Pregnancy can be uncomfortable and overwhelming. By combining the benefits of prenatal chiropractic care and prenatal yoga women can enjoy a healthier and easier pregnancy.
Let’s start by describing what prenatal yoga is, what it is like for someone who has never tried it and could you walk us through a typical prenatal yoga class or session?
Deb Flashenberg: Yeah, absolutely. So, I’m going to speak from the methodology that I created because every type of yoga is going to be a little different. So, I’ll speak on what I created. Now I also created it because of my own experience as a doula, a Lamaze teacher, but really also because of my own first birth which I was a little surprised by. I thought it would be easy. I’m like this is what I do. My baby should just walk right out. But it didn’t. It took about 42 hours. And so, what I learned from that experience is the importance of a balanced pelvis and balanced pelvic ligaments. And as chiropractors I’m sure you guys can totally understand that. So, my methodology is really about creating more function in the body. So that’s how I approach my class.
So, we start every class with what I call circle time and that’s where we check in with the students. So, I want to hear their name and how far along they are, whatever aches, pains and issues they bring to class that day. And that’s how I decide what needs to be done in class. I don’t want to come with this idea of like, oh, we’re going to be doing squats and then half the class saying, oh, my baby’s breech or I have placenta previa. So, it’s really based on the needs of the students.
And then we usually do some sort of restorative just to get connected to the body, the breath, really turn the mind off of everything on the outside world. Then I start, I bring them out of that, and I always have some sort of theme and it tends to be childbirth educated related. And from my background as a Lamaze teacher, I find when we can interweave these themes in class, it can be a really impactful, digestible way to learn about childbirth. So many times, when people sign up for their childbirth ed classes, it can be kind of nerve wracking, like okay I’m here, I’m ready to learn everything. When we can interweave it in a really casual way, I think it really can hit home and make it a little deeper.
So, then we start the class kind of warming up. Then from there it’s a typical yoga class with focus on balancing the pelvis, the pelvic ligaments. I’m not sure if anyone’s heard of spinning babies, it’s a methodology to help fetal alignment. And so, we interweave that through the asanas but we also have a fair amount of time at the end where we focus on the pelvic floor and on balancing the pelvic floor.
I think too often people are told when they’re pregnant, oh, you know, just do Kegels. And while they have their place, oftentimes it can lead someone too engaged in their pelvic floor. So, we spend a fair amount of time in class focusing on balancing your pelvic floor. Does it need tone? Does it need release? We also do a section of class where we work on the transverse abdominus to train those muscles because they can be incredibly important for pushing the baby out or for healing on the other side of the surgical birth.
And then we end with some restorative poses. So, it’s a 90-minute class that resembles the typical yoga class. We do our warrior poses and our down dogs but with a lot of awareness of the modifications that are needed for the anatomic and physiological changes of the pregnant body and really how can the yoga support a functional birth. So, that is our typical class.
RC: Thank you for that explanation.
So now for Dr. Rubinstein, we know that there are many different techniques that chiropractors use to treat patients with different conditions. Can you describe the techniques used to treat pregnant women?
Dr. Gregg Rubinstein: Absolutely. So, the primary technique that we’re going to use with the expecting mom is the Webster technique. It’s a specific chiropractic analysis that really analyzes and looks at the sacrum and adds diversified adjustments into the mix. The goal of the adjustment is to reduce the effects of sacral subluxations or misalignments, which is typically associated with sacroiliac dysfunction and in doing so, we can kind of work on the function and the alignment of the pelvis. The pelvis is really designed for a lot of mobility. There’s a lot of movement that occurs in it. And particularly during the birth process, the pubic symphysis is going to spread. The SI joints, it’s really important that they’re moving well. So, when they get turned out or they get locked up, it affects the way the soft tissues work in the pelvic floor.
So, the Webster technique will basically unlock the sacrum in the sacroiliac joints and relax the ligaments of the pelvis, particularly looking to work on the ligaments that attach to the uterus. So, we have the uterosacral ligament, the round ligament and the broad ligaments which basically suspend the uterus inside the pelvis. And if we can get all that balanced and those ligaments relaxed, it will allow for the most expansion during the actual birth and facilitate that. But also, by relaxing the ligaments that actually attach to the uterus, it relaxes the uterus and it keeps it in, I guess the best way to describe it as, the most open position where there’s the most room for the baby to flip and turn. It’s really a specific technique that just analyzes the sacrum and uses some gentle drop techniques and some techniques to relax the ligaments and when everything’s relaxed and easy, it just supports an easier birth and all the research shows that if you do the Webster technique up and through delivery, it usually results in shorter delivery times and less need for interventions and less pain.
So, a lot of moms will come to our office seeking relief from lower back pain or pelvic discomfort but in addition to that, we offer the Webster technique all the way through not just to alleviate symptoms, but to help facilitate the mom for an easier pregnancy and an easier birth.
Deb Flashenberg: Can I pop in and say something about that? I did that with my second and I really, I really credit the Webster technique to literally six minutes of pushing my second one out. I tell all my students about it. I think the combination of the Webster technique and the yoga for so many people can, as Dr. Gregg was saying, align and soften the uterus. When the baby is well positioned in there and the power of the uterus pushes baby down, it’s just more functional. And so, I just cannot speak highly enough about the Webster technique and it’s just so imperative for pregnant people.
Dr. Gregg Rubinstein: You know that’s really great. I’m sorry to cut you off, Liz, but you know just for anyone listening, Deb did a really awesome podcast a couple of weeks ago. I think it was like July 23rd or something that she talked about the pelvis. And when I watched that, Deb, I was just like this girl is practically a chiropractor so that was really telling and a great one and I highly recommend anyone listening to check out Deb’s podcasts, especially that one because it’s really apropos to what we’re speaking about.
RC: This is the perfect combination we have on here today. So, thank you both. It sort of leads right into the next question that I have for you both.
For women complaining about low back pain, swollen legs and other discomfort, could a combination of prenatal chiropractic and prenatal yoga help them feel more comfortable throughout their pregnancy?
Deb Flashenberg: I’m going to give a big resounding yes. Well just yes. I’ll go for it. So yeah, absolutely. Let’s talk about the lower back pain. So, when I have students come in, talk about lower back pain and that’s really the number one reason, the number one issue that most pregnant people have sometime throughout their pregnancy. Especially because when we look at the pregnant spine, as the belly gets bigger, all the curves exaggerate. The lumbar gets more swayed. The upper back gets more kyphosis. The chin sticks out. I call it the chicken neck. So, all of that contributes to a compressed lower back.
So, I’ll try to figure out where they’re feeling the lower back pain. Is it just a general lower back, most likely the QL, the quadratus lumborum or is it more isolated at the sacroiliac joint? So if it is, and I’ll ask them, especially now that we’re on Zoom and I can’t get my hands on them, I’ll say like point to where you’re feeling and if they’re showing me the SI, then I’m going to work on stability as well as releasing the piriform, it’s that muscle that goes from the sacrum to the greater trochanter.
If they’re just saying general lower back pain, then we’re going to try to release that QL. We’ll do like rocking cat cow. That’s when you get on all fours and you open your chest for cow without heavily dropping the belly, and then you round your back for cat and then I’ve added what I call rocking cat cow. You pull your hips back a little and it really gives that nice stretch to the lower back. Down dog is great to do that. Downward facing dog will really elongate those curves of the spine.
But when they do tell me SI issues, we have to be mindful because some of the yoga poses can actually worsen it. Typical poses that are used in most classes like warrior one, that can actually draw one hip back further and more posterior and the other one tipping anteriorly which is going to create that pain. So, we have to make sure that we’re understanding what the lower back pain is and then addressing that.
And swollen legs, that’s so common. That’s so unfortunate but it’s so common. So, movement helps, kind of moving the blood through. We can do some sort of legs up the wall or one I call the single leg drain, that’s just one leg up the wall so the person can be on their side. Then I also have a few things that remind them that they can do that’s not yoga related. They can do compression hose. They can make sure they hydrate. They can do an Epsom salt bath.
So, yeah, there’s lots of things that when there’s pain or discomfort that yoga can absolutely address.
Dr. Gregg Rubinstein: And if I can chime in a little bit, Liz. Really from a chiropractic standpoint of it and really when you look at what they’re doing in yoga, they’re moving, it’s really about that mind body connection. I always kind of tell people yoga is kind of like programming the software, whereas a chiropractor is really going to be working on the hardware and making sure that everything is connected properly so the software can actually do its job and execute it.
And by keeping these moms moving, that does cause muscular contraction which keeps pushing the blood flow and the venous return which helps with the drainage and the swelling of the legs. Most moms when they’re in pain and do these things, they stop moving around and motion is really life and that’s what keeps the spine healthy and everybody moving. And then we use some of the more traditional chiropractic techniques to kind of work with the spine and get pressure off the nerves. Because when those curves start to change, the center of gravity is moving forward which loads the joints of the spine differently. So, they get more likely to subluxate or misalign and then that can put pressure and irritate the nerves and that can make the muscles tighten. It creates this vicious cycle that can keep going through.
But if you keep stretching and moving them and you do the proper adjustments to get the pressure off the nerves, when you combine the two, I see excellent results and most of the moms that have come to me that have been referred from the prenatal yoga centers are already moving and they’re more in tune and in touch with what we do and we just seem to get great results with those referrals. So, it’s really been a wonderful relationship. And we both kind of work with the same tribe so it’s been a really nice match and I’ve been grateful for the amount of referrals that we’ve been able to give back and forth.
Deb Flashenberg: Absolutely. Really our work complements each other because we have the same mindset about just trying to have the end results of a functional birth, align everything inside so that baby can come out more easily.
Now my next question, probably for Deb, for pregnant women who are not able to exercise the way they did before their pregnancy, can prenatal yoga provide a good workout?
Deb Flashenberg: I think it can. Again, I think it’s how you address it. When I was first starting to do prenatal yoga, this was a while ago, this was back in like 2002, there wasn’t a lot out there and this is when I was still in my twenties, far away from having kids. I wanted to see what types were out there. And I saw some that were very strenuous. I found some that were literally, they seem to approach pregnancy like the person is broken. And you’re not sick or broken when you’re pregnant, you’re just pregnant. So, I think it’s how one approaches this.
The methodology that I teach, we really do give a solid workout. I think yoga is different than a workout, but we definitely can find that balance between strength and a conscious stretch. We want to have that power of strength because we need to build that endurance because labor, no matter how you’re approaching it, it takes endurance as does parenthood, more mental endurance. So, it definitely takes strengthening. And we do a lot of that. We do a lot of standing poses that can give strength, but it’s also important to find conscious stretching, especially because we know that when someone’s pregnant, all their hormones are so much juicier and everything’s more lax. So, when we stretch, we don’t want to just do passive stretch. We’re doing conscious stretch so we don’t overstretch.
So, I think the combination of strengthening and stretching is a really great way to keep strong mentally and physically.
Now the next question, probably for both of you, could you please explain how receiving prenatal chiropractic care and participating in prenatal yoga throughout pregnancy can help women have an easier birthing experience?
Deb Flashenberg: Oh, I love this question. Yeah. I’m going to jump in on that. So, I think there’s many things about prenatal yoga and having an easier birth experience. We touched on some of it already about aligning the bony pelvis, the soft ligament, the soft tissue, the ligaments of pelvic floor. We talked about how we can use the abs for the pushing stage. So, we know physically we can get the body there, we can help align the body. So basically, when the pelvis is aligned, we talked about how the uterus is aligned, baby can be better positioned, that the function of the uterus during labor can push baby down. The smallest part of the baby’s head opens the cervix. So that’s just going to lead to, I don’t want to use the word easier because having birthed two kids myself and having been a doula for more than a hundred births, I wouldn’t say easy, I’ll say functional. I don’t want to lie and make people think it will be easy, a functional birth.
But I think there’s also something to be said for exploration of coping skills. And that’s something we do a lot in prenatal yoga. I want them to purposely have sensation, safe sensation, so they can explore what their coping skills are. It’s one thing to do it in a childbirth class and just theorize about like, oh, I’m going to try this or I’ll do this, but if we’re actually uncomfortable, they can see what do they go to? They go to closing their eyes. They go to focusing externally. Do they go to making sound? We know that when the throat is relaxed, the pelvic floor is more relaxed. Do they go to mantra? So, we have all of these coping skills that people can explore. And then that leads to confidence that they can go in not being terrified of what birth is about but feeling confident that they’ve got the skills to get them to wherever they need to go as well as advocate for themselves.
So that’s where I think prenatal yoga really can be rich and juicy, that it’s so much more than just than just asanas. And we also learned, there’s a study done years ago that through this work of the prenatal yoga, we can raise the threshold of reaction. So, where someone maybe two weeks into it was reacting three breaths into a pose and then they build that endurance and they raise that threshold where now they’re five breaths in or eight breaths in. So, it’s just so rich to approach birth and have the confidence and the skills and the body and mind ready to give birth.
Dr. Gregg Rubinstein: And if I may jump in a little bit on this one, Deb, I love that you’re always going with the head space and that mind, body connection. Fear is a big problem in a lot of the moms because sometimes they’re at the OB/GYN and they’re like, well, if this baby doesn’t turn by such and such a date then we have to do a C-section. We always tell our moms-to-be that you can’t drop a baby when you’re running from a tiger. If you’re totally adrenalized and your body’s in sympathetic overdrive and everything’s tight, it’s really hard. You’re not going to dilate. Everything’s going to get slowed down and it’s really important because the neuro regulation of the birth process is really what chiropractors try to effect by making those corrective adjustments and improving the connectivity or making sure there’s no irritation to the nerves so the signaling from the brain to the body. Because as soon as that baby’s ready to breathe oxygen, it’s going to send a message up to mom’s brain and that starts that neurological cascade. And if the bone, and the pelvis, things are out of alignment and irritating the nerves, could you imagine if those messages from the brain aren’t getting through clearly or they’re distorted? It’s going to slow down the birth which is called dystocia which is a slow labored birth, usually in response to uterine constraint when the ligaments are tight and the mom is tight.
All those things come into play and a chiropractor and the prenatal yoga are addressing kind of the same things but using a different approach. So, it’s multifactorial in all of that. It’s so important that we do the preparation and we get the moms prepared. I love what you touched on about the fear, because some of the moms they’re coming in, they’re actually genuinely scared of, “Oh, well, if this doesn’t happen in such and such a time…” and I’m always telling them, “Look, you’re not really breech until you’re 37 weeks and breech.” They’re coming in early and they’re already nervous.
I love that Deb is always working on their head space and calming them down. I kind of work on the same thing and since we’re both mind, body practitioners, it really just meshes up so well giving the moms a great experience. I know that more of them actually end up having the type of birth that they want when they’re combining the two. So, it works really well together.
Now my last question, what are some prenatal yoga exercises pregnant women can do at home on a daily basis if they can’t fit an entire class into their schedule?
Deb Flashenberg: Oh, that’s a good question because I will admit our classes are 90 minutes. So, it is a bit of a commitment. I’m quite a fan of cat cow. I was talking about that earlier, where we get on all fours and we work the spine. I especially like that one as well as rocking cat cow where we draw the hips back.
I also refer to that with the students. I remind them that babies are subject to gravity and the heaviest part of a baby is the back of their head and their spine. So, when you get on all fours, the belly can be like a little hammock and we want that baby’s spine anterior in the hammock of the belly. That is going to again help align up for a more functional birth.
I also do something that I pulled from the Spinning Babies’ methodology. It is a forward-leaning inversion. Now they teach it, Spinning Babies teaches it with knees on a couch. I do it a little bit differently where I have people have their feet pretty wide, maybe three to four feet wide, turn their toes slightly in to get that internal rotation, and then they bend their knees, lean forward, lift their sit bones up and then their hands are on blocks in front of them and then they’re slowly trying to straighten their legs. So, we get that internal rotation which is going to widen the sit bones, lift the tail so we get the nice stretch of the pelvic floor. We also get the uterus gently pulling away from the pelvis so it can help balance the round ligaments. It can help with what Dr. Gregg was talking about, that intrauterine constraint. So, that’s one of my favorites. I tell people do that every day, about five breaths per time.
And then restorative poses are really nice. There’s one of my favorites called supta baddha konasana. We want to incline the person to be about 45 degrees so they’re not flat on their backs. Then with feet together, knees apart, if they don’t have SI issues, and they can wrap a blanket or a towel or something underneath their shins or knees so their knees aren’t flopping and that’s just a nice way to open up the front body as well as get some nice diaphragmatic breathing. That’s good for the nervous system. It’s good for the pelvic floor.
So, those are kind of my go to, a little cat cow, a little forward-leaning inversion, a little restorative, maybe if there’s neck and shoulder stuff but that can be a 15-minute practice.
To speak with Dr. Gregg Rubinstein, visit www.ChiropractorMidtown.com or call (212) 977-7094 to schedule an appointment. To learn more about Deb Flashenberg, visit www.PrenatalYogaCenter.com or find her on Instagram @prenatalyogacenter.