Yoga-Based Birth Skill #1- Movement (Asana)

Article Index

 

INTRODUCTION 

The successful implementation of movement as a Yoga-Based Birth Skill will effect your childbirth experience in a myriad of positive ways and makes a perfect place to start this journey through The Whole Way.

Movement is defined as the act or process of moving, the change of position, the change of location, regardless of its origin, movement is a process that affects change.

During the birth of your child, movement is not only the physiological ability that accomplishes birth—and a highly recommended, safe and easily accessible birth skill—movement is also an instrument of change.

Movement is the very definition of birth, the whole process is designed around the physiological ability of a woman’s body to move and change. Simply put— it is the flexion (movement) of your uterus that physically moves your baby down, out, and born.

Movement is often suggested as a healthy birth practice, it is an essentially harmless and evidence-based birth skill and you already know the basics.

Movements are processes that affect change. In America, the majority of women give birth in a hospital setting, which almost always means, once admitted, being placed in bed and tethered to a variety of medical devices. The hospital’s routine usage of these interventions is seldom if ever evidence-based and this includes continuous electronic fetal monitoring.

If there is no genuine medical need for you to remain flat on your back in bed tethered to machines then DON’T stay there. Doulas, childbirth educators, physiologists, midwives— we all give this advice— but although we can advise you—you are the one that needs to physically and mentally stand up.

If you want something different for your birth experience and if you are to be an instrument of change then you will need to advocate for your rights as a patient to optimal maternity care—and become a part of the Childbirth Movement.

Birth in America will never change if you don’t.

This article will cover the basic physiology of movement in general and specifically during labor and delivery.

We will look at the evidence from literature, childbirth organizations, the American College of Obstetricians and Gynecologists (ACOG), Midwife Organizations, evidence based studies, and Cochrane Database systemic reviews.

You will learn how to use movement to facilitate birth, the history of using movement in childbirth, and how to incorporate this skill as part of your healthy pregnancy.

You will learn a little bit of history regarding movement in the practice of Yoga, and how to incorporate Yoga during your pregnancy, labor, and delivery.

This article also begins the discussion of the roles that adrenaline, pain, and fear play during your labor and birth.

Your decision to utilize Movement as a Yoga-Based Labor Management Tool is one that when properly implemented will go a long way towards alleviating unnecessary suffering during your birth experience.

This is your path towards a calm, positive pregnancy and a strong, resilient birth.


 

ACOG Committee on Obstetric Practice Opinion: Approaches to Limit Intervention During Labor and Birth No. 766; 133(2) by American College of Obstetricians and Gynecologists, Wolters Kluwer Health, Inc. Publishers, February 2019

Adler, Daphne, Debunking the Bump: what the data really say about pregnancy’s 165 biggest risks and myths; 3rd ed.; 2018; Familius LLC; USA

Bryant, Edwin F. The Yoga Sutras of Patanjali—A New Edition, Translation, and Commentary; 2009; North Point Press; New York

Buckley, Sarah J. “Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care.” The Journal of perinatal education vol. 24,3 (2015): 145-53. doi:10.1891/1058-1243.24.3.145

Buckley, Sarah J. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women & Families, January 2015

Dekker, Rebecca; The Evidence on: Birthing Positions; www.evidencebasedbirth.com ; Pub. October 2012 Updated: February 2018; https://evidencebasedbirth.com/evidence-birthing-positions/

Dhillon A, Sparkes E, Duarte RV. Mindfulness-Based Interventions During Pregnancy: a Systematic Review and Meta-analysis. Mindfulness (N Y). 2017;8(6):1421–1437. doi:10.1007/s12671-017-0726-x

Gabriel, Cynthia, Natural Hospital Birth-The Best of Both Worlds, The Harvard Common Press, 2011

Gaskin, Ina May, Ina May's Guide to Childbirth, Bantam Books, 2003

Gilman, Celeste, Online Article: Your Brain in Birth? Labor from the neurological physiological perspective of the Mother; Website: Evolutionary Parenting with Tracy Cassels PhD; http://evolutionaryparenting.com/guest-post-your-brain-in-birth/

Hafen BB, Burns B. Physiology, Smooth Muscle. [Updated 2018 Dec 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526125/

Hannibal, Kara E, and Mark D Bishop. “Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation.” Physical therapy vol. 94,12 (2014): 1816-25. doi:10.2522/ptj.20130597

Harvard Health Publishing, Online Article: pub. March 2011 updated: May 1, 2018, Understanding the Stress Response https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

Ingraham, Paul, PainScience.com, Online Article: pub. update August 2018, Pain is Weird: pain science reveals a volatile misleading sensation etc., https://www.painscience.com/articles/pain-is-weird.php

Iyengar, B.K.S., The Tree of Yoga, 2nd ed.; 2002; Shambhala Publications, Inc.; Boston USA

Jansen L, Gibson M, Bowles BC, Leach J. First do no harm: interventions during childbirth. J Perinat Educ. 2013;22(2):83–92. doi:10.1891/1058-1243.22.2.83

Kitzinger, Sheila, The New Pregnancy and Childbirth-Choices and Challenges, Dorling Kindersley Limited, 4th Ed, 2003

Lowdermilk, Perry, Cashion, Alden, Maternity and Women's Health Care, Elsevier, 10th Ed., 2012

Ondeck Michelle. (2014). Healthy birth practice #2: walk, move around, and change positions throughout labor. The Journal of perinatal education, 23(4), 188–193. doi:10.1891/1058-1243.23.4.188

Osho, Yoga—The Science of the Soul; 2002; St. Martin’s Griffin Press; New York

Oster, Emily; Expecting Better: Why the conventional pregnancy wisdom is wrong-and what you really need to know; 2nd ed. 2016; Penguin Books; New York

Simkin, Hanson, Ancheta, The Labor Progress Handbook- Early Interventions to Prevent and Treat Dystocia, John Wiley & Sons, Inc., 4th Ed., 2017

Simkin, Penny: The Birth Partner: a complete guide to childbirth for dads, doulas, and all other labor companions; 4th ed. 2013; The Harvard Common Press; Boston, MA

Sundin, Julia; Murdoch, Sarah, 2007, Juju Sundin’s Birth Skills,  Allen & Unwin Book Publishers; Australia

WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO


Human bodies are designed for movement, our ever moving bodies are constructed out of muscles, bones, ligaments, tendons, joints, natural curves, and shock absorbers. Movement is an essential part of a healthy body’s normal function.

Natural movements occur at all of the body’s synovial joints—the “hinges” that make up and connect our skeletal frame. These joints allow for many types of movement and a huge range of motion.

Movement can arise from the actions of flexion/extension, adduction/abduction, rotation, etc, the specific type of movement is largely determined by the anatomical position of the body in space.

Your brain is the master coordinator of your body, it runs and controls just about everything the body does, even when you are asleep.

Generally speaking there are two types of movement, voluntary and involuntary, both are the result of brain function.

The cerebrum which makes up 85% of the brain’s total weight is home to the “thinking” part of the brain, conscious hard thinking, memory and reasoning.

The Motor Cortex, which is subdivided into 5 parts, is located in the frontal lobe of the cerebrum and is responsible for voluntary movement. The parts of the body that move when you tell them to move.

Voluntary muscles are constructed out of striated contractile muscle tissue, this type of tissue is capable of executing the basic motor functions that allow the ability for selective movements.

These types of movement are normally coordinated and executed by muscles under voluntary control. Your body can either execute a movement using conscious coordination of the movement or it can be left to execute the same movement automatically with little or no user input.

Voluntary movements are accomplished either on auto-pilot or by conscious direction and this is best illustrated by example:

If I were to ask you to walk across the room, you wouldn’t have to think too much about it, your body will just do it—because your body has a mind of its own.

Your “thinking” mind will initiate the movement and your Autonomic Nervous System will take care of the rest.

One of the main goals of the physical practice of Yoga (Asana) is to take the movement of voluntary muscles off of autopilot and back into consciously directed control. This practice is of great value to an aspiring Yogi who is looking to quiet her mind.

So simply asking you to walk across the room is one thing…

But saying step forward with your right foot on your inhale, step forward on your left foot with your exhale, raise your arms as you inhale, release your arms as you exhale, inhale through your nose, exhale through your mouth until you reach the far side of the room is quite another.

The first is done on autopilot the second is done through conscious directed movement. Your Autonomic Nervous System still does the majority of the work even though more “thought” is entailed.

Conscious directed movement is a Yoga-Based birth skill, it puts your mind in control of the body’s voluntary actions.  Actions such as these move your thinking mind from painful obsessing to instead being a part of a solution that eliminates needless suffering.

It literally moves the mind from thinking mode to doing mode.

Movement also requires the activation of the cerebellum, which is approximately 1/8th of the size of the cerebrum. This part of the brain coordinates how your muscles work together, helps you keep your balance and move around.

This type of movement is yours to control and this is just one of the many attributes that make Movement the amazing birth skill that it is.


 Birth, herself, is a different animal and she lives in a different world, a much older part of the human female brain.

Giving birth is an innately instinctive act, hardwired into our brains and bodies through millions of years of mammalian evolution and is designed to ensure the best possible outcomes for mothers and babies. We would hardly exist as a species if this was not so.

Human females gave birth before our species “stood up” and before our species grew a neocortex “new brain”.

Can we really birth instinctively if we cannot use our bodies freely?

However, if I were to ask you to contract your uterine muscles, no amount of conscious thought on your part would make it possible—but on your birthing day, you won’t have to think about it, your uterus will just do it—because your body has a mind of its own.

Some bodily functions are just too important to survival, too important to be left to the mostly voluntary realm of the cerebrum so these functions are controlled by a separate part of the nervous system, made up of the:

  • Brain Stem which connects the rest of the brain with the spinal cord. This portion of the brain is in charge of all the functions that keep our species alive: breathing, digestion, pumping blood, and contracting uteri. It’s job is is to control your involuntary muscles—the ones that work automatically without conscious thought.
  • Pituitary Gland which controls hormone production and regulation and pretty much controls the rate of uterine function.
  • Hypothalamus which sits above the Pituitary Gland and works in close conjunction with it. The hypothalamus is responsible for regulating body temperature, releasing hormones, regulating emotions, and sexual behavior. Oxytocin is produced here.
  • The Amygdala is a small almond shape mass of nuclei, the human brain actually has two- one in each hemisphere. They are involved in many of our motivations and emotions but their specialty is fear and preparing for emergency events— they have a special interest in survival. Interestingly enough, they determine what memories are stored and where these memories are stored in the mind.

These parts of the human brain control the many subsystems necessary for life, they run with no thought from the user through involuntary muscle movements.

Involuntary muscles are constructed out of smooth muscle tissue in which the contractile fibers are not highly ordered (non-striated), they occur in the gut, the internal organs, and the uterus and are not under the voluntary control of the cerebrum.

The smooth muscles of the uterus help a woman move her baby out, the smooth muscles of the bladder move out urine, they determine the rate of blood flow, and they move food through the digestive tract.

Our lungs exist in separate circumstance as they contain both smooth and striated muscle tissue, thus we are capable of a modicum of breath control, but when we aren’t paying attention to the breath— smooth muscles keep air moving in and out of our lungs.

Breath work is Yoga-Based Birth Skill #2 (Pranayama) and will have its own section. So we move on…

Without these vital involuntary movements the body would not be able to maintain even its most basic functions. It is essential that these functions remain out the direct control of conscious direction. 

Imagine having to think each time you took a breath, that you need to remind your heart to pump, you had to consciously summon white blood cells to fight infection, your stomach and intestines to digest food and your uterus to contract. Just thinking about all the critical necessities that entail basic level survival, is enough to make my thinking brain explode.

The main function of the involuntary movement of smooth muscle groups is to contract, and these groups contain unique properties that allow for synchronous contractions to occur, such as the contractions during labor.

The uterus is lined with smooth muscle tissue which creates the contractile force during birth, it is also the driving force behind the creation of numerous pharmaceuticals that have been created to help enhance uterine contractions, but I digress. 

Childbirth is quite literally designed around the physiological concept of movement.

Progress in labor is determined by movement.

The baby initiates the process by signaling— moving endocrine secretions first to the placenta which cues the production of estrogen which is moved to the brain which in turn allows the fetus to mature and the cervix to move and ripen. Hormones are agents of change within the body and during birth. 

First Stage of Labor: The cervix is drawn up (moved) into the main body of the uterus and then dilated (moving apart) and open by the intensity of uterine movement.

Second Stage of Labor: The flexion of the uterine muscles determines the rate at which the baby moves through the open cervix, down through the birth canal and out through the vaginal opening culminating in birth.

Third Stage: Then the body sloughs the placenta off of the uterine wall and expels it out of the body—it is re-“moved”. The uterus continues to move until it has shrunk itself back to close to its normal size.

Whereas involuntary movement is the primary internal process that accomplishes birth, voluntary movement is an invaluable birth skill that works in conjunction with the birthing process by enhancing labor progress.

In addition to those benefits, the choice to utilize gravity, remaining upright, and moving give birthing women a sense of control, which in turn increases both her comfort level and her sense of satisfaction with her overall experience.

Birth is a doing.  Movement is a doing. Yoga is a doing. They are not “think about” doings.

Applying this logic towards labor and delivery makes perfect sense as the addition of Yoga-Based Birth Skills will not only work to facilitate the birthing process, these skills will also help you to find ease and comfort in your body, aid in better positioning, deepen your breath and calm your mind.


“Walking and position changes including upright positions improve the effectiveness of contractions and reduce the length of first stage labor by 1 to 1 1/2 hours without any other intervention usage or negative effects to mother or baby. It improves a mothers sense of satisfaction with their overall birth experience, it is harmless practice that also improves their comfort and sense of control.” The Labor Progress Handbook 4th ed Penny Simkin, et al.

Lamaze International, in 2007, was looking to define parameters for optimal maternity care according to the systematic evidence reviews conducted by the Cochrane Database Collaboration. They found that optimal maternity care can be distilled into six characteristics. Optimal Maternity Care Practice #2 states that women should have freedom of movement during labor.

In 2014, Pittsburgh’s own, Michele Ondek, published an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor,”  that was originally published in The Journal of Perinatal Education, 16(3), 2007.

I really like the way she summarized her findings in this review:

“There is an optimal way to give birth and it is supporting the physiologic process (ACNM et al., 2012; Goer & Romano, 2012; Lothian, 2009). No study has ever shown that walking in labor is harmful in healthy women with normal labors, which is the evidence-based conclusion of the mother-friendly birth practice to provide the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor issued by the Coalition for Improving Maternity Services (Storton, 2007). “A woman’s position in labor, mobility, and fear and anxiety or, conversely, confidence may influence her experience of pain” (Jones et al., 2013, para. 1). Current practice, which is intervention intensive, has contributed to the high U.S. cesarean rate of almost one-third of women and has resulted in increased maternal morbidity and mortality (American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, 2014). Because dystocia is the most common indication for cesarean surgery, efforts to reduce the cesarean rate must include efforts to support the physiologic process in which the women’s ability to be mobile is key. Women need to feel that they can labor in a supportive environment that decreases their fear of pain by supporting their ability to cope with the pain of labor, including having the freedom to walk, move, and change position throughout labor.”

In US Midwives 2012, three midwife organizations issued the consensus that stated freedom of movement in labor and the woman’s choice of birth position are essential to the goal of healthy physiologic childbirth. American College of Nurse Midwives (ACNM) Midwives Alliance of North America (MANA) and National Association of Professional Midwives (NACPM).  In Great Britain, the Royal College of Midwives (RCM) also support active and upright positions.

In 2019, the World Health Organization’s Guideline Development Group issued recommendations designed to facilitate Intrapartum Care for a Positive Childbirth Experience. Recommendation #25 states “The adoption of mobility and an upright position during labor in low risk women is strongly recommended.” WHO further states that mobility represents a form of intervention that is beneficial, essentially harmless, cheap and easy to implement.

The benefits and effectiveness of mobility and upright positions during labor have also been proven to be evidence based. 

  • 2013 Cochrane Review of 25 randomized controlled trials (RCT) of more than 5,000 pregnant women that looked at the effects of mother’s positions and movements during 1st stage labor. Participants were either upright movers or remained on back or in bed. Participants in the upright moving group experienced shorter labors (by 11/2 hours), were less likely to request an epidural and less likely to have a Cesarean Section.
  • 2017 Cochrane Review of 32 RCT’s involving more than 9,000 pregnant women looked at the effects of mother’s positioning during 2nd stage labor in women without epidurals. Participants were either upright or supine during pushing and delivery. Women who gave birth in an upright position reported less pain and more overall satisfaction with their experience. There were two contraindications to giving birth in an upright position:
      • Women who gave birth (2nd stage labor) were 20% more likely to have a second degree tear than those who gave birth in a supine position.
      • Women who gave birth (2nd stage labor) were 48% more likely to have an “estimated” blood loss of greater than 500ml.
      • There is controversy surrounding both of these numbers. I feel both of these findings merit further discussion and perspective-this study will be addressed in the future articles about specific Yoga Based Birth Skills that are implemented during the Second Stage of Labor.
  • 2015 small study done regarding the use of a birthing ball during labor that found the utilization of such a ball significantly lowered the level of pain experienced by participants assigned to and trained to use a ball during labor.
  • 2012 A Systematic Review published in the journal: Evidence Based Complementary and Alternative Medicine. This review looked at 6 trials (3 RCT’s and 3 CT’s). The results for the RCT’s were published. This is a small amount of data and the review stated that more RCT’s were needed to obtain definitive results. The reviewers found that the participants that practiced Yoga while pregnant and during labor showed less stress, higher quality of experience, better Autonomic Nervous System functioning, more comfort, less pain, and a shorter duration of labor. No contraindications were discovered other than the fact that some women sometimes felt contractions during practice, but this was easily remedied by changing position and the intensity of the practice. [My Note: That yoga practice can bring on and perhaps intensify contractions can only be seen as a benefit during labor.]

The American College of Obstetricians and Gynecologists Committee on Obstetric Practice states in their 2019 Committee Opinion No. 766 that “frequent position changes during labor to enhance maternal comfort and promote optimal fetal positioning can be supported as long as adopted positions allow appropriate maternal and fetal monitoring and treatments are not contraindicated by maternal or obstetric complications.”


Before we move into this section I wish to state that the intention of this article is explore the varying roles of movement during childbirth, and with the realization that the vast of majority of your labor will be spent in the early and active phases of Stage One Labor is my way of saying:

The remainder of this work will address using Movement as a healthy mother-friendly birth practice.

I would also like to give you the reminder that no study has ever shown that walking in labor is harmful in healthy women with normal labors, it is a mother-friendly birth practice to provide the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor.

The primary focus this article are movements that you could choose to employ during Stage One Labor and through Transition, strategies to be used to assist labor progress and to distract your mind from the sensation of contractions.

Moving on—

Human organs, while amazing, are not totally infallible and the uterus is no exception, so just like hearts can skip beats, stomachs upset, and lungs fill with fluid—sometimes birth becomes complicated.

It might become medically necessary to remain still, in bed, and it might even mean you need to turn gravity on its head for awhile. It might also mean you need an intervention or two on your journey towards a healthy outcome for you and your baby.

I tend to take an empirical approach so I must look at using movement from all angles, it would be a disservice to my readers if I did not.

External Barriers:

In America, the majority of women give birth in a hospital setting and Pittsburgh is no exception. This choice almost always means, once admitted, being placed in bed and tethered to a variety of medical devices. The current practice of the vast majority of hospitals and healthcare providers today is intervention intensive.

When you place yourself under medical supervision, staff will begin to tell you what you need to do as is if their requests are mandatory rules necessary to keep you and your baby safe.

These are some of the mandates that entail “risk managed care” and routine interventions.  All of these represent a barrier to being free to use movement and upright positioning.

  • bed rest/ recumbent positions
  • continuous Electronic Fetal Monitoring
  • IV insertion and administration of fluids
  • limited oral intake
  • frequent vaginal exams
  • induction and other augmentations
  • amniotomy (manually ruptured membranes)
  • epidurals and other regional anesthesia
  • catheterization
  • Ineffective pushing (recumbent positions)

You need to learn to distinguish the difference between a procedure that represents a routine practice (done “just in case” as a preventative) and one that represents a genuine need for this particular medical intervention for a wide range of hospital and healthcare provider mandates and policies.

Is it disapproval—or is it a healthcare provider preference? Something that makes it easier for the provider—not the mother?  Answers that are normally expressed in terms of “it’s hospital policy’ “its my practice to..”, “that’s not our routine”…

For example:

Staff states, upon your arrival, that it is hospital policy that you remain in bed attached to a blood pressure cuff so as to prevent the possibility of you developing an abnormally high blood pressure, just as a precaution to keep you and your baby healthy. You and the baby are fine now but there is a potential life risk, so it is better to play it safe.

Versus,  the staff member who states I would like you to remain in bed for now, because every time you are upright your blood pressure skyrockets which is adversely effecting your health and that of your baby’s—we need to get this under control.

Learn the difference between genuine medical need versus routine usage for all of these “unfortunately” common routine interventions.

If there is no genuine dire medical need for you to remain flat on your back in bed tethered to machines and it is NOT your preference then DON’T stay there.

It is my personal belief that women are experts in their own bodies and babies, and without interference, they will make the choices that are right for themselves and their babies.

Going to bed and/or staying immobile (if not medically necessary) for entire length of your labor is a bad idea as these types of positions slow down labor and interfere with efficient progress—instead use gravity which will work to keep the baby’s head pressed downward against the cervix.

Recumbent positioning is a highly artificial position for laboring women, it was not until the end of the 18th century in Europe that women began to lie down in order to give birth. Before that time they walked around and used birth stools or sat up in a chair.

Lying on your back causes the fetus to press against the big blood vessels in the lower body, the resultant constriction interferes with circulation, lowers blood pressure, decreases urine production and can cause fetal distress.

Not lying in bed is supported by research and clinical tests— upright positioning and movement are evidence based and are proven to produce stronger contractions, shorter labors, and that utilizing an upright position results in the uterus working nearly twice as efficiently to dilate the cervix.

There exists an astonishing amount of ignorance regarding the natural physiology of birth in healthy women and this lack of knowledge has resulted in obstetric care practices that promote deliberate injury to both mother and fetus during their utilization.

Birth is a highly coordinated bodily function that is primarily handled by the uterus. In our bodies there exist organs that we just assume will get the job done—like the heart, the stomach, and the lungs.

We do not normally question their ability to do their jobs—instead we just let them do the work they were created to do and we don’t even spend much time thinking about them until something goes astray. We innately trust them to beat, digest, and breath.

The most highly evolved organ of this type is the female uterus, it is a strong powerful organ and if left to her own devices is highly efficient in birthing a baby—as if she was designed to do this job. We would hardly still exist as a species if our uterus was not.

Unfortunately, human females have been and continue to be brainwashed by healthcare providers, social media, and “well-meaning” friends and family into thinking that our uteruses are totally incompetent—a flaw in the design of the human female body.

That birth is a medical condition that needs to be cured, that technology does it better, and that it is not a matter of “if” something goes wrong it is a matter of “when”.

Most hospitals and healthcare providers do give lip service to mother-friendly birth practice #2 by suggesting change of positions, being upright, walking—in theory this is their advice.

However, in practice, while they “permit” you to be out of bed this comes with the caveat that movement and positioning must remain conducive to the monitoring of the the mother and the baby.

It bears repeating:  While all medical interventions, have their place and time when indicated—they cannot be justified as a standard procedure for a normal physiological occurrence in a healthy full term pregnancy.

In light of all these studies, reports, reviews, and secondary analyses, medical healthcare providers who still insist upon recumbent positioning seem woefully unaware of the contrary evidence.

The action of signing hospital intake permission paperwork does not mean that you lose your right to informed consent or informed refusal—you are the legal authority in the birthing room, office, etc. —the legal authority is you as the pregnant woman seeking medical guidance.

You have the legal right to make all decisions about your body and your baby, just like any American citizen, pregnant or not. This is your constitutional right and this right has been affirmed by the Ethics Committee of ACOG and it was re-affirmed in 2013.

So speak up—if you don’t want a procedure or to remain recumbent after proper counseling then politely refuse it.

The decision to utilize upright positioning and movement are birth preferences that you need to discuss thoroughly with your care provider, well before birth. Approaching the discussion in a calm reasonable and accommodating manner.

According to Cynthia Gabriel you are unlikely to convince a healthcare provider who has developed a different style of labor management that you are right and they are mistaken.  Instead you will be better served by explaining how important a physiological vaginal birth is to you, that you deeply desire something different, that you believe it is better for your health and your baby’s as well, and make a heartfelt request for their support.

I am paraphrasing Cynthia Gabriel’s “Natural Hospital Birth” phrasing:

“Certainly, my most important objective is a healthy baby. Your support for our birthing preferences would give me peace of mind. If the baby or myself aren’t doing well, I will gladly reconsider. But, if both the baby and myself are doing fine, I would really appreciate your support in allowing for intermittent monitoring, no routine fluids, and freedom of movement. As I am planning a vaginal birth, with minimal medical interventions, I’d like to do all I can to utilize gravity always assuming that both my baby and I are doing well.”

The best way to avoid unwanted and unnecessary medical interventions is to stay at home for as long as possible and this is where having a Birth Doula can really come in handy. She will give you the strength,confidence and support necessary to promote a calm positive birth.

Complications

Ideally, when labor begins at full term there is nothing between the baby’s head and the cervix except amniotic fluid. This not always the case:

  • Cord Prolapse where the cord slips between the presenting part of the fetus and the cervix,
  • Placenta Previa where the placenta is attached to the bottom of the uterus, between the presenting part of the fetus and the cervix

In theses rare instances, the smart move is turn gravity on its head and thereby taking the pressure of the presenting part of the fetus off of the cord and the placenta. These circumstances represent scenarios in which remaining upright is a contraindication as the additional pressure from gravity can result in harm and even mortality to the fetus.

Ideally, when labor begins at full term your placenta remains firmly attached to the side wall of the uterus and your fetus floats free on a long loose cord. This is not always the case:

  • Placenta Abruption where the placenta either partially or totally tears away from the uterus before labor begins or during the earlier stages of labor.  Abruption is rare and is usually a result of trauma.
  • Tight Nuchal Cord where the umbilical cord is short, knotted, or wrapped around the fetus. This scenario is more common, in extreme circumstance it can be a life threatening to the fetus—but it is normally not a serious complication.

In these rare instances, the smart move is turn gravity on its head and thereby making some slack space in the cord protecting yourself from further tearing and assuring that your baby continues to get sufficient oxygen and blood through the cord. These circumstances represent scenarios in which remaining upright is a contraindication as the additional pressure from gravity can worsen the damage causing harm for yourself and your baby.

These conditions are extremely rare, BUT if you turn out to be the exception then turn gravity on its head and take the pressure off the cervix, the cord, and/or the placenta while you deal with any of these genuine medical emergencies.

Most of the pressure can  be relieved by moving into and remaining in a head down, bottom up position. *****

Ideally when labor begins at full term your baby is in optimal fetal position for birth and is occiput anterior (OA). Head down, facing towards tailbone. Right OA and left OA are also compatible with ease of vaginal birth.

But this is not always the case, labor can begin with a baby in any number of head down positions, including face up (Occiput Posterior OP, right, or left), brow first, head tilted to one side, or hand/hands beside the face.

Vaginal birth is still a viable option as are a variety of positions and movement— with any of these presentations— your choice of movement and position will be made with the goal of shifting the baby into a more optimal position in mind.

The OP presentation or “sunny side up” presents the most challenge both during labor and during delivery. Intense back labor is often a common consequence as the hardest part of the baby’s head is constantly pressed against the lower spine and tailbone.

It is my intention to address this birth presentation at a later point as there are specialized movements that can be utilized to both alleviate the pain and assist vaginal birth. There are a multitude of viable strategies and techniques to try and the majority of babies shift into more optimal positions before transitioning through the cervix.

For now please realize that OP presentation needs specialized movements and patience, and if after considerable time the baby remains at a high station, showing little if any descent then a Cesarean Section may indeed be medically necessary.

Ideally when labor begins at full term your baby is in optimal fetal position (both head down and Occiput Anterior) but this is not always the case as some babies are more directionally challenged than others.

  • Breech positioning where the baby presents feet first (Footling breech) or the baby presents butt first (Frank breech) instead of head down.
    • In the United States, a Footling breech means an automatic Cesarean Section, this is a very complicated presentation.
    • While a Frank breech position is a less complicated presentation, the majority of American doctors are seldom adequately trained, even fewer have hands-on experience delivery experience.
    • Vaginal breech delivery is rapidly becoming an obsolete skill set among today’s obstetricians as their preference is to deliver all breech babies by Cesarean Section.
    • With a Frank presentation your doctor or midwife may attempt an External Cephalic Version (ECV) at full term. This is a “hands to belly” external attempt to rotate the fetus so that the baby is head down and in a more optimal position for birth.
    • It is my intention to more fully address this birth presentation at a later point as there are specialized movements and techniques that can be employed to encourage a breech baby to turn. This includes but is not limited to: chiropractic techniques, alternative practices, acupuncture, body work, inversion, myofascial release, the Webster technique, and active birthing techniques. The website Spinning Babies specializes in techniques to get your baby to move on its own.
    • Transverse positioning or “sideways position” where the baby is laying across the womb with head to one side and bum to the other-either stomach or back facing up. Babies can be completely horizontal or “at best” with a shoulder presentation.
      • This a normal albeit uncomfortable presentation for babies up to around 31 weeks gestation, this is not the case at term. A baby who is lying sideways can not be born vaginally, labor contractions are not strong enough to bring a transverse baby through the pelvis. The website Spinning Babies is also a good go to in this presentation as well.
      • Your best move here is to take steps to move your baby into a head down position before labor. This includes but is not limited to: ECV, inversions, tilts, releases, body work, chiropractic technique, Webster, massage, acupuncture, and myofascial release.
      • A vaginal birth with this presentation is highly risky to the mother who risks uterine rupture and subsequent infections. An attempt at delivery also causes fetal trauma and distress.
      • A baby who cannot be persuaded to move into a more optimal position needs to be delivered by Cesarean section.  As transverse positioning is sometimes due to less than optimal pelvic anatomy a Cesarean Section just might be the safest option for you and your baby.

Twin pregnancies (Multiples) where instead of just one cute bundle of joy you have “bundles” of joy.

  • this usually always means a scheduled Cesarean Section at close to term and more than two babies always means a Cesarean Section.
  • If you stumble across a healthcare provider who is willing to let labor begin on its own and who is willing to let you give labor a try then what movements you choose to use will be determined by the presentation of the first twin.

Vaginal Birth After Cesarean Section (VBAC)

  • depends on your doctor and hospital but if all indications are good then it is fine to proceed with normal range of motion and the positions of your choice.

Other Genuine Medical Reasons to Give Moving Around a Timeout

  • Fetal distress in the form of a prolonged stretch of non-reassuring fetal heart beats with no breaks.
  • Maternal instability in the form of light-headed, high or low blood pressure, preeclampsia, or other pre-existing physical injuries or concerns.
  • Preterm premature rupture of membranes
  • premature labor before 37 weeks
  • epidural

Second Stage Contraindications

Once you are completely dilated and the baby begins to make its descent down through the birth canal you enter what is designated as Stage Two—the Pushing, Crowning and Birth Phase.

In the recent Cochrane Review (2017) the results showed that there were two contraindications to remaining upright during delivery (2nd stage labor):

  • an increased risk of a second degree tear and;
  • an increased risk of losing more than 500ml of blood
  • For now, while no one wishes to tear-it is a better option than receiving an episiotomy. I also believe that women need to employ a completely different pushing strategy rather than the “pelvic floor destroyer” method commonly practiced in most hospitals. Most authors politely refer to this as “directed pushing”—I no longer do.
  • For now, please note that 500ml is approximately the amount you would donate if you gave blood and that staff was allowed to give a best guess estimate as to the amount of blood lost during the studies.

The methodologies and techniques are very different at this point in labor—so much so— that it seems to set Stage Two altogether apart and in a class by itself, therefore before I veer too far off of course, I will rein myself in:

I am leaving all further discussion of Stage Two including the two contraindications of the 2017 Cochrane Data Base Review to a later article. For now it will have to remain in the realm of “coming soon” as I have a lot more of research to do before I can write more knowledgeably on this topic.

Psychological Barriers

Ideally, when labor begins at full term your mind and your body are on the same page—ready to rock Birth but this is not always the case. We live in a complex busy world, full of social media, bombarded by scaremongers with their misconceptions, misunderstandings, and “good intentions” about Birth. Nor is life always sunshine and daisies.

  • The Fight Flight Freeze response
  • The Fear Tension Pain syndrome
  • Previous birth trauma
  • Previous sexual trauma

All of these can leave a woman curled up in a tight ball stiff frozen fighting against birth. A goal of this article is to start you on a path towards inner understanding. When you have the right knowledge your choices become clear. You are able to move in the direction that is most helpful for YOU.

The Fight, Flight, Freeze and The Fear, Tension, Pain Syndrome responses are discussed in more detail later in this article and will have in-depth articles in the future.

Movement is a viable non invasive option to get yourself unstuck and literally moving forward. Meditation is an optimal way of moving the mind through inner “mind stuff” before birth.  The role of previous trauma on your birth experience deserves and will eventually get its own article.

Timing and the Physical endurance

Birth is a marathon not a sprint. Pace yourself. Save big movements for later. At the beginning of labor remain in a semi upright resting position for as long as possible. In doing this you will give the uterus’ oxytocin receptors time to proliferate thereby letting your labor get well established. Let your body dictate when it is time to move. Don’t move just because you think you should, move because you can’t make yourself not move. Use all of what you've got to the best of your ability.

Let’s move on and get to the “fun” stuff!


 Movement gives you a sense of control.

Movement gives you a way to manage your pain.

Movement enables flow state.

Movement gives you a healthy outlet for excess adrenaline.

Movement works off stress.

Need more reasons?

Movement provides a natural and familiar activity to focus on— rather than the pain of contractions.

Movement is naturally rhythmic and rhythm is fundamental to focusing.

Movement “plays well” with other birth skills such as counting, mantras, and breath work.

Movement increases endorphin production.

Movement works with the labor process, with the body, with birth hormones and NOT against any of them.

Staying upright and moving will certainly be instrumental in encouraging effective contractions, opening the cervix, and moving your baby down through the pelvis and the birth canal.

However, for movement to work as a birth skill that reduces suffering you must keep your focus on your choice of movement and not on the eustress (the healthy physiological stress of uterine contractions).

For example:

You are outside on a beautiful crisp fall day, you are raking leaves into a pile at the curb, the leaf collection service is coming first thing tomorrow morning and you will be at work—so you have to get this job done, today. You have a large yard with many mature trees—so lots of leaves. You’ve been at this for awhile and your arms are beyond tired.

If your focus is entirely upon how tired you are, how sore your arms are, your aching back, and the momentous, monotonous task that still looms before you—-then the labor of raking leaves becomes a misery— your mind is full of suffering and your body feels more pain.

If instead your focus is elsewhere, the beautiful blue sky, the woodsy smell of the leaves, the coolness of the breeze, the warmth of the sun, the sense of flow and progress as you sweep the leaves across the yard, the promise of a rest at the end of this row, the reward and sense of accomplishment of a job well done…then your mind has slipped into the flow of the experience and before you know it the work is complete and the leaves are all at the curb.

The lesson here is to focus on what the body is doing during a contraction, not the sensations that are produced as a result. Use your mind to create a distraction away from obsessing over sensation.

During the period in between contractions you will be resting, taking in hydration and fuel. NOTHING ELSE.

Turning movement into a usable birth skill takes practice, discernment, and the devotion of your time ensuring that you will become comfortable with the most beneficial types of movement before labor begins.

Attending my Prenatal Yoga classes will assist you in becoming comfortable with using Movement to enhance birth and as a pain management tool well before your labor begins—it will also give you a chance to practice not just Movement skills but other Yoga-Based Labor Pain Management Skills as well.


 Movement including walking, position changes, and upright positions improve the effectiveness of contractions and reduce the overall length of labor without any other intervention usage or negative effects to mother or baby.

Movement is a harmless practice that also improves a mother’s sense of comfort and control.

Movement is a form of labor pain management. It can alleviate suffering and reduce pain.

I say these things about moving during birth now, and the wisdom and adoption of this practice is commonly accepted in this day and age, by almost everyone——BUT…

During the late 1700’s the King of France wanted to watch as his mistress gave birth, this recumbent sort of positioning is now known as the lithotomy position (1st devised for surgery to remove gall stones) patient lies on back with legs lifted in stirrups. Doctors came to prefer this positioning as it made their practice of delivering babies much easier.

It is also easier to use forceps and today this position also plays well with the “trash bag of birth” placed under your bum during delivery. Doctors and Midwives are trained using this position. In truth, if for nothing else it does make it easier to see what’s happening.

It is NOT comfortable, it is NOT natural and it is NOT easier for women and babies.

It gets worse as the truth is that the concept of moving and exercise during pregnancy and birth took another hit in the late 19th century. Daphne Adler in her recent book “Debunking the Bump” gave the following perspective:

During the 1880’s pregnant women where encouraged to remain indoors and near term were generally confined behind closed doors. Women were also encouraged to wear corsets to minimize the size of their bumps. Yes, this was the actual “medical” advice given to women by their doctors during this time period and women complied.

In 1985, pregnant women were advised by doctors that their maximum heart rate should not exceed 140ppm, and pregnant women should not engage in strenuous activities for longer than 15 minutes.

In 2002, (yes— almost 20 years later), the American College of Obstetricians and Gynecologist (ACOG) reversed this position and admitted that there is little evidence that exercise guidelines need to be different for pregnant versus non-pregnant women.

2010 even saw pregnant women preparing to run marathons, and in 2011 a mom finished the Chicago marathon, ran to the hospital and had her baby in just 4 hours of labor.

In the 21st century women have been given the green light to exercise freely. Exercise does not divert blood supply away from your baby, it does not cause dangerous fetal heart rate palpitations, raise temperatures to worrisome levels or result in undersized babies according to a recent (as of 2018) report by ACOG.

As a prenatal yoga teacher I was naturally concerned about finding some truths, is a yoga practice during pregnancy and childbirth a benefit or a risk? Especially in regard to stretching, abdominal work, and in using supine postures.

Here’s what Daphne found.

In regards to stretching the concern is about over stretching ligaments—not muscles. Light stretching is fine, in fact, it generally has more benefits and these benefits totally outweigh the hypothetical concern that you “might” over-stretch.

Of the evidence based studies done, light abdominal strengthening has minimal effect on birth outcomes and the health of your baby.

Lots of official bodies suggest that women should avoid doing exercises in the supine position (lying on your back), it turns out that this “advice” comes from sleep studies that show no conclusive evidence that sleeping on your back or your right side causes any harm.

“This is a purely hypothetical concern. There’s little evidence to support it.”

I find this particularly reassuring on several counts, primarily because there are many supine poses in Asana practice that are of genuine benefit during pregnancy. Further, the advice never made any sense to me, as a Birth Doula, especially given that hospitals often encourage women to remain flat on their backs once admitted and their preference is that you remain there.

Yoga in pregnancy is safe and may even improve birth outcomes, but, I do not know what or how other teachers teach in their prenatal yoga classes, I can only vouch for mine which are designed to bring you ease and comfort during your pregnancy.

Further, my classes will show you how to “yoke” together the movement, breath work, birth physiology and the philosophy of Yoga into actual easily accessible birth skills that can be used effectively while pregnant, during labor, and later as parents because they are also life skills.

Particularly, here in America, people are more used to Yoga practices that are structured solely along the physical aspect of this system so it is more than likely that you only have a passing knowledge of the Yoga Sutras, if in fact any awareness. So, a little history is in order…


The premise behind The Whole Way (Yoga-Based Pain Management Tools for your Labor & Birth) is that when Yoga Philosophy and Practice is combined with Human Physiology a path toward a calm positive birth experience is begun.

Millions of Americans practice asana (the physical aspect of yoga), the teaching and practice of Yoga at least in the aspect of poses and stretches is thoroughly mainstream.

However, American people are more used to practices that teach yoga as a flow-based aerobic exercise and these instructors share little, if any, knowledge of the philosophy behind the practice.

The reality is that Yoga is way more than a form of exercise and having a deeper understanding of where Yoga came from and what it actually is will give more depth of meaning to your practice of The Whole Way.

The language of Yoga is Sanskrit (an ancient Hindu dialect). This dialect is known for its rich resonant sounds—sounds that have a demonstrable effect on body and mind.

The sanskrit word yoga literally means “to yoke”. The ultimate goal of Yoga is to create a union with the Divine. The flavor of “Divine” is left up to the individual Yogi. The word Yoga by itself without any qualifications refers to the path of meditation particularly as outlined in the Yoga Sutras.

Yoga is a process of stilling and inward focus, in which utter physical and mental calm is brought to every aspect of your being and experience and may in fact refer to a number of different ancient spiritual systems.

Specifically— dhyana-yoga (the path of silent meditation) is the subject of Patanjali’s Yoga Sutras.

Yoga was developed more than 5000 years ago and is mentioned in all ancient Hindu texts and scriptures, including the Rig Veda, the Upanishads, the Bhagavad Gita and according to all of these texts the system of Yoga has been available to all of mankind since time immemorial.

The earliest evidence of Yoga was found in the ancient Indus Valley cave drawings. The system of Yoga emerged well prior to the development of mainstream Hinduism and since the very beginning of this religion— Yoga has exerted immense influence over Hindu philosophical discussion and Hindu religious practices.

Nearly 2000 years ago, an Indian sage named Patanjali, recorded the Sutras into written form. He was not the originator, he was the compiler of the Yoga Sutras—the Aphorisms of Yoga. Patanjali masterfully compiled and reformatted the doctrines that had previously been handed down from pre-historic times, as an oral tradition, passed along by word of mouth.

Patanjali put stylus to banana leaf and recorded the Sutras into written form for his contemporaries in a time before books, writing, and even reading were commonplace, the whole thing still needed to be memorized. The resultant short pithy aphorisms are intended as a practical aid to quiet the mind and end suffering.

The Yoga Sutras of Patanjali is the most important classical Hindu text and is a classic in Eastern thought, along with the Bhagavad Gita it is the text that has received the most attention outside of India.

Patanjali condensed Yoga into just 196 sutras (literally meaning thread), and in these sutras the entire system of Yoga is clearly laid out: its aim, the necessary practices, the obstacles you may meet along the way, their removal, and precise descriptions of the results that will be obtained from such practices.

The sutras cut straight to the heart of the human dilemma, as they analyze how we know what we know and why we suffer. Then Yoga provides a meditative system to help each of us fulfill the primary purposes of consciousness—to see things as they are and to achieve freedom from suffering.

It is true that Yoga is thought to have originated in India and its philosophy is certainly fundamental to the Hindu religion. These facts do not make Yoga a religion or for that matter even necessarily Indian.

Yoga principles are universal.

So while Yoga is an inseparable part of Hindu theology, Yoga is its own separate system, a system that pre-dates the Hindu religion.

In fact, Yoga is not even particularly sectarian, it does not prioritize a specific deity nor does it promote a particular form of worship.

Therefore Yoga can be used as a template, a system that can be and has been appropriated by followers of different schools and traditions. Such appropriations have been done throughout Indian religious history, the format of the sutras certainly lend themselves to different approaches. This is most recently seen in non-religious contexts in the West.

In its own way, The Whole Way uses these universal yogic aphorisms as a template to a calm positive pregnancy and a strong resilient birth.

The practice of Yoga gradually expanded out of India and moved West. Yoga is mentioned in classical Greek texts and Alexander the Great was fascinated by the practice. It was practiced in the 1960’s in the West as a meditative technique for enlightenment.

Most of Yoga taught in the West today comes from the work of three big names, K. Pattabhi Jois, T.K.V. Desikachar, and perhaps most importantly B.K.S. Iyengar.  Almost all serious teachers can trace their practice through the lineage of these Masters. Most will also have a valued copy of  Patanjali’s Yoga Sutras.

I began my practice with the Primary Series of Ashtanga Yoga, which was founded by K. Pattabhi Jois, but my practice and my teaching also owe a great deal to the teachings of B. K. S. Iyengar. 

I have many valued copies of the sutras. This history and the one that follows are deeply indebted to two of them:

The Yoga Sutras of Patanjali—A New Edition, Translation, and Commentary; Edwin F. Bryant; 2009; North Point Press; New York

Yoga—The Science of the Soul; Osho; 2002; St. Martin’s Griffin Press; New York


 Yoga is extremely popular today, both in the East and the West. Millions of Americans practice the physical aspect of Yoga—the poses and stretches, or Asana.  Indeed, almost the entirety of American yoga is typically understood and presented as being a physical practice, a movement-based form of exercise that helps a person stay fit, flexible, and healthy.

However, the reality is that Yoga is far more than an exercise program and the Yoga of Patanjali’s sutras is at its heart a meditative practice whose aim is to enable a person to see things as they are and to achieve freedom from suffering.

It is safe to say that most of what is taught today as yoga would unrecognizable to Patanjali’s contemporaries who attained their realizations through the silent practice of meditative stillness.

Asana is the 3rd stage or limb of Yoga, in its famed Eight Limbed Path which is found in Book II of the Sutras (the portion on practice) and in fact, Patanjali pays minimal attention to Asana in the Yoga Sutras.

SUTRA II:29   YAMA NIYAMASANA PRANAYAMA PRATYAHARA DHARANA DHYANA SAMADHAYO STAV ANGANI

“The eight limbs of Yoga are abstentions, observances, posture, breath control, disengagement of the senses, concentration, meditation, and adsorption.” ~my emphasis

While there are 16 sutras devoted to the first two limbs of Yoga, Patanjali has relatively little to say about Asana (the 3rd limb). There are just three sutras regarding posture and a total of 8 words, which is less than 1% of the total text of the Sutras.

This lack of detail does not mean that Asana is irrelevant to the goal of Yoga and does not mean that Patanjali considered Asana unimportant practices for aspiring yogis.

While no contemporary Asana specific texts survive from the time of Patanjali’s Yoga Sutras   that doesn’t mean that they didn’t exist at that time.

According to Edwin Bryant, one has grounds to suppose that Patanjali saw no need to elaborate on the details of Asana since information was already available elsewhere, in other texts or traditions that were specifically dedicated to that purpose.

Other scholars also surmise that an elaboration of Asana is not undertaken in these Sutras because the subject of Patanjali’s text was Raja Yoga and a full and detailed treatment of Asana is to be found elsewhere, in the works on Hatha Yoga.

The Hatha Yoga tradition has many important surviving texts and while these works come much later than Patanjali’s Sutras, one is relatively safe to assume that the surviving Hatha texts were drawn from much older sources, including oral traditions, similar in the manner in which Patanjali’s compiled the dhyana-yoga sutras.

The Marabhararata, 400 BCE as a text, a major Sanskrit epic poem of ancient India, that is also the source of the Bhagavad Gita makes passing reference to more than one Asana. There is a 5 CE text that lists at least 12.  Enough evidence exists to show that Hatha Yoga was definitely an element of Yoga practice prior to and during the time of Patanjali.

The most influential surviving text is the Sanskrit manual The Hatha Yoga Pradikapita written by Svami Svatmarama in the 15th century. It is believed to be a compilation of at least eight earlier works regarding Hatha Yoga. The subject matter of “Light on Hatha Yoga” concerns purification, postures (Asana), breath control, chakras, kundalini, bandha, nali, mind-body connections, and mudra. ~my emphasis

It is long, weirdly wonderful, and nothing like the Hatha Yoga taught today. I will let that work lie sleeping for now.

The Yoga-Based Birth Skills of The Whole Way are all derived from Patanjali’s Yoga Sutras and provide a solid base on which to lay a path towards a calm positive pregnancy and a strong resilient birth.

SUTRA II:46  STHIRA SUKAM ASANA

“Posture should be steady and comfortable.”

 

It is important to realize that mastery of Asana is a means and not an end goal unto itself. Only the successful removal of the Kleshas (attachments) and the attainment of Samadhi (complete adsorption) allow one to achieve the ultimate goal of Yoga.

The Sanskrit word, asana, literally means seat and an essential part of a devoted meditation practice is having the ability to sit firmly and comfortably for long periods of time. It is impossible to fix attention if you are sleeping, running about, or fidgeting.

The relevance and function of Asana is to train the body so that it does not distract or disturb the mind of a Yogi while she sits in meditation.

Asana is not the goal of Yoga, but attaining a meditative practice is—-so the point to grasp is that yogic postures are useful only to the extent to which they facilitate fixing the mind completely in meditative adsorption.

It is sometimes thought that Hatha Yoga came into being because of aspiring yogis who wanted to sit still but could not. It was developed as a means to allow yogis to gain the ability to sit comfortably still for long periods of time.

Because it was and still is understood by yogis that if the body is still, it becomes easier to allow the mind to still.

SUTRA II:47  PRAYATNA SAITHILYANANTA SAMAPATTIBHYAM

“[Such posture should be attained] by the relaxation of effort and adsorption into the Infinite.”

Asana becomes perfect when all effort or strain ceases and the body no longer trembles and when the mind is adsorbed into the infinite.

The ability to sit quietly in meditation for hours invites a level of bodily discomfort, especially when one first initiates a practice. The yogic “cure” for this discomfort—Asana—also involves a level of discomfort. One of Yoga’s many lessons is that it teaches us to sit quietly with discomfort.

After a time the discomfort disappears and the body completely relaxes into the pose—to the point that the body seems nonexistent. When the body relaxes the mind can be directed towards meditation without bodily distraction or disturbance.

Mastery of Asana is achieved when a state of calmness is reached in the body which allows for detachment from bodily sensation—Asana is a preliminary necessary ingredient in a far larger undertaking.

Once Asana is perfected you move on to breath control—Pranayamah.

You may very well be wondering about the same things I was:

  • If Yoga is a meditative practice at its heart why is it a such physical practice today?
  • Why did a strong physical practice fix my mind into stillness, at a time in my life when I could never sit for even a moment in quiet meditation?
  • Is there merit in this approach from the words of Patanjali?

Most of Yoga taught in the West today traces its lineage from the work of three Yoga Masters: R. Pattabhi Jois, T.K.V. Desikachar, and B.K.S. Iyengar. Those three big names have done more to popularize Asana (physical stretches and poses) practice than anyone else in the history of Yoga, particularly Iyengar.

In his book, “The Tree of Yoga”, Iyengar, presents Asana, yogic posture, as not just the 3rd of eight limbs of Yoga but also as a self-contained object of meditation that can itself bring about samadhi, the ultimate goal of Yoga, if approached and undertaken correctly.

According to Edwin Bryant, this represented a very innovative approach and was an unique contribution to the practice of Yoga.  Iyengar based his approach to Yoga practice as grounded in three sutras found the first book of Patanjali’s Sutras—The Portion on Contemplation.

SUTRA 1:34 PRACCHARDANA VIDHARANABHYAM VA PRANASYA

“Or [stability of mind is attained] by exhaling and retaining the breath.”

SUTRA 1:39 YATHABHIMATA DHYANAD VA

“Or [steadiness of the mind is attained] from meditation upon anything of one’s inclination.”

SUTRA 1:40 PARAMANU PARAMA MAHATTVANTO SYA VASIKARAH

“The yogi’s mastery extends from the smallest particle of matter to the ultimate totality of matter.”

Patanjali states that there are various meditation options for steadying the mind and he wraps up this particular series of  Sutras by acknowledging that ultimately a yogi may meditate on any desired object according to her/his own inclination—internal or external.

The point is to fix the mind in meditative stillness, a task that does not depend on the choosing of a particular method, so long as the chosen method allows the mind to remain fixed, it doesn’t matter the method utilized as long it achieves its goal.

Patanjali specified in Sutra I:34 that practices associated with breath control (4th limb of Yoga) can bring about the steadiness of mind that is a prerequisite of samadhi. In Sutras I:39 & 40 Patanjali allows that any object of one’s inclination can be used as a meditation prop to achieve this goal.

According to Iyengar, if one approaches Asana in conjunction with Pranayama (breath control) utilizing these as bona fide supports for fixing the mind, then this approach to practice becomes a justifiable methodology that is fully supported by Patanjali’s system, provided that Asana is practiced with this intent rather than for some superficial motive.

But the real beauty of Yoga is that a strongly directed practice that combines poses with breath control where the mind is fully adsorbed and fixed on the practice without distraction, whatever the actual motive for practice, the mind can still attain fixity and stillness. Thus an essential goal of yoga is nonetheless attained, regardless of whether you just want to look good in yoga pants or whether you would prefer to approach labor with a calm quiet serenity.

This more physical approach is one which many people particularly in the West might be best suited as it opens the door to a new way to practice Yoga, one that is more palatable in a present day mainstream context.

Especially for those who are not interested in pursuing Yoga’s more spiritual elements, you may find yourself very attracted to Asana, even if for solely physical reasons at first.

Even if this is the case, if the mind is fully fixed and adsorbed without distraction on the practice of Asana, for whatever motive, it can still attain fixity and stillness. Once the mind has steadiness in one area, this steadiness can readily be transferred to other areas.

Yoga in the West may be more physical than meditative but that does not mean that Asana does not still the mind, reduce suffering, ease pain, or reduce anxiety and stress. It most certainly does.

Iyengar makes an excellent use of Patanjali’s Yoga Sutras to support his claims. I don’t need them— I am a beneficiary of the beauty of a strong directed Asana practice, a practice that brought my mind to stillness and clarity when seemingly nothing else could. For the record I began practice because I wanted to lose weight, Yoga had other things in mind for me.

So now that you have a deeper understanding of both the history of Yoga and the role of movement in Yoga let’s move forward.


During the birth of your child, movement is not only the physiological ability that accomplishes birth—it is also a highly recommended, safe and easily accessible birth skill—that  works to lessen the awareness of pain, that reduces stress, anxiety, and fear— a skill that works with the birth process not against it.

Part of Asana practice is about eliminating unnecessary muscle tension, yes balanced alignment takes effort, but that effort works to effectively make the effort feel effortless.

Your body is designed to move and your knees are designed to bend, and trying to make your body flexible by limiting natural movement (motion) is counterintuitive  and only works to impede your natural functional abilities.

Your laboring body produces adrenaline for several reasons during birth, one of these reasons is to encourage you to utilize movement, flexibility, and gravity.

Laboring at your own pace, without either hurry or interference represents a form of effort that done with patience, devotion and faith will make your efforts seem effortless.

Trying to give birth by limiting natural movement (confined to a hospital bed, strapped to a multitude of machines) is counterintuitive and only serves to impede the functional physiological ability of your birthing body.

Our spines are designed to hold four complimentary curves that support and cushion our movements. Think of a curve like the body’s built in shock absorber.

Being upright, utilizing both movement and gravity during the First Stage of labor works with these natural curves—facilitating the opening of the cervix and the movement of the baby down into the pelvis.

Being upright, utilizing both movement and gravity during the Second Stage of labor continues to work with these natural curves—giving birth on your back flattens out these curves and this translates into positions where you must quite literally push your baby uphill to be born.

Babies at birth have a C-shaped spine, to better fit through the birth canal, the shape of the spine transforms after birth, as your baby learns to move and survive in her/his new gravity filled world.

Yoga is about creating a sustainable energy efficient body. Employing a Yoga-Based Birth Skill means moving in a way that works with birth, utilizing the right kind and the right amount of effort, effectively making the effort you choose to employ seem effortless—not to mention efficient.

Involuntary movement is the primary internal process that accomplishes birth, whereas voluntary movement is an invaluable birth skill that works in conjunction with the birthing process by enhancing labor progress.

The choice to utilize gravity, remaining upright, and moving during birth helps in many other ways as well as it will give you a a sense of control, which in turn will increase both your comfort level and your sense of satisfaction with your overall experience.

Labor pain is a type of healthy pain. It is normally not a “sick” pain.

Earlier I gave an analogy about focus and raking leaves, let us continue using that as our example, to simply explain what I mean about “healthy” versus “sick” pain.

Healthy pain is the type of pain that you would feel in your arms after a long afternoon spent raking leaves.  Achy tired well worked muscles.

Sick pain is the type of pain that you would feel in your right arm if for some unknown reason you managed to break it while raking the leaves. Agonizing excruciating sensations— your body rightly signaling a situation that needs your immediate attention.

Labor pain (eustress) is generated from the actions of a healthy involuntary muscle, the uterus, which is doing the job that it was created to do, just like your lungs, your heart, and your digestive tract.

As the afternoon wears on, your arms tire, your muscles fatigue, which is called ischemia. Your arms start sending alarm messages to your brain. Your uterus does the same as it fatigues.

Yes, continuing to rake leaves is a voluntary decision, technically, you can quit raking at any time, uterine contractions however are involuntary movements—they stop at the end of the 3rd Stage of Labor.

But they both represent forms of muscle fatigue so just like you can decide to continue to keep on raking with tired arms, you can become proactive about the management of the eustress signals sent from your uterus.

You can, without causing physical harm to your body, look away from these signals and instead become adsorbed into the task of laboring.

Focusing on what the body is doing during a contraction, not the sensation. Activity combined with focus causes the mind to fix where it is directed- not only during an Asana practice but also during labor.

The pain, the endorphins, and the deliberately applied focus on movement and breath will all lead to what is known as flow state. Flow state is defined as any goal oriented activity that commands your entire attention and focus to complete. BIRTH has all of these elements.

SUTRA 1:14 SA TU DIRGHA KALA NAIRANTARYA SATKARASEVITO DRDHA BHUMIH

"Practice becomes firmly established when it has been cultivated uninterruptedly and with devotion over a prolonged period of time."

Use everything you’ve got to the best of your ability, this effort is practice, and practice becomes firmly grounded when well attended to for a long time and in all earnestness.

According to Ju Ju Sundin in her book “Birth Skills” during labor you are presented with a basic choice—each contraction can mean approximately 60 seconds of painful helplessness or 60 seconds in which you take powerful action to temper the pain.

SUTRA 1:5 VRTTAYAH PANCATAYYAH KLISTAKLISTAH

"There are five kinds of changing states of the mind, and they are either detrimental or non detrimental [to the practice of Yoga]"

Yoga teaches that there exist two categories of mind modifications (vrttis), one variety brings us suffering; the other does not.

This sutra is NOT about pain versus no pain instead it is about the choice to suffer versus the choice to not suffer.

Buddha (not a Yogi) nevertheless famously said: In life there will always be moments of pain, the choice to suffer is optional.

So this sutra is also NOT about suffering versus pleasurable, as so called pleasures can ultimately bring about suffering as well.  Instead, it more closely means that one mindset brings suffering and the other mindset does not.

During birth one mindset (vrtti) brings about a sense of painful helplessness by setting up several maladaptive physiological cycles and the other mindset (vrtti) brings about sense of doing, the decision to take powerful action to alleviate suffering.

The first action makes it difficult to cope, it makes labor a real struggle. The other helps you avoid unnecessary pain.

Remember, labor pain is normally not sick pain, such as the sensations that come from pinched nerves, broken tailbones, or back labor. This variety of “sick” pain requires a separate set of skills and will be discussed, eventually, in its own section.

Instead labor pain is healthy pain. It comes from a healthy muscle doing its job. Your uterus healthily going about its business. Even big pain is simply ischemia—muscle fatigue. Only muscle fatigue.

The key to removing pain comes from various sources, it comes from using your body to facilitate the physiological birth process by utilizing movement, positioning, and gravity, but it also comes from using movement to help break free of two maladaptive cycles, the Fear-Tension-Pain syndrome and the Fight-Flight-Freeze Response.

 

“The senses can carry away the mind even of a woman of discrimination.” Bhagavad Gita II:60

 


 Yoga is a doing. Movement is a doing. Birth is a doing. They are not a think about doing.

Conscious directed movement puts your mind in control of the body’s voluntary actions.  Actions such as these move your thinking mind from painful obsessing to instead being a part of a solution that eliminates needless suffering.

It literally moves the mind from thinking mode to doing mode.

This type of movement is yours to control and this is just one of the many attributes that make Movement the amazing birth skill that it is.

SUTRA: 1:14  SA TU DIRGHA KALA NAIRANTARYA SATKARASEVITO DRDHA BHUMIH

Practice becomes firmly established when it has been cultivated uninterruptedly and with devotion over a prolonged period of time.

Just another way of saying it is wise to take time to practice and become comfortable with using these birth skills well before your labor begins.

It is a tendency for the majority of humans to want results immediately, but yoga practice, like birth, takes the mastery of three difficult qualities—patience, discipline, and resilience.

If you begin practice now, and are patient— your mind will become more settled and therefore your actions will have more value—-nothing done when you are unsettled or anxious will have the same quality.

Movement is a worthy formidable skill, but it is equally important to remember to pace yourself and not to over do—just enough to get through— this way you won’t tire out early in your birth experience. Think marathon not sprint.

Pace yourself, from the very beginning by matching the level of your actions to the level of  your sensation. It is vitally important to conserve your energy, to include periods of rest, and to give your body hydration and fuel.

It is necessary to start developing the ability to assess your contractions, learning what your body is doing, so what exertions you take work to assist but not hinder the birth process, and that they work to effectively and efficiently to focus your mind away from painful sensations.

The successful development of this ability enables you to come to your best decisions about how to best handle each of your contractions.

This will help you create helpful responses to utilize during contractions. Responses that  are helpful for dealing with pain and to accentuate the labor process, things that you yourself find helpful.

These responses need to be simple and doable, so that these skills are entirely possible to execute during labor. They need to make sense—TO YOU.

When your choice to utilize a particular movement is shared with your birth team, then they know how to best assist you in utilizing this response or any of your chosen Yoga-Based birth skills.

Easy simple rhythmic motions such as:

  • rocking,
  • swaying,
  • pacing the floor,
  • rhythmic stepping,
  • marching,
  • simple prenatal yoga poses as taught in my classes
  • stomping,
  • splashing water,
  • calf-sliding,
  • wall sliding
  • using a birthing ball.
  • Arm movements—big and small

When you mindfully move your hands through the air during labor you can physically move your experience, using your hands to gather energy, to ground and release worried thoughts  which can be profoundly calming to your body.

Move your hands instead of letting your mind take over your experience, make room for faith and trust in your body and in the labor process.

Imagine the benefits as you prepare yourself this way during your pregnancy, starting your practice well before your birthing day and then sticking with it.

But for any birth skill to work you must remember to:  FOCUS ON THE MOVEMENT NOT THE PAIN

The utilization of the Whole Way system means starting today, continuing through pregnancy, taking the skills you learned in class into labor and delivery and then continuing on into motherhood as these are not just birth skills they are life skills.

The best time to start preparing yourself for the birth of this baby is right now, drop into any of the studio’s Prenatal Yoga Classes today.


MOVEMENT AND PRENATAL YOGA

In Emily Oster’s book “Expecting Better” she considers it one thing to think about continuing regular exercise while pregnant and quite another to think about adding pregnancy specific exercise. Her take on the labor process:

“Labor is basically a really long workout that you can’t quit in the middle of. So maybe you should be preparing specifically for that. In fact, the uterus is preparing itself by flexing and un-flexing that’s ‘Braxton Hicks’.”

The uterus is comprised of smooth muscle tissue, it is an involuntary muscle, meaning that you cannot consciously direct your uterus to flex on command. The control of involuntary muscles is regulated by the Autonomic Nervous System.

So you can’t “practice” contractions because you can’t voluntarily flex your uterus but you can practice and strengthen the voluntary muscles that are essential to facilitate an active upright birth.

Preparing your body and mind to give birth is the primary focus of my Prenatal Yoga Classes.

A lot of people like the “idea” of yoga, but hate actually doing it. More than likely because it requires practice, and patience, and endurance, and resilience, and strength, and discipline.

What part of a woman’s life shares those exact same challenges—that’s right—childbirth. A challenge that continues right into becoming a Mother.

There exists plenty of actual concrete, and positive evidence that prenatal yoga is beneficial during pregnancy and birth in not one but in a variety of dimensions.

Evidence based studies have shown that practicing prenatal yoga allows for a reduction of discomfort in the last weeks of pregnancy, women experience a lower level of pain during labor, women on average spend a shorter 1st stage of labor (pre-pushing) and on average labors are about 2 1/2 hours shorter for women who practiced prenatal yoga.

If yoga is a practice that helps a woman remain comfortable during her pregnancy imagine how much better it will make your labor experience if you pack it as a tool in the your Birth Skills tool kit.

But it has to be said that:

Intellectual knowledge only becomes real wisdom when you experience it in your own heart and mind. In other words, you do not receive the benefits of practice by reading, talking, or thinking about Yoga, you need to actually do the practice and then continue to practice.

Practice requires discipline, the conscious decision to act in a way that strengthens you, and allowing yourself to surrender to a process that is greater than your individual self.

The above statement was written about the traditional practice of Yoga, about the need to deliberately prepare the mind and body for the discipline of the practice.

I ask you to consider if this is not exactly what childbirth asks of your mind and your body.

So in the words of Penny Simkin from her book “The Birth Partner”:

“What is needed for Labor are simple but powerful tools and techniques that will help you feel calm, confident and at ease. Skills that will promote a mind-body connection that will positively and directly affect your ability to give birth optimally, all by getting your mind to work for you rather than against you.

This allows a woman in labor to give herself permission to go wherever she needs to go, controlling what she can control and letting go of what she cannot. It helps eliminate the fear of Birth. Practices like these are what will enable you to do what you need to do in order to bring your baby into this world positively, calmly, happily, and confidently.”

My prenatal yoga classes are structured out of easy simple useable and doable movements, breath practices, meditations, visualizations and practices that aim to provide just that level of calm competence.

Read more about the many many benefits of The Yoga Whole's Prenatal Yoga Classes.


 The human physiological birth process hasn’t changed since the Stone Age, this process is still under the control of the hypothalamus and the pituitary gland which are archaic brain structures located in the brain stem.  Birth is an innate hormonally mediated physiological process.

There are four hormonal processes of physiologic childbearing that both anticipate and prepare the body for upcoming processes and biological needs of Birth. This processstarts with pregnancy, it ramps up during labor and birth, and continues through breastfeeding, and is essential for maintaining maternal-infant attachment.

While hormones direct the birth process, it is a delicately balanced system—one that is extremely vulnerable to interference.

A person cannot initiate or stop an involuntary process, for example you can’t stop or start your heart, the fact that it beats is out of your control.  But you certainly can do things that speed it up or slow it down, that is in your control.

During Birth you cannot stop or start the contractions of your uterus—sure there are technologies that “help” with those processes but you cannot “think” contractions into being and you cannot “think” them out of happening.

But you sure can use your mind and your body to do and think things that hinder the process.

Stress, fear, pain, anxiety, and tension can all act to slow the birth process by switching the gears of the Autonomic Nervous System from the parasympathetic mode to the sympathetic mode.

When the body senses a threat (real or imagined) it activates the acute stress response or the Fight, Flight, Freeze response which activates the sympathetic nervous system as if you were pressing down on a gas pedal. This immediate response system makes sure that your body is ready to defend itself —preferably using one of its preferred actions.

This reaction is out of your control, it is simply what your body is programmed to do, you can’t keep it from happening but you can control how you respond.

If you do not respond appropriately—it sends more signals—making you press harder on the gas pedal.

You can learn effective methods to keep your ANS running on the parasympathetic side of the equation, and maintaining homeostasis is what The Whole Way is all about.

The Parasympathetic Nervous System, PNS, is the brake pedal, it calms things down, slow and easy, restful—it restores the body to homeostasis. Exactly where your mind and body want to be during labor and delivery.

Hormones, Nervous Systems, Homeostasis, and Maladaptive Responses are all very worthy, fascinating topics, they have (or will have) their own articles—this article is all about how utilizing movement can help keep you in control and unnecessary suffering at bay.

A degree of stress can be useful in labor, in fact you will receive a stress signal at the start of each contraction-a shot of adrenaline. This is okay, it is part of the physiological process, and if the signal is responded to correctly and swiftly— it is easy to manage.

It is when these stressors begin to overwhelm you that you might react by freezing. When you freeze up in the midst of an acute stress response, you become worried, fearful, anxious and even more stressed.

 You will continue to receive jolts of hormones until you do something that convinces the ANS that you are taking this threat seriously.

If Adrenaline had a voice it would say get moving and if you would listen closely to anxiety it is telling you to make a decision.

So FROZEN compounds the problem-it creates more panic, more fear and more stress and ultimately more pain. It slows down labor and endorphin production.

SO MAKE THE DECISION TO MOVE. Relief is as simple as that.

In order to master responding to stress signals—you need to move quickly from a state of fear, misconception and anxiety (negative painful VRTTIS) towards focusing on conscious activities to apply to contractions.

It is not enough to simply apply “pain-less” pain relieving activities towards contractions you will also need to CONCENTRATE on them. You consciously determine your focus by consciously directing your movement and your breath.

Asana (physical yoga practice) is about utilizing movement and breath control to fix the mind, shutting off the mind stuff and bringing it into a quiet space of stillness.

Your choice: Do you allow your mind to become agitated by the body’s primitive reaction to the stress signal it just received from your uterus or do you rise above—up to the ledge—and control your reaction to this bodily sensation-choosing an appropriate response?

Your job is to match your level of movement with your stress level.

  • Minimal Stress=Minimal Movement like breath work and shifting positions.
  • Small Stress = Small Movement like a gentle walk or sway. Distracting activities.
  • Big Stress= Big Movement like marching, using longer strides, half lunges.

Move instinctively and match the level of intensity that you feel in your uterus.

The key to making this work is to move your concentration to your legs, arms and breath—focus on what they are doing.  Shifting your focus from your contraction and the stress signals it is sending to your brain. Focus on the movement not the stress and wait until your body actually sends signals to move.

Your body is going to birth your baby regardless of how you react to the sensations of birth.

Doesn’t it make better sense to learn how correctly deal with these stress signals during birth?

Accepting these signals for what they truly are and working with and not against them are skills that The Whole Way can teach you.

It is important to realize that just through fighting against these sensations, you give pain more meaning, it becomes more important—it receives more priority. It can invoke an Acute Stress Response or Fight, Flight, or Freeze.


The acute stress response or Fight, Flight, Freeze (FFF) is an old survival mechanism-three ways of responding—fight it, escape it, or remain perfectly still.

These types of responses are vital when there is actual physical danger heading your way. The release of the adrenaline complex in the presence of danger has promoted safety for laboring females in the wild throughout human evolution. Like I said—very interesting it will have its own section.

For now, it is vital that you learn how to turn the remnants of this ancient response system into a helpful friend during birth by learning how to appropriately and instantly respond to a stressor that provokes an acute stress response.

Chastising yourself to calm down will only make your body send more stress hormones your way—whereas—Yoga-based labor management skills will help you to find and implement strategies that provide helpful easy to use answers.

Neither fighting against labor or trying to escape it makes any sense—make no mistake these actions can and will agitate your mind and hinder the birth process.

So, The Whole Way presents a different way. Don’t fight. Don’t escape. Don’t freeze up. Just be alert. Just be conscious.

Be aware of your body and the sensations, the signals, and the emotions that—being in labor— is provoking in your mind. Conscious effort is needed as you will be searching for a means of inner competency— a way of “working with” not fighting against, by becoming aware of and letting go of old less helpful patterns. Your tried and true defense mechanisms against stress, pain, and anxiety may be of no use to you during birth.

This approach to labor is not without effort. But from effort strength comes. When you do something on your own you can gain from it. The more effort you put into something the more effortless it becomes.

If you find relief solely from the outside, where does that relief come from—are you the source—or are you totally dependent on that outside source for relief or comfort?  No sense of inner competence just dependence?   

I want to assure you that— you yourself are enough unto yourself. A healthcare provider, a technology or a drug that holds the only key to your relief is your jailer and is in charge of your relief or your suffering.

This is not to say that a well timed well justified epidural won’t ease fatigue, pain and stress—gaining for yourself much needed energy and strength to get you back in the game and across the finish line.

It is to say that getting an epidural as a “just in case” your experience becomes unmanageable is handing over control of your experience—placing your relief in the hands of technology and hospital staff.  This is a form of risk-managed care.

Nor is it to say that the presence of a loved one or a doula won’t soothe your fears, release anxiety and stress guaranteeing for yourself the support, comfort and reassurance necessary to feel protected and safe—free to do want ever you need to while giving birth.

It is to say that you will be giving birth during an era where the belief is that —technology does is better—this is the approach that the medicalization of Birth has produced. I really don’t want to come across as anti-technology, anti-medicine, or anti-healthcare providers—they all certainly have their place, especially as technology and its providers certainly saved my son’s life and most likely mine.

But it really shouldn’t come as a surprise that I believe in the strong evidence that suggests perhaps we should limit technology during childbirth— limiting it to being used only when medically necessary and when it is a choice made from your own volition based on an educated informed decision.

You can only feel in control while giving birth when you are free, independent and are able to make your own sense of a calm, positive, strong and resilient birth. When YOU are the center playing out the moment to moment journey of your own particular birth experience.

Obsessed with the pain and mad at the system does not calm and peaceful make.

Don’t create a fight. Don’t fight negative. Create positive.

This also takes wisdom and discernment for when pain, stress, anxiety, fatigue, and fear tip over into suffering—ask for and be grateful for the help—it is there for when you have a genuine need. It can and often does save lives.

SUTRA 1:12 ABHYASA VAIRAGYABHYAM TAN NIRODAH

[The vrttis (states of mind)] are stilled by practice and non attachment.

A conscious effort, the development of a constant inner practice that aims at achieving a tranquil state of mind free of attachment.

This state of mind allows you to become more alert, a master of yourself, less dominated by old habits, and it will help quiet the chaos of your inner mind. This gives you the ability to look objectively at your own direct experience and make more empowered choices.

Not killing pain, not seeking pain, and not fighting pain you simply find a better way to deal with labor eustress signals. Then the pain is not so important, and it withers away.

Correctly dealing with pain. Accepting it for what it truly is and working from there is what these Yoga-Bases Birth Skills are all about. When you fight or resist against pain you give pain more meaning, it becomes more important.

When you fight pain it becomes center in the mind. Then everything becomes about the pain not about birth, not about baby, not about the rest of the pain free body.

If you continuously engage the mind and occupy it elsewhere, for example:

You accidentally burn a finger while fixing Thanksgiving dinner for your whole family. You barely notice while caught up in cooking but as soon as you sit down to dinner—bam the pain rushes in.

Pain only hurts when you look directly at it and you make the decision to go with the instant reaction (FFF) and in this instance resistance means suffering, you struggle, and resist— you don’t want it— you don't deserve it.

Don’t fall prey to ancient fears and ancient response systems—this is wrong knowledge—instead realize that both your maternal and fetal systems are fully primed and precisely aligned for safe effective labor and birth—your body is not in danger—your baby is not in danger—this is eustress—the healthy physiological stress of labor and birth—this amount of stress is normal and beneficial to the healthy functioning of the birth process for both mother and baby.

You have a choice—you can react to the stress and switch on your body’s negativity bias which brings about fear, anxiety, tension and more pain and a longer labor. 

You may find yourself in a birth scenario where you are simply unable to look away—if so, then a bit of outside pain relief may indeed bring you back into control and ease your suffering. But tread cautiously as this is the path that often leads to a cascade of medical interventions.

You have a choice—you can find a way to deal with the stress—no matter the stress there is a way to deal with it.

Saying to yourself that at this moment my body is giving birth and at this moment I must work with what is possible within the direct circumstances of my own experience.

Don’t resist the sensations or the feelings, don’t pull yourself separate, flow into it. These sensations and feelings are simply changes in your balance of hormones and they all have a specific role to play.

You do not give birth everyday and especially if you are a first time mom then everything is strange a little mysterious and scary. It is normal to feel this way—it is key to getting the right cocktail of hormones flowing through your system. The cocktail that releases the good stuff—top shelf ingredients.

This stress response to Birth is a healthy reaction, stress is meant to feel uncomfortable, it is Nature’s way of saying “immediate attention is needed” and you need to act—you need to address this situation—right now.

This surge of hormones will always happen with contractions but the choice of a resistant reaction (FFF) is not the wise path as it does not deal with these hormonal surges constructively during Birth.

The better way is to implement any of the Whole Way’s birth management skills—especially movement—so take a deep breath and shift your body.

Then you will feel a sudden surge of “feel good” endorphins. Fight increases pain.  Your body is going to have this baby—one way or the other. It is happening.

One of the deepest secrets of life is that pain disappears when you flow with it, when you flow you transform the situation and through transformation you transcend it. Find the comfort measure and/or birth skill that brings you relief and move towards that.


Pain is a primary symptom driving women to seek analgesic relief during labor and the lessening of pain commonly defines a successful result, regardless of its potential to have an adverse effect on the birth process.

During labor a physiological stress response may be evoked not only by pain but also by fear, perceived threats to safety, status, or well being and these are all sensations that trigger the fight, flight or freeze response.

There exists an abundance of evidence that links chronic stress and pain, these studies suggest that exaggerated psychological responses such as fear, catastrophizing, and negative coping are “maladaptive” and likely to intensify the pain experience and impede the birth process.

This is all rather fascinating but beyond the scope of this article, rest assured it will have its own article. For now, just accept that an “adaptive” response to Acute Stress (FFF) such as movement is the appropriate choice.

There are two alternative responses to the experience of labor induced pain sensations:

  1. the avoidance, catastrophizing response that may prolong labor, prolong pain, and augment a cycle of suffering, pain, anxiety, stress and fear.  (Mal-adaptive)
  2. the confrontation response- you meet labor head on, developing meaningful effective strategies to manage contractions and break the pain-fear-avoidance cycle. (Adaptive)

Fear is an emotional response that can freeze you up or get you moving. 

When a stressor continues after the initial Acute Stress response it builds into repeated surges of hormones that left unchecked builds into a sense of anxiety, fear, and distress and chronic stress.

When the initial surge rushes in demanding you to do something, to go, to take action—answer the call with powerful focused movements.

Such as the constant steady  movement of your legs and/or arms during a contraction as this  will do wonders to work off the build up of excess stress hormones in your body.

The mastery of your labor pain involves you finding and utilizing various Yoga-Based Birth Skills to work off the stress that surfaces in your body as the eustress of contractions build up over time.

If you panic and freeze during your contractions then you will feel more pain, more tension, a decreased release of endorphins and oxytocin—all of which results in a slower less efficient labor.

This choice of response, if left unchecked, leaves you feeling that it is enormously difficult to maintain any command or control over your labor. You slip into the Avoidance Response (A) and you become overwhelmed and unable to cope.

If adrenaline had the ability to vocalize its needs it would shout: Get up and move!!

So instead shift into powerful action, and moving is a simple way to turn away from suffering and back towards coping and managing. Confrontation Response (B)

What you can sense you can change. Be a careful listener and learn to recognize these signs. When you are in tune with the needs of Birth then:

  • you will instinctively move to a new position that brings more ease
  • you will speak up to get what your body needs
  • you will drink when thirsty
  • you will eat when hungry
  • you will give voice to your experience.

 

SUTRA II.16 HEYAM  DUHKHAM ANAGATAM

Suffering that has yet to manifest is to be avoided.

In other words— pain that can be anticipated can be avoided.

Yoga is about working through discomfort to find ease and comfort. It will never mean deliberately keeping the body in sustained uncomfortable contorted or painful positions. I hold true that posture should be steady and comfortable and that is how I teach asana.

The Whole Way method is about learning to work with your body—finding both ease and strength.  It is counterintuitive to remain in positions during labor that have no value, that are not evidence based—positions that hinder rather enhance progress in labor.

Asana is about applying movement to the body to quiet the mind, to give mastery and control so that it fixes the mind on the task at hand-the labor of birth.

All women have the potential to experience unbelievable pain in labor but we also have the potential to produce behaviors and actions to reduce it.

You will have no direct control over contractions or the level of pain, so don’t waste time trying to control what you can’t, instead put 120% of your energy into what you can control.

You absolutely have control over what to do with:

  • your legs and arms
  • your hands and feet
  • your breath and sound
  • your eyes and ears
  • your nose and skin
  • your thoughts and words

As previously said, pain is your body’s signal to move. There is no specific recipe or special time—just use what works best for you

Mild pain requires mild adjustments —moderate pain moderate adjustments—big pain big adjustments.

More intensity=more stress=more adrenaline=more potential energy=more pain reducing potential

Match the level of action to the level of sensation. More sensation—then move faster, stomp harder, vocalizing instead of just breathing.

Research shows that the level of to which women can master their labor pain is based on the level of pain and their ability to adapt to pain. What ever technique you use— pain mastery comes from your level of pain adaptability.

Pain is not always a reliable sign of what is actually happening in your body. It is instead “volatile complex sensation that is completely tuned by the brain and is often over-protectively exaggerated so much so that the sensitization often becomes more serious and chronic than the original problem.” Paul Ingraham; Pain is Weird; online article

There is no such thing as a “pain nerve” as nerves do not detect pain—nerves detect some kind of stimulus in the tissue and the brain decides what to make of it, how to feel about it and what to do about it..if anything.

People seldom if ever realize how powerfully pain is influenced by perception. Pain in fact is nothing more than “opinion”— it is an interpreted experience that is surprisingly sensitive to context.

These “all in your head” implications are all very fascinating so rest assured that there will be articles regarding the “pain phenomena”.

Is it likely that you will be able to think labor pain completely away—probably not—but it is within your power to influence labor pain sensation if you understand it.

You can adapt your responses to labor eustress so that you can directly lower your feeling and awareness of that level of pain.

Contraction pain involves exposing yourself to short manageable bursts of eustress that increase as labor progresses. Unless you continue to adapt along the way the eustress (contractions) will become unmanageable.

Your brain builds memories surrounding your response to each and every moment of an Acute Stress Response—if you build adaptive memories then you will cope well the experience of labor and if you build maladaptive memories then you will begin to feel more pain, stress and anxiety and fear and you will be less able to cope with your labor experience.

In the context of labor, adapting well means adding activity to these 60 second intervals of eustress. Your response can be passive, active, mental, physical or a mix of all of the above.

During a challenging workout your are using your muscles in a healthy way. Is it pain-free? Nope, in fact it is the painful contraction of the muscle you are working that strengthens  the muscle.

During the challenge of Labor you are using your uterine muscles in a healthy way. Is it pain-free?  Nope, in fact it is the painful uterine contractions in labor that do the work.

Healthy activity creates healthy workable forms of eustress.  During labor, uterine contractions represent a healthy workable form of eustress and the utilization of movement as a pain-free means of distraction is an example of how this concept works.

Using your legs is one way to adapt easily to the stress of labor and take control of your contraction pain. Leg activity changes your perception of pain by stimulating sensations at other sensory reception sites—soles of your feet, skin of your legs, hips, ankles, knees, etc. These sensations which are pain-free sensations are then transferred to the brain. If you generate enough leg activity your brain will register this as the dominate sensation rather than the uterine contraction.

Your PAIN-FREE leg activity will take precedence over the PAIN-FULL uterine contraction.

The same logic holds true for whatever part of the body you decide to move and why that burn didn’t hurt until you sat down to your turkey dinner.

The brain can only focus on one thing at a time and it will always focus on the dominate sensation. Essentially you will work to override the painful sensations by bombarding the brain with PAIN-FREE sensations.

Unless there is a STRONG medical reason, every woman has the right to choose what she does and remaining in bed is one of her options, if bed is NOT where you want to be—no problem. MOVE! Laboring women can stand, sit, lie down, kneel, lean, walk or use any other position that suits.

Aside from the physical benefits that come from using movement during labor, it is also a valuable tool for expression.

Stomping, clapping, yelling— we’ve all expressed ourselves in this manner—at a Steelers game, at a concert, while dancing. Hopping mad, dance it out, SHOUT!

Use Movement as a means of expression, not just for joy or exuberance but as an outward expression of pain during labor. Use movement as a means of turning fear and pain into positive actions. These are very helpful ways to harness acute stress signals and turn them into positive actions that help labor to progress.

Use Movement as:  an expression of pain — a distraction—a means to mobilize endorphins—as a primary and secondary tool—pair it with counting, visualization, in the shower, bath, bed and/or on a birthing ball.

During the FFF response your large muscle groups (the largest being your legs) undergo instant surges of energy during times of need so that they may be recruited immediately to adapt to the crisis. (1/2 way up the tree)

This means that we have been given the physiological means to use our legs to help us cope with pain, danger, and stress and not lose control.

If this Adrenal complex is not literally moved out of the body it stays and becomes chronic. Using movement as a birth skill keeps it moving right along by quickly and adaptively metabolizing it away.

Save leg work for later, when you can literally no longer remain still during a contraction, rest and use low level distractive activities during early labor. This is the adaptive response as it allows oxytocin preceptors to proliferate and keeps stress hormones at a minimum.

Match the level of movement to the level of pain. Pace yourself. Ensure that you are upright, you are using gravity to its best advantage. Movement is only pain-free until you exhaust yourself.

Mobilize yourself with a rhythmic pain free activity (rhythms and rituals are of great comfort during labor) a focus that helps put fear and panic on the back burner.

If you do something and you focus on it, you will have decreased your conscious ability to register fear and panic, and you will have definitely decreased your brain’s perception of pain.

During a contraction, your uterus produces stress, which triggers the adrenaline pump that fuels the action you need to take in order to cope.

GO is the greatest thing your partner can say if you are having trouble getting out of a shock/freeze state. Don’t persist with relax when go is needed.

Take an immediate action—not too big or too small but just the right amount to swiftly counteract the perception of pain.

Labor is not easy -you just get better at it—this holds true no matter what you are working on. If you know what to do, you have competence and control over the task at hand. This allows you to put hesitation and inhibition on the back burner and into the flow of the experience.

In the context of Labor this means that for each 60 seconds duration of a contraction you instantly apply the resources required to see you through.

The more you focus on pain free skills the less you will feel fear—remember your brain can only focus on one thing at a time. You will get into the zone—in the flow. You will suspend thoughts, mind stuff, fear, inhibitions, panic and hesitation.

You must focus and I mean focus on the activity for this strategy to work well. Use whatever you need— when passive rest during contractions begins to bring about suffering, move on, instead give yourself layers of distraction.

I have geared my Prenatal Yoga Classes so that they are almost entirely constructed of Birth Skills, simple doable actions that can be done as-is— or easily modified into more usable skills—as a stand alone skill—or as a skill that mixes well with others.

Using MOVEMENT as a birth skill (indeed all of the skills found in the Whole Way) are well supported by evidence from science, anthropology, psychology, and medicine.


 When we stretch our bodies we stretch our minds because our bodies and our minds are inseparable.

When Asana is combined with Pranayama and Drishti your mind becomes fixed in Mediation giving one a gap moment where you can choose a response rather than instantly react to each and every sensory input.

In other words, when positioning (movement) is combined with breath work and focus your mind is fixed into your immediate experience giving you a moment to gain control over your response to sensory stimuli.

Approaching a contraction from this perspective gives you the potential to readily identify the  stimulus without becoming completely absorbed or overcome by the sensations provoked.

Movement as a birth skill represents a mix of relaxation, activity, rhythm and ritual to decrease awareness of pain, preventing suffering. I am not saying these skills will remove pain but instead that they will reduce the awareness of painful sensation to the level of coping do-ability.

Moving and being active will help you feel confident in your body’s ability to do this job and why the hell not—this is quite literally what your body is designed to do.

Simple but powerful tools. Used alone or in combination with counting, drishti, or mantra. Yoga-based birth skills are abundantly rich in giving you the tools to do this!

The Whole Way wishes you to know and believe that there is an alternative to your engrained thought patterns about birth. Turn away from the negative bias against normal physiological birth—the negativity that comes in through healthcare providers, hospitals, insurance companies, medical technology, well-meaning “friends and loved ones”, social media, books, and TV.

When you arrive at your first Prenatal Yoga class you have chosen to alter your awareness— you have made a conscious choice. You are consciously choosing a different way of thinking and doing.

You have thoughts about using gravity allowing your pelvic girdle to move freely—thoughts about turning towards the sensations of labor and not working against them.

Yoga is about applying your body in ways that assist your body into quieting the mind, so as to give mastery, and control over the mind stuff.

Your choice— do you allow your mind to become agitated and fixated by maladaptive reactions to stimuli sent to your brain by your uterus or do you find a way to rise above stay on top and cope?

The practice of Yoga allows you to move more instinctively, you are making a conscious choice to listen and then matching what you feel. You have shifted your focus using movement with gravity in a manner that honors what your body needs.

Why does this work? Because your voluntary movements are pain-free, You don’t often consider it this way but hopefully your uterus (an involuntary muscle) is the only part of your body experiencing eustress right now.

Your brain will always focus on the dominant activity. If you allow your brain to remain focused on maladaptive responses then you will be the one to suffer.


I hope I have convinced you that the successful implementation of movement as a Yoga-Based Birth Skill will effect your childbirth experience in a myriad of positive ways.

Movement is the very definition of birth, it is the process that initiates, prepares, propels, and accomplishes all the necessary actions that make up the birth process.

The process of birth mostly entails the use of involuntary muscles and the utilization of these muscles are out of your conscious control, this is important for the survival of our species. The right knowledge is to just let your body do its thing.

Don’t waste valuable energy trying to control what is not yours to control, instead put all of your energy into using voluntary movement—recognizing it as an invaluable birth skill—one that works in conjunction with the birthing process by enhancing labor progress.

Voluntary movement is yours to control and this is just one of the many attributes that make Movement the amazing birth skill that it is.

The decision to sign up for Prenatal Yoga classes at The Yoga Whole means you will develop a practice that will enable you to take the movement of voluntary muscles off of autopilot and back into consciously directed control.

In addition to those benefits, the choice to utilize gravity, remaining upright, and moving will give you a sense of control, which in turn increases both your comfort level and your sense of satisfaction with your overall experience.

Birth is a doing.  Movement is a doing. Yoga is a doing. They are not “think about” doings.

One of the main goals of the physical practice of Yoga (Asana) is to move the mind from thinking mode to doing mode.

That being said—sometimes birth can become complicated and it might become medically necessary to limit your range of motion or you might even need to turn gravity on its head for awhile.

But just because you are in bed does not mean you can’t use gravity, that you can’t slide your legs along the mattress, that you can’t move your arms, that you can't use your breathe or mantra or meditation etc.

Movement works with the labor process, with the body, with birth hormones and NOT against any of them.

I am with WHO in their statement that mobility represents a form of intervention that is beneficial, essentially harmless, cheap and easy to implement.

Not bad for a physiological process that you already use everyday and all the time. A lot of bang for very little buck.

The great news is that Birth Skill #1 Asana (Movement) works even better when combined with Birth Skill #2 Pranayama (Breath Control). Which is were we will move next.