Keeping up or starting a yoga practice during pregnancy has numerous benefits and just plain feels amazing (particularly the side bends…oooooh so lovely!). However, there are some questions that commonly come up for practitioners regarding the safety vs. danger of certain types of poses during these wondrous 40 weeks. Thought I’d share some great articles answering what are probably the top 3 common questions written by prenatal yoga teacher, childbirth educator and doula, Carole Westerman, MA, RPYT, RCYT (copied from 90monkeys.com).
What is an Inversion?
Believe it or not, there are differing opinions in the yoga world on what exactly constitutes an “inversion”. In some circles, it is defined as any pose where your feet are above your head. This definition of an inversion would then include poses such as:
- Viparita Karini (Legs Up the Wall)
- Sirsasasna (Headstand)
- Sarvangasana (Shoulderstand)
- Adho Mukha Vrksasana (Handstand)
- Pincha Mayurasana (Scorpion)
Depending on who you ask, you may also get the answer that inversions are any pose where the head is below the heart. With the second definition of an inversion, we add more poses to the above list including; Adho Mukha Svanasana (Downward Dog), Uttanasana (Standing Forward Fold), and Prasarita Padottanasana (Standing Straddle Fold).
It is important to our discussion of inversions during pregnancy, that we be clear on which definition and type of inversion we are referring to. This is because in pregnancy, one of the most important factors is where the pelvis is in relation to the heart, rather than simply the heart’s relationship to the feet or head. With this in mind, I would like to introduce to you a third way of considering inversions, especially as they relate to pregnancy.
For our purposes then, the definition of an inversion is any pose where the pelvis and feet are elevated above the heart. With this working definition, the following poses would then be considered inversions during pregnancy:
- Sirsasana (Headstand)
- Sarvangasana (Shoulderstand)
- Adho Mukha Vriksasana (Handstand)
- Pincha Mayurasana (Scorpion)
These poses would not be considered inversions during pregnancy:
- Adho Mukha Svanasana (Downward Facing Dog)
- Viparita Karani (Legs Up the Wall), with no props elevating the hips
Are Inversions Safe During Pregnancy?
Let me start off by making two important points in regards to practicing yoga during pregnancy. Firstly, pregnancy is not a time to start an inversion practice. The American College of Obstetricians and Gynecologists (ACOG) does not recommend that pregnant women start new forms of exercise during their pregnancy that have a risk of falling. This caution by ACOG is partially to do with a woman’s center of gravity being shifted during pregnancy, which can affect her balance and increase chances of falling.
Also, with the hormones produced during pregnancy (namely Relaxin) a woman’s joints and ligaments are more at risk of injury as they adjust to the new center of gravity. This time of adjustment for the body, is a time when the back and pelvis can be vulnerable to possible strain and injury. Therefore, inversions should only be a done by women who have an established inversion practice, know their limits, and have experience in getting up and down from their inversions safely.
Secondly, a woman should always listen to her body and her intuition while practicing yoga, especially during pregnancy. Thusly, a woman should never come into an inversion on a day when she doesn’t feel completely grounded, safe, and comfortable.
With that being said, there are differing opinions on the practice of inversions during pregnancy. I have practiced yoga through three pregnancies, and have taught Prenatal Yoga for over 8 years. My opinion on the matter of inversions during pregnancy draws from my own experience, my education as a childbirth educator and doula, and my multiple trainings in Prenatal Yoga. The following guidelines are for women with normal, healthy pregnancies. Any questions regarding the practice of yoga for special conditions, should be directed to the woman’s care provider.
Inversion Considerations for the First Trimester:
I do not recommend women practice inversions during their first trimester. This is because during the first trimester of pregnancy, the risk of miscarriage is at it’s highest and we are trying to establish a healthy pregnancy, setting the stage for the next 40 weeks. The first 12 weeks of pregnancy are also a time when a woman’s energy levels can be very low, hormone levels can be unpredictable, and often there is nausea and morning sickness.
Many times a woman’s intuition will guide her to pause her inversion practice during the first trimester, because it just doesn’t feel right. Please note that Viparita Karani (Legs Up the Wall), with no props to elevate the hips, is safe to practice during the first trimester during a normal pregnancy.
Inversion Considerations for the Second & Third Trimesters:
Once a women gets past her first trimester, and begins her second and third trimesters, she may return to her inversion practice if she so desires. By then, the risk of miscarriage is greatly decreased, and the pregnancy will have been established. In addition, many women see a decrease in nausea and morning sickness by 12 weeks, and an increase in their energy levels. Even with the green light to practice inversions during the second and third trimesters, it is important that the woman continue to listen to her body on a daily basis, and only practice inversions on the days that it feels right.
At about 16 weeks in a woman’s pregnancy, just past the beginning of her second trimester, a few milestones of growth need to be addressed. This is an important time of transition in her yoga practice, as a few changes will need to be made. A woman’s blood volume at this time has increased by up to 50%. With this increase in blood volume, some women may notice a tendency to get dizzy as the body adjusts to the increase in fluid. This can happen during quick changes in position, in relation of the heart to the head. This may occur during the practice of inversions, and is something for the teacher and student to be aware of.
Some pregnant women also report a feeling of “wooziness” during vinyasa transitions, such as in Surya Namaskars as they come to standing. Awareness of this possibility is key, and if this does happen, a woman can simply move more gradually back to an upright position.
So, is Adho Mukha Svanasana (Downward Dog) Safe During Pregnancy?
During a normal pregnancy, yes! Because according to our definition of an inversion stated above, Adho Mukha Svanasana isn’t a true inversion, since it’s a pose that does not have the pelvis and feet above the heart. Therefore, it can safely be practiced during all phases of pregnancy according to the woman’s comfort level. However, a slight widening of the feet is recommended to accommodate the growing belly and create space in the pelvis.
There are a few things to keep in mind, for our safe practice of Adho Mukha Svanasana during pregnancy:
- After the 30 week mark, holds of 30 seconds or less in the pose are recommended.
- On days when the expectant mother is feeling queasy or suffering from symptoms of reflux, she should avoid having her head below her heart. In this case, a good substitute for Adho Mukha Svanasana would be Balasana (Child’s Pose).
- Do not practice Adho Mukha Svanasana if you have been diagnosed with very high or very low blood pressure, placenta problems, and/or are being monitored weekly for excess amniotic fluid.
Will Adho Mukha Svanasana (Downward Facing Dog) Cause a “Breech Baby”?
No! In fact, it may be that the forward-leaning position of the body may help to keep the baby head down in the pelvis. Studies have shown that holding the forward-leaning position, such as in Adho Mukha Svanasana (Downward Facing Dog), for periods of 30 seconds can be beneficial in encouraging the baby into an optimal birthing position. Remember the magic number of 30! After 30 weeks, only hold Adho Mukha Svanasana (Downward Facing Dog) for 30 seconds per hold (about 5 breaths), in order to maintain the optimal positioning of the baby in the pelvis.
What are Some Alternatives to Adho Mukha Svanasana (Downward Facing Dog)?
There may be times, when an expectant mother does not feel like practicing Adho Mukha Svanasana. There are several options for poses that can be practiced instead, depending on the effect you want the pose to have:
- Resting Pose: Balasana (Child’s Pose), Cat/Cow, Anahatasana (Puppy Pose)
- Hamstring Opening: Uttanasana (Standing Forward Fold), Prasarita Padottanasana (Standing Straddle Fold)
- Transition Pose: All Fours, Cat/Cow, Anahatasana (Puppy Pose)
- Inversion Quality: Uttanasana (Standing Forward Fold), Prasarita Padottanasana (Standing Straddle Fold), Viparita Karani (use prop to elevate hips after 16 week mark in pregnancy)
- Shoulder Opener: Anahatasana (Puppy Pose), Gomukasana (Cow Pose)
- Hip Opener: Balasana (Child’s Pose), Anahatasana (Puppy Pose), Malasana (Yogic Squat)
Most Important Take-aways On Inversions and Pregnancy:
Encourage the expectant mother to honor her body and her pregnancy, as this is a short time in the life of her practice, and there is always time to add things back into the practice once baby arrives
Pregnancy is not the time to begin learning inversions
First Trimester: Avoid Inversions where both the feet and the pelvis are above the heart. Vipariti Karani (Legs Up the Wall) may be practiced with the hips on the earth
Second Trimester: Practice Vipariti Karani (Legs Up the Wall) with a prop to eleveate the hips, other inversions may be added back into the practice of experienced Yoginis
Third Trimester: Practice Vipariti Karani (Legs Up the Wall) with a prop to eleveate the hips, other inversions may continue to be practiced by experienced Yoginis
After the 30 week mark, Adho Mukha Svanasana (Downward Facing Dog) should be practiced for periods of 30 seconds or less
When in doubt, offer a modification or alternate pose
2) Core work:
What is the “core”?
The first thing we need to establish, is our definition of the word “core,” as there are many different meanings floating around out there. Simply put, the “core” of the body is the torso. It’s the main portion of the body, not including the head, arms, and legs.
With this definition of the “core,” we include much more of the body than just the “abs,” which is primarily what people associate with the “core.” This includes the following muscle groups in our discussion of “core”; pelvic floor, abdominals, spinal muscles, the diaphragm. In fact, some definitions of “core” actually include the glutes, hips and thighs, which further emphasizes the fact that the true definition of “core” includes so much more than just our abdominal muscles.
Now that we have an accurate description, let’s move our discussion forward. During pregnancy it’s safe, and in fact recommended, to keep the “core” strong and healthy. A strong core is needed in order to support the pregnant body, baby, and to help with recovery after birth.
But remember, with our definition of “core” we know that this involves so much more than just “abs.” During pregnancy we need to concentrate primarily on strengthening the pelvic floor, back muscles, and diaphragm. The abdominal strengthening will take a back seat during pregnancy, as the strength of the other core muscles is actually more beneficial.
As we already know, yoga is fabulous for strengthening the back muscles and toning the diaphragm. The combination of movement, alignment, focus on posture and breath is perfect for keeping these two “core” components in tip-top shape. In addition, the strength and tone of the pelvic floor is also addressed in yoga, through the practice of “Mula Bandha,” the root lock, which is very similar to “Kegel exercises.”
Do we need strong abdominals during pregnancy?
Now we’re down to the “nitty gritty” of what this article is all about, the “abs.” The “abs” are actually a set of several muscles including; transverse abdominis, internal obliques, external obliques, and rectus abdominis.
During pregnancy we want to keep the transverse abdominals toned, because they support the belly by wrapping and hugging from underneath, somewhat like a “cummberbund.” Internal and external obliques are also important, but play a lesser role in supporting the pregnant belly, although they do help to provide a nice side-wrapping support effect. The rectus abdominis on the other hand, does not need to be strengthened during pregnancy. In fact, over strengthening of the rectis abdominis during pregnancy is ill-advised because it can contribute to a condition called “diastasis recti.”
What is “diastasis recti”?
Diastatis recti is a condition in which the left and right halves of the rectis abdominis (6-pack muscles) are separated, and a gap forms between the two sheets of muscles. Some slight separation between these two muscles is considered normal during pregnancy, and usually heals up by several month post-partum. However, any opening over 2 finger widths is considered a diagnosis of “diastasis recti.”
The effects of diastasis recti include a bulge or puffiness to the abdominal region in mild cases, and sometimes a bulging of the uterus and/or internal organs in more severe cases. Ironically enough, diastasis recti can be in part caused by rectis abdominis muscles that are actually too tight and strong.
That’s right, some core work can actually cause the opposite effect of what we’re looking for! The reason is simple. If you think about bending the knees and lowering down into a Malasana (yogic squat) in an overly tight pair of jeans, the seam is going to split because there’s just no other way for expansion to happen. That’s the same principle that’s at play in diastatis recti. If the rectis abdominis is too taut and strong, as the baby grows something’s got to give. And sometimes that’s a separation of the abdominal muscles in order to create space for growth. Factors that have been shown to increase the chances of diastasis recti include; aggressive abdominal work, multiple pregnancy, repeated pregnancies, large weight gain, and maternal age over 35. Therefore, rectis abdominis targeted exercises are not recommended during any phase of pregnancy.
What about crunches?
Hopefully by now, it’s pretty clear that we want to avoid abdominal work that targets the rectis abdominis. Not only do we want to have a quality of yielding in the belly, we also want to embody a sense of receptiveness and ability to adapt to change. For many women, the growing belly can be exciting, but for others it can bring up body image issues. As yoga teachers, this is the perfect opportunity for us to encourage women to marvel in the miracle of their bodies, and to let go of cultural standards of the flat belly.
The most common forms for rectis abdominis strengtheners are good old-fashioned “crunches.” In addition to increasing the chances of diastasis recti, crunches should be avoided during pregnancy because they are done lying on the back. At the 16 week mark, it is no longer recommended that women lay flat on their backs because it can compromise the blood flow to the baby. This happens because the increased size and weight of the baby and uterus can press down onto the inferior vena cava (a large vein in the back), possibly compressing the vein enough to affect blood flow to mother and baby. Therefore, all abdominal work that is done on the back, should be avoided after 16 weeks.
What “core work” is safe during pregnancy?
There are many safe and effective core strengtheners that can be done during pregnancy, to the comfort level and appropriate experience level of the expectant mother. Here are a few ideas:
– Bird Dog Pose (done on all-fours, extending opposite leg and opposite arm)
– Pelvic Tilts (done on the floor during the 1st trimester, and done standing or against a wall during the 2nd and 3rd trimesters)
– Sufi’s Ride (seated in simple cross-legged position, simple churning around of the hips in a cirlce, this movement may also include a churning of the torso as well)
– Planks and Fore-Arm Planks
– Wall Planks and Wall Push-ups
– Modified Navasana (one or both feet on the floor and hands to the back of the thighs)
– Mula Bandha (root lock)
3) Lying on the back:
Why can’t pregnant women lay on their backs?
During the first trimester of pregnancy, it is safe for women to lay on their backs and enjoy a traditional Savasana. However, during the second and third trimesters, women are recommended to enjoy Savasana on their side.
During the second trimester, around the 16 week mark, a woman’s volume of blood increases by up to 50%. That, combined with the weight of the baby and the enlarged uterus, can put too much weight and pressure on the large vein that runs along the spine. This vein is called the Inferior Vena Cava, and runs slightly to the right of the spine. The Vena Cava is responsible for returning blood from the legs back to the heart. When a woman lays on her back the pressure and weight of the growing baby and uterus can be enough to compress this vein and compromise blood flow, oxygen, and nutrient delivery to mother, placenta, and child. Compression of this vein may also cause dizziness, numbness in the limbs, and an overall feeling of faintness.
It is generally believed that a woman needs to lay on her back for a “prolonged” period of time for the position to become a problem, but each woman is different and the exact amount of time that constitutes “prolonged” is not clearly defined in the medical literature. Therefore, as yoga teachers, it is best for us to err on the side of caution and recommend a side-lying Savasana for the comfort and safety of the mother and child during the second and third trimesters.
In addition to this recommendation being the safest option for mother and child, when you recommend this option to your students it shows them you are a committed yoga teacher and educated in modifications for pregnancy. This will instill their trust and confidence in you as a teacher, and can help them feel cared for during this time of great change and uncertainty in their lives.
What are side-lying Savasana options?
Setting up a safe and comfortable Savasana is very simple. In the picture featured with this article, you can see the most ideal set-up for pregnancy. However, you can always make due even if you don’t have any props.
Since the Inferior Vena Cava runs slightly to the right of the spine, it is believed to be most beneficial for pregnant women to lay on their left sides. Although for the length of a typical Savasana this may or may not make a huge difference anatomically, it can make a difference for you as a yoga teacher. Knowledge of this information conveys to your students that you are professional, educated, and invested in keeping all students safe and comfortable.
Ideally, when laying on their sides, women have support under their head to keep it in line with the rest of their spine. You can use a pillow, folded blanket, sweatshirt, or block to achieve this height. This will help prevent any pulling, compression, or over-stretching in the neck and shoulder area.
It is also best to support the top leg of your student, so that they feel comfortable and avoid any possibility of compressing their bottom leg and hip joint. Using a bolster, folded blankets, or even a block for this purpose can do the trick. While it’s certainly okay to place the prop between the legs, it is much preferred to place the prop in front of the bottom leg, as is pictured above. With the bottom leg straight, and the top leg is shifted forward and supported by props, this allows space in the body and pelvis, and avoids compressing the bottom leg and hip joint. Try this position yourself, even if you’re not pregnant, and notice how wonderful and spacious it feels!
What if I don’t have any props?
If you find yourself in a situation without any props, no problem! As you look around your teaching space, there’s almost always something you can use in a pinch! Things like sweatshirts, sweaters, purses, foot stools, books, yoga bags and rolled up yoga mats can be used as make-shift props.
After you scan your teaching space, if you still find yourself without any “prop” options, you can just have the student place her folded arm under her head to keep it supported and in-line with her spine. As far as the support for the legs, you can simply have the student lay on her left side with her legs stacked, one supporting the other. While this isn’t ideal, it’s certainly fine for the average length of time in Savasana.
A nice option, if you will be seeing the student on a regular basis, is to suggest to her to bring a pillow and/or a blanket from home next time.