SDS is a new small business owner and mother to a 5-year-old boy & 10-month-old girl. Her main goal was not clear from the initial intake. After clarification, SDS expressed that she would like to build some supportive postnatal practices involving movement, stress management, and time management to maintain home/ work boundaries.
SDS has been seeing a Pelvic Floor PT for the past month but did not see anyone immediately after birth. She had a routine non-traumatic & uneventful home birth with her daughter. She has a history of hip, leg and pelvic trauma on the left that involved a reconstruction, rod and screws. It can be uncomfortable to lay in side lying without cushioning on her left for this reason. She has completed PT for now but has been practicing homework occasionally. She is working on 3x10 bilateral clamshell, bridge on ball, modified side plank lifts (on forearm with bent knees), rollups on the physio ball, and containment holds /palpation focusing on left labia bulbospongiosis, ischiocavernosis and adductor attachments. A small movement practice & breath practice could be useful integrating principles from where her PT homework left off.
SDS self-describes as a spiritual person and follows the messages the spirits give her. She has a number of healthy habits in place. Such as a morning body scan visualizing light entering each layer of her being as she wakes and lighting a candle setting an intention. Also, regular journaling and list writing to help organize her thoughts. In the evening she has a routine guided meditation practice that she listens to. That said, she does not always practice these regularly and typically has no set schedule fitting things in around her work and family’s fluctuating schedules.
Recently, sleep & energy has been an issue. Her daughter still wakes to nurse several times in the night. We discussed doshas and how time is split throughout the day in Ayurveda. SDS expressed a real interest in this and setting up some regular bedtime routines. She mentioned that she struggles with managing time efficiently and would like support with this to avoid burnout as well.

Post Assessment/ Intake HW: Write out what the ideal bedtime routine would look like so we can discuss it next time. Aim to put down distractions and go to bed at 10pm at least 3 nights in a row between now and next week.

Practices that she has already created for herself:
Morning Intention Setting Practice - 5 min (light candle and practice guided meditation of lighting your own inner flame for the day)
Journal as needed throughout the day to reduce metal load and preserve peace of mind
Sleep Ritual 30 min each night prior to bed (ideally starting around 9:30pm)

Chanting, Pranayama, & Asana: 10-20 min (during nap/ playtime every day)
Elongated Exhalation, Brahmari, LAM Chant 3x
Pelvic tilts with the breath, articulated bridging, single leg bridge with hip disassociation bilaterally, bridge on the ball (from PT homework), adduction with ball, double leg lift 90/ 90 with the ball, + knee extensions, chest raise (navasana preparation), knee fold, toe tap, pelvic tilts, roll back/ sit up, cobra pose, downward facing dog on forearms + dolphin plank holds, side plank (on forearm) + 3 hip dips bilaterally, clam shell bilaterally (from PT homework), supine twist bilaterally, viparita karani & piriformis stretches at the wall for 2mins.

1) Ayurveda Manual - Durga Leela

2) Yoga for Pelvic Pain Manual - Dustienne Miller, MPT, WCS

3) Boybay Koyuncu S, Yayan EH. Effect of Postpartum Yoga on Breastfeeding Self-Efficacy and Maternal Attachment in Primiparous Mothers. Breastfeed Med. 2022 Apr;17(4):311-317. doi: 10.1089/bfm.2021.0320. Epub 2022 Feb 10. PMID: 35143340.
"After yoga practice, there was a statistically significant increase in the breastfeeding self-efficacy and improvement in the maternal attachment of the experimental group (p < 0.05). The corresponding increase and improvement of the mothers in the control group were less than those of the mothers in the experimental group (p < 0.05). "

4) Li Q, Lei S, Liu Y, Liu Q, Chen Y, Lin X, Zhang X. Effectiveness of Yoga on the Interrectus Distance in Early Postpartum Women: A High-Frequency Ultrasound Study. Biomed Res Int. 2022 May 20;2022:8908095. doi: 10.1155/2022/8908095. PMID: 35647191; PMCID: PMC9142290.
"progressive yoga exercises are suggested to resume function of muscles that influence the rehabilitation process in DRA... This study found that a 12-week progressive yoga rehabilitation exercise intervention effectively shortened the supraumbilical, unbilical, and subumbilical IRD."

5) Li Q. The Effects of Yoga Exercise on Pelvic Floor Rehabilitation of Postpartum Women. J Healthc Eng. 2022 Jan 25;2022:1924232. doi: 10.1155/2022/1924232. PMID: 35126906; PMCID: PMC8808187.
"yoga had a very significant improvement on the physical indicators and mental health of postpartum women."

• Yes

We reviewed the Dosha Questionnaire she filled out and how it might influence her sleep wake and work tendencies. SDS mentioned she is able to fall asleep quickly but struggles with allowing herself to get to bed. She mentioned she did set the intention of going to bed earlier and ended up falling asleep when she put the kids to bed a few times. SDS discussed setting a boundary around emails and possibly putting something in the signature of the email or an automated response to provide time when she cannot respond right away. We also reviewed the new asana homework with the pranayama, chanting, and asana.

Continue to practice intention setting in the morning. During free time practice asana & pranayama from today’s session for 5-15 mins. Continue to aim for bedtime before or around 10pm.

SDS has been going to bed around or even before 10pm. She said her head hits the pillow and she falls asleep. She is, however, waking up a bit earlier too which she is happy with but this could also mean that she is actually not getting more sleep. SDS reports that she is practicing the elongated exhalation throughout the day now and it has been very supportive when she either feels stress build in the mind or tension build up in the body.

SDS did not have most of her props in the room she was in. I need to be sure to send a reminder email with what props to have ready with SDS as she generally will not have things out unless I specifically let her know we will use it prior to the session time. Both her 5-year-old and 10-month-old were present in the session. I tried to engage the 5 year old to practice with his mother but he lost interest quickly. I will try to engage both of them as best I can if they are with us and starting to interrupt her work again. Of course, her daughter will need to nurse occasionally, but when toys start to fly across the room it’s a sign, we could shift the collective energy in her space to support everyone. By doing this I know it will also support her sessions too.

At one point in the session, I caught myself wondering if it would work with both of her kids in the room awake and ready to play. I thought about it and realized this is a perfect way to practice under real life circumstances. Despite us having a bit less time and a bit more distractions, SDS was able to practice in a realistic manner and still get some of her sadhana completed while both of her kids were awake. By practicing this way, it ensures she can start to feel comfortable taking time out for breath, movement, and meditative practices each day on her own. Parents cannot always have the perfect setting for their practice but if they can keep their practice up, that is what is most important. It will also be a wonderful lesson for her children to see her taking care of her mind, spirit, breath, and body too.

Discuss and practice a protection focused guided meditation practice next week. Add in the modified practices with the ball that were from the pelvic floor PT next week.

• Yes

We discussed how the last week went for SDS and practiced pranayama, wall & mat asana (including the ball homework from her PT that was left out last time).

Add on the ball work anytime that the asana homework is practiced. Have the new goal of 5-15 minutes 3 times a week (as everyday was not as achievable).

SDS had a challenging couple of days prior to our session and reflected on it. She has been falling back on her intention setting in the morning and breathwork. She has not been practicing her PT homework or the asana home practice generally either. Instead, she does a few minutes of stretching or movement when she feels an ache or remembers to.

SDS was in the playrooom again with her children for the session. While they were playing, she was still able to practice quite a bit and her son was able to help gather some of the props for her. I would like to find creative ways to support her that do no busy her more. The original care plan I provided her has the practices that she was already using for support that may have been enough. When we first met she mentioned wanting to have a daily movement practice and that she had time each morning for it.

I wonder if just having 15 minutes to herself for movement or a meditative practice when her husband is home would be better than fitting it in very early in the morning or throughout the day. She is predominantly vata so having some regularity is a challenge and finding something that works for her in this way has been a bit of a challenge too.

Suggest a sadhana schedule or chart and choose one supportive practice to do regularly every day for the week. Commit to that practice & charting it for the next week.

• Yes

We practiced gentle breathwork (brahmari & LAM chanting) and gentle asana focusing on downtraining for pelvic floor and nervous system, transversus integration. We finished with a long guided relaxation focused on rest and protection.

Continue to set the morning intention, practice breathwork throughout the day, and get to bed around 10pm as regularly as she can.

SDS shared with me during our check in that she has been focusing on setting her intention in the morning. She had a grant proposal due and she did not get much sleep prior to our session so we focused on relaxation and rest in this session together. She seemed quite positive despite the exhaustion. Her children played on their own quietly without much disturbance for most of the session and she seemed to be able to really rest.

I believe that the gentle movement, breathwork, and longer time spent in deep relaxation was helpful for SDS today. While I believe setting aside time for herself regularly could be grounding, when so much of her work and home life are in flux, I felt that giving the homework to create a regular practice and revisit that idea with a sadhana chart was not appropriate for today. She was exhausted so it seemed like some stretching, breathwork, and a nap was better suited. I watched her children and they stayed calm during the breathwork and the deep relaxation playing on their own or quietly with each other. It was nice to see their energy match well with their mother's energy and practices.

SDS was a wonderful client to work who gave her all in sessions even if her adherence to homework was not always consistent. When we started to work together, she already had several supportive practices in place. One area she could have benefitted more from in our time together was time management. She did start off well with setting a morning intention and creating a sleep ritual prior to 10pm. Unfortunately, as her work and life situations became more challenging the time between waking and going to bed was not always consistent.

I also noticed that during the weeks that I added on some of the movement practices, she experienced some work challenges too. In retrospect having just the sleep ritual alone may have been more than enough for the first 5 weeks together. By adding on more it became less achievable in our time together. I think that when someone is juggling a lot and asks to work on a lot in their sessions too, I need to manage their expectations better. Sometimes not giving a client everything, they ask for provides more of what they really need. I do not try to address all of their goals at once or in a short period of time to create positive change in our work together. Focusing on sleep and home and work life boundaries could have been more than enough. I need to remember that I do not need to create a full movement routine for each client that asks for one. Asana doesn’t need to be homework for everyone either. Instead, we could explore movement during our session time if this is a goal. This would have provided less pressure and perhaps more consistency with other goals and homework. I look forward to applying this lesson when designing to future care plans.

Continuing with gentle asana and breathwork focused on pelvic floor down training and stress mangement during session time. Simplify future homework around one daily practice that she can commit to.