Diet and Folic Acid

Folic acid or folate is vitamin B9. It is extremely important for the development of a healthy foetus. It has been shown to reduce the risk of neural tube defects such as spina bifida. Natural sources of folate are green leafy vegetables, brown rice, granary bread and it is possible to get food fortified with folate such as breakfast cereals, although care should be taken to read the labels an ensure they are not high in sugars. Liver is also a very rich source of folate and could be eaten preconception however it is not advised to eat liver during pregnancy due to its high levels of vitamin A which can be harmful to the foetus. It is extremely difficult to reach the recommended levels of folate through diet and the Department of Health recommend taking a supplement of 400 micrograms of folate per day (or a higher dose of 5 mg per day up to 12 weeks gestation for those at higher risk of neural tube defects) ideally pre-conception and through at least the first trimester, or at least from when a woman discovers she is pregnant. These are easily available over the counter.

Diet is important during pregnancy and certain foods should be avoided. As mentioned above, liver is best avoided due to the high levels of vitamin A which can be detrimental to the health of the foetus. Uncooked soft cheese and pate should be avoided due to the risk of listeria infection which can cause illness for the baby and even stillbirth and miscarriage. Under cooked eggs can lead to salmonella poisoning, which although it is unlikely to cause problems for the baby it can cause sickness and diarrhea for the mother. This is also less likely with eggs that are lion stamped, but it is better to cook them thoroughly to be safe. Under cooked, raw and cold cured meats can contain a parasite that causes toxoplasmosis which again can be harmful to the baby so meat should be cooked thoroughly. Fresh tuna should be limited to twice a week and shark, marlin and swordfish should be avoided due to the high levels of mercury. It used to be the case that pregnant women were told to avoid sushi and shellfish, however this is no longer the case and they are considered safe if they have been frozen. Finally, caffeine should be limited as it can lead to low birth weight and in high enough doses can lead to miscarriage and it will dehydrate the mother.

Oedema

Oedema is fluid collecting in the tissues. Mild oedema is very common in pregnancy, most commonly seen as swelling of the feet, ankles and hands and puffiness in the face. It usually gets worse and occurs more often as the pregnancy continues due to the growing uterus. This puts pressure on the pelvic veins and the vena cava slowing the blood flow and therefore the blood pools in the extremities. During pregnancy the body also retains more water and again this will pool. If the swelling becomes severe and is sudden, or it is accompanied by headaches and blurred vision, medical advice should be sought as it can be a sign of pre-eclampsia. If it is mild, the following can help to alleviate it:

• Wearing comfortable shoes and avoid socks with tight elastic (you can buy socks that are mesh instead and expand with the ankle)
• Raise the feet and stretch the legs
• Avoid standing for prolonged periods and don’t cross the legs
• Drink plenty of water
• Exercise as much as possible but safely
• Follow a healthy diet
• Using kalma mamas mobility stretches can help at the beginning and end of the day

Gestational diabetes

Gestational diabetes occurs when the body has difficulty regulating sugar levels during pregnancy. As it is brought on by pregnancy it is usually easily controlled using a healthy diet and exercise and medication where necessary. Mothers are usually given a blood monitor which allows them to monitor their blood sugar levels at home and alter their diet as necessary. It usually disappears after the birth of the baby, but the mother is at increased risk of being diagnosed with Type II diabetes in later life and with subsequent pregnancies so she should be monitored.

How yoga can help?

Yoga and pranayama significantly decrease blood glucose level which in turn can prevent adverse maternal and fetal outcomes of GD. Yogic exercises cause the muscles to absorb the excess glucose in the blood, thereby reducing the blood sugar level. They help the pancreas and liver to function effectively, which regulates the blood sugar levels. Asanas help in rejuvenating the pancreatic cells, thereby assisting insulin secretion. The muscular movements also help in bringing down the blood sugar levels.

Constipation

Constipation is a common complaint during pregnancy. This is due to the expanding of the uterus and movement of the organs and digestion becomes sluggish. To help relieve constipation, the mother should eat plenty of fresh fruit and vegetables, drink plenty of fluids and exercise regularly. These will all help with movement of the bowel.

How yoga helps?

Ask parents to take a yoga block underneath your sitting bones, take your knees wide and have a squat! You can put a blanket underneath the heels for more lift. Squat pose will help to open the hips and lengthen the muscles of the pelvic floor. Constipation is common in pregnancy and this pose can help aid in digestion.

Morning Sickness

Two thirds of pregnant women suffer from morning sickness. It most commonly occurs at 4 weeks and stops by week 12, so during the first trimester. One in 5 will continue to have morning sickness in the second trimester and just a few throughout their whole pregnancy. Its cause is unknown. The best way to treat it is to work out which smells and tastes trigger the sickness and avoid them. Ginger can help relieve nausea (I lived on ginger biscuits for a while!) Eating little and often can help as big meals can be difficult. Making sure clothes aren’t too tight around the abdomen can help to make sure there’s no pressure. It is important to keep drinking lots of water if vomiting is occurring to avoid dehydration. As with all ailments during pregnancy it is important not to take any medications without seeking medical advice first, but if it is necessary there are anti sickness.Yoga helps you feel more energetic, healthy, calm and reduces the aches and pains normally associated with pregnancy. It helps you prepare for labour and get back to shape after your baby is born. It is not at all surprising to me that more and more doctors are encouraging women to take up yoga during pregnancy.   medications that are safe during pregnancy such as ondensatron. Medical advice should always be sort if the mother is concerned. Hyperemesis Gravidarum is severe nausea and vomiting leading to weight loss and possibly dehydration.

How can yoga help?

As well eating little and often and drinking ginger tea.  Breathing exercises can help to take the edge off nausea, try deep belly breathing as a way to reduce stress and tension in the body.

Placenta Praevia

Placenta praevia, is a complication of pregnancy where the placenta that feeds the growing baby is attached to the lower part of the womb near to or covering the cervix.  Low-lying placenta may be picked up during a routine 20-week ultrasound scan appointment.  In some cases, a placenta that is seen to be low-lying will move upwards later in pregnancy.

Any bleeding from placenta praevia at the entrance to the womb in the second half of the pregnancy can be heavy and a risk to the baby and the mother’s health. After a low-lying placenta diagnosis, seek medical advice if there’s any bleeding during pregnancy.  Having a low-lying placenta means it is more likely a caesarean section delivery will be recommended.

There are four gradings of previa:

• Grade I— low lying: the placenta is lying close to, but not covering, the cervical opening
• Grade II—marginal: the placenta is at the edge of the cervical opening but does not cover it
• Grade III—partial: the placenta partially covers the cervical opening
• Grade IV—full: the placenta fully covers the cervical opening

The cause of placenta praevia is usually unknown, although it occurs more commonly among women who are older, smoke, have had children before, have had a cesarean section or other surgery on the uterus, or have scars inside the uterus.  Women’s who have had previous low lying and c section are at greater risk of it happening again. The main symptom of placenta praevia, and the greatest risk to mama and baby, is vaginal bleeding. If they have bled too much, other symptoms include anemia, pale skin, rapid and weak pulse, shortness of breath, and low blood pressure. The bleeding that suggests placenta praevia may occur at the end of the second trimester or beginning of the third trimester. It may be heavy or light.

Bleeding is usually painless, and it may happen without labour or during labour. Mothers with a placenta praevia are also at increased risk of delivering prematurely, before 37 weeks of pregnancy.  Bleeding is a common sign of it and women should always be directed to their doctors. 90% of cases happen early on and can resolve themselves.  There maybe a need for scans and in some cases early deliveries.  In any circumstance please refer to their midwives if they are worried.

What yoga poses should you avoid?

So how do you support women who come to your prenatal yoga class with this diagnosis? These women may be feeling quite nervous and may have been told they should be on bed rest. It’s important to check as to the advice of the woman’s OB/midwife and to find out if it’s a full or partial covering.

FULL PLACENTA PREVIA

For a full Placenta Previa, a woman should avoid doing yoga asana (postures). Instead, practices such as Yoga Nidra, and visualising the placenta moving out of the way, can be very powerful. Some women with previa, usually full previa or those that have had vaginal bleeding, may be put on bed rest or pelvic rest. Others may be asked just to reduce their activity. To accommodate those with placenta previa during yoga we need to eliminate or modify poses that add extra pelvic pressure or compress the abdomen.

PARTIAL PLACENTA PREVIA

If it’s a partial or marginal Previa, and the woman is midway through her pregnancy, she can practice in class but the teacher needs to work with her carefully.  To accommodate these mamas we need to avoid or modify poses that create pelvic compression.  Avoid wide legged poses (wide-legged, hip and groin opening postures), and squatting. Bringing the feet closer together and not bending the knees as deeply in the Warrior poses (Virabhadrasana I and II) or Side Angle pose (Parsvakonasana) will help protect the pelvic area. Do Trikonasana (Triangle Pose) with legs closer together instead of the Warrior poses.

• While squats during pregnancy are highly beneficial in helping open the pelvis and hips, it can be a good idea to avoid unsupported squats in any pregnancy class as some placenta previas are not yet diagnosed. Deep unsupported squats such as Malasana put pressure on the cervical opening. Instead, always have your students use two or three blocks under their buttocks so that they are essentially sitting in the squat (pictured). Additionally, she should do poses like virabhadrasana II (warrior II) either with a shorter stance or sitting on a chair.
• Avoid Malasana altogether in cases of Previa, and instead, have mamas sit on a folded blanket with knees parted and bent – this still helps open the hips without placing undue pressure on the cervix (pictured).
• Baddhakonasa (seated groin stretch/ Butterly pose) is also best to be avoided. Alternatively, have women take an easy Cross Legged pose while sitting on a blanket.
• Chairs can be beneficial for any pregnancy yoga practice but even more so in supporting Previa as the opening to the womb is supported. Please see the chair sequence below that can be used for any pregnancy yoga class but is particularly suitable for women with low lying placentas

It is also important to stay away from poses that compress the abdomen. Deep twists are contraindicated during pregnancy, so that is easy to avoid. When twisting the pregnant mother should focus isolating her twist to the upper back, “above the bra strap line” is how I like to describe it. It would also be best to avoid abdominal toning. In our prenatal yoga classes, we focus on tranversus abdominal exercises. If you come across mothers with this invite mothers with previa to either take a restorative pose, rest in child’s pose or do extra kegels.  Other than those exceptions above, a woman with placenta previa can still enjoy most of what the prenatal yoga class has to offer.

Placenta accreta

This is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. Typically, the placenta detaches from the uterine wall after childbirth. With placenta accreta, part or all of the placenta remains attached. This can cause severe blood loss after delivery.

It’s also possible for the placenta to invade the muscles of the uterus (placenta increta) or grow through the uterine wall (placenta percreta).  Placenta accreta is considered a high-risk pregnancy complication. If the condition is diagnosed during pregnancy, you’ll likely need an early C-section delivery followed by the surgical removal of your uterus (hysterectomy).

Symptoms

Placenta accreta often causes no signs or symptoms during pregnancy — although vaginal bleeding during the third trimester might occur.  Occasionally, placenta accreta is detected during a routine ultrasound.

Causes

Placenta accreta is thought to be related to abnormalities in the lining of the uterus, typically due to scarring after a C-section or other uterine surgery. Sometimes, however, placenta accreta occurs without a history of uterine surgery.  It can cause bleeding and premature.

There are risk factors which increase this:

• Previous uterine surgery. The risk of placenta accreta increases with the number of C-sections or other uterine surgeries you’ve had.
• Placenta position. If the placenta partially or totally covers your cervix (placenta previa) or sits in the lower portion of your uterus, you’re at increased risk of placenta accreta.
• Maternal age. Placenta accreta is more common in women older than 35.
• Previous childbirth. The risk of placenta accreta increases as your number of pregnancies increases.

During yoga we need to eliminate or modify poses that add extra pelvic pressure or compress the abdomen. No deep squats.  Most women will have been put on rest with this ailment.

Pre Eclampsia

This marked by high blood pressure in women who haven’t had high blood pressure before. Pre-eclamptic women will have a high level of protein in their urine and often also have swelling in the feet, legs, and hands. Relaxation and yoga can have a really positive influence on blood pressure, lowering it. Some women can also develop low blood pressure which can lead to fainting.

How yoga can help?

“The Effects of Yoga in Prevention of Pregnancy Complications in High-Risk Pregnancies: A Randomized Controlled Trial,” conducted by SVYASA University’s Department of Life Sciences in Bengaluru, India.  The primary result seen was that the maternal blood pressure was lower. The secondary result had to do with the maternal stress rate. There was measurable improvement with the Heart Rate Variability (HRV) as well as the perceived lowering of stress from the pregnant mother’s point of view (1). The study showed significantly fewer pregnancy with induced hypertension (PIH), preeclampsia, gestational diabetes (GDM) and intrauterine growth restriction (IUGR) cases in the yoga group. There were also significantly fewer Small for Gestational Age (SGA) babies and newborns with low APGAR scores in the yoga group, as well as significantly fewer cases of preterm deliveries, which are all prevalent birth issues in India

SPD

Some women develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD).

SPD is a collection of uncomfortable symptoms caused by a stiffness of your pelvic joints or the joints moving unevenly at either the back or front of your pelvis. It isn’t harmful to your baby, but it can be painful and make it hard to get around.

Women with PGP may feel pain:

• over the pubic bone at the front in the centre, roughly level with your hips
• across 1 or both sides of your lower back
• in the area between your vagina and anus (perineum)
• spreading to your thighs

Some women feel or hear a clicking or grinding in the pelvic area.

The pain can be worse when you’re:

• walking
• going up or down stairs
• standing on 1 leg (for example, when you’re getting dressed)
• turning over in bed
• moving your legs apart (for example, when you get out of a car)

Most women with PGP can have a vaginal birth.  Most yoga poses may aggravate SPD but there are some which help because they stabilise the pelvis by strengthening the muscles that support it.  Many of the postures below strengthen the pelvic floor and the core muscles in particular.

How can yoga help?

Poses such as mountain down dog at a wall, chair pose at a wall, side stretch cat pose will help strengthen core and pelvic floor.

Multiple Babies

Some twin pregnancies come with complication and risk — others do not.  The question of how much one can exercise hinges on the client’s specific risks. If they are at high risk for complications, their doctor may recommend that they put exercise on hold until after their babies are born. It is important to have this discussion before they join your classes.

Don’t do any movements that require lying flat on their back, especially after 16 weeks.  These positions may lower blood pressure and make them feel faint. Lying flat on their tummy isn’t advisable either.  When the students become further on there maybe restrictions with movement and stretches may become uncomfortable.  Using props, blocks, cushions and yoga straps may help them.

Maternal Mental Health during Pregnancy

During pregnancy a woman’s emotional well-being will most likely come under pressure but she will likely go on to have a healthy baby.  It is important to remind the women in the classes that it is normal to be a little bit stressed about the changes that are happening in their lives and the changes which are happening to their body.  If this turns to stress day in and out along with anxiety then suggesting advice should be sought by the mother to be from the midwife or DR as high levels may affect the unborn baby.  This is due to the stress hormone Cortisol which can cross the placenta and influence the building blocks of your baby’s emotional development.

Hormones during pregnancy are chemicals that circulate in the blood, and they have powerful and varied functions.  Different hormones regulate body functions and carry messages from one part of the body to another. Hormones recognise emotional triggers; they can cause you to cry when you are sad and to react to fear or danger with the ‘fight or flight’ response.  Hormones (during pregnancy) are there to help regulate the many changes taking place to enable your baby to be born safely. Understanding what the hormones are doing may help you understand the changes in your body, and help decide what’s normal and what may not be.

Some of the most significant hormones in pregnancy are:

oestrogen

progesterone

oxytocin

endorphins

prolactin

Evidence is well documented in relation to a significant number of women experiencing mental health problems such as anxiety and depression during pregnancy. A study by O’Hara and Swaim (1996) showed that approximately 15% of pregnant women experience significant feelings of stress, anxiety or depression.  A majority of women experiencing postnatal depression had also suffered antenatal depression, and in contrast postnatal anxiety was initiated by antenatal anxiety (ibid).

Promoting mindfulness and visualisation in pregnancy can be helpful in increasing feelings of being in control, and connect mothers to their unborn babies which in-turn creates positive maternal bonding and attachment in the antenatal and postnatal period. Mindfulness in pregnancy helps to put all attention into what is happening in the present moment within body, womb and the growing baby.

Within Kalma Mama classes we focus on visualisation, mindfulness, gentle stretches and breathing techniques that can be used in pregnancy to help lower anxieties reducing low mood in pregnancy. Our vision is to create a space where mothers to be can have 1-1 time connecting with their unborn babies, thus promoting the bonding process.  All of the practices within the class settings of Kalma Mamas will help to reduce the affects of anxiety.  Breathing will help the muscles relax and thus the body.  Resulting in lower stress and anxiety.

Optimal positioning

Towards the end of pregnancy 36/37 weeks babies should be in a ideal position of head down in the pelvis.  There are cases whereby babies maybe transverse or breech.  We can as prenatal teachers encourage this by communicating with the baby visualisation and massaging the belly to encourage babies to turn.  We can use cat pose in classes as this gives more space, as mamas bottom is up as gives more space for baby in the pelvis for baby to turn.  Trying to sit more forward with hips apart on a bean bag or birthing ball.

Here are some examples of yoga poses that help with the preparation of the pelvic area during pregnancy:

• CAT POSE: HIP CIRCLES ON ALL FOURS AND/OR STANDING-The desired effect of all of these movements is to create a repertoire of movement patterns that may help change the orientation of the pelvis for birth. Ensure that your student has adequate support under the knees and moves her body in a way that supports her needs at all times.

• PRASARITA PADOTTANASANA / STANDING WIDE LEG FORWARD BEND (SUPPORTED WITH HAND ON CHAIR OR BLOCK)-Modern life has made the sacrum more vulnerable than it used to be. This particular pose helps lengthen the hamstrings, which are attached to the base of the Iliac Bone (tuberosity). Ultimately this will affect the sacro-illiac joint function, which is essential for correct movement during a vaginal birth. Notes: add more height to the chair as is necessary, and place her buttocks on the wall behind for extra support. Caution needs to be taken for Pelvic Girdle Pain.

• LUNGE POSE/ ANJANEYASANA. SUPPORTED WARRIOR 1 (WITH CHAIR)-In yoga we often talk about the benefits of releasing our psoas muscle to ease back pain, rebalance the pelvis, and for general comfort and alignment. If the psoas muscle has excessive tightness, it has a cascade effect of unbalancing the whole of the pelvis and its associated muscles. By releasing the psoas we can help balance and correct the alignment of the uterus in the pelvis Notes: blanket under the knees for extra support. Caution needs to be taken for Pelvic Girdle Pain.

• MALASANA / SQUATTING-Aside from any contraindications relevant to the individual women’s pregnancy, squatting helps to lengthen the pelvic floor and add flexibility to the soft tissues within and around the pelvis. When we squat the muscles in the back, gluts’ and pelvic floor lengthen and relax encouraging blood supply to the whole pelvic area. The pelvic floor muscles need to be in a state of balance to move the baby out. We know that squatting is a fabulous position for giving birth, especially in the second stage where the inferior opening of the pelvis is opened to its widest, when in this position. Note: Ideally begin squatting from second trimester if the woman has not ever included squatting into her routine prior, and gradually build up.