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A Gentle Way to Labour

(originally published in 'Spectrum', the British Wheel of Yoga magazine)

Yoga is a way of working with the mind and body, with the breath as the link; it is not competitive, as everyone works at his or her own level. It helps towards having a sense of quietness from within and to relax the mind and body. An added benefit is that it also helps the body to be comfortable in its natural shape.

Yoga is not magical, mystical or mysterious. It is a basic and down-to-earth form of exercise that can fit into everyone's life regardless of class, age, sex, religion or disabilities.

Yoga is an appropriate form of exercise for pregnant women, as it can be adapted to their needs, working on movements that help the body to be relaxed, supple and well-toned throughout pregnancy. Yoga movements that may be beneficial during labour can also be learnt. In pregnancy the ligaments and joints soften and loosen to make more space in the body. It is particularly important therefore, to protect well-toned muscles.

I work at the Workers' Educational Association (WEA) in Leicester teaching both antenatal and postnatal yoga. I have been teaching yoga to pregnant women for a number of years. I taught before my first pregnancy and then through both my first and second pregnancies, the second with twins.

In my antenatal yoga classes a small group of women at differing stages of pregnancy meet for one to two terms. I always ask women to check with their doctor and/or midwife before attending. A yoga session lasts just over an hour, then in the second hour the format varies from watching relevant videos, to general discussions. This second hour is just as important as the first. The groups are small so women are able to get to know one another.

The course also includes two Saturday-morning sessions with partners. One is 'Yoga in pairs' where we work on yoga movements that, like those in the weekly classes, are helpful in pregnancy and may be useful to some women in labour. The second Saturday session is on shiatsu, taken by Adam Newman Turner. Mr Newman Turner has taught shiatsu for the past 20 years. He and his partner have used shiatsu during the birth of all their three children and throughout her pregnancies. He explains what shiatsu is and how it is useful during pregnancy and labour in particular.

My yoga sessions concentrate on working on various yoga postures with emphasis on breathing. Many of the postures are practised in pairs. The women become familiar with movements they can practise at home with their partners and it is a way of sharing energy, of giving and receiving. Practice also helps the woman by increasing the stretch of the posture. Each yoga session finishes with pranayama (controlled breathing) and yoga relaxation.

Women appear to find yoga beneficial during pregnancy and childbirth and come back to the classes for their second and third pregnancies.

The type of benefits women experience include:

Improved posture: posture is important at any time but particularly when one is pregnant and carrying extra weight that is not evenly distributed.

The alleviation of various problems such as backache, including sciatica, varicose veins, oedema and heartburn.

We also practise pelvic floor exercises to increase the strength and suppleness of the pelvic floor. Being able to learn to let go of these muscles is as important as being able to contract them. As with all muscles, when supplied with blood and oxygen from frequent exercise they will have the ability to stretch without strain and are less likely to tear. All the postures are carried out while working with the breath. The sessions help women learn how to relax before and after the birth.

One of the key aspects of yoga is working with the breath. It is particularly important during labour, and what women always report as being most important during giving birth is 'the role of the breath'. In yoga we see the breath as the link between the mind and body. In general we work with the breath by breathing in and out through the nose. In labour we work with the breath by breathing out through the mouth. Thus, much time is spent working on breathing exercises that help women to relax as well as breathing exercises specifically for working with contractions. The women do, however, learn how to breathe properly using the whole of their lungs. If you watch small children asleep, their abdominal muscles move up and down with their breath. We are born with the ability to use the whole of our lungs comfortably and naturally, yet as we become adults we find that we no longer do so and breathing has to be re-learnt. Working with the breath is more difficult for smokers and for those with a respiratory illness.

Practising yoga and relaxation all the way through pregnancy and doing all the 'right things' does not guarantee a perfect labour. I always suggest that women keep an open mind. If events do not go to plan, the yoga and relaxation will hold them in good stead, thus helping to deal with any eventuality. Women can still hang on to their sense of self and work in the best way they can. Giving birth is like running a marathon. One would not run a marathon without preparing for it, and yoga can help with that preparation.

The shiatsu sessions offer couples massage techniques that are useful for both pregnancy and childbirth. According to Mr Newman Turner, shiatsu is a form of massage therapy, which is closely linked to acupuncture. However, very few women have access to a qualified acupuncturist or shiatsu practitioner during labour. It is possible, however, to teach some basic techniques of shiatsu quite safely to couples who are expecting babies. Many have found that simple, self-help massage techniques useful during pregnancy and labour, help the women to become calm and relaxed, releasing tension and increasing the healthy flow of energy throughout the body.

The word 'shiatsu' means 'finger pressure', but this sometimes gives people the misleading idea that it mainly involves painful poking of mysterious 'pressure points'. In fact, a wide range of diagnostic and therapeutic massage techniques is used by trained practitioners. Although complementary to acupuncture, shiatsu is a holistic theory in its own right.

Within a half-day workshop women and their partners are able to learn and practise three or four simple techniques which can help to relax and support aching backs, reduce the pain of contractions, reduce the urge to push too early and stimulate the specific energies to complete the natural labour processes. Particular emphasis is given, however, to the avoidance of any techniques which might be unsafe or cause unwanted reactions.

A significant part of each shiatsu workshop is spent on exercises designed to increase awareness of the movement of energy within the body and to develop flexibility, concentration and relaxation. These are known as 'do in' self-massage techniques (pronounced 'dough in') and offer another approach to working with the body and mind, which is compatible with yoga.

The postnatal yoga classes offer women an opportunity to come together to work on yoga postures that help their bodies regain their natural shape, to have time to themselves. The babies are in the crèche, but inevitably there are always one or two babies who need the breast or just want to be with their mothers, so the classes work around this.

The role of the group is vital in offering support. In fact the last group I ran went on to form their own yoga group, meeting in each other's homes and working with one of my yoga tapes, while a couple of women looked after the babies and toddlers.

Working with pregnant women and being able to follow it through until after the babies are born is rewarding, fulfilling and fun. I consider myself very lucky to be able to earn part of my living in this way.

Although research has been carried out into the benefits of yoga generally, little work has been done on investigating the benefits for pregnant women. However, Dr Deepti Dongaonkar, a gynecologist based in Bombay, who spent some time at the Queen's Medical Centre, Nottingham, recently became interested in the medical applications of yoga and believes that yoga is a practical system for improving general health and helping relieve some of the physical and mental stress associated with pregnancy. Involved in research into hypertension in pregnancy, she says that although hypertension in pregnancy cannot be prevented, its onset can be delayed and severity minimised through the use of yoga, thereby reducing the side-effects of hypertension on the mother and babies health.

While in Nottingham she and Professor David James from the division of feto-maternal medicine carried out a pilot study of the efficacy of yoga in lowering BP in pregnancy-induced hypertension. Their study involved 18 pregnant women selected from the antenatal ward at Queen's Medical Centre who were admitted for pregnancy-induced hypertension. They were divided randomly into a study group (yoga) or a control group (physical rest). The women in the yoga group were given information about the role of yoga in lowering BP and other advantages and the physiology of relaxation and concept of controlled breathing were explained. The blood pressure of both groups was taken before and after the yoga sessions and the physical rest taken by the control group was supervised by a trained staff nurse, who was unaware of which group the women were in. The women in the control group were asked to lie on their left side and relax without any instructions for one hour. Dr Dongaonkar conducted yoga sessions teaching yoga postures, controlled breathing and yogic relaxation.

The two groups were comparable in age, number of previous pregnancies and other variables. The results of the study showed that there were greater falls in the median blood pressures in the yoga group compared to the control group. However, none of these differences were statistically significant. If yoga is to be shown to be of value at lowering pregnancy-related hypertension, research involving larger numbers is required.