March 2, 2012

Placenta Previa and Prenatal Yoga

Last Friday’s class was a bit challenging in juggling the myriad of issues present in class. Amongst the typical aches and pains, there were a few cases that needed a bit extra attention: two students were suffering with acid reflux, a hand full had sacroiliac issues, and two mothers had placenta previa. It was absolutely necessary to offer adjustments and modifications to the students with more specialized issues. After class, one of the students that has placenta previa approached me and expressed her relief in understanding what she needed to modify in her practice. She had been taking “normal” yoga classes and the teacher, understandably, did not know of this condition. So that leads me to this blog, explaining placenta previa and how it relates to the mama-to-be’s yoga practice.

What is placenta previa?
Placenta previa is a condition in which the placenta is covering the cervical opening, either fully, partially or marginally.

Fully The placenta is fully covering the cervical opening
Partially The placenta is covering part of the cervical opening
Marginally The placenta is next to the cervical opening.

This condition occurs in 1 out of 200 women. It is usually detected in the mid second trimester via ultrasound. For most women that have partial or marginal cervical coverage, the previa is usually cleared up as pregnancy progresses. The placenta is adhered to the uterus, so as the uterus grows, the placenta is lifted away from the cervical opening. This may not happen to those with full previa. If a woman is presenting with previa near her due date, she will need to give birth via cesarean. (For those that will need to have a c-section, you may want to read Keep A Cesarean Birth As Intimate As Possible)

A pregnant woman is more likely to have previa if she has had it in previous pregnancies, had a previous c-section, uterine scars, carrying twins, a smoker or over the age of 35. But don’t worry- if you fall into one of those categories and your provider has not mentioned previa to you, you are likely fine. Once the placenta implants itself on the uterine wall away from the cervix, it does not move downward.

What yoga poses should you avoid?
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.

Poses that create deep pelvic openings should be removed or modified during the practice, such as deep unsupported squats. Instead, a woman can squat on two or three blocks, supporting the pelvic floor. Additionally, she should do poses like virabhadrasana II (warrior II) either with a shorter stance or sitting on a chair. The same modification should be made for utthita parsvakonasana (extended side angle).

Some seated poses like baddha konasana (bound angle pose also known as tailor’s pose) need to be adjusted. The mother should be seated on either a bolster or one or two blankets with her feet further forward, more like tarasana (star pose) with blocks propping her knees up. This will lessen the opening of the pelvic outlet.

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. During this segment of class, I invite mothers with previa to either take a restorative pose, rest in child’s pose or do extra kegels.

Other than those exceptions, a woman with placenta previa can still enjoy most of what the prenatal yoga class has to offer. I hope that these explanations are helpful to those practitioners with placenta previa, and to yoga teachers working with pregnant women. Enjoy your practice!!



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