For years I have been asked to substantiate with a clinical study the idea that prenatal yoga helps pregnant women during labor. So you can imagine my excitement when I was reading from the Journal of Perinatal Education and found this article doing just that. Please read and enjoy the article. This may help remind you, each time you step on your mat, that you are not just taking care of your body in the present, but you are benefiting yourself in the future.
Chuntharapat, S., Petpichetchian, W., & Hatthakit, U. (2008). Yoga during pregnancy: Effects on maternal comfort, labor pain and birth outcomes. Complementary Therapies in Clinical Practice, 14(2), 105-115. [Abstract]
Summary: In this trial conducted in Thailand, nulliparous pregnant women without previous yoga experience were randomly assigned to practice prenatal yoga (n=37) or to usual care (n=37). The yoga group attended a series of six 1-hour yoga classes every two weeks in the final trimester and were given a booklet and audio tape for self-study, which they were encouraged to practice at least three times per week. Daily diaries kept by participants and weekly phone contact from researchers helped ensure compliance. Participants in both groups completed a prenatal questionnaire to assess anxiety and collect demographic data.
Once in labor, pain and comfort were assessed every 2 hours in the first stage of labor (for a maximum of three measurements) and again 2 hours postpartum using multiple pain-measurement instruments that have previously been validated for use in laboring women. The researchers controlled for maternal age, marital status, education level, religion, income, and maternal trait anxiety.
Data were available for 33 of 37 women assigned to each group but the researchers provide no explanation for this attrition. Although this omission limits the reliability of the study, the strength and consistency of the researchers’ findings suggest that attrition probably did not significantly alter results. The experimental group (yoga group) had significantly less pain and more comfort than the control group at each of the three measurement intervals during labor and at the postpartum measurement. This finding was consistent and significant across all three pain main measurement instruments used.
The researchers do not present data about mode of birth. However, the length of the first stage of labor and total duration of labor were significantly shorter in the yoga group (mean length of first stage = 520 minutes in yoga group versus 660 minutes in control group; mean total time in labor 559 minutes in yoga group versus 684 minutes in control group). There were no differences in length of second stage of labor, pethidine usage or dose given, augmentation of labor, newborn weight, or Apgar scores. Epidural analgesia was not mentioned so presumably it was not available.
Significance for Normal Birth: This study provides evidence that regular yoga practice in the last 10-12 weeks of pregnancy improves maternal comfort in labor and may facilitate labor progress. The researchers offer several theories for these effects. First, yoga involves synchronization of breathing awareness and muscle relaxation which decrease tension and the perception of pain. Second, yoga movements, breathing, and chanting may increase circulating endorphins and serotonin, “raising the threshold of mind-body relationship to pain” (p. 112). Third, practicing yoga postures over time alters pain pathways through the parasympathetic nervous system, decreasing one’s need to actively respond to unpleasant physical sensations.
Prenatal strategies that help women prepare emotionally and physically for labor may help reduce pain and suffering and optimize wellbeing in childbirth by providing coping skills and increasing self-confidence and a sense of mastery. More research is needed to confirm the findings of this study. However, yoga’s many health benefits and the lack of evidence that yoga is harmful in pregnancy or birth provide justification for encouraging interested women to incorporate yoga into their preparations for childbirth.
September 15th, 2008
Last week I stumbled upon the article “A Top Obstetrician On Why Men Should NEVER Be At the Birth Of Their Child” by a very renowned obstetrician, Michel Odent, about the father’s place in labor and birth. Odent is a father of three and a pioneer in water birth. At first I was very surprised by his stance that the father’s presence does not necessarily help the laboring woman. But the more I read about his beliefs, the more I started to understand his point of view.
Let’s backtrack a bit and look at the history of men’s presence at childbirth in our culture: For many years, women birthed at home with a midwife and an extended female family unit for support. It was not until births moved to a hospital setting in the 1940’s that women were isolated from the support of family and left to birth on their own. This was also the age of the ‘twilight sleep’ birthing style. Things began to shift in the 1960’s when women took more control of their births, educated themselves through childbirth education classes, and partners and husbands became more involved in the birthing process. Men were expected to be “birth coaches” or helpers during labor and delivery. Many men can find this overwhelming. One man I asked about this said, “How can I coach when I have never played the game?”
I have attended about 65 births and have seen a wide range of reactions from fathers. With most I have observed a willingness and eagerness to participate in the labor experience, helping out however they feel they can, although many seem a little bewildered about the situation unraveling in front of them. Some fathers have expressed huge relief when the labor support doula or midwife arrives on the scene, taking the pressure off of them to be the responsible helper of their laboring partner. I have also seen many fathers get very excited about the opportunity to have a ‘job’. Just recently at a birth I was attending, the laboring woman said, “Yes, give my husband a job. He likes jobs, he will feel useful.” Many men tend to get very involved with informing family members and friends - continuously - about the progress of the situation. (This should really be read as: LEAVE THE BLACKBERRY AT HOME!!! Not once has a laboring women seemed to appreciate seeing her partner glued to his cell phone.)
But there are also some men who have chosen to sit back and not get too involved. I don’t think these men should be judged any differently then those who are right there in the middle of things, applying the cold compress to the mother’s forehead. Interestingly enough, in 1960, a doctor working at a hospital in London interviewed fathers and their partners post-delivery, asking them if they had been happy witnesses to the births of their children. Without exception they responded with a collective ‘yes’. The doctor, George Davidson, then spoke to each father alone and assured them that their responses were confidential. This time, most of the men said that although the birth was an interesting and extraordinary experience, it was one they could have lived without.
There is also the question of whether or not the mother wants her partner present. One of my students confided in me that she is not sure how involved she wants her husband to be in her birth. She thinks that his nervousness will be more of a hindrance then a help. She’s not the only one: Michele Odent commented “Having been in charge of thousands of births, at homes, in hospitals, in the UK, in France, with the father present, with him absent, I have reached my own conclusions. I am more and more convinced that the participation of the father is one of the main reasons for long and difficult labours.” A long and difficult labor is something that neither mother nor father wants.
It is very hard for a man to watch the woman he loves in a lot of discomfort. I have heard many dads say things like, “OK, enough of this. Let’s ask for the epidural” or, “Please don’t refuse the heart monitor. We need to know the baby is alright.” This nervousness and corresponding spike in adrenalin can be very contagious and affect the mother’s production of oxytocin, thus arresting her contractions or lowering her confidence. These types of comments, though not made maliciously, can also move the mother more into her rational mind, when at this time she needs to “go primal” and move past the thinking brain to the animal brain. This primal behavior can be very upsetting for some men to watch. One man was quoted as saying “I kept thinking she was just like any other birthing animal, and there was something hugely disturbing seeing her reduced to that’.
Odent goes on to explore the consequences of witnessing birth in terms of the effects on the sexual relationship. “When men first started standing at their partner’s side during labour, I remember my mother’s generation saying, very matter of factly, that the couple’s intimate life would be ruined as a result. And, given that the key to eroticism is a degree of mystery, I am left believing they had a point. There are many things we do in private in order to preserve a degree of modesty and mystery. And, for the benefit of our sex lives, it may be worth adding childbirth to this list.
I talked to a friend about this issue. We both agreed there is so much pressure in our society to look good and to maintain a certain appearance of sexuality. Some women may feel shy about how they look in the throngs of labor. This sort of thinking will inhibit them and potentially make them unable to ‘let go’ and labor. Others are afraid their partners will not be able to see them as sexual beings after watching a baby emerge from their vagina.
Please don’t think now that you need to leave your partner outside the room or send him for ice chips every five minutes. Perhaps this is a good jumping off point for a very candid, honest discussion with your partner. Maybe there is a happy medium, like inviting a doula, mother or sister into the picture to take the pressure and responsibility off the father. When it comes down to it, this is a life-changing experience for you, your partner and your baby. You all need to be involved in the decision-making about what is best for your family.
September 8th, 2008
