Guidance for yoga teachers and students on how to use prenatal yoga to empower women for birth
By Anahata Giri
Prenatal yoga is an effective way to help women prepare physically, mentally and emotionally for one of the most powerful experiences a woman may have in her life: childbirth. To do this, prenatal yoga needs to offer more than just “inner” tools. Prenatal yoga can be a forum to help women understand the social reality of birth today and help women make informed choices. As a prenatal yoga teacher, I use prenatal yoga classes to open up a sensitive and empowering conversation with students about birth itself, to help women embrace birth as a transformative and potentially joyous life experience.
Steps to achieve a normal physiological birth
Pregnant women need to ask themselves: What kind of birth do I want to have? In prenatal yoga classes I often refer to a goal that most women share: the goal to have a normal physiological birth (Dempsey, 1998). To increase the likelihood of a normal birth, these steps are crucial for the pregnant woman. She needs to:
1. Be prepared for the medical and social context of birth
2. Have continuity of care from trained professionals that share the same values as the birthing woman;
3. Be prepared for the intensity and often pain of birth;
4. Use medical intervention minimally and only when medically necessary;
5. Use instinctive processes wherever possible including the use of movement, active birthing positions, sound and the breath;
6. Give birth with a deep awareness, to embrace the birthing process moment by moment – often referred to as conscious birth.
It is important to mention at the outset, that whilst yoga can help women prepare for the process of birth on all these levels, it is Life that takes care of the outcomes. We are not aiming for ‘perfect’ births. The aim is that women are informed, supported and empowered so they are ready for childbirth. Thorough preparation will help women gracefully accept medical intervention if it is needed.
We will now explore these elements in more detail beginning with the one that is often overlooked in prenatal yoga classes: how to prepare women for the social context of birth.
The Social Context of Birth
When we examine the social context of birth, it may seem like a lofty aim to have a normal physiological birth in our current birthing culture. The majority of births in Australia use some form of medical intervention. For example in 2012, there was widespread use of analgesia. In 2012, of all women who laboured, 76.5% of women used analgesia. For first time mothers who laboured, the rate of analgesia use was 86.7%.The rate of caesarean births has increased steadily over the last 13 years from 21.8% in 1999 to an alarming 32.9% in 2012 (Li, McNally, Hilder & Sullivan, 2012). Of these women who gave birth by caesarian section, 19.4% of women had a caesarian section without labour and 12.9% had a caesarian section with labour.
Medical intervention is to be applauded when it is medically necessary and then it can save lives. But the use of analgesia in Australia today is so pervasive that we now have a birthing culture that assumes that most women ‘need’ these drugs during labour to remove the pain. The World Health Organisation (WHO) states that in normal birth there should be a valid reason to intervene with the natural process of birth (WHO, 1996).
This widespread overuse of analgesia for pain relief can interfere with the basic instinctive processes that in most cases are the best way to bring babies safely into this world. Specifically, the use of analgesia can interfere with the cocktail of natural birthing hormones that orchestrate the birthing process in the first place (Buckley, 2005). The use of analgesia can: interfere with a woman’s active use of her body and of gravity to work with the contractions; lead to a cascade of interventions; have harmful side-effects for the mother and the baby and interfere with a woman’s capacity to stay absolutely present with the intense sensations. This deep awareness is crucial if women are to move with the birth process.
The place of birth (public or private hospital or at home) affects both the kind of care given to women and birth outcomes. This is important for women to know! 29.0% of women gave birth in a private hospital. Women who gave birth in a public hospital had higher levels of non-instrumental vagina births – 59.1% compared with 41% in private hospital. The caesarean rate is 43.6% for women in private hospitals, compared with 29.2% in public hospitals. In contrast, of the 1,177 (0.4%) of women who gave birth at home, 99.5% of these women had a non-instrumental vaginal birth (Li, McNally, Hilder & Sullivan, 2012). The World Health Organisation states that the world-wide epidemic of operative deliveries needs close analysis because unnecessary interventions are harmful to women and infants (WHO, 1996).
As a prenatal yoga teacher, I have had many students describe their experience of being swept unprepared along the medical path and feeling robbed of their experience of birth. Whilst it is beyond the scope of yoga teachers to take on the full role of birth education, the potential of prenatal yoga is greatly diminished if the social reality of birth is ignored. We need to give women more than just the inner tools of yoga! The social reality of birth needs to be brought into prenatal yoga classes, in a sensitive and empowering way. This is for the primary purpose of motivating women to be highly proactive in their preparation for birth, on all the levels, as outlined in this article. If prenatal yoga teachers explore the social context of birth with students, then teachers can help women navigate their way and make choices that fit their own values.
An important way that prenatal yoga teachers can assist this process is to refer women to specialists in the birthing field by giving out a list of local independent midwives and birth attendants. This is part of our networking and professionalism as prenatal yoga teachers and it helps women have safe and empowered births.
Continuity of care and the right Support
Many women do not know that they have a choice about who is at the birth. The presence of an independent midwife or birth attendant can be the crucial difference between a highly medicalised birth and an empowered birth. The World Health Organisation describes the midwife as the most appropriate type of health care provider for normal birth (WHO, 1996).
A Cochrane Systematic Review of 11 randomised controlled trials, involving more than 12,000 women worldwide, demonstrated that outcomes for women receiving continuity of care from known midwives were better than outcomes for women who received fragmented care from multiple midwives and doctors (Hatem, Sandall, Devane, Soltani & Gates, 2008). Women have the best birth outcomes when they have trained, competent professionals who they trust and who share the same values and goals for the birth as the woman in labour. An independent midwife or birth attendant can provide continuity of care to build a trusting relationship with the pregnant woman so she feels safe to give birth. To reduce medical intervention and increase the chance of normal physiological birth I think it is essential that women in prenatal classes are informed about the effectiveness of independent birth professionals. Then they can make an informed choice about who is at the birth.
Embracing the intensity of birth
Probably the crux of achieving a normal physiological birth revolves around how prepared a woman is for the intensity of birth. Most women have a fear of not being able to cope with the pain of birth. Yoga and meditation offer a practical and profound approach to embracing the strong sensations of birth – and the strong sensations of life! However, to make the most of yoga’s practices during birth, women first need to make the mental shift of understanding that the pain of childbirth is normal and intrinsically valuable.
If a woman fears the pain of birth, her body will tense up, adrenalin will increase and the flight/fight response can be triggered. This can decrease the flow of endorphins, nature’s opiates, which assist with embracing the pain. With fear and tension, her breathing becomes shallow, reducing blood and oxygen to the uterus and this continues a cycle of pain, tension and fear. This highlights how the interplay of thoughts, beliefs and emotions affect the actual physiology of birth. It can be very undermining and detrimental for women to be offered drugs at this point as they are not medically necessary and they also interfere with the woman’s capacity to stay with the intensity. A common scenario for women seems to be: ‘I was unprepared for the pain. I did not have good support around me and I felt completely alone. I was very scared. The birthing process slowed down. Drugs seemed to be the only way’.
Dempsey argues that just as we celebrate the accomplished athlete pushing through pain and limits to excel in her sporting achievement, we need to celebrate birth as a peak bodily performance. This involves embracing what Dempsey calls functional pain which is physiological pain felt in a healthy body working well, but at levels of high intensity, beyond usual comfort levels. This is distinct from pathological pain which comes from injury or disease (Dempsey, 1998). This distinction is very important for all who practise yoga and who give birth. It is often lost in the medical culture of birth with their emphasis on pathological pain and pain relief.
Thus, the pain of childbirth is a natural part of the birthing process as a woman’s body does the powerful physiological work that is required to birth babies. The muscular contractions of the uterus to open the cervix to an amazing 10cm dilation is impressive effort indeed! It can be very helpful for women to know that the functional pain of labour has a physiological basis and is a sign that all is progressing as nature intended. The intensity of childbirth can be understood as a highly effective rite of passage that can birth our babies safely. By embracing the intensity of birth a woman is embracing the peak performance of her body and then the pain becomes the power of birth!
To have the best possible chance of a normal birth, women need to have a strong support team that helps her embrace the normal physiological pain of birth. A trusted midwife or birth attendant can be vital to help women adapt to the strong sensations of birth. Encouragement and intense attention given to the labouring woman can be enough to keep the woman going. The WHO states that pharmacological methods should not replace personal attention to the labouring woman and loving care (WHO, 1996). Once women mentally embrace the pain of childbirth as natural and valuable, women will be ready to fully engage with the experience of birth, moment by moment.
Conscious birth involves meeting each moment of the birthing process with full awareness. We can easily see the parallels here between yoga, meditation and birth. The altered state, or birthing trance, of women in labour parallels states of deep meditation. It helps enormously for the birth if a woman has practised meditation beforehand. Then she knows how to be deeply present with her immediate felt experience. She knows how to calmly witness sensations, thoughts and emotions and remain, at the same time, anchored in her own inner beingness, however she experiences this for herself. This is the art of meditation: the process of noticing what is going on, without avoidance and without dramatisation, in a deep embrace of the moment exactly as it is.
Of course, the woman may not always be at one with the birthing process. As Dempsey describes, a crisis of confidence is also a natural part of human creative endeavours including childbirth (Dempsey, 1998). Fears and reactivity may arise – just as it does in our meditation practice. But the birthing woman is supported to stay deeply present with her body. She is encouraged to breathe and to relax. However intense sensations are, she stays connected to her essential self that remains innately and naturally aware, open, spacious and calm. If a woman is anchored in her own beingness, then her ego can literally get out of the way and she lets Life move through her in birth, in her yoga practice, in everything she does. Then birth is, literally, mediation in action! Just like our yoga and meditation practice, birth can deepen a woman’s relationship with life itself.
Prenatal yoga as preparation for birth
If women are supported, informed and empowered then they have an excellent chance of achieving a normal physiological birth. Prenatal yoga teachers can be part of this process. Prenatal yoga can be a forum to help women answer these questions, in preparation for birth: What kind of birth do I want to have? Where will I have my baby? Who will best support me at the birth to have the birth I want to have? How will I embrace the pain and intensity of birth? Prenatal yoga teachers can remind women of their choices. With thorough preparation, the way is cleared so that during the actual labour, women can be fully absorbed in their bodies and let their bodies lead the way. Thorough mental and emotional preparation will allow women to be with the moment by moment experience of birth as it arises. Birth can then be a deepening of our inner path and a wonderful celebration of life. And of course, this gives babies the best chance of being born safely and lovingly.
About Anahata Giri
Anahata teaches yoga, meditation and prenatal yoga and is passionate about helping women embrace birth as a transformative life experience. She is the Founder of One Heart Yoga & Meditation based at the Abbotsford Convent in Melbourne, Australia. She runs The Yoga of Birth Prenatal Yoga Teacher Training which offers comprehensive and inspiring 50 Hour Training and is registered with Yoga Australia. She is a member of Yoga Australia (YA). She is also a trained yoga therapist and is a member of the Australian Association of Yoga Therapists (AAYT).
– Buckley, S. Gentle Birth, Gentle Mothering. One Moon Press, Australia, 2005.
– Dempsey R. Embracing the Intensity – Celebrating Birth as a Peak Bodily Performance Birth Matters, Volume 2.2, 1998.
– Hatem M., Sandall J., Devane D., Soltani H., Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews Issue 4. Art. No.: CD004667, 2008.
– Hilder L, Zhichao Z, Parker M, Jahan S, Chambers GM 2014. Australia’s mothers and babies 2012. Perinatal statistics series no. 30. Cat. no. PER 69. Canberra: AIHW.
– World Health Organization, Care in Normal Birth: A practical guide. Department of Reproductive Health and Research, WHO, Document No: O/FRH/MSM/96.24, 1996.