holistically prepare for labour and birth.

“The pain can be intense, but if you are able to stay focused on the sensations, breathing into them rather than running away from them, then you won’t be overwhelmed: you will, like a surfer, ride the waves of pain, rather than drowning in them. Thus you will avoid or reduce the necessity for pain-relieving drugs in labor” – Judith Hanson Lasater, PhD from Yoga in Pregnancy: What Every Mom-to-Be Needs to Know

The breathing techniques used in yoga emphasise inhaling and exhaling through the nostrils and bringing awareness to, or being mindful of, the physiological mechanism of the breath and the sensations and thoughts that this brings. The idea behind this is that the breath and the body cannot operate without receiving instructions from the mind. If there is underlying anxiety or physical pain arising when practicing yoga, the breath tends to become irregular and women may feel that their breath is sharp, shallow, paused or noisy. Irregularity of the breath is mirrored in the mind, and this can trigger a physiological response that includes a faster heart rate, higher cortisol levels and shallow breathing.

Becoming consciously aware of the breath, practicing breathing through the nostrils, directing the breath to the abdominal area (also known as diaphragmatic breathing) and gently extending each exhalation has been shown to create what is commonly called ‘the relaxation response’, where the autonomic nervous system is soothed by increased oxygen intake. Many parts of the autonomic nervous system tend to follow the activity of breathing. When a pregnant woman learns to voluntarily regulate her breathing pattern and practice mindfulness so that she is relaxed, she is able to:

  • regulate the autonomic nervous system (ie. slow breathing; lower heart rate and lower blood pressure) and can thereby reduce the stress/pain response
  • find clarity of mind and the confidence to regulate the emotional response to what may be triggering that stress/pain response
  • significantly reduce the release of arousal hormones, such as cortisol and adrenaline, when faced with that stressor/pain (Beddoe et al., 2009; Holzel et. al, 2011)

This focus on the breath is related to yoga postures and mindfulness meditation in that the mind is concentrating on one task or action with the breath as the constant backdrop. This is an extremely important part of managing feelings of unease and pain during labour and birth, particularly during the 2nd stage of labour, when women are often ‘coached’ to push. This coaching is referred to as ‘purple pushing’ as it involves holding the breath. Recent research and ACOG guidelines suggest that the ‘pushing’ stage of labour should be spontaneous and self-directed and that women choosing their own method of pushing should be accepted as best clinical practice (Prins et al., 2011). This fits in very well with the goal of yoga, mindfulness and breathing in pregnancy, labour and birth as it supports women in managing their pain through focusing and following the flow of their own breath. It connects a woman to her labor and birth and the non-judgmental acceptance of what this may bring, rather than relying on the ‘coaching’ from others.

moksha yoga

 As Rachel Yellin, a prenatal yoga teacher in San Francisco, says:

“Doing prenatal yoga doesn’t mean you’ll have the ‘perfect’ birth; it means you’ll be able to accept the perfection of the birth you’re given, regardless of whether it goes according to your plan. The primary benefit of prenatal yoga is breath awareness. If you can use the breath as an anchor, it will draw your attention inward and downward, exactly the direction you want your baby to go.” (Guthrie, C., 2012)

Yellin gently reminds her students that the breath should always be their primary focus; the physical sensations arising from the asanas, or postures, are secondary. In this way, she explains, they learn to train their focus on the breath during labor and not on the contraction: “Using the breath as an anchor keeps a woman grounded, no matter how overwhelming the sensations might be.” (Guthrie, 2012)

What Women Say:

“In the end, childbirth, like parenting, comes down to trusting your intuition, feeling what’s right, and not relying on what others think. That’s what the practice of yoga is all about…being fully, deeply, richly, and radically present with your own self.” Judith Lasater, PhD – Yoga Teacher and Physical Therapist

and

“Yoga and its teachings helped beyond words. I breathed through everything. My legs felt strong, I knew how to move, my partner knew how to move with me. The midwives commented “you can always tell the ones who’ve done yoga”. Although the final act was different than planned, we were wonderfully prepared for all of the initial stages. Yoga classes were the most important pillar for me, I’d say, in the final weeks of pregnancy and the overdue days, my pre-labour and for my partner’s level of preparedness for the whole process”

and

“The yoga classes really empowered me during the whole pregnancy, labour and starting breast feeding. Before I started pre-natal yoga I assumed that I would be having an epidural, wouldn’t be able to breast feed etc. Unfortunately, I had listened to a lot of people who told me that the natural route was too painful and old fashioned. I approached the yoga classes with an open mind and have to say that I found that they provided an opportunity each week for me to reflect on the pregnancy and the little baby inside me and gave me confidence in my own ability and courage to stand up for myself when in the hospital. In the end, I did not have an epidural and I am really delighted that I had that experience of fully being part of the process…the hormones are truly amazing and that surge of love for your little baby when they are born is so powerful, it’s incredible. “

and

“I had to have a c-section because my baby was breech. In the pregnancy yoga class it was always said that ‘you don’t know what labor and delivery will bring’. Although I had a planned c-section, so much of what I prepared still mattered. I used breathing techniques before the surgery to help stay present, calm and in my body in spite of the spinal. I know for a fact that this helped me feel more like the delivery was mine…because I was able to stay present and feel him coming out of me. I was able to connect with my delivery and still feel like I had a real labour experience”

and

“I looked so forward to my weekly prenatal yoga classes on both of my pregnancies. I got to be surrounded by other pregnant women and I got to find the time to relax and to connect with my baby and my breathing. During both of my labours I felt strong and confident and I never forgot to breathe! It was the one constant that kept me focused so that I was able to simply ‘feel’ what was happening without getting anxious or fearful. It also gave me the tools to calm my mind and body as a new mother when some of the immense responsibility felt overwhelming.”

References

Arendt, K.W. and Tessmer-Tuck, J.A. (2013). Nonpharmacologic Labor Analgesia. Clinics in Perinatology – Pain Management in the Peripartum Period. Sept 2013; 40(3): pp 351-371.

Atkinson NL, Permuth-Levine R. (2009). Benefits, barriers, and cues to action of yoga practice: A focus group approach. American Journal of Health Behavior. Vol 33: pp. 3–14.

Beddoe, A.E., Yang, P., Kennedy, H.P., WEiss, S.J. and Lee, K.A. The effects of mindfulness-based pregnancy yoga on maternal psychological and physical distress. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2009 May-June; 38(3): pp. 310-319.

Curtis, K., Weinrib, A., and Katz, J. (June 2012). Systematic review of yoga for pregnant women: Current status and future directions. Evidence Based Complementary and Alternative Medicine; 2012, 13 pages.

Guthrie, C. Labour of Love. Australian Yoga Journal, November/December 2012.

Holzel, B.K., Lazar, S.W., Gard, T., Schuman-Olivier, Z., Vago, D.R. and Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science. November 2011; Vol 6(6): pp 537-559.

Lasater, J. H. (1994). Yoga for Pregnancy: What Every Mom-to-Be Needs to Know. Rodmell Press: Berkeley, CA.

Post, D. (2012). Pain relief without drugs or surgery. Harvard Medical school Special Report. Harvard Health Publications, Brigham and Women’s Hospital: Boston.

Prins, M., Boxem, J., Lucas, C. and Hutton, E. (2011). Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG: An International Journal of Obstetrics & Gynaecology, 118: pp. 662–670.

Salmon, P., Lush, E., Jablonski, M., Sephton, S.E. Yoga and mindfulness: Clinical aspects of an ancient mind/body practice. Cognitive and Behavioral Practice, Vol 16(1), Feb 2009, 59-72.

Related Articles:

No epidural? Pain management and alternative tips – Part 1

No epidural? Pain management and alternative tips – Part 2: TENS Machine

No epidural? Pain management and alternative tips – Part 3: Water therapy, water immersion and waterbirth

No epidural? Pain management and alternative tips – Part 4: Using a doula

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