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Potential Delivery Complications

Delivery complications after natural child birth are so common nowadays wide-spread to the extent that some of them might actually be excluded from the list of "complications". However, they decrease life quality of a young mum and require some treatment. The most frequent post-delivery complications are perineal rupture, uterus subinvolution (that is, uterus is slow in returning to its normal dimensions after delivery), post-delivery bleedings, hemorrhoids, chronic constipation, lactostasis and hypogalactia (problems with breast milk production and outflow), as well as problems of locomotorium and nervous system disorders.

Adequate yoga-therapy allows to tackle the majority (if not all!) of these disorders, taking into account their psychosomatic nature. That makes yoga-therapy one of the most effective treatment methods for the pathologies mentioned above.

In opinions of According to yoga-therapists and physical therapists, the time of starting an exercise routine even after non-complicated vaginal delivery varies from the second day to the third week. However, some yoga-therapeutic techniques (e.g. breathing and meditation) will be definitely useful for all women starting from the second post-delivery day. Certainly, it is necessary to take into account young mum’s general condition, as well as severity of complications and their combination in every individual case.

To make things clear and simple we shall review only a few of the most frequent complications and applied yoga-therapeutic techniques in these cases.

Perineal rupture
There are three degrees of severity levels of perineal rupture. The first is the lightest one, when the muscles of perineum remain integral. Whereas the third implies that rupture affects not only the perineum skin, but also the vagina and muscles up to the anal sphincter, as well as the rectum. In theory of physical therapy, the third degree rupture is a contraindication to any exercise at all. However, experience and general understanding of yoga-therapy techniques prove that it is possible to exercise even in these cases in the following way.

First 7−10 days we exclude all sitting positions, both in everyday life and in yoga practice. We also exclude spreading the legs to avoid possible damage to the sutures. During two weeks, it is also necessary to avoid any body positions, which can cause rapid increase of intra-abdominal pressure (any tension of abdomen indeed).

When a young mum decides to start exercise, on the second post-delivery day she should concentrate on her pelvic floor muscles while lying in bed and become aware of their relaxation during 10−20 breath cycles, afterwards she may try to contract them very gently. The main thing is not to strive after any effect and not to get upset, if the muscles do not obey. That just means that you should take more rest and start exercising a bit later on.

While sneezing, coughing and raising from bed (it is necessary to do it sideways!) you should try to gently tighten the pelvic floor muscles and keep them toned, which actually is a Mula bandha technique. Also, the Mula bandha should be done, either in full effort or in half the effort, depending on your current state, as an independent dynamic practice, as well as in combination with abdominal breathing. Besides, it is recommended to do an Ashvini mudra (contraction and relaxation of the anal sphincter only). Abdominal breathing implies keeping your lower abdomen slightly toned during inhalation, and strengthening it during exhalation, when we consciously tighten the abdomen, helping our diaphragm to raise and relax. At the end of inhalation you should tighten the pelvic floor muscles a bit more and keep them toned during exhalation. Thus there is no complete relaxation of pelvic floor muscles, and the muscle tone will gradually increase this way. This will help to develop awareness in this area and to tone perineal and abdominal muscles, assisting in speedy regeneration process as well as normal muscle tone recovery.

If the suggested Mula bandha exercise seems difficult at the beginning, it makes sense to stick to contraction-relaxation routine for some time, keeping your breath natural in supine position only. You can bend your legs or put them on a chair or on the wall. Proper physical exercise (as a rule, without directly affecting the "problem zone") is a guarantee for a speedy recovery after any trauma or operation. That is why starting from the second post-delivery day you should start your practice with gentle vyayama for arm and leg joints (not affecting, however, the pelvic joints). According to a young mum’s condition, they could be performed either lying in bed (if it’s not too soft) or on the floor, as well as standing.
If you feel well enough to do standing practice, it is really necessary to "build" Tadasana straight away. In this asana, if it’s performed correctly, you should feel pelvic floor and abdominal muscles tighten without overstraining. It also allows your lower back to relax, as the compression load to the lower back in standing position is four times less, than in sitting one. Moreover Tadasana gives an opportunity to feel oneself standing with both feet on the ground, really grounded, calm and confident.

It is better to start building your Tadasana from the feet — as it’s impossible to build a house without a foundation. It is very efficient to use a yoga block, if you put it between your hips as close to the crotch as possible. At first you should press your metatarsophalangeal articulations firmly to the floor — that is to raise your toes and to press the front part of your feet to the floor as if you were going to tip-toe. This way the calf muscles will be put to work. Then you should press the heels firmly to the floor tightening the thighs and pulling the knee-caps up. Next we try to push the yoga block backwards and imagine that there is a weight attached to the tailbone, at the same time raising the chest up. At this moment we can feel the pelvic floor muscles tightening upward and the navel moving towards the spine, while neither the buttocks nor the abdominals get overstrained.

From the third or fourth day of your exercise you could add to your abdominal breathing and Tadasana the practice of Marjariasana. Marjariasana is a wave-like movement of the spine while you are standing on all fours. The back bend is done gradually while inhaling, starting your movement from the tailbone. Arching your back is done in the same manner while exhaling and it is also necessary to tighten your pelvic floor muscles.
Chronic constipation

Constipation is a frequent young mum’s condition, partially due to disorders of intestinal peristalsis during pregnancy, partially due to the weakness of pelvic floor muscles after delivery as well as increased water absorption in the colon due to laсtation.

Movement, as well as the right diet, is the best medicine in this case. In this case — movement along with the correct diet is the best cure. We recommend starting your practice with abdominal breathing, while lying on your back with your legs bent or legs up the wall. You should observe your relaxed stomach raising and expanding on inhale, and consciously tighten your abdominals on exhale. It will be great to use Ujjayi breathing: constricting the throat muscles at least on exhale. It will help to control both prolongation of exhale and abdominals work and will also strengthen the tone of your parasympathetic nervous system, and that, in its turn, will have a very positive effect on gastrointestinal tract as a whole.

One should note that constipation in most cases has a well-defined psychosomatic nature. This condition, as a rule, characterizes people who can hardly ever relax and "let go", so called "control-freaks". That’s why it makes sense to add Nadi Shodhana breathing as a restorative technique for the nervous system, as well as yoga meditation techniques (e.g. concentration on various body parts, visualization, etc.).
A great way to tackle constipation is to do yoga twists, especially while it is not possible to perform abdominal manipulations due to post-delivery bleeding. You can start to do open twists in supine position, and later proceed to standing variations with support of a wall. It is necessary to hold Mula bandha while doing any variant of a twist. If there are no contraindications, it is recommended to make "closed" twists in sitting position, as they have the best effect on your hepatobiliary system functioning (that is, your liver and gall bladder work), as well as on your gastrointestinal motility. However, if there are any second or third degree ruptures, you should be extra careful while doing these twists during first two-three weeks after the child-birth. After you have a couple of classes in static mode, holding a position for up to five breaths, it is recommended to add dynamic variants — twisting on exhale and returning to initial position on inhale.

Marjariasana described aboveis also a great addition to your practice tackling the constipation problem.

When bleeding is over the best way to get rid of constipation will be Kapalabhati, Agnisara Dhauti and Nauli performed every morning, as well as the inverted positions preferably combined with twists (provided assuming you have mastered these techniques before).

Hemorrhoids

Hemorrhoids can appear after delivery or even during pregnancy; in the latter case it will get even worse after delivery. Medical science describes four stages of this condition; the fourth or sometimes, the third degree is an indication for operation. In case of the first or the second stage yoga-therapy alongside with proper diet will undoubtedly prove to be very effective.
First of all — all asanas should be performed with Mula bandha, especially those related to the increase in abdominal pressure. especially those involving the tension of compression of abdomen. It is absolutely necessary also to use hygienic shower instead of toilet paper.

In general, you could use the above-described practice for constipation relief, adding Urdhva Prasarita Padasana with wall support (lying on your back with legs stretched up the wall) with Ashwini mudra.

After bleeding is over, according to your general condition and level of practice, it is necessary to add inverted positions with Ashwini mudra to your exercise routine. The most simple, but very effective is Viparita Karani mudra with a bolster under your pelvis and your legs up the wall. Besides the inverted asanas, the most effective is Madhyam Nauli (or at least simple Uddiyana Bandha) practice due to its pumping action — the blood and even the pelvic floor goes upwards while diaphragm is in its highest position and thoracic and abdominal pressure is low.

Pelvic bones hypermobility and back pain

The ligaments weakened during pregnancy by the effect of a hormone called relaxin, go back to the norm within an on average for 8 weeks. This explains most of the discomfort the majority of unpleasant sensations in the area of in the pelvic bones joints (pubic symphysis and sacroiliac joints), as well as in lower back and neck.
Some of these conditions above named pathologies in a severe form, such as symphyseopathy of the third degree (when pubic bones are more than two centimeters apart) are only to may be treated using a special corset and keeping at rest. However, even in such cases breathing and meditation as well as physical exercise without affecting the problem zone (e.g. vyayamas for arms, any variant of Chaturanga Dandasana, etc.) will have a general therapeutic effect.

If a young mum’s condition allows doing simple asanas, it is recommended to be extra careful while doing any positions for flexibility. At the same time one shouldn’t totally reject them, especially as compensation for strength development positions.

Besides the exercises, it is necessary to bring some more awareness to everyday routine: to find comfortable breastfeeding positions, to use a baby sling or other baby-carriers, as well as to "build" your Tadasana, trying to hold it as far as you can during your household activities which could be done standing.

If there is any lumbalgia condition (lower back pain) of different types, the variants of Supta Padangushtasana 1 & 3, as well as Marjariasana, can prove to be very effective. If you are in real pain, you shouldn’t try to "build up" your back muscles with power backbends, it is much better to pay attention to strengthening the pelvic floor and abdominal muscles.
It is also very effective to add some sound-healing techniques to yoga practice. Especially using a low humming sound (the lowest available to your voice but comfortable so that your lower jaw and neck are relaxed) while performing Tadasana for 10 breaths and direct the sound to the feet feeling or imagining your roots deep in the ground and filling your legs and pelvis with the sound vibration.

Nervous system disorders

Delivery is actually a stress for the whole body. No wonder that different nervous system disorders could follow, starting from eating disorders and general weakness to post-delivery depression.

That is where yoga-therapy exercises could achieve valuable results with the most important of them — the harmonization of all body system efficiency.

Naturally, regular practice of even the most simple yoga asanas will have a positive effect on nervous system in general. But we’ll review a few of specific techniques.

First of all, there is a normal abdominal breathing with a prolonged Ujjayi exhale. This breathing type has a substantial sedative effect, and you can practice it any time and basically in any body position many times per day.
Second technique which one should practice at least twice a day for 5−10 minutes (if you have time and strength — up to half an hour) is Nadi Shodhana pranayam. Nadi Shodhana harmonizes the work of cerebral hemispheres and aligns their activity. In case of sleep disorders you can put one drop of essential oil of lavender to your middle or index finger and enjoy the healing aroma with every inhalation. If there are other clearly manifested symptoms of post-delivery depression, essential oil of vetiver will have a miraculous healing effect and you will feel calm and confident again.

The third effective technique is Kapalabhati. This shatkarma stimulates reticular formation which is responsible for stimulation-inhibition processes in the brain cortex and it also has a gentle stimulation effect. It should be done either regularly in the mornings as an independent practice, or before Nadi Shodhana pranayam. However, you shouldn’t start Kapalabhati during first ten post-delivery days if there are perineal ruptures of or first or second degree; in case of third degree rupture, you should wait until the crotch heals completely. In case of hemorrhoids, you should be extra careful while doing this shatkarma, taking into account your condition and only while performing Mula bandha.

Experience shows that cyclic meditation, practiced in Vivekananda Yoga Research Institute (VYASA), is an effective way to work with post-delivery nervous disorders.

The advantage of this particular meditation form is that physical movement is not only possible, but it’s required. The practice consists of doing a few simple asanas in a very slow mode with maximum awareness and closed eyes. The practice finishes with Shavasana and signing of mantra Om.

The cyclic meditation increases proprioceptive (posture) sensibility and allows a young mum to restore the feeling of being in contact with her own body, separate from her baby.

To remove neck tension it is great to do arm Gomukhasana, followed by Garudasana, as well as arm asanas, practiced by Andrei Lappa (Universal Yoga school): the dragonfly and the arm half-lotus.
From theory to practice

Below is an example of an adequate yoga-therapeutic asana sequence for the potential post-delivery complications:

1. Dynamic Marjariasana, as described above;

2. Static Marjariasana, with raising one arm parallel to the floor and the opposite leg simultaneously (when you become confident enough you can add raising the same side arm and leg);
3. Shashankasana followed by Adho Mukha Shvanasana, when the bleeding stops;
4. Gomukhasana, followed by arm Garudasana, as described above;

5. Urdhva Prasarita Padasana with legs on the wall, or Viparita Karani mudra with a bolster under pelvis, when the bleeding stops. If you have time, you can precede by Supta Padangushtasana 1;

6. Adho Mukha Vrikshasana — variant with legs on the wall; the so-called "corner"
7. Shavasana with a bolster under the knees and some neck or head support (not high).

This is a detailed enough sequence for a young mum, which takes from 15 to 30 minutes, depending on the time of holding each asana. No doubt the general therapeutic effect of this sequence will increase if you can breathe Ujjayi during the practice.

Conclusion: if you run after two hares, you will catch… three!

Yoga therapy allows for harmonizing all body system functions, as it is, in its essence, a method of psychosomatic therapy.

Yoga therapy allows you to "build" the functioning of all systems of the body, being in fact a method of psychosomatic therapy.

However, there are certain "buts". First of all, it’s necessary to take into account the multifactorial current state of a young mum. This is a rare case, when you can and should concentrate on a few pathologies at once, so that to avoid "fix one thing and break another" situation.

Second, it is necessary to get a young mum inspired for a daily, or sometimes twice daily, exercise, as only in this case the practice will be effective. This is especially relevant during post-delivery complications therapy as the young mums usually complain about the chronic lack of time rather than actual problems with their bodies. That is why it is better to recommend to a young mum to do at least suitable breathing exercises for 5−10 minutes a day, followed by 2−3 asanas for another 15 minutes a day.

Third, to have a for systemic effect on the whole body, you should add generally restorative techniques to every individual sequence and take into account the psychosomatic nature of a majority of health problems. It is also very important to teach a young mum to work with her attention and awareness.
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