JS105 is a former dancer and busy special ed school teacher who is in her 3rd trimester. Her primary goal is to learn tools to prepare for a natural birth. She practices Zumba a few times a week but would like to have a regular asana & pranayama practice to specifically prepare for birth mentally and physically. She is not a fan of chanting but open to meditation, mantra repetition, pranayama and asana. Two affirmations that have worked for her already are: "my body is the perfect body for my baby" and " You are protected, you are safe, you are calm, you are strong." She has had some round ligament pain and her baby typically favors Right Occiput (RO) position which causes pain on her right side of the waist, hip and ribs. She has started to wake up regularly in the night with her baby/bladder. Setting a bedtime routine was one of the topics we discussed as she feels her energy is very low right now.

During our assessment session, I observed that JS has some hypermobility in her elbows and spine and would benefit from some Transversus Ab/ Belly Lift practices along with some upper body strength work to prepare to hold her newborn. That along with pelvic floor down-training and pain & stress management strategies for birth would be helpful in addressing the goals she mentioned.

Post Intake/ Assessment Homework: Aim to get to bed by 10pm over the next few days.

Journal Homework: Sit down with CS (husband) and write out one page of birth preferences, after you both have one page share each other’s papers and compare notes, discuss for up to 30 minutes and start to put your revised preferences together as a plan so that you two can be on the same page.

Meditation focusing on the breath inhale 1 exhale 1-2 / Daily 1 min
Asana Practice to Prep for Birth 20-30 min a day (unless she is dancing that day)
Journaling 1x a week 30min
Partner Sleep Routine 5 mins (this is something they are already practicing)

Some at work practices she can do if she is achy or has extra time:
palming eyes and jaw, foot, glutes & posterior pelvic floor release on chair, adduction/ abduction with hands at knees, and piriformis stretch on the chair

Pranayama: Cleansing Breath, Counting Breath, Brahmari

Asana:
Standing: Wall Cactus with block, Pectoralis stretch, Half Moon, Wall Chaturanga with exhale, calf stretch, down dog/ L, wall slides into chair pose

Seated on floor or on birth ball: Gentle neck stretches & twist, cat/cow, around the moon/ circles, wags

Kneeling: Lunge, side lunge, rocking back, Shhh & bird dog, child’s or puppy pose with pelvic breathing/ imagining butter melting,

Seated: Deer pose, Wide angle pose

Side lying: leg lifts, side lying leg up the wall, deep relaxation on side

1) Kawanishi Y, Hanley SJ, Tabata K, Nakagi Y, Ito T, Yoshioka E, Yoshida T, Saijo Y. [Effects of prenatal yoga: a systematic review of randomized controlled trials]. Nihon Koshu Eisei Zasshi. 2015;62(5):221-31. Japanese. doi: 10.11236/jph.62.5_221. PMID: 26118705.
"The findings suggest that prenatal yoga may help reduce pelvic pain. It may also improve mental condition (stress, depression, anxiety, etc.), physical condition (pain and pleasure at the delivery, etc.), and perinatal outcomes (obstetrical complications, delivery time, etc.)."

2) Rong L, Dai LJ, Ouyang YQ. The effectiveness of prenatal yoga on delivery outcomes: A meta-analysis. Complement Ther Clin Pract. 2020 May;39:101157. doi: 10.1016/j.ctcp.2020.101157. Epub 2020 Mar 28. PMID: 32379685.
"Prenatal yoga is an effective complementary medicine to improve delivery outcomes and not to increase the risk of fetus, which is worth recommending to pregnant women."

3) Yekefallah L, Namdar P, Dehghankar L, Golestaneh F, Taheri S, Mohammadkhaniha F. The effect of yoga on the delivery and neonatal outcomes in nulliparous pregnant women in Iran: a clinical trial study. BMC Pregnancy Childbirth. 2021 May 3;21(1):351. doi: 10.1186/s12884-021-03794-6. PMID: 33941083; PMCID: PMC8091762.
"The results of the present study showed that yoga exercises could lead to a normal birth weight and improve the infant’s Apgar score and reduce emergency CS, labor duration, induction of labor, and preterm labor. Therefore, they can be used as part of the care protocol along with childbirth preparation classes to reduce the complications of pregnancy and delivery. Therefore, yoga exercises can be part of the usual midwifery nursing care. Since these exercises are low-cost and uncomplicated, they can be used by nurses, midwives, and gynecologists for willing nulliparous pregnant women."

4) [Abstract Only] Bolanthakodi C, Raghunandan C, Saili A, Mondal S, Saxena P. Prenatal Yoga: Effects on Alleviation of Labor Pain and Birth Outcomes. J Altern Complement Med. 2018 Dec;24(12):1181-1188. doi: 10.1089/acm.2018.0079. Epub 2018 Aug 30. PMID: 30160530.
"The study has highlighted that yoga is a noninvasive, easy to learn mind-body medicine and complementary health practice, effective in alleviation of labor pain and possibly improving birth outcome."

• Yes

JS started by sharing she was tired and got to bed late the night before but did get to bed by 11 or earlier in the weekend. She updated me on her Pelvic Floor physical Therapy evaluation and homework and discussed insights about holding patterns she notices in body. We practiced brahmari and she shared she has done "buzzing breathing" with her students when they need to settle down. She seemed to really enjoy this practice and we discussed how it can help relieve tension in the mind, jaw, and pelvic floor. She practiced with the birth ball and block from her care plan.

Journal: Set aside 15 minutes to journal & share: On one page each write down the tools CS has used to support you through something challenging. This could be emotionally or mentally challenging or physically (such as things he did to help the cyst burst). If there are tools you like that he does not always use, add them too. He can write down the tools he’s noticed that helped you when you've gone through challenging experiences. Then share what you wrote with each other and discuss. Have some of your unique comfort tools that you've practiced as a team in mind for labor.
Asana with Pranayama: Practice reverse kegel/ pelvic breathing in seated, puppy, hook lying & child’s pose to see which provides the most sensation.

JS is very positive and committed to preparing as much as she can prior to birth and parenthood. She has been practicing some of the breathwork and asana that was covered in the intake/ evaluation session. JS & CS journalled and JS reflected that it was a relief to take time to to focus on preparing for their baby together.

This session had quite a lot of asana from the care plan, while she is a professional mover and picks up sequencing well it may have been a bit too much. She already has homework from the PT which she is doing now as well.

Practice the wall asana that we did not review from the care plan this week.

• Yes

JS stated she has started to prepare more for the birth and her husband has started to clear out the nursery and prepare things in there for the baby. She had an emotional Mother’s Day being apart from her mother but knowing she will come visit soon after the baby is born. JS showed me a very thick binder with all she has learned and prepared for the baby. JS practiced the wall asana from the care plan and some of the seated practices for work.

Journal: Write down all the qualities you feel your partner has that will make them an incredible parent to your baby. On the other side of the page, reflect on the qualities you already have yourself that will make you an incredible parent for your baby too. Take a moment to share these reflections with each other and see just how prepared you two already are for this next step in your relationship together.

Other Practices: Continue to practice movement intuitively and meditation for a minute or more focusing on the breath or a sound.

JS is naturally starting to focus in on meeting her baby. The past week she has listened to messages from her body and used her practice as a tool at work (such as the muscle energy technique, piriformis stretch, and breathwork). JS even shared that she taught her colleague the brahmari breath at work and they practiced it together during a challenging day. She is practicing her PT, asana, and dance daily in ways that feel intuitive. This seems like a wonderful way to practice listening to what she needs in the moment now, in the labor room, and later on as a parent. JS shared that she practiced a meditation and it had chanting in the beginning. She had originally been opposed to chanting but now it is growing on her and she decided to try it again.

JS has so many wonderful practices already in place and has started to research and find her own tools as well (as with the chanting meditation). She is at the end of pregnancy so it doesn't seem like she needs more insight or information, she may just need to know that she is prepared and she already has the tools she needs to birth and parent her baby. For this reason I have just encouraged her and not asked her to follow the exercises as listed in the care plan. Instead I am encouraging her to pick and choose based on how she feels and let the practices shift as her needs shift too.

Practice asana as needed but focus on interoception, body scan, and meditation for birth.

• Yes

Pranayama:
Cleansing Breath 3x & with Arms and sigh 3x
Brahmari 3x
LAM 3x

Asana:
Birth Ball Cat/ Cow, Torso & Hip Circles
Kneeling Lunge and Side Lunge with the Ball
Pelvic Breathing/ Reverse Kegel with Puppy Pose
Standing Footwork Root & Sacral Chakra, Subclavius, and Mid Trapezius Release
Seated Coccygeus & Superficial Transverse Perineal Release

Relaxation:
Side Lying Savasana with Yoga Nidra

Continue to practice what feels supportive and move in ways that provide comfort now, during labor, and postnatally too. Teach your partner palming for the jaw and practice yoga for labor & birth tools together that you found helpful.

Journal: Postpartum who are the people that you can call that can do a load of laundry, walk Chamomile the dog, bring cooked meals, and leave groceries for you after the baby comes? Who can you ask to visit when you need a nap or shower without needing to entertain or clean-up for them? Make a shortlist of people nearby you know you can rely on and make a list of reasonable tasks they could help you and your husband with in your first 3 months postpartum. Honoring them with this responsibility & reach out to see who can make a meal train list for you and offload some of these tasks.

JS is approaching the end of her pregnancy and has made some wonderful changes both in her life prioritizing herself, rest, and her partner and friends. She has also voiced her boundaries at work and made decisions to work from home on a reduced school schedule going forward. She said several times in a matter of a few sentences that she should not stress... for her baby, she should not overdo it... for her baby, etc... I pointed out while she is such a great parent thinking of her baby so often, she should not stress because it is bad for her not just because it is unhealthy for her baby. Her wellbeing matters now but it also matters when it isn't involving a baby too. Putting herself in the forefront might be hard, but she deserves to not overdo it or stress too.

JS has continued to practice breathwork, meditation, and asana for birth listening to her needs both physically and energetically. JS has worked hard to prepare a circle of support for herself as she prepares for birth. She has moved both intuitively and actively reflected along the way. Her confidence, interoception and introspection has really deepened in the past month we have worked together.

While JS is working very well towards her goals of preparing for labor and birth our original care plan was not followed. At times meditation practices I had taught were replaced with video meditations she found on youtube. While this was a great exercise in asserting herself and finding what worked best for herself during pregnancy, I noticed the underlying desire for care plan compliance on my part. I do feel I did not express this and was flexible and positive about the additional new practices she shared with me but I noticed this feeling about myself.

Pregnancy is an excellent opportunity to live in the present moment. Whether it is the fatigue or nausea of first trimester, physical changes during second trimester, or the emotional connection to the baby as it moves and kicks in third trimester each moment is an exercise in living in the present and practicing surrender. We surrender our bodies making space for the baby quite literally, we make space in our home as CS did for JS in their nursery (his old office), and we make space in our heart to love in an entirely new and overwhelmingly powerful way. While the sessions with JS did not follow the plan, they followed her plan as she lived in the present in her third trimester. She listened deeply to her feelings of loss missing sharing these moments in person with her mother in Australia. She made choices for herself at work and at home advocating for her needs as they shifted and she prepared for her baby. She also listened to her body when her energy was low or she had aches and made movement and breath choices based on those messages. By listening to her body and baby on the mat she has practiced her self advocacy tool that will be so very useful in labor. As a woman of color birthing in the USA she is already at high risk for maternal mortality. Advocacy skills are the most important tool she will need as she moves towards labor and birth. So, while we may have not accomplished a clean-cut practice of the care plan each week, she has uncovered her voice and used it several times already. This is a much more valuable tool to have, than the tools I originally offered in our care plan. I believe the lesson here is that the client is the expert of not only their conditions, their body, and in this case their baby; they are an expert in revealing what is really needed too.

Next session we plan to work on asana for labor & birth, following breath and body sensations intuitively, vocalizing, and Penny Simkin's body scan.