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Frequently Asked Questions: Pre-Natal Yoga Question one: When is it safe to begin practicing Prenatal Yoga or attending a prenatal yoga class? Question one: Answer Dr. G: The answer to this question depends on whether the pregnancy is low or high risk. Any movement therapy for fitness routine started during pregnancy should only be started in conjunction with clearance from your physician, midwife, and/or physiotherapist. This is absolutely required if a pregnancy is considered high risk. If the pregnancy is low risk, and a mother is not currently exercising or has practiced yoga before, clearance from your health care provider is still recommended. If the pregnancy is low risk and a mother was fit and healthy pre- pregnancy, prenatal yoga can be started at any time during any trimester. There are no contraindications to starting a yoga practice in the first trimester, however, most moms may feel nauseated, fatigued, and/or have acid reflux issues due to hormonal changes. This will self-limit practice and require modifications, which makes yoga adaptable and accessible to mothers in any trimester. If you are uncertain, discuss your desire to start a yoga practice with your physician, midwife, and/or physiotherapist, who can safely direct you toward best care practices for fitness and health during your pregnancy. Emma: This question seems to have many differing schools of thought. Some Prenatal yoga teachers, strictly advise to hold off from attending prenatal yoga classes until the women is completely through her 1 st trimester, around 12 or 13 weeks when technically she moves into the ‘safer’ stage of her pregnancy. This is because by week 12 of pregnancy, the risk of miscarriage drops to around 3%.

Frequently Asked Questions: Pre-Natal Yoga · 2018. 1. 30. · yoga teachers, strictly advise to hold off from attending prenatal yoga classes ... to avoid urinary tract infections

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Page 1: Frequently Asked Questions: Pre-Natal Yoga · 2018. 1. 30. · yoga teachers, strictly advise to hold off from attending prenatal yoga classes ... to avoid urinary tract infections

Frequently Asked Questions: Pre-Natal Yoga

Question one:

When is it safe to begin practicing Prenatal Yoga or attending a prenatal

yoga class?

Question one: Answer

Dr. G:

The answer to this question depends on whether the pregnancy is low or high

risk. Any movement therapy for fitness routine started during pregnancy should

only be started in conjunction with clearance from your physician, midwife, and/or

physiotherapist. This is absolutely required if a pregnancy is considered high risk.

If the pregnancy is low risk, and a mother is not currently exercising or has

practiced yoga before, clearance from your health care provider is still

recommended. If the pregnancy is low risk and a mother was fit and healthy pre-

pregnancy, prenatal yoga can be started at any time during any trimester.

There are no contraindications to starting a yoga practice in the first trimester,

however, most moms may feel nauseated, fatigued, and/or have acid reflux

issues due to hormonal changes. This will self-limit practice and require

modifications, which makes yoga adaptable and accessible to mothers in any

trimester.

If you are uncertain, discuss your desire to start a yoga practice with your

physician, midwife, and/or physiotherapist, who can safely direct you

toward best care practices for fitness and health during your pregnancy.

Emma:

This question seems to have many differing schools of thought. Some Prenatal

yoga teachers, strictly advise to hold off from attending prenatal yoga classes

until the women is completely through her 1st trimester, around 12 or 13 weeks

when technically she moves into the ‘safer’ stage of her pregnancy. This is

because by week 12 of pregnancy, the risk of miscarriage drops to around 3%.

Page 2: Frequently Asked Questions: Pre-Natal Yoga · 2018. 1. 30. · yoga teachers, strictly advise to hold off from attending prenatal yoga classes ... to avoid urinary tract infections

Other Prenatal yoga teachers are more relaxed and feel that a prenatal yoga

class is safe enough and appropriate for a pregnant women anytime throughout

her pregnancy. Certainly, a prenatal yoga class will be more safe for a pregnant

woman than a general yoga class where the teacher may not be familiar with

teaching pregnant women.

My belief combines both of these approaches. When a woman asks, “at what

week can I begin coming to prenatal yoga classes”, I usually say, “It depends”!

If you have had a regular yoga practice for a number of years, then beginning a

prenatal yoga class will be safe for her to attend in this first trimester, as her body

will not experience any big changes through this gentle yoga practice. If,

however, a woman is new to yoga or she has experienced previous miscarriages,

then my suggestion is to wait until she is 13 or 14 weeks pregnant. The main

reason for this is because when we first begin practicing yoga, our body (mind &

spirit) will go through a period of purification or detoxification, as the organs,

muscles, tissues (as well as the nervous system, energetic body, emotions &

mind) are squeezed, stretched and cleansed, so we would not want these

resulting toxins moving through the mother and into the foetus, especially during

the first trimester when the pregnancy and health of the baby is still being

established.

If you can’t decide when to begin prenatal yoga, then trust your instinct or

gut feeling. And usually best to err on the side of caution, especially up

until the 2nd trimester or around week 13 or 14 of your pregnancy.

Question Two:

How can I practice yoga safely throughout my pregnancy?

Question TWO: Answer

Dr. G:

The first step in practicing safe yoga is to maintain an open dialogue about your

yoga and other fitness and wellness practices with your healthcare provider.

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Second, there are some basic recommendations to consider when practicing

yoga in each trimester:

First Trimester: Nausea, fatigue, constipation, and/or acid reflux are common

symptoms of pregnancy in the first trimester. Hormonally-driven, the best way to

address these symptoms can often be through an adaptive or therapeutic yoga

practice. Therapeutic yoga is a type of yoga practice that focuses on your

individual needs (typically a 1-on-1 approach), rather than focusing on general

prenatal yoga in a class setting. However, in a general prenatal yoga class, my

main suggestions would be to 1) Honor your limitations. 2) Don’t use yoga for

“stretch.” Now is not the time to “stretch” deeper into any posture. To be safe,

avoid full ranges of motion in all yoga postures. 3) Ideally, have a physiotherapist

screen your pelvis and hips for structural and soft tissue issues such as SIJ

dysfunction, pelvic pain or pelvic floor weakness, pubic symphysis and hip

dysplasia or bony deformities, which can help lower injury risk and improve

effectiveness and safety of your yoga and overall fitness practice. 4) Avoid deep

squats, lunges, and spinal twists, as these are considered “detoxifying” and

encourage downward flow or elimination energy (apana vayu). This is anecdotal

evidence only, but for women with a previous history of miscarriage, it is best to

err on the side of caution and avoid these positions until the pregnancy is firmly

established and outside the early danger zone of the first trimester.

Second Trimester: Generally speaking, energy levels return and you may feel

your best during your second trimester. Nausea can persist through week 17 or

18 but often can subside by this time. Constipation may continue to be a theme,

and as blood volume increases, congestion, swelling in the hands and lower legs,

sinus congestion, and headaches, can be common. It is INCREDIBLY important

that regular prenatal visits are maintained during this time, where blood pressure

and other vitals are screened. Swelling in the hands and lower legs, headaches,

and regular incidences of high blood pressure can be signs of pre-eclampsia, and

should never be ignored at any stage of pregnancy, even into the “fourth

trimester” of postpartum. Dizziness, light-headedness, or shortness of breath

should also never be ignored during yoga practice as well. Maintain hydration and

never ignore urges to go the bathroom during class or practice, to avoid urinary

tract infections or incontinence. During the second trimester prone- and supine-

lying are generally substituted for left side-lying, in order to avoid vascular

compromise. Yoga postures will need adapting to make room for growing baby,

such as widening the feet or separating the legs in postures like mountain, chair,

or child’s pose.

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Third Trimester: Is Baby Locked and Loaded? Early third trimester I

recommend continued focus on readying for the big birth day! This includes

targeted training of the deeper abdominal and gluteal muscles for endurance and

strength (power), and until about week 36 or 37, continued pelvic floor

strengthening.* Deep squats should be avoided until baby is head down and

what I call “Locked and Loaded.” Semi-inversions (high child’s pose and other

similar postures) can be performed to assist in turning a breech baby, and should

be discontinued after baby is locked and loaded. I also recommend daily

restorative yoga posture practice for moms as the third trimester progresses and

fatigue returns. Insomnia, or difficulty sleeping, is also a common problem in the

third trimester – and since sleep deprivation affects global systemic health

(concentration, hormonal health, cognitive functioning, and more) – it is most

important that yoga practice helps moms can adequate rest. Finally, pubic

symphysis and SIJ issues can be quite common, along with regular low back pain

or upper extremity problems like carpal tunnel syndrome, during the third

trimester. While common, it is not normal, and a referral to physiotherapy is

recommended in order to optimally address these issues in combination with

yoga practice.

*Pelvic floor rehabilitation should only be undertaken by a licensed

physiotherapist who is trained in women’s health. Non-relaxing pelvic floor,

sexual dysfunction, and pelvic pain should never be ignored and require an

immediate referral for further evaluation. This means pelvic floor strengthening

(Kegels or mula bandha) are not always indicated or helpful for pregnant women.

Finding a therapist who is trained in both yoga and physiotherapy can be an ideal

combination, and allow you to be able to remain in your regular yoga class while

also receiving therapy. Find a Dual-Trained Yoga & Physiotherapist Practitioner

Emma: The main way to practice yoga safely during your pregnancy is by

allowing for your growing belly and baby. As a general guide, you never

want to compress, overstretch or strain your belly. Usually your instincts

and intuition will tell you what feels good and what no longer feels good. I

encourage women to listen to their body during their yoga class and trust

their feelings & intuition, as a guide all the way through their pregnancy.

Quite early on in your pregnancy, possibly from the first 5 or 6 weeks, it may feel

uncomfortable lying on your stomach, like you are laying on a hardboiled egg or

soft stone. You may have a strong biological instinct telling you to no longer lie on

your stomach, giving you the message to protect the growing baby inside of you.

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Therefore, prone positions are contra-indicated early on in the pregnancy usually

from the mid-first trimester. Also, practicing strong abdominal exercises or

crunches may feel uncomfortable or straining for the belly and pelvis.

As your belly grows through the first trimester, you will need to widen your feet or

knees to allow for your bigger belly. Also, you may notice a tightness across your

lower belly when you practice backbends or postures that stretch the abdomen

such as updog, telling you this may compressing your baby.

Due to the high levels of the hormone relaxin in your body’s ligaments and

tissues, be mindful of not over-stretching or straining your body, especially

around the hip & groin area, which may create instability in the pelvis or even

damage to the surrounding ligaments.

By the 3rd trimester or around 28 weeks, there will be poses that are simply no

longer possible, such as deep close twists and it usually recommended to stop

practicing inversions around 7 months to allow the baby to prepare for a head

down position for the final 5 or 6 weeks of pregnancy.

It is advised that by 28 weeks to lay on your left side for yoga nidra and sleeping,

rather than on your back. This is because the main vein (vena cava) that returns

blood to the heart sits on your right side and may be compressed by the weight of

the baby when you is laying on her back or sometimes on her right side.

It is advised to avoid holding 1-legged poses or standing poses for too long to

avoid the venous pooling in the feet and legs. This will lower blood pressure

which can result in dizziness and feeling unstable. Also, because her heart rate

and average body temperature is higher than normal, it is important to avoid

overheating, through a vigorous yoga practice, being in a heated room or in the

sun for too long.

By week 35, if the baby is in a head down, anterior position, then it is advised to

avoid any inversions or postures where the heart is lower than the belly such as

downdog. This ensures that the baby remains in the optimal anterior position.

Summary:

· Do not compress, constrict, over-stretch or strain the belly and pelvis

· No prone positions or lying on your belly from around 6 – 8 weeks onwards

· No close twists from around end of 1st trimester, instead gentle open twists

· Avoid straining the pelvis or abdominal muscles with deep hip stretches,

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twists or ab crunches

· If there is pelvic instability such as SIJ or SPD, then avoid deep hip

openers, squats, asymmetrical or 1 leg postures. Instead practice poses that

create balance and alignment such as tadasana, virasana with block, all 4’s

postures or downdog.

· Do not hold 1 leg or standing postures for extended periods of time to

avoid low blood pressure which may result in blood pooling or dizziness.

· Avoid lying on your back or right side for more than a few minutes or at all

in the 3rd trimester

· Avoid practicing inversions after the 2nd trimester, unless baby is in breech

or posterior position

Question THREE:

How do I alleviate fluid retention in my hands and feet?

Question THREE: Answer

Dr. G: First, we must address why fluid retention occurs. Blood volume increases

during pregnancy by up to 50%, which is significant - and as a result, edema

(swelling) in the hands and feet can be common. However, edema is also a sign

of pre-eclampsia, a series and life-threatening situation, and as a result, you

should always be evaluated by a healthcare provider if edema is noticed.

Additionally, signs of tingling, numbness, or changes in sensation in the hands

and feet also require medical evaluation. Pitting edema is a type of swelling in the

lower extremities that, when a finger is pressed into the foot or lower leg, an

indentation is left after the finger compression is removed. This type of edema is

most concerning and should be addressed by a health care provider as well.

Blood pressure, headaches, changes in vision, and/or edema are all signs of pre-

eclampsia and are considered a medical emergency. Never ignore these signs

and symptoms, and see a physician or midwife right away if they are noticed.

After ruling out pre-eclampsia, yoga postures can be wonderful for addressing

benign (harmless) fluid retention and swelling:

For the lower extremities, semi-inversions that elevate the legs higher than the

heart, such as legs-up-the-wall pose (viaparita karani) on what I call a “Declined

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Yoga Couch” (See photo below) to encourage lymphatic and venous return, can

be effective at managing fluid retention, especially at the end of the day if you’ve

been on your feet all day. Additionally, ankle pumps or calf raises can be used to

both manage edema and prevent blood clots, especially if you have a desk job or

have to sit or travel for more than an hour at a time. 20 ankle pumps or calf raises

can be done for every hour of sitting or traveling. For chronic fluid retention, and

to prevent blood clot risk in the lower extremities, consult your healthcare provider

to learn about additional strategies, such as proper hydration, nutrition, and/or the

possibility of compression garments for the lower extremities.

Caption: The “Declined Yoga Couch” (the top tier will face the wall so the legs can rest up the wall in viparita karani “legs up the wall” pose) can be used to

perform legs up the wall without resting flat on the back (which is contraindicated from the second trimester on). The pelvis will rest on the top tier, the trunk on the

second tier, and the shoulders on the lowest tier, with the neck and shoulders either resting on the yoga mat or additional head support for comfort. Photo courtesy

of Ginger Garner. ©2005. The Yoga Couch. Ginger Garner. All rights reserved.

For the upper extremities, elevation can be helpful but isn’t always realistic. The

muscle pumping action of using the upper extremities can be more helpful, as

well as exploring other causes for complicating issues (called comorbidities) like

carpal tunnel syndrome and thoracic outlet syndrome. Any change in sensation or

strength in the upper extremities, whether or not edema occurs with it, should be

evaluated by a physiotherapist. Additionally, edema could be aggravated or made

worse by work habits or ergonomic setup. A desk chair that is too low coupled

with a keyboard that is too high, could contribute to altered arm mechanics, which

could cause upper extremity pain or impairment. A physiotherapist can also help

assure that your workplace setup is optimized to help manage your edema and/or

upper extremity issues like thoracic outlet syndrome or carpal tunnel syndrome.

Yoga postures that can assist with upper extremity edema include upstretched

mountain (arms above the head) to encourage lymphatic and vascular return, and

ones that use muscle pumping action (such as downward facing dog with a

neutral (wrist extension of 10-15 degrees) wrist, or what I call downward facing

dog with arm spiral and an “Unbroken Wrist.”

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Emma: There are a number of ways yoga can help relieve this fluid retention or

swelling, known as Oedema. Firstly, the reason this happens is because the body

holds more fluid during pregnancy than usual mainly because there is around an

additional 50% more blood produced during pregnancy. This puts extra pressure

on the cardiovascular system and may slow down the blood circulation which in

turn will result in pooling of blood and fluid in hands and feet. Often, pregnant

women find the fluid retention increases as the day goes on.

Pawanmuktasana is a series of postures that are practiced to release air (vayu)

from the joints and therefore allow the prana/energy or fluids to flow more easily

throughout the body. This comprises of joint releases, stretches and circling,

which can be practiced particularly for the wrists and ankles to help release any

fluid stuck in the hands or feet and increasing the blood circulation to these areas.

(photos

By elevating legs and arms above the heart, blood, lymph, plasma will naturally

flow out of the limbs and back down into the heart and torso. This will help

distribute the fluid more evenly throughout the body and is great to practice at the

end of the day. Poses such as supported Viparita Karani are excellent or reclined

side poses offer great variations to raise the feet and/or hands above the heart.

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Photos: Courtesy of Red Tent Yoga and Emma Grant. ⓒ 2015

Reducing salt in your diet can minimize the absorption of water or fluid into the

body. Ayurveda, the ancient Indian system of health & wellness, suggests

reducing intake of salt in the last few months of pregnancy to avoid excess fluid in

the joints, limbs and the birth canal for a comfortable pregnancy and an easeful

birth.

Question FOUR:

My hips feel really sore and achy at night. Why is this happening and how can

yoga help?

Question FOUR: Answer

Dr. G:

The pregnant pelvis is both fragile and powerful at the same time. It is fragile

because it must be highly mobile, especially as baby grows, weight increases,

and the end of the pregnancy grows near. However, it is also powerful, because it

is capable of delivering a human being into the world!

First, congratulations for paying close attention to the soreness and

achiness you feel in the hips. You are listening to your body, and that is so

beneficial for you and baby! Second, I would wonder about the status of your

mattress. Is it too old? Too soft? Too hard? Not supportive enough? Also, what

kind of pillows do you have to support the pelvis in a neutral position at night.

Neutral position lying down is the same as standing up. It means the pelvis is in a

“happy” posture that is neither sway-backed or tucked under. The hip joint is also

an important part of this equation. Sleep positioning – left sidelying, puts the hip

in a compressed, close-packed (meaning the joint is tightly fitted together, without

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much room for movement) position, which can put the hip and pelvis in an

uncomfortable position. I generally recommend a quarter-sidelying position, one

that is not quite side-lying and not quite supine-lying (which in the second

trimester and beyond is contraindicated) (SEE PHOTO BELOW). You will need

several yoga props such as blankets or bolsters and/or firm supportive pillows to

find this “happy” pelvic neutral posture. This posture also takes pressure off of hip

bursae, the hip joint, the low back and the SIJ, which makes for a globally happy

sleeping posture!

Dr. G practicing “quarter side-lying” using yoga blankets and props during her second trimester of her second pregnancy.

Photo courtesy of Ginger Garner. © 2006. Ginger Garner. All rights reserved.

Next, what can yoga postures do?

First, screening by a physiotherapist to make sure the hips and pelvis are both

stable and supple (structurally and soft-tissue wise) is incredibly important. Any

congenital or acquired structural issues in the pelvis should be identified so yoga

(and general fitness activities) can be adapted. For example, if a physiotherapist

finds that a femoral version angle is extreme, certain yoga postures have to be

modified or even avoided.

Second, avoid full range of motion in yoga postures, and also avoid using yoga to

‘stretch’ the joints or tissues. During pregnancy, yoga can be most safely used by

encouraging stability and resilience of the tissues. For example, in a sun

salutation, emphasis on core stability is incredibly important for pelvic health and

management of back or pelvic pain. Additionally, primary focus on breathwork

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(pranayama) can optimize functioning of the three diaphragms and the pressure

system (the pelvic, respiratory, and thoracic diaphragms all interact to promote

pelvic health). Gentle range of motion in the mid-range can address fascial

resilience and response, joint mobility with stability (what I call controlled

flexibility), and is also safe even if there are structural hip concerns that prevent

hip rotation. Ginger’s new book (due out in late 2016), Medical Therapeutic Yoga,

can help you master practice of yoga locks, three diaphragm health, and

controlled flexibility.

Emma: Achy and sore hips experienced especially at night can mean different

things to different women.

Usually, when there is discomfort or pain in the body it indicates that there is an

uneven distribution of prana or energy in the body, so either your hips have too

much or too little prana circulating in the pelvic area.

If your hips feel cold, numb or lack of sensation it may be an indication that there

is not much prana or energy in your hip area. If your hips feel hot and inflamed

then there may be excess prana in this part of your body. Either way, yoga

postures and deep breathing can help redistribute and better the circulate the

prana or energy through your body.

Whether there is too little or too much prana in the hips, hip circling is a safe

posture sequence that can release or move this energy and may ease your achy

or sore hips.

This can be done in various positions including:

1) On all hands & knees,

2) In a kneeling position or

3) In a standing position.

Begin by rotating the hips in small circles; this creates the most stability for the

pelvis and is the safest version of the pose. You will feel the muscles of the pelvic

floor being activated. Circle back in the opposite direction for an equal amount of

rotations whether it be 3, 5, 10 or more. Then circle back in the original direction,

either keeping the movements small or if it feels right increasing the size of the

rotations so that the front and sides of the hips feel released as well as the

buttocks, sacrum and lower back. Again, repeat in the opposite direction for an

equal amount of rotations.

Page 12: Frequently Asked Questions: Pre-Natal Yoga · 2018. 1. 30. · yoga teachers, strictly advise to hold off from attending prenatal yoga classes ... to avoid urinary tract infections

Photos: Courtesy of Red Tent Yoga and Emma Grant. ⓒ 2015

Question FIVE:

Why do I experience pain in my pubic bone and groin area? And what can I do to

alleviate this in my yoga practice?

Question FIVE: Answer

Dr. G:

Pain in the front of the pelvic or groin that is below baby, can often implicate

multiple joints. The first is the pubic symphysis, a joint that connects the two sides

of the pelvis together, and one that must naturally separate during birth. The

other two areas that are often involved are the pelvic floor, and the hip and its

surrounding soft tissue. Determining which of these, or perhaps all, are involved,

is optimally evaluated by a physiotherapist, specifically one who specializes in

women’s health.

Evaluation and management of pelvic pain, which can include any of the joints or

soft tissue mentioned above should be an multidisciplinary approach that can

include the physiotherapist, midwife or physician, and yoga teacher. Pubic

symphysis dysfunction often causes pain during unilateral stance, such as stair

climbing, rolling over in bed, getting out of bed, or getting out of a car. However,

round ligament pain can sometimes mimic pubic symphysis dysfunction.

Sacroiliac joint pain, by contrast, usually causes posterior or buttock-related pain

that rarely radiates to the front of the pelvis. Hip pain (inside or outside the joint)

is yet another condition that can mimic pubic bone pain, but usually settles into

the groin, outside hip, upper gluteal area, or within the pelvic bowl itself. Hip pain

can also cause pain with one-legged activities, similar to pubic symphysis pain.

Seeing a physiotherapist who specializes in the pelvis and hip, typically a

women’s health therapist can differentially diagnose the source of the pain and

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work with you and your yoga teacher to provide a best plan for managing your

pain.

In your yoga practice, it is best to see a physiotherapist before continuing to

practice yoga postures in order to determine exactly what movements (including

yoga postures) are safe. However, there are many aspects of yoga practice that

you can continue during your therapy which can also help tremendously with pain

perception and comfort. Those include breathwork (pranayama), hand postures

(mudras), mild lock work (bandhas) without breath-holding/valsalva in various

yoga postures that encourage stabilization and not stretching/flexibility,

meditation, guided relaxation, restorative yoga postures that do not separate the

side of the pelvis (i.e. upright or reclined cobbler’s pose would be

contraindicated), and any standing, seated, or sidelying yoga posture that

encourages pelvic stability (not mobility or flexibility).

Emma: During pregnancy a woman’s body and pelvis are designed to move and expand to allow for her growing body and baby, and eventually for the birth of her baby. Ligaments and connective tissue in the body, especially in the pelvis, are softened and literally “relaxed’ by a hormone called Relaxin. The release of relaxin in the body when combined with other factors, can result in a pain in and around the groin or pubic bone which is a joint call the pubic symphysis which connects the front of the left and right side of the pelvis. Some of these other factors that can contribute to this discomfort or pain in the pubic bone are:

1) Pre-existing misalignment or imbalance in the pelvis, especially between the left and right sides

2) Movement or exercise that continually shifts the weight between the left and right side such as walking up or down long flights of stairs or any uneven surfaces

3) Holding postures for too long on one side of the body such as Tree pose (Vrkshasana) or holding a baby/toddler on one hip for too long on one side.

4) Practicing wide leg postures that causes further separation and mobility of the pubic symphysis and associated ligaments.

5) Particularly big babies or subsequent pregnancies that put extra pressure on the pelvic floor and ligaments connected to the pubic bone

There are some simple practices that can assist in reducing this discomfort in the front pelvis and groin area. These practices will share a common goal of stabilising the pelvis and especially the pubic symphysis joint.

● Keep feet and knees hip width, therefore avoiding wide leg postures ● Keep movements small, slow and mindful avoiding big, jerky movements ● Strengthen the muscles of the pelvic floor and the transverse abdominus (muscle

the sits across and under the belly) to better support the pelvic symphysis ● Keep weight even between the left and right sides by mindfully activating the feet

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and legs equally, and avoiding 1 leg or extremely asymmetrical postures. ● Gently engage and strengthen the adductors or muscles inside the thighs that

connect into the pubic bone and pelvic floor (using a block between legs can be helpful)

● If you are experiencing pain in the groin or pubic bone area, it is advised to see a pelvic physical therapist who specialises in the pelvis and/or pregnancy.

And no matter what, keep listening to your body and honoring instincts or intuition that will give you wise messages and feedback telling you what is right or wrong for you and your body at this time. Postures Safe for groin pain in pregnancy (Symphysis Pubis Disfunction or SPD)

Tadasana with feet All 4’s (block optional) Half Down Dog (block optional) hip distance

Supported Camel Virasana knees hip width Down Dog pose Photos: Courtesy of Red Tent Yoga and Emma Grant. ⓒ 2015

Question Six:

I feel like my instincts and intuitions are significantly heightened now that I

am pregnant. Why is this?

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Question six: Answer

Emma:

Instinct comes from the the latin word instinctus or impulse, meaning a hardwired,

primal biological tendency. These are usually involuntary which the body will do

before the mind even has a chance to process what has happened. For instance,

if you touch something very hot your hand will automatically quickly pull back

away from the heat. Instincts are a way for the body to keep itself safe and alive

so that, on a very primal level, we continue reproducing and continuing our

species. It is natural that a pregnant woman has strong instincts, so she can keep

herself and her baby safe.

Intuition, on the other hand, is a feeling or ‘hunch’ that is beyond rational thought

or reason, and makes you drawn to one choice over another. In yoga we may call

this our inner or satguru. Intuition is something we all have, however, can be

developed especially by practicing yoga, meditation or other mindfulness based

practices. During pregnancy most women experience higher levels of intuition or

sensation of a ‘6th sense” that often has no explanation. Again, this heightened

intuition is simply a way to keep you and your baby healthy and safe.

Question Seven:

How do I adapt my prenatal yoga practice when my baby is in breech?

Question seven: Answer

Dr. G:

Breech position is actually not a single position, but can be defined by a number

of positions. (PHOTO) A breech baby can present transverse (horizontal across

the body), footling (feet or foot first), frank breech (bottom first with legs straight

against the chest), or complete breech (bottom first and body in the fetal position

and feet facing down).

Babies can flip-flop freely throughout pregnancy until “real estate” becomes a

premium, somewhere after week 34-36. At that time, if baby is still breech, there

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are several yoga postures and things you can practice to help baby move head

down and engaged, or what I call “Locked and Loaded.”

First, guided imagery can be helpful. There is some evidence to support that

imagining baby turning head down can make actually turn baby to the right

position (occiput anterior, head down). During my own pregnancies, my husband

made colorful animated humorous notebook paper-sized handmade posters of

the family encouraging (and showing) baby going head down. Whether or not it

actually helps, the jury is out. However, it cannot hurt, and it always brought a

smile to my face to see the silly posters hung in random places around the house.

Second, semi-inversions are helpful and shown to be effective at turning breech

babies. Postures like threading the needle or high child’s pose (see photo below),

Decline Yoga Couch with legs up the wall, and even downward facing dog, can

help turn baby head down.

Caption: Dr. G demonstrating high child’s pose for turning a breech baby during third trimester. Photo courtesy of Ginger Garner. © 2007. Ginger Garner. All rights

reserved.

Emma:

For most of the pregnancy, your baby has lots of space to move, turn around and

change positions. It is usually not until the last 5 or 6 weeks of your pregnancy

that your rapidly growing baby will have less space to move around. If by this

time, your baby is in any version of the Breech position, explained by Dr. Ginger

above, there are a number of ways to give your baby the opportunity to turn.

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Firstly, you can connect with your baby mentally by having a ‘conversation’ with

your baby. Trust the words or thoughts that come into your head when listening

for a response from your baby and remember to trust your strong intuition at this

time. You can also, connect with your baby visually. By using your mind’s eye,

you can visualise your baby turning into an optimum anterior position. Whether

this helps or not, will at least build a deeper communion between the 2 of your

leading up to the birth where you can continue this visual connection.

Saying this, I was a breech born baby. My mother’s obstetrician attempted to turn

me by bringing my head down, however, each time I turned back to a breech

position. I have since learnt that people born can be stubborn and tend to do

things their own way. However, perhaps if my mum had talked to me sweetly

while I was in the womb, I may have been more reasonable and turned…?

There are certain yoga positions that can help create more physical space for

your baby to move into a anterior (head down) positions, as seen below.

Reclining on bolster Right Angle into wall Supported Forward bend

Inversions will work more directly with gravity, giving baby the perfect position

and angle to draw back out of your pelvis and therefore, the again opportunity to

move around and possibly change position, ideally into a head down anterior

position. Fingers crossed!

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Down Dog Pose Half down dog pose Supported Viparita Karani

If your baby is in breech position in these last 5 or 6 weeks, then you may want to

avoid practicing any deep squats, which will create more space in the pelvis for

your baby to drop even deeper into the breech position. Instead, try practicing the

suggested positions above.