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Pregnancy Yoga

by Tracy Games McCafferty
As published in the Yoga Journal
January/February 1997

LABOR OF LOVE

"Ease into childbirth without drugs or surgery-with the help of a popular Dutch system called "Pregnancy Yoga."

I had my first baby in Holland, land of bicycles and windmills, canals and tulips, coffee shops known for their readily available drugs, and delivery rooms known for their absence of them. In Holland, the prevailing philosophy is that childbirth is a natural physical process, not a sickness, and should only be treated with drugs in extreme, emergency situations. A reasonable enough philosophy-but not one I found initially appealing, given my five-foot-six, 115-pound, small-hipped body and my American mind that thought an epidural was the natural form of childbirth. Needless to say, I was more than a little scared when I first learned I was pregnant. But I can honestly say that by the time those first labor pains started, I was calm, focused, and confident. In fact, I was even hoping that no situation would arise in which drugs or any other "unnatural" means of delivery would be necessary.

This was a major turnaround since I first discovered I was pregnant. What was responsible? A common method of childbirth preparation in Holland called zwangerschapsyoga or Pregnancy Yoga.

Pregnancy yoga first came into practice in Holland about 10 years ago and has grown in popularity since. Now thousands of couples a year choose to study yoga during the prenatal months, and most areas of Holland claim at least one instructor specifically trained in pregnancy yoga. Since there are no actual licensing requirements to teach pregnancy yoga, expectant Dutch couples are advised to contact their regional offices for listings of qualified teachers in their area. These instructors have completed a six- month training program in yoga theory and practice and have observed experienced teachers in a sort of student teaching program. Doctors and midwives also often keep a listing of local pregnancy yoga instructors for referrals.

I first became familiar with pregnancy yoga through an American friend whose second child was born in Holland. She remarked that she was not known for her high tolerance for pain, but that with yoga, she had managed hours of drug-free labor "without having to cry out."

That sounded like a good start to me, but I wasn't quite convinced. My previous knowledge of yoga wasn't extensive, but I knew I wasn't quite prepared to sit in pretzel-like positions with a bulging belly while wind chimes and incense wafted in the background.

What did convince me was a conversation with pregnancy yoga instructor Anneke Rozenboom, who assured me her classes were much more practical than metaphysical. A physical therapist by occupation, Anneke had been through pregnancy yoga training and had taught courses for five years. She explained that the hour-and-a-half-long classes would be held every Tuesday night, starting at the beginning of my sixth month and lasting until a few days before my due date. Classes would include not more than three or four couples, in order to give individual attention.

The fact that classes were designed for couples was a big plus for me. When we arrived at the delivery room, I wanted my husband and coach, Bob, to have as much knowledge as I did. Add in the fact that the classes were reasonably priced (about $8.75 each) and that Bob and I would get to improve our Dutch language skills, and I was sold.

Getting Started

Before we knew it, it was already time for our first class. Bob and I put on our sweats and headed for the address Anneke had given me months before, an upper room in her office building furnished with pillows, mats, and chairs.

We shared the class with two other couples, both Dutch and both also having their first child. The atmosphere was relaxed and cozy (gezellig, as the Dutch say), which put me at ease from the start-an important factor in any yoga class, as I was soon to learn.

The first class set the tone for the course. We started off with some simple stretches to keep our muscles loose and flexible, then went immediately into the two main skills stressed in pregnancy yoga: breathing and relaxation.

First we concentrated on our "breathing centers," where most of the movement occurs when breathing. We practiced sending breath to the rib cage and the belly and exaggerating the in-and-out movements in these two locations. Such breathing exercises would become an integral part of each class, as we continually practiced deep, relaxed breathing to the abdomen and ribs in a variety of positions, styles, and techniques. Supporting partners were always encouraged to try all exercises themselves so they would understand exactly how they worked. This thorough understanding would make for better coaching later on. We finished off the class in a manner that would become common-a relaxation exercise. This drill was also a Dutch anatomy lesson for my husband and me, as Anneke talked us through getting loose, from our big toes all the way to the tops of our heads. We left the class in a comfortable zombie state and slept extremely soundly that night and every Tuesday night for the next few months.

Ready to Deliver

The main goal of pregnancy yoga classes is to prepare for the actual act of childbirth, but the course also offered some helpful tips and advice on getting comfortable throughout pregnancy. Anneke instructed us on such topics as proper posture to avoid back pain, exercises to help with circulation, massage techniques to help with the aches and pains of added weight, and daily pelvic and perineum exercises that would help prepare those areas for the birth.

In the last four or five classes, Anneke tied together all the skills and techniques we'd been practicing for months, to concentrate on getting us through labor. With the help of books, illustrations, and a lot of knowledge, she talked us through the stages of labor, explaining how various techniques we'd learned would help us through each stage. In Holland, the entire labor period prior to pushing (early or latent labor, active labor, and transition) is referred to as the ontsluitings or "opening" period.

Anneke described exactly what would be happening to our bodies throughout this time as the uterus contracted and the cervix dilated to 10 centimeters to allow the baby into the birth canal. She emphasized that it was important to take long, relaxed breaths to the abdomen, the way we had been practicing for months, for as much of this stage as possible. If the abdominal pain became too much, we were to move the breathing, still slow and relaxed, to the rib area. Coaches were encouraged to help us concentrate on sending our breathing to these areas by placing their hands on them as a kind of target.

Next, Anneke stressed the importance of relaxation, having us tense different parts of our bodies and showing how hard it is to breathe deeply and consistently when our muscles are tense. We reviewed many of the relaxing exercises we had learned, while our partners practiced guiding us through them with Anneke's help.

With these basic premises in mind, Anneke told us that how the rest of the "opening" stage progressed was up to us. She armed us with a variety of positions: sitting cobbler-style, lying on our sides, leaning against the wall, kneeling on all fours, standing upright. She also instructed our partners in methods of massage that could help with the pain of labor. To give us even more options, we also experimented with "toning" (using vowel sounds to focus the breathing to either the stomach or ribs), imagery (our class got the giggles as we were instructed to conjure up a pink elephant to take our minds off the pain), and pain tolerance. (A pinch to the inner thigh seemed excruciating until I practiced focusing my attention on Bob's hand, which rested on my leg, then moving up to his arm, then to his shoulder. When he pinched me again, this time with my attention focused on his shoulder, I barely felt it!) Anneke assured us that what we used or discarded of this information was up to us, and that whatever seemed to work for us was the right thing to do.

Next, we prepared for the final phase of labor: pushing. First Anneke taught us the yoga method of pushing, which involves using deep, focused breathing more than muscle to gently push the baby down and out. As nice as it sounded, all of us in the class had our doubts about this being enough pressure to push out a child, so practical Anneke also taught us the normal method of pushing (using abdominal and pelvic muscles), as well as a combination of yoga and normal pushing (taking a deep breath and pushing the air down to the abdomen, then using the abdominal and pelvic muscles). While we pushed, our partners were instructed to count to eight, then remind us not to push too long and overdo it.

Along with this lesson, we learned three methods to help us not to push. "Stop pushing" is a common request by the health practitioner when the baby's head is crowning. Pushing often needs to be discontinued in order to keep the baby from being born too quickly, which can result in ripping for the mother or trauma to the baby's head or neck.

Methods to stop pushing all involved breathing lightly into the upper chest region. The techniques were "sniffing a rose"; breathing to hands held under the armpits; and "Tante Sidonia," a position named for a tall, thin Dutch comic strip figure. (My husband and I renamed this one "Olive Oyl.") Imitating Tante Sidonia or Olive Oyl by sitting in a straight-up position- with the tongue sticking out as a last resort-it's impossible to breath into the abdomen.

Anneke even spent some time talking about situations in which medical assistance might be needed, such as the use of forceps, vacuums, episiotomies, epidurals, and C-sections. Although we had all been practicing for months to have a smooth and natural labor, she wanted us to be aware of what other means might have to be used. As she spoke, I was amazed to realize how dedicated I was to having my baby totally naturally. I found myself hoping none of these techniques would have to be used. I had definitely come a long way.

Labor Day

Yoga classes had been over for a little less than a week. I was armed with my journal entries documenting what we'd learned in class, a "cheat sheet" summary that Anneke had written up, and the confidence that I understood what would be happening and had many options at my disposal for coping with childbirth.

On Monday evening, December 12, 1994, at 9:30 p.m., I started having slight pains. Remembering that these could just be prelabor symptoms, my husband and I lay down to read in bed. I couldn't concentrate on my book as the pains recurred every 20 minutes. Was this it? I felt excited, a touch nervous, and very well prepared, like a marathon runner who has trained for months and is now at the starting line.

About four and a half hours later, the pains were 10 to15 minutes apart. I'd been alternating between sitting in the cobbler position and lying on my side and cat-napping. I continued to breathe deeply to my abdomen as the pains hit me, and relaxed in between them, still wondering if this was really labor. If it was, I was amazed at how fast the time was going. Then my water broke with one of the contractions. This was really it!

Bob called the midwife, Meike Joosse, to tell her my water had broken, and we were instructed to call her back when the contractions had been five minutes apart for an hour. I continued as before, mainly lying on my side at this point, and was still able to catch a few winks of sleep, only half waking to breathe through the contractions.

Between about 4:30 and 5:30, the napping stopped, and the contractions began to come five minutes apart. We called Meike again at 6:00 a.m., and she came to the house to discover I was only two centimeters dilated. She told us she'd call the hospital and tell them to expect us, but we could stay at home as long as we were comfortable. In Holland, many people have their babies at home, so there's no rush to get to the hospital. Meike left and we went back to work.

Now the contractions were building, and my coach was in full swing and doing a great job. I lay on my side, and he talked me through the yoga relaxation techniques between contractions. He gave me pep talks on breathing to my abdomen, letting my muscles do their job, and riding the wave on each contraction until it peaked and I was over the top and ready to relax for the next one.

At about 9:30 a.m., Meike called to check on us, since we hadn't gone to the hospital yet. We were just doing so well at home, we didn't feel like leaving. About a half hour more, and we decided to head for the hospital. It was hard to get ready, as contractions were hitting me fairly often now, but I stopped what I was doing to breathe through them, and we made it to the car and then to the hospital by 10:20. The sitting-up position actually seemed to be a nice change of pace from lying on my side, and I continued to take advantage of it as I headed to the birthing room in my wheelchair. We met our nurse, Gerda, at 10:30, and by then the pains were quite intense. I tried sitting on the bed, but my feet didn't touch the ground and this was uncomfortable, so my husband suggested one of his favorite positions from class, the "contraction dance." We stood hugging each other and swaying to a rhythm that I determined (in this dance, the woman always leads!) as he whispered breathing and relaxation cues into my ear. Soon I was uncomfortable and wanting to try something else, so-arms folded and my head resting on them-I leaned against the bed. By this time, the pain was too strong to breathe to my abdomen, so Bob instructed me to breathe to my ribs-but I was having a little trouble switching over. Just as we practiced in class, he placed his hands on my ribs as a target, and it was immediately easier to focus my breathing to his hands.

At 12:00, nurse Gerda visited us again and was met by my rear end swaying in the air, with Bob next to me with his hands on my ribs. She stayed for a couple minutes to gauge the contractions, then told us she was going to call the midwife. We were getting close.

At 12:30, Meike was there, and an examination showed I was now seven centimeters dilated. She informed me I needed to empty my bladder and then things would progress much faster. I bravely said I'd follow nurse Gerda to the bathroom, but stopped to breathe as I was hit by two contractions before we made it to the door. They handed me a bedpan. I was on my side again for about another hour. I really had to work at relaxing between contractions, because they were so much closer together and lasted so much longer. I was starting to feel a new sensation-less like pain and more like pressure. My brilliant coach took time off from his back massages, pep talks, and forehead-dabbing to call the nurse and midwife back into the room. Meike told me I still had a teeny bit to go before I was 10 centimeters dilated. As they all stood around me, Meike and nurse Gerda asked Bob if we had taken zwangerschapsyoga, then said they could tell by my controlled breathing. Then Meike told me I could start pushing a little along with the new, different-feeling contractions. After so many hours of consistent, slow breathing, it was hard for me to switch to the pushing technique. I missed a couple of contractions by continuing to breathe steadily, until Bob reminded me to take a deep breath, hold it, and push while he counted.

That was all the reminder I needed-we were off and pushing. The midwife and nurse didn't recommend the yogic "press breath into your abdomen and count to eight" method. They wanted strong pushes using every muscle I had, and they wanted them to last as long as the contraction did. Who was I to argue at this point? I gave them what they wanted-and was amazed to see tiny dark hairs appearing in a mirror they held up between my legs. A few more pushes and the head was crowning. My dedicated coach told the midwife that I'd prefer no episiotomy, so she told me that I had to hold off the pushing when she told me to. Another push and she was telling me to hold off. I "sniffed the rose" with all my strength, taking soft little breaths high up in my chest. My uterus pushed without me while I was in the rose garden, Meike skillfully guided with her hands, and a dark head popped out, squinty eyes turning toward my husband. One more push (33 minutes of pushing in total) and our beautiful daughter, Nicola Lynn McCafferty, entered the world and her mother's embrace at 1:48 p.m., December 13.

Four hours later, Bob, Nicola, and I were back home, lying together in bed, ready to spend our first night together as a family. I had no stitches or tearing, no side effects from drugs, and was able to enjoy having two people whom I loved dearly near me. I also had a feeling of deep gratitude to Anneke and her yoga classes for a wonderful birthing experience, and a new pride and self-confidence that if the three of us could do what we just did, we could do anything.

Six weeks later, the yoga group was reunited. All of us (except instructor Anneke) had magically transformed from expectant parents to parents. We told our delivery stories; they were all different, but a common thread of confidence and calmness ran through all of them. We all sincerely believed the yoga classes, and the skills and knowledge we learned from them, were invaluable. u

Tracy Games McCafferty is a freelance writer and editor who has enjoyed living in Europe for the past five years. Before experiencing parenthood in Holland, she spent two years in Germany, where she wrote a children's novel and worked for Radio Free Europe.