Transcription:
Mind-Body Techniques for Pregnancy and Postpartum

Andrew Wilner, MD (Host): Thanks for joining me for another episode of Pediatrics in Practice with Children's Mercy, Kansas City. I'm your host, Dr. Andrew Wilner. My guest today is Dr. Shilpa Babbar, an Assistant Professor of Obstetrics and Gynecology, university of Missouri, Kansas city school of medicine, and a practicing physician at Children's Mercy, Kansas City. I invite you to listen in, as we discuss mind, body techniques for pregnancy and the postpartum period. Welcome Dr. Babbar.

Shilpa Babbar, MD (Guest): Thank you so much for having me.

Host: Dr. Babbar, can you start by telling us how you became interested in this topic? And why is it so important?

Dr. Babbar: My passion for this topic began during my OBGYN residency. As a resident, we were given the task of completing a research project during our four years. During my intern year, I received the best piece of advice that I could receive at the moment. I was told to pick a research topic that I really love and really care about, otherwise the process is going to be super painful.

So, as a young intern, I had absolutely no clue on what I really loved at the time. But a very astute friend of mine randomly suggested prenatal yoga after I continually dragged her to all of my yoga classes. So that's when the light bulb in my head switched on. I looked further into this topic and realized that there was not a lot of literature out there.

So it led me to conduct a survey study the local population to understand how many women in my area were engaging in exercise and yoga. And although approximately 65% of women were exercising during their pregnancy, only 6% of them said that they were engaging in prenatal yoga, but over 50% of them said that they were actually interested in trying it if they could.

So, at the time, this was actually, data that was very consistent when national averages. But it led me down the path of pursuing a Maternal Fetal Medicine Fellowship in which I conducted a randomized trial, looking at the acute fetal response to prenatal yoga. So this randomized trial demonstrated that the fetus tolerated prenatal yoga without any significant changes in physiological parameters, such as the fetal heart rate or blood flow. So, this is how I kind of got interested in and has led me to where I am today.

Host: So prenatal yoga is safe for the unborn child. That's what you were able to demonstrate. And but now you're going to tell us why would anybody bother doing it?

Dr. Babbar: Sure. Well, there's a multitude of benefits when it comes to a prenatal yoga practice. what's been studied and the literature again is really increasing exponentially over the years, since yoga has become a very popular practice or exercise in the American population. So, there's other what's been studied consistently is a reduction in anxiety, depression, and stress that's associated with pregnancy and the postpartum period.

There's been some studies that have also looked at a reduction in back pain or which is very common in pregnancy, over 60% of women experience low back pain during pregnancy. And then also there's been three international studies that have looked at the effects of prenatal yoga practice on labor outcomes, specifically duration of labor.

These three studies had women engage in yoga in the third trimester for about 10 to 12 weeks prior to their delivery and all of them consistently showed a reduction in the duration of all stages of labor, meaning that women had shorter durations of labor when they practiced prenatal yoga regularly in their pregnancy.

So there's a multitude of benefits, not just showing that the baby can tolerate it, but multitude of benefits for the mom. And again, there's no long-term data out on it just yet, but there's, I'm sure there's some likely long-term benefits for the baby as well.

Host: Would you classify yoga as a mind, body technique?

Dr. Babbar: I would. Mind, body techniques really are an umbrella term for practices that enhance the mind's interaction with the body function to induce a relaxed physiological state, and improve overall health and wellbeing. So, yoga is definitely an activity or an exercise that would fall into that category.

Host: Are there other ones that might be helpful during pregnancy and the postpartum period?

Dr. Babbar: Yes, absolutely. There's a whole host of different techniques or exercises that women can engage in. So, for example, there's hypnosis, there's deep breathing exercises, guided imagery, meditation, and mindfulness practices. Biofeedback is another option. And all of these that I just mentioned do have some literature to support their benefits during pregnancy and after delivery. But there's other practices such as Reiki that has not really been well studied, but Hasn't shown to be beneficial in the non-pregnant population, but for whatever reason just has not been studied yet in pregnancy. So, there's some things that are out there that just hasn't been studied. There's a lot of anecdotal evidence to show that it is beneficial, but but these are some of the techniques that I think would be beneficial in pregnancy.

Host: What about acupuncture and acupressure is that in this category as well?

Dr. Babbar: Absolutely. So even a bigger umbrella is something called complimentary and alternative medicine, right? So that's where I think there's other things beyond mind, body techniques, so accupuncture, acupressure, chiropractic care, aroma therapy, massage therapy that are also extremely beneficial.

And again, there's literature to support the practice, these practices in pregnancy that do kind of fall into, you know, alternative medicine or integrative medicine that are, that should be encouraged during pregnancy, along with like mainstream medicine. So, so yeah, those are all kind of therapies that would fall into this category.

Host: Well, I think that's really exciting and important because one of the issues as you well know when you have women who are pregnant and they have a symptom is you don't want to give them a medication because, they're the baby, the fetus is going to be exposed to the medication. So always, well, is this medicine safe in pregnancy?

And you know, we know that some are not, but most of them, we don't really know. You know, and then how safe is it? And is it safe for that particular, you know, woman it's all of that could be avoided if you have a non medication approach. So how do you decide which woman should have, which treatment? In other words, what are the indications for these techniques?

Dr. Babbar: Sure. So, I totally agree that many women actually don't want to take medications. Right. Western medicine for example, is very medication heavy. Right? So it's like you have this symptom, let me give you a pill for that. Right. So, but you're like, just exactly, like you said, in pregnant women generally don't want to take medications, even though if we tell them, but yeah, this is safe.

We have data to support this medication, but still like there's a lot of hesitancy. And again, understandably, because they're worried that, you know, is it gonna, is this medication gonna affect their child? So really all women who are pregnant are eligible for these techniques and these therapies. Really, I think it comes down to taking the time to understand number one, what's going on with a patient and what are options for them, you know?

So presenting them to say, okay, like if you have nausea and vomiting. Okay. You can take a pill, you can take this pill or you can try some acupuncture. You you can try some deep breathing exercises to see if that can be helpful. And for the most part, every time I present these alternative therapies to my patients, they are always like, yeah, I will try that. I'd rather try that, than to take a pill. And then, you know, sometimes in some scenarios, depending on what's going on with the patient, they might actually need medication to help them. And sometimes alternative therapies may not be the number one choice, but even if they are on medications, engaging in these alternative therapies can still be beneficial.

And all of these therapies for the most part have excellent safety profiles. Really, there's no major contraindications to practicing these therapies during pregnancy. All the literature that's out there supports more benefit than there is any harm. So there's definitely options and really it's for every pregnant woman.

But the issue is that these therapies are not really taught in medical school. So for practicing providers or OBGYN providers it's if they only have an interest in it, then they could potentially say, okay, well I'm here might be an alternative thing for you to engage in. But they might just not know enough about the data that supports these therapies.

Host: Right. So one important point is I like the term complimentary therapies that, that these if used alone and they work great, but if they don't, then Western medicine, you know, should not be rejected and maybe in combination, the problem can be fixed. And then the other point as well, but these things are incredibly safe.

You know, nobody ever died from too much meditation, you know, or mindfulness. So, you know, it's a no, no risk, pretty much no risk to give these things a try except for the investment in time. And sometimes money. Now, your study showed that only 6% of women I guess these were pregnant women were using yoga. So that, that sounds like there are many more. Perhaps because their doctors didn't recommend it. So where can patients learn to do these techniques?

Dr. Babbar: Yeah, so the study that I mentioned where it was only 6%, that was done several years ago kind of when yoga was, it was still a popular activity, but really, I feel like in the past you know, five to seven years or so, yoga has really like grown into Western society. So, where they can learn these techniques is finding local providers. For example, if we're talking about yoga and meditation, so yoga, there's lots of yoga studios. And now of course, during this pandemic, a lot of things have moved online.

So there's online classes that are available and just kind of looking for what's available in the local area is a great place to start. When it comes to meditation and mindfulness, there are lots of apps out there that can help guide women through meditation during their pregnancy. There's one in particular called Expectful, which is guided meditation only for women who are pregnant and in the postpartum period.

And they're great. They have all different topics on there. They go by trimesters. So it's a wonderful resource for women to engage in meditation during their pregnancy. When it comes to hypnosis, there are online courses that are available for home study and there's local providers that can also teach these courses in different areas. So, there's lots of places, there's lots of resources specifically online that women can turn to, to learn about these techniques and then to engage with them.

But the other thing I really like about these techniques is once women learn them, they can engage in them at any point whenever they need to. So, it's teaching them the tools specifically when it comes down to childbirth. So a lot of, worry and fear comes around the act of childbirth and you know, how much pain are they going to experience and how is that going to feel and all those things.

And so kind of preparing oneself for that moment or really that timeframe and learning the different techniques that you can engage in whenever you need to. And then even after delivery you know, after the baby's here, life is still really hectic. It can be anxiety provoking, stressful and all those things. So like learning these techniques can really go a very long way, not just in pregnancy, and the postpartum period, but at any point that they need to engage in them.

Host: Well, I was really impressed by your finding that the whole process of labor was improved by basically shortening the times. And usually, I mean, in most cases, a shorter labor is better. Isn't that right? And so it sounds like. Do you recommend these to all of your patients? It sounds like pretty much, you know, every patient that's going to that is going to deliver probably has some concerns about the whole process. So is this applicable pretty much to everyone?

Dr. Babbar: Yes, 100%. So really all women, like I was mentioning can engage at any of these. Now it comes down to what people's preferences are, right? So like massage therapy may work really well for one person. And another person like hates being touched and says, I can never do a massage, you know, cause I just, it's just too much for me, you know? So like informing women about the options that are available and then allowing them to choose what they feel is best for them.

Cause I could talk to women and say, you know, prenatal yoga is the best thing since sliced bread, and this is what you need to do. And if it's something that they're not interested in, they're not going to do it. Right? So, so offering options, presenting them with like the things that are available and what they feel is best for them, I think is the best approach for this.

Host: Oh, that's great. Dr. Babbar. I want to thank you very much for this interesting and helpful discussion.

Dr. Babbar: My pleasure. Thank you so much for having me.

Host: Well, that's all for today. This has been Pediatrics in Practice with Children's Mercy, Kansas City. Please remember to subscribe, rate and review this podcast and all the other Children's Mercy podcasts. To refer your patient, or for more information, please visit children'smercy.org to get connected with one of our providers. I'm your host, Dr. Andrew Wilner. Thanks for listening.