Archive for category: Women’s Health

3 Tips for Teaching the Post-Partum Student

My last article left you at Sirsasana while I was 27weeks pregnant with twins. I had gained 14kg and was feeling fantastic on the mat and off. That 14kg turned into nearly 30 by full-term and Sirsasana became a calculated risk, but I still felt amazing, for the most part.

After our twins arrived, everything changed. I was shocked at how incredibly tired I was. Breastfeeding two newborns, totally sleep deprived and recovering from the birth along with a postpartum hemorrhage that left me anemic, all took its toll on me physically and mentally. I was trashed. I wanted to return to practice. I craved it. At times, I found myself longing for my old life and freedom on the mat. I imagine every new parent experiences something similar once the novelty of the first few days has worn off. It wasn’t until I embraced the change in my life and was ready to show myself a little compassion that I rolled out my mat.

From my experience, and my knowledge of anatomy, I want to share with you some valuable tips for teaching your post-partum students. Before sharing them, I will re-iterate that every woman is different and pregnancies vary. Recommendations on when it’s safe to return to practice vary and are highly dependent on the woman and circumstances around her pregnancy and birth.

Keep the following in mind when teaching asana to any woman after giving birth.

1. Don’t rush it.

Don’t rush the return to the mat and certainly don’t rush things while on the mat.

Returning to the Mat

Although an avid practitioner may be keen to jump on the mat just days after her bundle(s) have arrived, remind her that her body has been through a lot. It takes a few days just to replenish the calories lost during the work of labor and delivery, not to mention the sleep. It’s important to ensure that she has recovered from the initial physical and mental expenditure.

Further, if a woman has suffered any pregnancy induced injuries, it will take even more time. 25% of women experience Symphysis Pubis Dysfuntion during their pregnancy and some continue to have symptoms, indicating that more time is needed, well after birth.

Over 60% of women experience some degree of abdominal separation (diastis recti) in their third trimester or the immediate postpartum period. The gap takes a minimum of 4 weeks to close, and care must be taken when practice is resumed not to increase the gap and prevent healing.

On the Mat

There are many factors at play for the new mother that will affect what she brings to the mat. Sleep deprivation is almost a given in the early days. A sleepy body is a heavy body, so she must listen and approach practice as recovery, rather than something that will add to her lack of energy. Do what feels good. It will take some time to get back to a regular routine. There may also be some specific asana that need to be avoided or modified at first to encourage healing and rest. Encourage her to enjoy each breath she has on the mat as a chance to be healthy and clear her head in order to care for her newborn(s).

2. Let Go…

It is difficult in the beginning to understand that when you have children, you aren’t actually giving up anything . Instead, you are practicing vairagya (non-attachment). It’s ok to let stuff go. Actually, it’s imperative.

Past Self

As a new mother, she must take some time to mourn and let go of her previous life. This is not a bad thing. Babies do change lives and clinging to the “old” identity of “self” doesn’t do anyone any good. A seated practice can be very helpful in taking this needed time, without the physical practice to get in the way of clearing that image, in order to move on and be fully present as a mother.

Expectations of Self

Not only must a new mother let go of what she thinks she should be like in order to be the perfect parent, she must also let go of any expectations she has of her babies. Trying to be everything to everyone is impossible and often a stumbling block for new mothers. It can also assist in brewing post partum depression if a new mom fails to meet her own expectations.

Expectations of Self on the mat

It’s no secret that having a baby or two changes a woman’s body. Even a consistent practice through the entire pregnancy cannot completely combat nature. The body will shift. Some asanas will become impossible, others unsafe. After the birth, some of those same asanas will still be impossible. Possibly, what she was challenged with most physically as a beginner, will be easy and asana that used to be effortless will now require effort. It will take some time to build back the physicality. As her teacher, remind her, there is no rush.

3. Get to know your New Body

A woman’s body does not magically return to it s pre-pregnancy form after giving birth. This means she shouldn’t just pick up with asana where she left off pre-pregnancy. She should start at the beginning; building the foundation of primary series, regardless of what “level” she was at before she got pregnant. Her pelvis will feel different, her hamstrings and hip flexors will inevitably be tight, and if she is breast- feeding, her whole front line will be shortened. Starting at the foundation will assist in correctly realigning her body.

While these tips are extremely important to post-partum practitioners, they only scratch the surface of teaching students experiencing this massive spiritual and anatomical shift.
This June, Elonne and I are teaching “Yoga and the Female Body”, a continuing education course that will cover this and other practice considerations for women in more detail.

5 Tips for Teaching Pregnant Women in a Yoga Class

Many pregnant women look to start a yoga practice during pregnancy, and although they should go to a Prenatal Yoga class, what happens when they show up to yours?  Without the proper knowledge, it can be frightening to glance up at the group when your class is starting to see a woman with a baby on board.  Too often, pregnant women are actually ignored in classes, or just told to “skip this one” because the teacher doesn’t know what to do.  Here are 5 Tips to steer you in the right direction.

  1. Remember, she’s pregnant, not sick.
    There is a fine line between coddling and caring.  A Pregnant woman will like to have reassurance and be cared for during a class, however coddling her as if she was sick in bed with the world’s worst flu likely won’t turn her into a raving fan, nor will it do her much good to prepare her for the marathon of birth.  Providing her with necessary props and modifications, as well as quick check-ins to ensure she’s comfortable will provide her enough support and you the feedback you need.
  2. Encourage Rest.
    Always encourage a pregnant woman to take a comfortable resting position when she needs it. This allows her to monitor her own energy levels and not overdue it. Often women experience dizziness with positional changes in the first trimester due to their pregnancy-induced decreased blood pressure. Adequate rest is built into a prenatal class, as is a long side-lying or inclined savasana.
  3. Modify as needed.
    Deep closed twists are ill advised during any time in pregnancy and rather than have her sit and do nothing while the rest of the class breathes into Marichyasana C, show her how she can twist the opposite direction and stay comfortable and safe.  Every day will be different for her in terms of what feels good so be sure to check in and give her modifications on the spot as needed.
    This modification of Baddhakonasana opens the pelvis, allows for a release or lift of the pelvic floor and opens the chest and diaphragm

  4. Know the Do’s and Don’ts.
    Did you know that it is advised that women no longer lay supine once they are past 14 weeks? This is because pressure could be exhibited on the inferior vena cava, which would restrict blood flow. This, like many other things are quite specific in terms of what a pregnant woman should and should not do during a yoga class to remain safe, feel good and reap the benefits of practicing. High-risk pregnancies require even more attention.
  5. Get Educated.
    There are many reasons why Prenatal Yoga Teacher Trainings exist.  There is a lot to learn and understand about the physiology and biomechanics of the pregnancy journey.  A good course will cover pre-pregnancy and post partum topics as well as focus on pregnancy-specific practices.  Think about it like this:  All athletes can benefit from increasing their strength and basic fitness level, however, specialized sport specific training will better prepare them for performance at the highest level, is required.  This is the same for pregnant women.  Participating in a yoga class will bring them great benefit, however, working with a prenatal yoga teacher will help prepare her mentally and physically for both childbirth and the postpartum months of early motherhood. Also, learning how to teach prenatal yoga makes you a better yoga teacher overall.  In a prenatal course you’ll learn a variety of modifications that can also be used for beginners, in a restorative class or for students with injuries.

This barely scratches the surface. If you want to be confident teaching pregnant women in your classes or you’d like to start a prenatal program, you should check out my next prenatal course : “Prenatal and Postpartum Yoga Teacher Training” in beautiful Thailand.

Understanding the Female Body

A woman experiences two or more (depending on pregnancies) significant hormonal shifts in her life, which can dramatically impact what’s going on for her physically and emotionally when she comes to the mat everyday. If you are teacher, ask yourself… before you adjust someone in an asana, do you take into consideration what tendencies they are predisposed to because of their gender? Or, if the student is a woman, where they are in the female hormonal life cycle? The very fact that a woman’s body is designed to bear children, tells us it has some distinct features adapted for this miracle. As a male or female yoga teacher, recognizing and understanding these distinctions enables us to both educate and assist students thoroughly and sometimes, more safely.

Directed by the brain, the hormonal (endocrine) system takes women through puberty, pregnancy and menopause, contributing to different changes in bodily functions. These changes exhibit themselves in body structure, neural control and co-ordination, along with mental and emotional state. They differentiate men from women anatomically, physiologically and psychologically. This should not be interpreted to mean that men and women cannot accomplish many of the same things, but that the result may be reached in a different way.

I am a firm believer that no two people will look exactly the same in a given asana and that we need to account for individual differences and exceptions to any rule. However, when merely considering biomechanics, there are key anatomical components we look for in every pose. It is in those key components that being female (or male for that matter) can be the difference between finding space, or creating strain, when we align our body in a certain way. Understanding these can help guide us to whether a student, or ourselves, may need to focus on building support (strength) or improving range of motion (mobility) in a movement or posture.

Specifically, consider the changes in female bone, muscle and other supportive tissue that begin during the grand hormonal shift of puberty. With the ultimate purpose of preparing the body for pregnancy, these changes often create tissue laxity, or joint instability which, on a simplified basis, translates into decreased lower body co-ordination and increased hip and upper body flexibility, including the already mobility-oriented shoulder joint. Applying this information to Ashtanga asana practice, we must pay special attention to joint stabilization in women, and keep a close eye on their shoulder positioning during any asana that loads the upper body.

An important focal point for yoga practice, and another, perhaps more obvious example is in the pelvis. We cannot deny that women have a broader pelvis then men. A woman’s ilium bones (hip bones) are more outwardly flared, creating an open, circular inlet, which serves as the birth canal. This contributes a greater angle between the hip and the knee (called a Q-angle) and for some women, means an adjustment in the alignment of their feet or hips in some postures to reduce the risk of repetitive strain injuries in the knees or back. Women also exhibit a more anterior pelvic tilt, where the upper hipbones come forward and down, which puts a greater demand and higher injury risk on the hamstrings during straight-leg forward folding movements.

An introductory article such as this only scratches the surface of the complexity of the female body. We must also consider where a woman is at in her menstrual cycle and hormonal life as a whole. The processes happening underneath the skin, on a physiological, emotional and energetic level, have their own implications for a woman’s yoga practices. A deeper knowledge and understanding in these areas can be extremely helpful in providing insight for us and for our students.

Practicing During and Around Our Cycle

A Common Topic of Discussion

Questions that come up in every training and retreat — without fail! -reflect concern about a woman’s monthly cycle. And it is always surprising how many students deal with amenorrhea (absence of periods) or irregular periods.

Often students ask Paul, which many people find funny, considering that he doesn’t have direct experience. But then he is wont to point out (while smiling), “It’s okay because I have been a woman before in many past lifetimes.” He is comfortable discussing the topic and knows more about the topic than many female teachers.

We have all been mothers, fathers, men, women, etc. countless times. And we don’t need to tap into this storehouse of memories and past impressions to empathize with others,to understand what they are going through. We don’t need to have had a period in our presentbody to understand the female cycle. If our intention is to teach, or if we are teaching already, we should know how to advise our students, regardless of our gender.

As women, we need to give personal accounts, and there is the added responsibility to set a good example for our students by staying healthy. While it can be an uncomfortable topic in a co-ed classroom, we should have no problem talking about these things, which are natural and directly affect practice, whether talking in first person or not.

Growing-up with Sports

When I first heard about what a woman should and shouldn’t do in practice during her cycle, I thought it was stupid and archaic. I associated it with how they used to limit a woman’s physical activity in athletics because they were afraid it would hurt her ability to bear children.

I grew up very active – I swam on a swim team from age 3 until age 14, and I ran cross-country and distance track in high school and for two years of college. The attitude was always practice through menses. I dealt with bouts of amenorrhea throughout my teenage years due to stress, unhealthy sleep habits and a very strict vegan diet. Over-activity certainly didn’t help the situation, even though I don’t think it was the primary cause.

Intellectually I knew for years how serious the situation was. But it was my running coach at Bowdoin College, Peter Slovenski, who made me really understand and change; and ironically, he reached me through a very light-hearted, silly yet deeply caringapproach.

Amenorrhea is common among young, female runners. But Coach Slovenski promoted healthy running; he would always say, “Do it for the team!” That meant get our periods for the team. How we ranked or finished in a race was always secondary to our health and healthy attitude.

And he went out of his way to make things fun and stress-free. Distance runs would be runs like “Beans and Back,” which was running 9 miles to the L.L. Bean outlet in Freeport, ME and getting ice cream – or in my case, sorbet. The “Back” was optional, and usually after the ice cream most of us were content to hop in the van and let Coach drive us home.

One thing I have been blessed with over the years is some amazing mentors, teachers and coaches. I caught the problem in time, and my cycle has been very regular now for over 11 years, largely in part to Coach’s lasting influence.

Changing Over Time

I have been doing yoga throughout those 11 years, but in that time my opinion about practicing on my period has changed. I wasn’t as aware of subtle energy and the effect practicing had on my cycle when I was in my early 20’s; things that didn’t bother me before do now. And I wasn’t doing Ashtanga in my early-mid 20’s.

Physically, I have felt shifts in my body over the years. The processes of the body are living things, and like everything they change. Energetically things change as well. Every year my cycle is a little different and every month is also not the same. Our practice should make us increasingly aware of subtle changes.

To respect our cycle doesn’t mean to do the same thing every month, year in and out. Rather, it is to listen to what is going on and to adjust our practice accordingly. What we do this month will not be what we did 10 years ago, what we will do 10 years from now, and maybe not even what we do next month.

One thing Paul reminds me of is that “Nothing is lost.” If we need to alter our practice around our cycle we do not get in the way of our growth. In fact, by respecting the natural processes in the body we are better able to harness and cultivate the energy, and things are less likely to go off.

Ashtanga

Menstruation is an apanic process, like going to the bathroom. Anytime we over engagemulabandha and uddiyanabandhaduring our cycle we are messing with the apanic/downward moving energy, which can easily disturb our cycle. It would be like having to go to the bathroom but holding it in, on a regular basis.

Ashtanga works with mulabandha more than many other forms of asana. Some schools don’t even mention the use mulabandhaduring asana. Definitely watch that you are not overly squeezing mulabandha or you are likely to run into problems with your cycle, constipation, hemorrhoids, etc. It should be a more refined hold, the amount of mulabandha you use varying depending on the intensity of the pose. And a few days before your cycle it could be extra delicate and refined. During the first 2-4 days of your cycle, use only what is minimally necessary.

It is, therefore, advised not to do Ashtanga on the heavy cycle days (taking 2-4 days off). You might take the first two days of your cycle off, even though you could do some gentle or restorative asana. Some months you might decide to skip the third day as well. Other months maybe you find the day or few days before your cycle comes you need to ease up on asana, taking an extra day off due to fatigue.

By the fourth or fifth day (if you are still bleeding at all) you could get back into your regular practice. If you are into Second, maybe you take at least one day of Primary to reset the system. When you get back into your practice you will feel great, happy to have taken the time andgrateful to be practicing normally again.

I am not saying everyone should do the same thing, but every woman should try to find what works for her. We should never listen blindly, but we also don’t want to ignore what we hear or read without taking it into consideration and making sense of it for ourselves. Each of us must figure out a way to practice that is supportive of ourindividual monthly ebb and flow.

What to Practice in Asana During Our Cycle

Of course people know not to do inversions. But a lot of times you will see women modifying their pranayama and skipping the inversions while continuing to do everything else full-on in asana practice.

A lot of jumping (particularly in the Asthanga practice, when the hands are on the ground and you are really working mulabandha), deep binds and twists that work with the internal pressures in the body, any postures that put the feet in lotus or foot in half lotus, anytime you are required to sit on your heel or press your heel into your pelvis (i.e., Janushirshasana B and C), and any poses that require a great deal of pelvic floor support should all be avoided.

That doesn’t mean we are invalid. Exercise, gentle stretching and restorative asanascan help ease menstrual symptoms. But you might prefer to go for a walk, swim, easy run, etc., which do not require the same mulabandhaactivity, even though you always need some. And of course other exerciseand stretching are very different from the asana, but I am speaking in terms of being active.

Some great poses to hold during your cycle days are: Trikonasana, BaddhaKonasana (more on the passive side, without too much mulabandha activity, and you could have the legs further out in front of you), UpavishthaKonasana (also more restorative and passive than normal), Pigeon (simple version), Hanumanasana (assuming this pose is not too uncomfortable for you), SuptaVirasana and Matsyasana. Restorative poses with bolsters and blocks are also therapeutic.

What to Practice in Pranayama During Our Cycle

Assuming you practice pranayama, anything that overheats or overly engagesmulabandha and uddiyanabandha should be avoided. Therefore, retention work is skipped the first 2-4 days of our cycle. Surya Bhedana, as well asNauliKriya, Kapalabhati and Agni Sara are also skipped the first few days. However, by the end of our cycle Nauli can aid the final elimination process, and a light Kapalabhati is also fine, even beneficial.

You might also find that the few days before your cycle you need to lower your retention count because the internal pressure is off. And maybe the day or two before your period comes you need to do your cycle practice if you feel uncomfortable.

It is important that we sit, no matter what. But what we practice when we sit will change, depending on the time of the month. You may also decide to do some extra chanting or japa/mantra repetition during and around your cycle, which is very soothing.

Avoiding Injury

One thing I have found is that when I get injured (minor/small things or major ones), it is almost always around my cycle. Mostly this is – I think — because my connection to mulabandha is a lot less, so there is extra strain in other areas of the body to support me.

Normally I am surefooted, but around my cycle I am more clumsy and I lack grounding. I am not as mindful as I normally am and, therefore, it is easier to pull or strain something in practice or when adjusting in Mysore. Knowing this about myself forces me to be extra attentive, to watch the gaps in my awareness and to ease up, doing 70% or less of what I normally might in asana practice, and being extra attentive to my own posture when adjusting.

And with fluid retention, aches and pains, joints being more open, etc., there is all the more reason to back off and modify practice as needed. Again, “nothing is lost.”

Amenorrhea or Irregular Cycle

If you are missing your cycle or are very irregular, you should take the days off each month that would normally be during your cycle. Everyone needs time off, even men. Physically days off are needed, and mentally they are even more necessary. Do your cycle pranayama practice on these days as well. Pretend you have it, respecting it even though it is absent. Also make sure you are regularly taking at least a day or two off from asana each week.

And make sure that your entire practice is always enjoyable. That doesn’t mean it is stimulating the senses, fun and exhilarating every day. Instead, it should bring a sense of inner calm and stability, regardless of how it feels physically. It should allow you to go inwards, taking you beyond the sensory effect of the practice. And if you are overly tired, achy, negative, overly distracted while practicing, etc., these are signs you are overdoing it.

Also look at other factors, like food. Make sure you are getting enough iron, protein and healthy fats in your diet. For me, protein was a huge factor. Not only was eating more solid sources of protein important, but also being able to relax a little with myself and not be so strict with my diet was a big stress release. It was part of a process of letting go, which I am to this day still working on.

I am not saying that veganism is bad, but it is very difficult – for me it was not possible at that time – to be vegan, be very active and stay healthy. It also depends on where you live (what foods and supplements are available), your genetics, your age, what you grew up eating, your approach and attitude towards diet, etc. It is for you to look at and assess for yourself. And allow yourself the freedom to change your mind. Never identify with what or how you eat or take food or life too seriously.

Another huge factor is stress. Look at outside strain from work, family, relationships, etc. If you are going through a very stressful period, you might want to modify your practice. Keep practicing, but maybe do less, and/or with less intensity, on days/weeks you feel particularly stressed. Sit each morning (at least for 10-20 minutes), but maybe cut your asana down to 3-4 days a week (if you are doing more than that).

Our practice should give us the energy and focus we need to do everything we need to do in the day; it should not make us want to go back to bed. It should make us peaceful, instead of robbing us of our peace. It should make us less stressed rather than adding to our stress levels. And it should support a positive outlook and a balanced way of life that free us, rather than promote unhealthy patterns and behaviors that imprison us.

Let’s all enjoy our practice and stay healthy!

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