| Table 1: Assessment for the Practice of Yoga During Pregnancy7,10 |
Identify patients who may benefit from low-impact exercise during pregnancy.
Pregnant patients with minimal obstetric or medical complications
Obese pregnant patients who have or are at increased risk for developing gestational diabetes
Pregnant patients who would like to relieve common discomforts of pregnancy and connect with other pregnant women
Identify patient's readiness to adopt a yoga exercise program.
Identify medical contraindications to participation in prenatal yoga classes.
Heart disease that adversely affects circulation
Restrictive lung disease
Cervical incompetency or cerclage
Increased risk for preterm labor or presence of preterm labor
Persistent second or third trimester bleeding
Placenta previa after 26 weeks' gestation
Ruptured membranes
Herniated disc or back injury
Identify appropriate and inappropriate types of yoga for patients. Identify community resources and accessibility of yoga classes.
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"Susan," age 30, was pregnant for the first time. At her initial prenatal visit, she reported experiencing sleeping difficulty, mild anxiety and sciatic nerve pain. Further discussion indicated that Susan's anxiety was linked to having limited social supports, since she and her partner had only recently moved to the area. Susan was healthy, and her history revealed no significant medical conditions. At the end of her visit, her nurse practitioner recommended a prenatal yoga class as a strategy for coping with the typical discomforts of pregnancy.
At her next appointment a month later, Susan enthusiastically talked about the prenatal yoga class. While her sciatic nerve pain wasn't completely gone, she reported feeling significantly better overall. She was sleeping well at night and reported having increased energy. She also described happiness about developing friendships with the other pregnant women in her class, and she stated that this increased sense of community had helped decrease her anxiety about her pregnancy.
As a form of exercise, stretching and relaxation, yoga has become immensely popular in the United States over the past 20 years.1 Approximately 36% of the U.S. population now uses some form of complementary and alternative medicine (CAM), a category in which yoga is an established therapeutic form.2 An estimated 15 million Americans have practiced yoga at some point.3 Many pregnant women use yoga to increase flexibility, enhance breathing techniques and learn relaxation techniques in preparation for childbirth.
Millions of pregnant women who use complementary or alternative medicine therapies often do so without informing their obstetric providers. As the popularity of yoga continues to grow, nurse practitioners should be prepared to make recommendations to their patients about participation in yoga programs during pregnancy.
Yoga and Pregnancy
The practice of yoga has many positive effects on pregnant women. Yoga is a multifaceted approach to exercise that encompasses physical stretching, mental centering and breath awareness, making it an ideal preparation for labor and childbirth. Yoga encourages relaxation, internal focus and slowed breathing patterns, goals that are common in many types of childbirth preparation classes. Yoga may help relieve many of the common discomforts of pregnancy, such as lower back pain, nausea, insomnia, carpal tunnel syndrome and headaches.4,5 In addition, prenatal yoga classes often offer a supportive environment in which pregnant women can share their experiences, which may help relieve feelings of anxiety or depression.
Specifically, research suggests that yoga can help ease the musculoskeletal consequences of pregnancy while preparing the muscles of the lower body for use in childbirth.6 The breathing techniques used in yoga can help reduce or manage the shortness of breath that may accompany pregnancy and teach women how to breathe through physically challenging experiences such as labor.7 Yoga encourages pregnant women to be mindful of the body's innate capacities and to recognize the connection among mind, body and breath. Yoga techniques also may be useful in promoting postpartum recovery and coping with the stresses of parenting.6
Recent studies show that yoga during pregnancy is safe for most healthy women and may not increase the risk of complications. Women who participate in daily yoga practice have decreased rates of intrauterine growth retardation and decreased rates of pregnancy-induced hypertension and may have decreased rates of preterm delivery.4
Because yoga involves movement of the body and can be considered a type of exercise, it is helpful to examine research about exercise in pregnancy. A review of the literature reveals that most kinds of gentle exercise during pregnancy may help decrease rates of pregnancy-induced hypertension, gestational diabetes, low back pain and symptoms of carpal tunnel syndrome, and reduce fatigue, anxiety and depression.8
The American College of Obstetricians and Gynecologists (ACOG) provides guidelines for general exercise during pregnancy. ACOG has concluded that almost all women with uncomplicated pregnancies can benefit from exercise. Women with numerous complications should be cautioned against strenuous exercise; for example, exercise by women with uncontrolled hypertension is contraindicated.9
The versatility of yoga suggests that it is more suitable for pregnant women with chronic conditions than other types of exercise. Research shows that the breathing patterns of yoga may have benefits even for patients with chronic hypertension, asthma and anxiety.10,11 Studies of exercise during pregnancy have documented few to no adverse effects in pregnant women or their developing fetuses.8,12-15
Furthermore, group exercise classes that include physical movement and the presence and support of other antepartum women may reduce the incidence of postpartum depression.8
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