Tuesday, December 11, 2012

The Benefits of Prenatal and Postnatal Yoga for Bereaved Mothers

I wrote this as part of a required coursework for my certification as a prenatal yoga instructor, and wanted to share it here, as I think it is extremely applicable to many of us on the pregnancy-after-loss and bereaved parent journeys.


The Benefits of Prenatal and Postnatal Yoga for Bereaved Mothers

Whether you have taken yoga before becoming pregnant or your growing belly has encouraged you to embrace your inner yogini, studies have shown that prenatal yoga has a variety of positive benefits both for mothers-to-be and their babies.  According to an article published in the Journal of the Indian Medical Association, children born to mothers who practiced yoga during pregnancy were reported to have higher birth rates, less risk of preterm delivery, and a reduced risk of intrauterine growth retardation.[i]  For mothers, in addition to a decreased risk of premature labor, yoga during pregnancy can reduce stress, improve sleep, ease pain, and assist in a more positive pregnancy and delivery experience.[ii]  The physical postures of yoga are a great way to prepare for birth and they provide a low-impact way to get back into shape after birth; the mental exercises of meditation and relaxation can provide you with focus during pregnancy and delivery, while the physical asanas can help tone and strengthen the body for the marathon that is labor and life after birth. Yet, there is a subset of pregnant mothers for whom yoga may offer many, yet untold, benefits: bereaved mothers and mothers who are pregnant after a loss.

Pregnancy loss, defined as the loss of a child at any gestational age, and neonatal loss, defined as the death of a child from birth through the first year of life, impacts a staggering number of parents.  As many as one in three mothers will experience a loss.  In the U.S., approximately two million women will experience a miscarriage or stillbirth, while almost 28,000 infants will die before their first birthday.[iii] For these orphaned parents, the grief they experience can be overwhelming and their sense of “parenthood” distorted. After loss, couples may experience long lasting grief, which may be compounded due to a lack of family support or a poor birthing experience.  During a subsequent pregnancy, mothers may suffer from depression, mood swings, and a general sense of fear.  They may approach their pregnancy with indifference at times, intense anxiety, and may be unable to enjoy the time of their child in-utero.[iv]  In addition, mothers who suffer loss are also at a risk for postpartum depression in the postnatal period surrounding a loss, as well as after a subsequent successful delivery.  Research has shown that clinical depression is more common in women who have suffered a miscarriage than in women who have not been pregnant, and the risk for depression greatly increases if there is an associated perinatal loss or other trauma.[v] For this subgroup of parents, yoga in the prenatal and postnatal periods can help bond with a new baby, while assisting in the grieving process of a child or children who have passed away.  It can also help a mother deal with feelings of inadequacy or anger at her body, and may assist in working through depression and anxiety.

Postnatal Yoga After Loss

Pregnancy is one of the most exciting and wonderful experience in a woman’s life. When a pregnancy ends in loss or a child dies within the first year of life, the grief can be overwhelming. Parents feel alone in their sorrow and, many times, have their sadness downplayed by those around them.  When birth trauma is present, these mothers may feel even more isolated. As they work through their feelings of denial, anger, and sadness, they struggle to cope with the same physical differences a mother with a successful pregnancy experience is going through, yet they may not feel that they have the same options of postnatal support that typical mothers have. A postnatal yoga class that is open only to bereaved parents is beneficial to these mothers.

For many, the image of a postnatal yoga class includes asanas that focus on bonding with the new baby; in addition to this, there are many benefits of yoga for the new mother. After birth, a mother’s body changes; after loss, the mother’s body still goes through these changes and, often times, will prepare for a baby that is no longer here.  Depending on the delivery, there may be new physical changes to adapt to as the body heals. The abdomen muscles will need to be strengthened and the pelvic muscles must be toned. The physical pains that can be associated with the postnatal period may be magnified by the grief that accompanies child loss.

Postnatal yoga after loss can also be a factor in the risk of postpartum depression (PPD). Research suggests that mothers after loss be monitored for the first month, as the risk of PPD is high, regardless of the gestational age of the loss or maternal age.[vi] In a society where loss can be overshadowed and the grief of losing a child can be overwhelming, a postnatal yoga class can help a mother by bringing words to an unspeakable situation; her pregnancy experience can be validated, her child(ren) can be discussed openly, and her tears can be shared. Such a class can also begin a new trust relationship between a woman and her body at a time when she has such negative beliefs about a body that has failed her, her baby, and her partner.

Prenatal Yoga During a Pregnancy After Loss

Pregnancy after loss is an extremely stressful time.  Women who experience high stress during pregnancy are at a greater risk of premature delivery, postpartum depression, unplanned cesarean delivery, and low birth weight infants.[vii] Depending on when a mother’s loss occurred, whether or not the cause of the loss is known, and the risk of loss in a subsequent pregnancy, expectant mothers can find themselves full of anxiety and angst, unable to fully enjoy the new pregnancy because of the heartache of their previous experience.  Although research is lacking on the development of the unborn child, there is much research advocating reduced maternal stress in the prenatal period. The limited research available on antenatal child development shows that the more relaxed the mother is during pregnancy, the better child temperament and emotional regulation will be for the infant.[viii] In addition, many mothers feel unable to fully bond with their new child while pregnant, for fear that they will suffer a repeat pregnancy loss or neonatal death. Because prenatal yoga focuses on building the bond between mother and child, it can help create a bond when a mother is fearful of connecting to her child during pregnancy. Yoga, with its proven result of improving mindfulness, may provide a deeper awareness to mothers with insecure attachment and be able, in the postnatal period as well, promote a more positive mother-baby connection.[ix]

Although stress and fear are common complaints of mothers who are pregnant after loss, these mothers also experience the same physical discomforts of other moms-to-be.  While meditation helps to calm the mind and lessen their fears, the natural antidepressants effect of endorphins, released during the physical asanas, can ease their physical discomforts. Mothers need to prepare for the physical rigors of giving birth, as well as cope with the physical discomforts, like back pain, nausea, and headaches, that pregnancy can bring.  Many mothers also struggle with insomnia, and prenatal yoga can help promote and improve sleep.[x]

Preparing for labor is important for all mothers, but in a situation where birth trauma occurred, it can be even more vital to a positive, healing pregnancy experience.  Whether the birth setting, delivery interventions and method, or a combination of such with the loss of a child was the trauma, if it is not resolved it can remain with the mother.  It can result in severe physical disabilities which significantly limit development and capability. It can result in psychological and emotional trauma which determines the whole psycho-emotional development of the individual.[xi]  Prenatal yoga can help a mother discuss, remember, and work through the trauma of her birth, while giving her a positive expectation for a future delivery. Especially by utilizing relaxation methods, yoga can teach a mother to listen and truly hear her body, and give her the techniques to respond calmly.  It can teach the practice of birthing lightly: making use of breath to control the muscles of the body and increase the efficacy of contractions while the rest of the body remains relaxed.[xii]

Many mothers who are pregnant after loss report a fear of attending "typical" pregnancy activities, like childbirth education classes and prenatal yoga, thereby missing out on the benefits. They feel out of place with "first timers" when they have no living children at home, feel unable to share their previous pregnancy or parenting journeys without discomfort (both for them and for their classmates), and are afraid of how they will be perceived around, whom they view as, “normal” pregnant women. Gearing a prenatal class specifically towards mothers-to-be who are in a pregnancy after loss can allow them to not only experience some normal pregnancy activities, but also give them the opportunity to meet other mothers in similar situations.  Because many parents feel alone in their grief, this can be almost as beneficial as the noted benefits of yoga and meditation.

Postnatal Yoga After a Successful Pregnancy After Loss

Previously, in discussing how prenatal yoga may influence the mother-baby bond during pregnancy, it is possible that because of the prenatal connection, a more caring infant-mother bond is created post-birth that will facilitate healthy child development.[xiii]  However, there are more benefits to a postnatal yoga class after a successful delivery. Many parents feel that their new baby overshadows the memory of their child(ren) who died. Family, without malice or ill-intent, may gloss over their previous pregnancy or child(ren) with phrases that can be hurtful or by ignoring their loss(es) at a time when many parents need the validation of their parenthood even more. With perinatal loss, many parents already feel a sense of exclusion because, for most, the only people to really "know" their child(ren) who died were the parents themselves.  In addition, because many people may expect bereaved parents to "get over" the death of their child(ren), especially in light of a new baby, their grief and mourning may be stunted.[xiv] This could have a negative impact on their parenting, increase the risk of postpartum depression, and negatively effective the relationship of the parents together.

Postnatal classes specifically geared towards those who are parenting after a loss can help by further facilitating the bond between the mother and her new baby, while also validating her feelings of loss that are intertwined with her feelings of fulfillment in light of her new child.  The grief of perhaps never holding the child(ren) who died, or of never being able to experience typical mother-child behaviors, can be worked through during the asanas and meditation, and rather than having feelings redirected onto the new baby, the individualism of the new child can be embraced as a public acknowledgement of that child’s older sibling(s) helps the grieving mother work through her feelings.

After the Yoga Class

It is important to realize that the grief never goes away; a new child doesn’t replace a child who has died and the parent of a child who has passed away is still a parent with feelings that need to be validated and a grief that needs to be accepted. Prenatal and postnatal yoga are one of many lifestyle choices that can help grieving parents come to a place of acceptance with their loss and facilitate a positive integration of their loss(es) and grief into their lives, while preparing them for the physical and emotional challenges of bringing a new baby into the world.  When caring yoga instructors incorporate bereaved mothers into their scheduling of prenatal and postnatal yoga classes, they can share the benefits of yoga with a subgroup of parents who may need it most and be unable to find comfort in a traditional prenatal or postnatal class.


[i] Narendran, S., et al. Efficacy of yoga in pregnant women with abnormal Doppler study of umbilical and uterine arteries. Journal of the Indian Medical Association. 1/2005  http://www.ncbi.nlm.nih.gov/pubmed/16008324

[ii] Neumann, Devon. Prenatal yoga: the right choice for mother and baby.  Grand Valley State University. 1/2011.  http://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1088&context=honorsprojects

[iii] American Pregnancy Association. Statistics. 2012. http://www.americanpregnancy.org/main/statistics.html

[iv] Lamb, Elizabeth. The impact of previous perinatal loss on subsequent pregnancy and parenting.  Journal of Perinatal Education.  Spring 2002. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595109/

[v] Andor, Csilla. Postpartum mood disorders after perinatal loss. The Fourth Trimester. 2007. http://www.fourth-trimester.com/postpartumdepressionperinatal.html

[vi] Kleinman, Karen. Pregnancy loss and depression: understanding the trauma of fetal loss. Psychology Today. 2/29/2012. http://www.psychologytoday.com/blog/isnt-what-i-expected/201202/pregnancy-loss-and-depression

[vii] Meinzer, Chet and Toriggino, Marisa. The effects of prenatal yoga on the unborn child, attachment style, and mindful parenting: a call for research. The Yoga Garden. 2010. http://www.yogagardensf.com/wp-content/uploads/2010/11/EffectsOfYogaOnUnbornChild.pdf

[viii] Ibid.

[ix] Ibid.

[x] Harms, Roger, et al. Prenatal yoga: what you need to know. Mayo Clinic. 2012. http://www.mayoclinic.com/health/prenatal-yoga/MY01542

[xi] Attlee, Thomas. Birth Trauma. Caduceus Magazine. http://www.signifier.co.uk/CCST/articles.html

[xii] Freedman, Francoise Barbira. Yoga for pregnancy, birth, and beyond. New York: DK, 2004. pg. 8

[xiii] Meinzer, Chet and Toriggino, Marisa. The effects of prenatal yoga on the unborn child, attachment style, and mindful parenting: a call for research. The Yoga Garden. 2010. http://www.yogagardensf.com/wp-content/uploads/2010/11/EffectsOfYogaOnUnbornChild.pdf

[xiv] Callister, Lynn. Perinatal loss: a family perspective.  Journal of Perinatal Neonatal Nursing. July-Sept 2006.http://www.ncbi.nlm.nih.gov/pubmed/16915054

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