by Guest Contributor Lauren Anderson
When talking about “the dos and don’ts” during the perinatal period, there are many misconceptions when it comes to what is deemed safe in terms of movement, exercise, and pregnant and postpartum bodies,. These fallacies seem to be ever more prevalent in the pre and postnatal yoga world where myths run deep and long held beliefs are quite widespread amongst even the most seasoned teachers.
Often these ideas focus on the perinatal body being inherently fragile, unstable, weak, incapable and needing only rest and light movement during pregnancy and early postpartum. However, we can see from the wide array of activities (whether you personally believe them to be safe or not) performed during pregnancy and postpartum (e.g. marathons, CrossFit, and competitive sporting events) that these beliefs are rather “old school” and lacking scientific evidence.
Yoga, by nature, is rather low impact and low intensity and while injuries can be sustained in any movement modality, our chances of injury are substantially decreased when we not only understand why we are offering the movement at hand, but also when understand our clients, their bodies, and their lifestyles.
The goal of this article then, is to get us thinking differently in regards to pregnant and early postpartum bodies, change the dialogue, and understand that movements are completely dependent on who we’re working with, their level of fitness, and their specific health needs.
Here are the most common myths and misconceptions I hear when talking and teaching to fellow prenatal and postpartum yoga teachers and some questions we should be asking ourselves when it comes to our students and clients:
Myth #1: Be mindful to not overstretch because of relaxin.
The idea is that elevated relaxin levels that accompany pregnancy and postpartum make perinatal women prone to overstretching and therefore at higher risk of damaging connective tissues needed to keep the body stable.
Relaxin is incredibly important during pregnancy for embryo implantation, uterine growth, early labor inhibition, adaptation of the cardiovascular and renal systems to increases in oxygen and waste biproducts, and towards the end of pregnancy in promoting the rupture of the water sacs and helping to soften the connective tissues of the pelvis to prepare for birth. However, the research about relaxin’s effects on other joints to what extent they may be affected is divided and fairly controversial.
Some studies show that an increase in serum relaxin concentration may correlate with joint laxity (Lubahn et al., 2006; Dragoo et al., 2011a, 2011b), but this effect during pregnancy is not found by all (Forst et al., 1997). While some studies have reported higher relaxin levels in pregnant women with pelvic joint instability or hip joint laxity as compared with controls (Saugstad, 1991; Steinetz et al., 2008), Ohtera et al., 2002 found this to be untrue.
Overall, a majority of the research deduces that relaxin locally affects the pelvis to decrease stiffness at the SI joints and pubic symphysis, the linea alba, and low back (areas widening with childbirth) however, studies also show that increases in joint pain are not correlated with levels of serum relaxin (Marnach, et al., 2003), meaning that relaxin may have nothing to do with joints outside the pelvic cavity. Could this be stress from increasing loads and forces that accompany excess weight gain or simply sensations from moving less?
More anecdotally, in my experience most pregnant women do not feel abundantly loose and flowing. Many, in fact, come into class complaining of tightness, stiffness, and soreness- which coincides with some research on hypermobility where joint laxity altered perception at the joint in question, making it feel, stiff, tight and sore (Hauser & Woldin, 2018).
In summary, the blanket caution that women should be careful with stretching during pregnancy may not be supported by the available evidence.
Myth #2: Don’t twist.
The thought here is that deep closed twisting, where the belly is compressed, has the ability to cut off circulation to the uterus (and baby). Additionally, it is thought that deep rotational movements can overstretch the connective tissues of the abdomen, worsening or increasing the incidence of diastasis rectus abdominis (DRA, separation of the abdominals).
Rotation however, is a foundational component of spinal movement. We were quite literally built to twist, spin, and rotate. Turning away from the sink to load the dishwasher, moving from one side of our desk to another in a swivel chair, picking up and putting down children, and wiping ourselves in the bathroom from front to back – movements we do day in and day out – all require some degree of rotation. Furthermore, these movements are often performed when the individual is completely unaware of how open or closed the rotation is. And while it may increase the severity of DRA, our connective tissues are strengthened through tensile forces and our muscles are strengthened through contracting through their range of motion – so why would we stop moving in a way that our body is built to move? In inhibiting these motions, aren’t we losing out on mobility that we may need later down the line?
However this doesn’t necessarily mean we should continue twisting as deeply as possible during these periods. Can your pregnant or newly postpartum client (perhaps recovering from a c-section) perform that movement? Is it even comfortable? Are they someone who feels a lack stability or pain in the pelvic area (see above? We must question what is best for the bodies in our class.
Myth #3: Don’t lie flat on your back.
Lying flat the back (supine), as the belly becomes larger, can compress the inferior vena cava, a large vein on the right side of the body which returns deoxygenated blood back to the heart, decreasing circulation and blood flow to uterus and baby. Can this happen?
Yes, however it usually occurs after an extended period of time – meaning that poses that last 30 seconds to 5 minutes (e.g. a round of bridge poses) may be ok. Typically, someone who has issues with circulation will feel nauseated, dizzy, and lightheaded if they lie in position that doesn’t suit their body. A really easy adjustment is to elevate the hips and slightly rock to the left with a blanket or two (Higuchi et al., 2015).
Myth #4: No deep backbends.
The concern here lies in exacerbating or increasing the incidence of DRA (or diastasis). The fact here is, we don’t really know. Again, the spine was meant to extend (think of foundational joint movements). Yes, extreme extension may increase or add to an already developing DRA (up to 70% of all women develop a diastasis and 100% develop a small separation) (Theodorsen et.al, 2019). However, there are many contributing factors when it comes to DRA, including genetics and tissue quality (Mota et al., 2015).
The biggest question you should be asking in this (and any pose), is: is this comfortable for my client? Are they light headed? Are they pushing, stressing, or forcing? These are the questions that will enable us, as movement professionals to best serve the people we work with.
While some movement specialists would have you believe that the pregnant body is inherently fragile, we can challenge this bias and misconception simply by observing women stepping outside the norms, working in laborious positions or sports, throughout the entirety of their pregnancy and soon thereafter. And while this might not be the social ideal or what is best emotionally for mom and baby, it shows us that while pregnancy and postpartum are indeed physiologically and anatomically phenomenal, your body is not bound to break just because you are carrying or caring for another human life and moving at the same time.
The caveat to all of the aforementioned would, of course be, specific contraindications to movement during pregnancy and/or postpartum diagnosed by a healthcare professional (OB, Midwife, Urogynecologist, or Physical Therapist). This is a wonderful reason to collect and understand intake forms for all “special population” classes and to create relationships and referral networks outside of the yoga community.
**Special announcement: you can now take pre & postnatal yoga classes with the amazing & knowledgeable Lauren Anderson as part of the selection of classes in Jenni’s online class library!
References
Dragoo, J. L., Castillo, T. N., Braun, H. J., Ridley, B. A., Kennedy, A. C., & Golish, S. R. (2011). Prospective correlation between serum relaxin concentration and anterior cruciate ligament tears among elite collegiate female athletes. The American journal of sports medicine, 39(10), 2175-2180.
Forst, J., Forst, C., Forst, R., & Heller, K. D. (1997). Pathogenetic relevance of the pregnancy hormone relaxin to inborn hip instability. Archives of orthopaedic and trauma surgery, 116(4), 209-212.
Hauser, R. A., & Woldin, B. A. (2018). Joint Instability as the cause of chronic musculoskeletal pain and its successful treatment with prolotherapy. In Anatomy, Posture, Prevalence, Pain, Treatment and Interventions of Musculoskeletal Disorders. IntechOpen.
Higuchi, H., Takagi, S., Zhang, K., Furui, I., & Ozaki, M. (2015). Effect of lateral tilt angle on the volume of the abdominal aorta and inferior vena cava in pregnant and nonpregnant women determined by magnetic resonance imaging. Anesthesiology: The Journal of the American Society of Anesthesiologists, 122(2), 286-293.
Lubahn, J., Ivance, D., Konieczko, E., & Cooney, T. (2006). Immunohistochemical detection of relaxin binding to the volar oblique ligament. The Journal of hand surgery, 31(1), 80-84.
Marnach, M. L., Ramin, K. D., Ramsey, P. S., Song, S. W., Stensland, J. J., & An, K. N. (2003). Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstetrics & Gynecology, 101(2), 331-335.
Mota, P., Gil Pascoal, A., & Bo, K. (2015). Diastasis recti abdominis in pregnancy and postpartum period. Risk factors, functional implications and resolution. Current Women’s Health Reviews, 11(1), 59-67.
Ohtera, K., Zobitz, M. E., Luo, Z. P., Morrey, B. F., O’Driscoll, S. W., Ramin, K. D., & An, K. N. (2002). Effect of pregnancy on joint contracture in the rat knee. Journal of applied physiology, 92(4), 1494-1498.
Saugstad, L. F. (1991). Persistent pelvic pain and pelvic joint instability. European Journal of Obstetrics & Gynecology and Reproductive Biology, 41(3), 197-201.
Steinetz, B. G., Williams, A. J., Lust, G., Schwabe, C., Büllesbach, E. E., & Goldsmith, L. T. (2008). Transmission of relaxin and estrogens to suckling canine pups via milk and possible association with hip joint laxity. American journal of veterinary research, 69(1), 59-67.
Theodorsen, N. M., Strand, L. I., & Bø, K. (2019). Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy, 105(3), 315-320.
About the Guest Author:
Lauren Anderson has been training, teaching yoga, writing and lecturing about health, fitness, and wellness for 15 years. She received her Master’s Degree in Exercise Science and holds several fitness certifications including ACSM Certified Personal Trainer, Postnatal Fitness Specialist, and E-RYT. She is also currently pursuing her Postpartum Doula Certification. Learn more from Lauren’s offerings:
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