Subjective:
ET lives in the city with her husband and 10 month old son. She returned to work about 5 months postpartum. Had an uneventful vaginal delivery without complications, repairs, and interventions. She is currently breastfeeding & pumping 3-4x a day but not at night.
Primary goal was to get moving again after returning to work (mostly sitting during the day) and juggling 10 month old.
Secondary goals are improving energy and sleep. Reports having a restless mind & trouble getting to sleep and returning to sleep if woken.
Occasional Low Back Pain (LBP) treated with monthy chiropractic (sometimes every 2 months).
Has time in early morning (8:30am) while son is sleeping to practice yoga/ yoga therapy homework. Open to having a routine and open to meditation.

Objective:
ET lacks a clear schedule for going to bed/ sleep hygiene. While ET spends time on weekends resting, she does not have much down time for herself to rest during the week.

Assessment:
ET is a typical new parent who is finding it hard to balance self care, work, and childcare responsibilities.
Annamaya & Pranamaya koshas seem to be in tamas (sitting at work long periods, feeling low energy) while manomaya & vijnanamaya koshas appear to be in rajas (unable to settle her thoughts and put down the "to do" lists).
Physical virtual self assessment showed no signs of diastasis recti. During ET's pelvic floor self assessment for coccegeous tone and coccyx alignment she self reported that she felt some release afterwards. As she has some infrequent but reoccurring low back pain we focussed on transversus abdominal (TVA) activation with the breath. At 10 months postpartum she is in a good place to work on deep core strength and some functional skills like sitting up, forward weighted poses, and general strength and mobility.

Shhhh breath, Reverse kegels as taught by Lara Kohn Thompson & Dustienne Miller, Knee fall outs, knee folds, & for TVA engagement, and restorative half moon to assist with potential holding patterns in thoracolumbar fascia. We finished with viparita karani and a body scan.

Post Assessment Homework: Go through a body scan before bed or if she gets up to care for her son and has trouble getting back to sleep.

Plan: Setting a regular sleep and movement routine to help to ensure she gets this time to care for herself mentally, physically, and energetically.

Pranayama:
Elongated Exhale 2min
Alternate Nostril Breathing 2min
Shhh during exertion/ effort in practice or in life

Asana:
Neck stretches, cat/ cow seated, chair pose 3x for up to 10 breaths, child's pose reverse kegel/ pelvic downtraining, bird-dog alternating 6x, box pose, cobra 3x, bridging 3x, side lying abduction for overflow into pelvic floor, reclined twist bilateral, legs up the wall for up to 2 mins, piriformis stretch at the wall.

Mindfulness/ Meditation/ Relaxation:

Intention Setting

Seated meditation focusing on the in and out breath -for 108 breaths

Body scan in bed before sleep or getting back to sleep

1) Buttner MM, Brock RL, O'Hara MW, Stuart S. Efficacy of yoga for depressed postpartum women: A randomized controlled trial. Complement Ther Clin Pract. 2015 May;21(2):94-100. doi: 10.1016/j.ctcp.2015.03.003. Epub 2015 Apr 1. PMID: 25886805.
"The yoga group experienced significantly greater rate of improvement in depression, anxiety, and HRQOL, relative to the control group with moderate to large effects... 78% of women in the yoga group experienced clinically significant change."

2) Shohani M, Badfar G, Nasirkandy MP, Kaikhavani S, Rahmati S, Modmeli Y, Soleymani A, Azami M. The Effect of Yoga on Stress, Anxiety, and Depression in Women. Int J Prev Med. 2018 Feb 21;9:21. doi: 10.4103/ijpvm.IJPVM_242_16. PMID: 29541436; PMCID: PMC5843960.
"12 sessions of intervention as hatha yoga exercise signigicantly reduced stress, anxiety, and depression in women."

3) Moszeik, E.N., von Oertzen, T. & Renner, KH. Effectiveness of a short Yoga Nidra meditation on stress, sleep, and well-being in a large and diverse sample. Curr Psychol 41, 5272–5286 (2022). https://doi.org/10.1007/s12144-020-01042-2
Even "an 11-min Yoga Nidra meditation that may especially be integrated in a busy daily schedule by people who can only afford short time for breaks... showed lower stress, higher well-being and inproved sleep quality after the intervention."

• Yes

We followed up and discussed the care plan & plan for the session.
Practiced the pranayama & asana and modified a few practices to make them less/ more challenging.

Gave homework to set an intention/ write an affirmation that she connects with.
Additional homework was to follow the asana portion of the care plan on 2 weekday mornings (without the meditation). Also to practice the body scan & naddi shuddi anytime it is challenging to go to sleep or get back to bed.

ET seems motivated to have a regular self care schedule for herself.

I offered a lot of practices to ET this week which may have been too much. I think she is eager to do more but I may have tried to hard to fulfill that desire rather than provide appropriate pacing. I am concerned this may not be an achievable amount of work to add in one week.

Plan for next week adjust the care plan if needed, focus on meditation and set meditation practice to 2 min a day. Check in with client if this is best before asana in the morning or before bed at night (or another time).

• Yes

Followed up on how last week's homework went. We discussed options for meditation. S. Ashokananda's counting meditation from Raja TT seemed like it might work for her. She said she has counted before for her hypnosis practice in the past and feels it is helpful. We set the goal of daily morning meditation 108 breaths counted.

We worked through all her asana practice from her care plan & added on some nod & curl for rectus abdominal stregth too. We also added single & double leg lift in flexion supine (chest raise similar to a crunch but different focus). Exhale on effort to decompress the Intra-abdominal and pelvic pressure associated with this movement. We skipped the side lying leg lift and clam & the viparita karani and practiced a tense & release and yoga nidra instead.

Counting (108 breaths) meditation daily in the morning, Asana 2x a week, and Yoga Nidra every evening this week if possible.

ET practiced her asana last week and reported some some muscle soreness after last session which she liked. However, I am taking note of the soreness to see how she feels after practice this week.

ET did not pick an affirmation or word to set an intention and shared that she didn't feel aligned with that practice. So we discussed other options for her meditation and chose counting the breaths.

I am glad that ET was able to share that intention setting did not seem like something she felt connected to. This made me feel like we broke a bit of a barrier and she is feeling more comfortable to share her likes and dislikes.

Add the new core strength work to the asana homework that we practiced in our session this week.

• Yes

We started with a follow up as the past 3 weeks ET and I had not met due to colds and cancellations. ET had a relapse of TMJD symptoms and a persistant headache which she sought emergency medical care for as well as chiropractic. She said it was just a pinched nerve due to stress most likely. So we worked on some standing and supine asana for postural support: deep neck flexor & paraspinal strength and pec, neck, back, & ab releases. In addition, we practiced face stretches and the "penetrating of the layers" that Arturo Peal teaches in Therapeutic Yoga.

Homework was adapted to 54 breaths and trying to get to it as frequently as possible and 5-10 mins any other practices that feel supportive from her care plan as needed during her baby free time.

Client reported persistant headache that she sought care for over the past 3 weeks. The pain has meant she had to take a break from some of the asana practices but she did say that she was practicing them regularly prior to that. The practices she has returned to most are naddi shuddi when she is woken in the night by her son and unable to get back to sleep as easily; body scan/ yoga nidra meditations in bed, viparita karani (daily), & neck stretches and cat/cow. Although she has not been able to sit or practice meditation as much since the headache started she said that she has been sleeping better overall since we started and that she did feel less stressed and more balanced after doing the seated meditation.

Initially I thought that the headache and missed sessions were a set back to ET and her goals. But on deeper reflection, ET did seek out the practices that soothed her most. This revealed a better plan going forward of less asana practices for postnatal strength and more focus on targeted stress management.

ET originally came wanting to get moving again and regain energy. Through the set back of several cancellations and tension/ headache the underlying bigger issue of stress became glaringly evident. As a result, the practices she was most consistent with were in fact the practices she needed most. The body scan/ yoga nidra, viparita karani, neck stretches and cat/cow were all things she practiced despite colds, stress, work, childcare, and a persistant headache.

Although she did not practice meditation as regularly, she did practice alternate nostril breathing at night somewhat regularly. She noted that she's been sleeping better overall since starting. Additionally, on days that she did practice the counting meditation she noticed feeling less stressed and overwhelmed. At the start of our work together ET filled out a PSQI short form and repeated it at our 4th session together. There was improvement in getting to bed within 30 minutes, waking in the night, going to the bathroom at night resolved all together, and dreams were less frequent and enthusiasm during the day improved conservatively.

These sessions taught me that less is often just what is needed especially with people who are busy and have rajas tendencies. Even though this client requested a routine to get moving, it does not mean movement has to be the main focus of the care plan.In fact, the care plan may support that focus better by addressing deeper issues and patterns. Focusing on practices that most support ET's whole being, not just her whole body, became the key to consistency for her. In the end she sought the right plan for herself and revealed it to me.

I feel that I would work on a new plan of the practices she was most drawn to and reduce all other home practices. Our sessions could be focused on asana and homework could be focused on the stress management tools she had kept practicing over our 3 week break.