Yoga & Pregnancy: What Does the Research Show?




Yoga seems to be beneficial for lots of conditions (stress, high blood pressure, back pain, etc.) but is yoga beneficial during and after pregnancy?


It’s probably best to dissect this question a little. First, during and after pregnancy (otherwise called pre-and post-partum) are two different conditions. Second, what does “beneficial” mean?


Let’s start with pre-partum yoga, meaning practicing yoga while pregnant.


In reviews of many studies the practice of yoga during pregnancy has been shown to be safe for both women and babies (Kwon et al, 2020; Rong et al, 2020). Polis and colleagues (2015) measured fetal heart rate in 26 asanas, several of which were recommended by well-respected magazines and websites to be avoided during pregnancy. They found that fetal heart rate remained normal across all postures. In another study of pregnant women who practiced alternate nostril breathing and a wide range of seated and standing asanas, fetal blood flow remained normal (Babbar, et al, 2016)



Now that we know it’s safe, what about the benefits? Let’s talk about pregnant women first.


Practicing yoga has been shown to significantly improve sleep during the 3rd trimester of pregnancy compared to women who didn’t practice yoga and they exhibited decrease stress based on the objective measures of heart rate variability (HRV) and salivary a-amylase (Hayase & Shimada, 2018). This suggests that yoga is effective in activating the parasympathetic nervous system, which can have far-reaching implications for physical and psychological resiliency.


What about labor, pain and delivery?

There’s more good yoga news. Jahdi and colleagues (2017) found that compared with women who did not practice yoga, those who did had significantly

- shorter labor (especially in the 2nd and 3rd stages),

- less labor pain (at all intervals),

- fewer Cesarean deliveries (13.3% vs. 50%)



And if those benefits aren’t enough, read this!

Between women who practiced yoga and those who didn’t researchers found a significant difference in the episiotomy severity^. Fifty-five percent (55%) of the women who practiced yoga did not experience a tear while the others only had a first-degree tear. Compare that to women who didn’t practice yoga. Zero percent (0%) didn’t have a tear, while 44% had first-degree, 47% had second-degree and 9% had third-degree tears (Yekeffallh et al 2021).


What about that little bundle of joy?

Yoga is good for the baby, too! When women practiced yoga their babies’ weight were normal or greater than babies whose mom’s didn’t practice yoga AND, they were more likely to be of the appropriate gestational age (Kwon et al, 2020; Yekeffallh et al, 2021) indicating that they were less like to be born prematurity and with low birth weight.

PLUS, the babies with mom’s who did yoga had higher 1-minute and 5-minute Apgar scores than their counterparts. (The Apgar score is a measure of breathing and heart rate, muscle tone, reflexes, and skin color) Way to enter the world from a place of strength!!


Now for post-partum yoga, meaning practicing yoga after pregnancy.

The science isn’t as conclusive as it is for pre-natal yoga, but we can start with a benefit that can be backed up by strong evidence. Practicing yoga after the baby has been born can significantly reduce symptoms of post-partum depression in a clinically meaningful way (Buttner et al 2015).


When it comes to whether yoga can help with the mother’s physical recovery, much is still unknown. Delivering a baby through the birth canal is definitely associated with pelvic floor muscle disruption and risk of incontinence, but the good news is that for many women, pelvic floor muscle (PFM) strength and function is restored between 2-12 months post-partum (Jundt et al, 2010; VanGeelen et al, 2013) as part of a natural healing process. Nevertheless, disruption of the pelvic floor and waiting for it to heal has the potential to interfere with pain-free mobility and caring for the baby.


Currently, there is no consensus on whether general physical activity can strengthen or hasten the recovery of the pelvic floor. Exercising women generally have similar or stronger PFM strength than non-exercising women (Bo & Nygarrd, 2020) however, researchers have found instances in which women who play sports such as volleyball, handball and basketball actually had weaker PFM strength than non-exercisers (Moss, et al 2020).


Nevertheless, when specific PFM exercises are performed, regardless of woman’s pregnancy status, the PFM get stronger and can provide enhanced support for spinal stability and continence. (Pereira-Baldon et al, 2019) And for women with incontinence, PFM training can indeed decrease incontinence and improve muscle strength and endurance (Sigurdardotti et al, 2020)


But yoga is different than pelvic floor muscle (PFM) training, right?

Yes. Although most people think of Kegel exercises when they hear “pelvic floor muscle training”, the truth is that PFM training often needs to include more than simply contracting the pubococcygeus muscle, especially when there’s been trauma to the pelvic floor and/or incontinence.*


For those who practice yoga, performing mula bandha can increase attention to the supportive musculature of the pelvis and is a reasonable first step for gaining control of the perineum especially after delivering a baby.* However, many women would like to know if a physical yoga practice can offer assistance in either a speedier or more complete recovery.

Unfortunately, there’s no clear cut answer just yet, although anecdotal reports suggest that post-partum yoga can help to decrease discomfort, enhance physical awareness and improve a sense of controlled mobility. In a recently published abstract in Medicine & Science in Sports & Exercise, the authors observed that that yoga training effectively enhances type I and II muscle fiber strength of the pelvic floor and reduces the impact of pelvic floor dysfunction symptoms on daily life. We’ll just have to wait to see if a complete, paper is published soon. When it is, we’ll provide additional details about the study and the actual yoga practice itself.


In the meantime, Siff and colleagues (2020) have shown that when post-partum women perform bird-dog, forearm plank and leg-lifts (which are often part of an asana practice) they generate PFM contractions that are stronger or equal to a Kegel exercise. They went on to suggest that these exercises be further evaluated as alternatives to Kegels and/or included in a post-partum PFM training program.



Bird-dog

Forearm plank



Leg lift






What are the take-aways when it comes to yoga during and after pregnancy?

  • Yoga is safe for mother and baby.

  • Pre-partum for Mom: Pre-natal yoga is associated with better sleep, less stress, shorter labor, less labor pain, fewer Cesarean deliveries, and less episiotomy severity.

  • Pre-partum for Baby: Pre-natal yoga is associated with full-term deliveries, good birth weight, and higher Apgar scores.

  • Post-partum yoga can reduce post-partum depression, and enhance recovery of pelvic floor muscle strength and function.




*Depending on the status of the pelvic floor, not all women will benefit from Kegel-type exercises. If pain, incontinence or discomfort does not resolve with 2-3 weeks postpartum we highly recommend seeing a physical therapist who specializes in pelvic health.





^Severity of episiotomies are classified by degrees based on the severity or extent of the tear.

  • First Degree: A first-degree episiotomy consists of a small tear that only extends through the lining of the vagina. It doesn’t involve the underlying tissues.

  • Second Degree: This is the most common type of episiotomy. It extends through the vaginal lining as well as the vaginal tissue. However, it doesn’t involve the rectal lining or anal sphincter.

  • Third Degree: A third-degree tear involves the vaginal lining, the vaginal tissues, and part of the anal sphincter.

  • Fourth Degree: The most severe type of episiotomy includes the vaginal lining, vaginal tissues, anal sphincter, and rectal lining.





References

Apgar Score. https://medlineplus.gov/ency/article/003402.htm


Babbar, S., et al. (2016).Acute feTal behavioral response to prenatal yoga: a single, blinded, randomized controlled trial (TRY yoga). American Journal of Obstetrics and Gynecology,214,399, e1-8.


Bo, K., & Nygarrd, I.E. (2020). Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review. Sports Medicine 50, 471–484.


Buttner, M.M., et al (2015). Efficacy of yoga for depressed postpartum women: A randomized controlled trial. Complementary Therapies in Clinical Practice, 21(2).


Hayase, M., & Shimada, M. (2018). Effects of maternity yoga on the autonomic nervous system during pregnancy. Journal of Obstetrics and Gynaecology Research,44(10), 1887-1895.


Jahdi, F., et al. (2017). Yoga during pregnancy: the effects on labor pain and delivery outcomes (A randomized controlled trial). Complementary Therapies in Clinical Practice, 27,1–4.

Jundt, K.,et al. (2010). Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. European Journal of Medical Research,15, 246–252.


Kwon, R., et al. (2020). A systematic review: The effects of yoga on pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 250,171–177.

Moss, W., et al. (2020). The association between pelvic floor muscle force and general strength and fitness in postpartum women. Female Pelvic Medicine & Reconstructive Surgery,26(6),351-357.


Pereira-Baldon, V.S., et al. (2019). Effects of different regimens for pelvic floor muscle training in young continent women: Randomized controlled clinical trial. Journal of Electromyography and Kinesiology,44, 31-35.


Pollis, R., et al. (2015). Yoga in pregnancy: An examination of maternal and fetal response to 26 yoga postures. Obstetrics & Gynecology,126(6),1237-1241.


Rong, L., et al. (2020). The effectiveness of prenatal yoga on delivery outcomes: A meta-analysis. Complementary Therapies in Clinical Practice, 101157.

Sigurdardotti, T., et al. (2020). Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial. American Journal of Obstetrics and Gynecology; 222(3),247.



Siff, L.N., et al. (2020). The effect of commonly performed exercises on the levator hiatus area and the length and strength of pelvic floor muscles in postpartum women.

Female Pelvic Med Reconstr Surgery,26,61–66.


Xu, K., et al. (2021). The effect of yoga on pelvic floor muscle strength and postpartum mental status of postpartum women status of postpartum women. Medicine & Science in Sports & Exercise,53(8S), 255-255.


Van Geelen H., et al. (2018). A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. International Urogynecology Journal,29(3),327-338.


Yekeffallh, L., et al. (2021). The effect of yoga on the delivery and neonatal outcomes in nulliparous pregnant women in Iran: a clinical trial study. BMC Pregnancy and Childbirth,21,351.


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