Fertility Yoga: The Evidence


Recently, I was asked to put together a handout reviewing the research supporting the benefits of fertility yoga.  I am often recommending these modalities to patients for self-care during preconception, pregnancy and post-partum and even I was surprised by the wealth of evidence out there. Importantly, while most of the focus tends to be on prenatal yoga, the evidence points to starting a yoga practice, like a prenatal vitamin, months prior to conception to improve fertility, including in conjunction with conventional fertility treatments, and though the postpartum period to reap the benefits for both mother & baby.

It is important to note that this article and many of the studies, use the term "yoga" to represent a multifaceted approach to exercise that encourages strength & stretching (asana), mental centering (meditation), and focused breathing (pranayama).

Research suggests that in this way, yoga prior to and during pregnancy is safe and can have many benefits for women and their babies:

  • Improved sleep, quality of life  & self-efficacy 1,2, 5, 6, 13

  • Reduced stress, depression and anxiety. Compared to non-depressed women, depressed pregnant women experience higher rates of pre-eclampsia, miscarriage, pre-birth complications, pre-term delivery, low birth weight and is associated with cognitive and emotional problems in children 1-7, 9-16, 18, 21

  • Improve fertility and increase the success rates of IVF by improving physiological & psychological states, in addition to improved tolerance of IVF treatments. 19, 20

  • Improved immune function as evidenced by increased immunoglobulin A 10 

  • Decreased heart rate variability, indicating increased parasympathetic: sympathetic functioning more than relaxation or exercise alone 2 

  • Increased strength, flexibility and endurance of muscles needed for childbirth 2

  • Decreased lower back pain, nausea, carpal tunnel syndrome, headaches, hypertension, diabetes and shortness of breath 1, 2, 5, 6, 14, 23

  • Significantly decreased duration of first stage of labor and the total duration of labor, frequency of labor induction, perineal tears, episiotomy & C-section; increased rates of comfort during delivery and post delivery through the increased production of endorphins and dopamine 2, 5, 11, 15, 23

  • Improves socialization with other pregnant women and prepares for the stress of being a new parent. 2, 3, 4, 5 as evidenced by decreased levels of cortisol 10, 12, 14, 18

  • Cord blood cortisol level of babies indicates positive health status of the newborns verifies that prenatal meditation can influence fetal health and better temperament at fifth month reflecting the importance of prenatal meditation in relation to child health. 17

  • Infants prenatally exposed to maternal mindfulness have been found to be “less fussy” when compared to those exposed to higher levels of anxiety; an example of “prenatal programming”: Positive/negative traits of mother during pregnancy may ‘program’ infant. 18

  • In the postnatal period, yoga during pregnancy & after delivery was linked with a lower risk of maternal depression & anxiety by up to 67%. 24-26

When to start and what to do

Yoga can be started anytime in the preconception period. New or returning students should focus on yin, slow flow, restorative or prenatal classes; heated classes should be avoided. Research indicates that pregnant women should start at by 18-26 weeks gestation, one to three times per week for 30-60 minutes with the most benefit seen in the integrated yoga interventions (mindfulness + asana). Students should inform the teacher of possibility of pregnancy. 2, 6-9.


1. Yoga during Pregnancy: A Review, American Journal of Perinatology; 2012.

2. Systematic Review of Yoga for Pregnant Women: Current Status and Future Directions;Evid Based Complement Alternat Med. 2012.

3. Mindfulness-based childbirth and parenting education: promoting family mindfulness during the perinatal period. Journal of Child and Family Studies. 2010

4.  Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Archives of Women’s Mental Health. 2008.

5. [Effects of prenatal yoga: a systematic review of randomized controlled trials]. Nihon Koshu Eisei Zasshi.2015.

6 .Yoga in Pregnancy. Clin Obstet Gynecol. 2016.

7. Potential for prenatal yoga to serve as an intervention to treat depression during pregnancy.Womens Health Issues. 2015 . 

8. Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study.Complement Ther Clin Pract. 2012.

9. Yoga for prenatal depression: a systematic review and meta-analysis, BMC Psychiatry. 2015.

10.Effects of prenatal yoga on women's stress and immune function across pregnancy: A randomized controlled trial. Complement Ther Med. 2017.

11. Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial).  Complement Ther Clin Pract. 2017.

12. The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complement Ther Clin Pract. 2014.

13. The Effects of Prenatal Yoga on Birth Outcomes: A Systematic Review of the Literature. Journal of Prenatal & Perinatal Psychology & Health. 2013.

14. The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress. J Obstet Gynecol Neonatal Nurs. 2009.

15. Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison, BMC Pregnancy Childbirth. 2017.

16. CALM Pregnancy: Results of a Pilot Study of Mindfulness-Based Cognitive Therapy for Perinatal Anxiety. Arch Womens Ment Health. 2014.

17.Prenatal meditation influences infant behaviors. Infant Behav Dev. 2014.

18. Maternal mindfulness and anxiety during pregnancy affect infants’ neural responses to sounds. Social Cognitive and Affective Neuroscience,2015. 

19. Yoga can improve ART outcomes in couples with infertility. Altern Ther Health Med 2018.

20. Yoga: an adjunct to infertility treatment. Fertil Steril. 2003.

21. Meditation for preterm birth prevention: A randomized controlled trail in Udonthani, Thailand. International Journal of Public Health. 2016.

22. Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood. Arch Womens Ment Health. 2008.

23 Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011.

24. Impact of prenatal exercise on both prenatal and postnatal anxiety & depressive symptoms. Br J Sports Med. Nov 2018

25. Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized control trials. Birth. Sept 2017

26. Efficacy of yoga for depressed and postpartum women: A randomized controlled trial. Complement Ther Clin Pract. May 2015

Misconceptions of Preconception

Photo by {artist}/{collectionName} / Getty Images

Photo by {artist}/{collectionName} / Getty Images

By Leigh Lewis ND, L.Ac, Naturopathic Doctor

Are you hoping for pregnancy in 2018?  If so, keep reading for information that may help you reach you goals.  You may be surprised to learn that the conception rate for any one act of intercourse at the right time of the month, when the stars are aligned and without any fertility issues, is only about 25%.  Yet, even knowing this, many couples expect to be able to conceive easily without much forethought or planning.  This may be in part because we, especially as women, have spent most of our lives trying NOT to get pregnant.  As such, it is not surprising that many couples are blindsided if they are not pregnant within the first several months of trying.   However, there are a few simple things you can do to increases your chance for a timely & healthy pregnancy.

Preparation is Key:  General Recommendations for All

Prenatal lifestyle & supplements: As with many goals in life, the path to a successful conception and a healthy pregnancy is planning.  Lifestyle factors, including cigarette, alcohol & caffeine consumption, and marijuana and other recreational or prescription drug use in either partner can increase time to conception and increase risk of miscarriage & chronic health issues in children.  Current research suggests that even if you have very regular and normal cycles starting a prenatal vitamin with adequate methylfolate several months prior to intended conception has numerous benefits in decreasing the risk of nutritional deficiencies, decreasing time to conception, preventing birth defects and decreasing risk of miscarriage as well as decreasing the risk of future autism spectrum disorders and other learning disabilities.  While a prenatal helps correct nutritional deficiencies, some women may need additional vitamin D, B12 and iron depending on lab levels.  These nutrients, if low, can interfere with one’s ability to get and maintain a healthy pregnancy.  The  omega 3 fatty acid derived from fish oil, DHA, has been found to benefit brain development and should also be part of the pre-conception plan.  Finally, finding prenatal supplements that are well-tolerated prior to pregnancy can help avoid problems with consistency if nausea and vomiting are an issue early in pregnancy.  A well-rounded multivitamin and mineral can also improve many aspects of sperm health when taken for at least 3 months prior to planned conception.  First pregnancy and want to improve chances?  Be sure to seek help on tracking ovulation and cycle via basal body temps or apps combined with timing intercourse (see resources below).

Pre-conception weight: Another recommendation that can decrease time to conception and increase probability of a healthy pregnancy is a normal weight.  Being overweight or underweight can interfere with fertility by decreasing ovulatory cycles.  Being overweight can also predispose to gestational diabetes and hypertension that can increase the risk of both conditions for mother and baby later in life.  Normal weight has also been found to improve the success of fertility treatments like IVF.  In short, it stands to reason that taking 3-6 months to address any weight issues can go a long way to improving health parameters for both mother and baby.  Special diets or intense exercise can also cause some deficiencies that can be ruled-out with simple blood tests.

Contraception: It should be noted that it may take up to 12 months to re-establish normal ovulation and cycles after discontinuing hormonal contraception.  That said, some women may be able to conceive the month after stopping contraception.  The best course of action is to stop any hormonal contraception a year prior to intended conception, using non-hormonal forms (i.e. condoms) until conception is desired, to allow the body to re-set.  This would also be a good time for both partners to start their respective supplements mentioned above.  For those that are trying to avoid or delay pregnancy, remember prevention is the best medicine…there are several safe and effective forms of contraception to choose from.  Finally, a word about lactation:  While breastfeeding can help to space babies, it is not fool-proof and many women will return to fertility while breastfeeding, some even before regular menstruation resumes.  For some women however, even breastfeeding infrequently can delay another conception. Please keep this in mind whether hoping for a pregnancy or to prevent one.

For those with fertility problems:

According to the CDC, American infertility statistics between 2011-2015 were as follows:

  • 12.1% women aged 15-44 with impaired fertility
  • 7.3 million women aged 15-44 who have ever used infertility services

While as many as 30% of couples never find the cause of their infertility, we do know several possible contributing factors that may play a role:

  • Age: fertility rates within one year decrease & time to conception increases after 30 years of age

30s:  75% chance
At 40:  40% chance
By age 43: 1-2%

  • Underweight, overweight and nutritional deficiencies (see above).
  • Hormonal imbalances: thyroid disorders, endometriosis, polycystic ovarian syndrome, low estrogen and/or progesterone.
  • Stress, anxiety, & depression: evolution may have set us up to delay conception at times of emotional stress
  • Structural issues: blocked tubes from prior infections, uterine fibroids/polyps, adhesions or scarring from endometriosis or previous pelvic surgery
  • Chronic illness such as autoimmune conditions

Infertility is diagnosed as no conception within 12 months of trying if under 35 years and 6 months if over 35 years. It helps to recognize the importance of these definitions as further lab testing, semen analysis, pelvic imaging and consultation may be recommended at this time.  

Couples with any of the above issues should consider when they ideally would like to conceive and give themselves at least 6-12 months to get healthy by following the above general recommendations and seek guidance from a practitioner who specializes in women’s health and fertility to address specific issues in particular.  The same could be said for women in between pregnancies in order to prep selves for a future conception as pregnancy, breastfeeding and caring for a growing family can take a toll on the body and mind.

If ovulatory, menstrual, or hormonal irregularities are suspected, addressing them by ruling out underlying factors is key.  Research shows that acupuncture and specific herbal formulas and supplements may help normalize hormones and cycles, facilitate conception and improve the health and wellbeing during pregnancy and increase the success of conventional fertility treatments.

Fertility issues can be stressful, especially when combined with pre-existing insomnia, depression, or anxiety, and this can interfere with fertility and exacerbate emotional issues; truly a vicious cycle.  However, there are safe ways to address these issues through meditation, yoga, acupuncture, herbs and supplements.  In some cases medications may be the safest option with several studies showing that medications are preferable to “white-knuckling it” through depression and anxiety.

We here at ilumina are here to help you at any stage: from pre-conception and prenatal to postpartum and beyond, we offer diet & lifestyle counseling, mental health support, acupuncture, western & oriental herbs and supplements, massage and medications to address these issues.  Please feel free to contact us today to get started on your pre-conception health & wellness plan.

1. Taking Control of Your Fertility
2. RESOLVE: The National Infertility Association
3. American Society for Reproductive Medicine (ASRM)
4.  American Board of Oriental Reproductive Medicine (ABORM)
5. Clue: Menstrual/Fertility Tracker App

Benefits of Breastfeeding

In Chinese Medicine theory breast milk is an expression of Blood energy and Qi (vital energy).  It is understood that once a baby is born the Blood that was once nourishing the placenta is now transformed into breast milk. Breastfeeding has many benefits to the baby and mother, and is recommended by WHO (World Health Organization) to breastfeed the first six-months of your babies life for some of the reasons listed below.

  • Better healing post labor: Oxytocin is released when your baby is nursing. Oxytocin helps your uterus to contract and return to its normal size more quickly.

  • Baby Health: The incidence of pneumonia, colds, and viruses are reduced among breastfeed babies. Also, breastfeed babies are less likely to develop type1 diabetes, Crohn’s Disease, and Celiac Disease.  

  • Getting to Know Your Baby: You have to read your baby's 'satiety cues' a little better, because unlike with a bottle, you can't see how much he's eaten," Kelly says. "You have to rely on your own instincts and your baby's behavior to know when your baby is full."

  • Lower SID’s Risk: Breastfeeding lowers your baby’s risk of sudden infant death syndrome by half.

  • Stronger Bones: Women who breastfeed have a lower risk of postmenopausal osteoporosis. When a woman is pregnant and lactating, her body absorbs calcium much more efficiently

  • Custom-Made Supply: Formula isn't able to change its constitution, but your breast milk changes to meet your baby's needs. Colostrum that comes in after you deliver is full of antibodies to protect your newborn baby. It's also higher in protein and lower in sugar than full milk, so even a small amount can hold off your baby's hunger

  • Calorie Incinerator: If you feed your baby 20 ounces a day, that's 400 calories, you've swept out of your body. Women lose their mommy tummy more quickly with breastfeeding.

Below is a great source for all breastfeeding questions:

Need a little help understanding Pre-eclampsia?

Hypertension in Pregnancy

Pre-eclampsia is a pregnancy complication defined by high blood pressure, 140/90 millimeters of mercury (mm Hg) or higher, and signs of damage to another organ systems, most often the liver and kidneys. Pre-eclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of pre-eclampsia.

What factors increase risk of pre-eclampsia?

  • Previous history of pre-eclampsia
  • Multiple gestations
  • History of Chronic High Blood pressure, PCOS, Diabetes, Kidney disease, and organ transplant.
  • First Pregnancy
  • Obesity, BMI 30 or greater
  • Family History

How does pre-eclampsia affect pregnancy?

Hypertension can impair kidney and liver function, and cause blood clotting problems, pulmonary edema, seizures and severe edema. Pre-eclampsia affects the blood flow to the placenta, often leading to smaller or prematurely born babies.

What can help with pre-eclampsia?

  • Continue to follow a healthy diet and regular exercise (low sodium diet)
  • Magnesium is an excellent supplement safely used in pregnancy. Magnesium citrate, at doses of 400-600 per day, is often used in both preventing and treating hypertension. Hospitals use IV magnesium for hypertensive episodes and pre-eclampsia to reduce blood pressure.
  • Acupuncture helps to smooth the flow of blood and increase the tone of the vascular system, and returns the body to parasympathetic state.
  • Vitamin D levels should be checked, because Vitamin D deficiency has been linked to hypertension.
  • Coenzyme Q10 was studied for prevention of pre-eclampsia at 200mg per day from 20 weeks to delivery. This should be taken under the supervision of a physician.
  • Medications to lower blood pressure. Medications, called anti-hypertensives, are used to lower your blood pressure if it's dangerously high.


The Baby Box


SIDS: How to Reduce the Risk

At ilumina we work very hard helping women and couple conceive and have a healthy baby. We have been focusing on educating women on the benefits of acupuncture & Chinese medicine during postpartum for fatigue, breast milk production, and anxiety/depression. So I started thinking to myself what can we do for the babies?

My answer came while driving to work one day when I heard about Baby Boxes and how Finland has the lowest infant mortality rate due in part to the government handing out baby boxes to expectant mothers on their prenatal visits.

A riff of the Finnish model is being incorporated here in the United States with Alabama and Ohio joining New Jersey in providing expectant mothers with a baby box. Arizona is not on board yet but hopefully soon.

If you would like to learn more about Baby Boxes and how to get one on your own you can see the Baby Box University's website.   Also see the American Academy of Pediatrics sleep guidelines website.
You can also see NPR's original story on Baby Boxes

Acupuncture Throughout Your Pregnancy


Acupuncture’s positive effects on regulating menses and improving fertility have been known for many years, but acupuncture, Chinese herbs, diet and massage can also have many benefits throughout the pregnancy and beyond.

First Trimester
As early as the first positive home pregnancy test, acupuncture can help decrease risk of miscarriage and alleviate several of the well-known early symptoms of pregnancy, though while encouraging, can have a negative impact on a woman’s quality of life and ability to carry out daily tasks at work and home.

  • Fatigue
  • Nausea & vomiting
  • Headaches
  • Mood swings
  • Sleep disturbance

Second Trimester
The second trimester is often entered with a sigh of relief as the risk of early miscarriage and intensity of morning sickness decreases at week 12. However, as your baby grows in size, this increases demand on blood supply and pressure on surrounding organs leading to several new symptoms.  Some are diagnosed with blood sugar or blood pressure issues, and we can provide nutrition advice and acupuncture for this as well.

  • Back pain
  • Congestion and nose bleeds
  • Headaches
  • Constipation
  • Heartburn
  • Weight gain
  • Increased susceptibility to infections

Third Trimester
As weight gain continues with the increased size of your baby, the same symptoms that can cause problems in the second trimester increase in intensity with additional issues that can significantly interfere with your quality of life and well-being.  Also, keep in mind that while acupuncture can help decrease these symptoms, it can also be helpful for breech presentation and labor preparation in the final weeks before delivery.

  • Fatigue
  • Leg pain
  • Swelling of hands/wrists and feet and ankles
  • Shortness of breath

“Fourth” Trimester
Here at ilumina, we like to be conscientious of the months after delivery and the issues that can creep up after you are back at home with your newborn.  Sleep deprivation and the resultant fatigue and moodiness is expected, but knowing when to ask for help and making time for yourself in key in helping you care for your baby.  It may also be time to have labs to check for thyroid dysfunction and nutritional deficiencies that are common in post-partum.  Finally, in addition to helping with energy and mood, acupuncture can help with lactation, muscle aches, and menstrual issues as your cycle starts up again.

Labor of Love

Tune in to your body, connect with community, and embrace the birth you're given with prenatal yoga.By Catherine Guthrie (as appeared in Yoga Journal)After the birth of her first child, Colleen Millen, 35, knew that she would approach childbirth differently if given another chance. Then a Forrest Yoga teacher in Chicago, Millen stuck to her typical yoga routine throughout her pregnancy. She modified her practice as her belly blossomed, but she shrugged off the prenatal classes at her studio, assuming her years of practicing yoga had bestowed on her the tools for a trouble-free childbirth.But when the initial pangs of labor brought unrelenting nausea, Millen and her husband raced to the hospital, where her confidence unraveled. Nurses rushed to start intravenous fluids and hook up equipment to monitor the baby's heart rate. Millen was soon on her back, and as the contractions intensified, so did her feelings of helplessness. "I'd practiced yoga for years, but none of that was a comfort when the pain came," she says. After a long, difficult labor, she gave birth to a healthy baby boy, Jacob, but she still feels haunted by the lack of presence she felt during the experience.Three years later, while planning for baby number two, Millen dived into prenatal yoga. "I cultivated a strong prenatal practice so that when the time came, the movements and breath would kick in instinctually." And that's what happened. When her labor began, Millen focused her attention on a gazing point, relaxed her jaw (to encourage the pelvis to release), and harnessed the power of her breath to make the most of every contraction. "My preparation helped me surrender to the energy and move with it instead of fighting and struggling against it."After just 15 minutes of pushing, she and her husband welcomed their daughter, Samantha, into the world. But even if she'd had to face an arduous labor again, Millen believes that her prenatal practice would've helped. Not only did she feel more physically prepared the second time around, but she felt as though her mind and energy were more united throughout the entire birth experience.Prenatal yoga, the deliberate weaving together of yoga and childbirth preparation, opens the door for women to reclaim their physical, mental, and emotional power and receptivity during the birth process. "Somehow, as women, we think we will automatically know how to give birth," says Gurmukh Kaur Khalsa, co--founder and director of Golden Bridge Yoga in Los Angeles, who has taught prenatal yoga for nearly 30 years. "But we are so detached from our instinctual selves that sometimes we need to be reminded of what we already know."For a growing number of women, that reminder is prenatal yoga. Expectant mothers in urban centers are flocking to yoga studios that have whimsical names such as Mamaste and Baby Om, while moms-to-be in smaller locales are finding a proliferation of prenatal classes at yoga studios, gyms, and birthing centers. What's the universal appeal? Prenatal yoga classes offer a place of refuge where women learn to connect with their chang-ing bodies, their babies, and each other. Asana prepares them physically for giving birth, but most women find that the awareness of body, mind, and breath that it teaches is what truly helps them when it's time to deliver. As Rachel Yellin, a prenatal yoga teacher in San Francisco, says, "Doing prenatal yoga doesn't mean you'll have the 'perfect' birth; it means you'll be able to accept the perfection of the birth you're given, regardless of whether it goes according to your plan."

Creating Connection

The community-oriented approach of prenatal yoga took Stephanie Snyder, 35, by surprise. A Vinyasa Yoga teacher in San Francisco, she was accustomed to using her practice as a means to feel connected to others. But the true meaning of oneness didn't fully resonate until she joined her first prenatal class. "When I practice yoga in the company of pregnant women, not only do I feel connected to them, but I feel connected to every woman who has ever been pregnant and any woman who will ever give birth," she says. "That primal connection is empowering, and I know it will help me through the labor and delivery."Cultivating that bond is a big part of most prenatal classes. Like many of her counterparts, Deb Flashenberg, founder and director of the Prenatal Yoga Center in New York City, encourages the women in her classes to get to know one another. She starts each class by asking students to introduce themselves, give their due date, and share any pregnancy-related aches and pains. The check-in is both an icebreaker and a means of lessening isolation. "I can see the relief register on women's faces when they realize they aren't the only ones with a particular complaint," Flashenberg says. "The sharing of information among new mothers is a wonderful perk of prenatal yoga."Snyder, pregnant at press time with her first child, often found that her jitters were best soothed by those women in her class who were pregnant for the second or third time. Judith Hanson Lasater, president of the California Yoga Teachers' Association and author of Yoga for Pregnancy: What Every Mom-to-Be Needs to Know, says that prenatal classes provide the space for women to pass down the legacy and wisdom of childbirth. "The way we live now, pregnant women aren't around their family and friends as much." The result? As Lasater explains, "There is very little tribal support anymore for pregnant women." Prenatal yoga can be the answer. Flashenberg notes that many of her students form bonds that last long after they leave the classroom. Connections blossom into friendships, moms' groups form, and their children often become friends. What manifests is a network of support that grows richer as their children grow.

Not Just for Newbies

The community-based atmosphere makes prenatal yoga a magnet for newbies, but even experienced students may find themselves stretching in new directions. Snyder, for instance, has practiced two to three hours of Vinyasa Yoga daily for the past 12 years. Needless to say, she knows her way around a mat, yet she's discovered the value of bringing a beginner's mind to her prenatal yoga class. For the first time, she's actively mellowing out her practice and shifting her focus away from rigorous vinyasa and toward the union of being one with her baby. "It's a great way to literally start making space in your life and in your practice for your baby," she says. "And I get to practice asana that is geared toward the special sensations and vibrations that come with pregnancy." She especially enjoys Savasana (Corpse Pose) at the end of class, when the teacher offers guided visualizations, prompting the women to envision their babies surrounded by love and warmth. "Prenatal yoga is a special bonding time for me and my child in a way that's different from my regular asana practice," Snyder says.For others, the switch from practicing solo to having a baby on board can be a little bumpier. Releasing the ego can be a challenge for intermediate and advanced practitioners, Flashenberg says. Students may find it hard to accept how pregnancy changes their bodies and how their practice must shift. Some women can continue to practice fairly vigorously. But certain poses should be dialed back or phased out during pregnancy, particularly unsupported inversions, deep twists, prone backbends like Bhujangasana (Cobra Pose) and Salabhasana (Locust Pose), and strenuous backbends. That means forgoing Sun Salutations with Cobra or Urdhva Mukha Svanasana (Upward Facing Dog) and instead stepping back to simple lunges. Also, certain pranayama techniques should be avoided, such as Kapalabhati Pranayama (Skull Shining Breath) and anything in which you hold the breath, which is called Kumbhaka Pranayama (breath retention).Attending classes can help you reconsider the temptation to overdo. "Prenatal yoga reminds you it's not just your body," Flashenberg says. "You're sharing it now, which means it's not the time to push yourself." She also notes that during pregnancy, the ligaments in your pelvic area and lower back loosen due to an increase in the hormone relaxin, which is thought to help widen the pelvis and facilitate labor. So it's especially important to avoid overstretching, or you could wind up injured for lack of the usual painful warning signs telling you to stop.That's not to say prenatal yoga is for wimps. You won't master any new Handstand variations and you should avoid jump-throughs, but the level of intensity might surprise you. Classes focus on uncovering hidden sources of stamina, nurturing new ones, and maximizing hip flexibility. To that end, the most strenuous portion of the class is typically the standing segment, during which you can expect to work your edge by holding poses for a minute or longer—the length of an average contraction.Prenatal teachers knowingly seed their classes with opportunities for students to safely explore and expand their threshold for discomfort. When Amy Zurowski, 32, a prenatal yoga teacher who lives in McMinnville, Oregon, takes her students into Warrior II, for example, she guides them through an imaginary labor. As they hold steady in the pose, thighs working overtime, they imagine themselves breathing through a contraction. Zurowski encourages them to stay present and accept the discomfort by gently reminding them that women have been birthing babies for hundreds of thousands of years. "As you ease out of your pose, perhaps with tired quads, you are more confident of your innate abilities as a woman and as a mother-to-be," she says.Otherwise, classes typically start with gentle warm-ups, graduate to standing and some basic balancing poses, then move to the floor for seated poses. Savasana may be as long as 15 to 20 minutes, giving students time to set up props and sink into deep relaxation. After the first trimester, lying on the back for long periods of time is not recommended since it can slow blood flow to the baby, so blankets and bolsters are used to support students as they lie on their left side to rest.

Don't Forget to Breathe

Prenatal yoga conditions the mind even more than the body. "The primary benefit of prenatal yoga is breath awareness," Yellin says. "If you can use the breath as an anchor, it will draw your attention inward and downward, exactly the direction you want your baby to go."Yellin gently reminds her students that the breath should always be their primary focus; the physical sensations arising from the asana are secondary. In this way, she explains, they learn to train their focus on the breath during labor and not on the contraction: "Using the breath as an anchor keeps a woman grounded, no matter how overwhelming the sensations might be."Monica Paredes, a Kripalu Yoga teacher in Austin, Texas, relied on her breath during the birth of her son, Gabriel. On the taxi ride to the hospital, she took comfort in the vibration of chanting Om. Later, as her labor progressed, she relied on the Ujjayi Pranayama (Victorious Breath) to steady her resolve. Looking back, she says, "My breath and intention were focused on trust and surrender. I dropped into my breath and let everything else go."As a Kundalini teacher, Gurmukh Kaur Khalsa encourages her prenatal students to return to the breath as a touchstone during the intensity of labor and childbirth. She uses the mantra Sat nam with the breath. Loosely translated, it means "Truth is my identity." Say "sat" on the inhalation and "nam" on the exhalation. The mantra can quell anxiety during pregnancy and childbirth. Gurmukh says, "Added to the breath during pregnancy, it can help you realize that where there is truth, there is no fear, and where there is no fear, there is only love."

Own Your Birth

The benefits of prenatal yoga can extend well beyond the big moment. Yoga's time-honored teachings of acceptance and surrender can gently nudge practitioners past a birth that doesn't go according to plan. Flashenberg likes to remind her prenatal students that birth is like everything else in life: You don't always get to choose your circumstances, but you can choose how you react to them.The acceptance she honed in her prenatal yoga class helped Jennifer Coffin, 36, a yoga teacher in Knoxville, Tennessee, come to terms with the birth of her son, Max. She'd set her sights on having a natural birth, but Max had other ideas. Toward the end of her last trimester, an ultrasound revealed the baby was about to enter the world feet first, a breech position often considered too dangerous for vaginal delivery. First, Coffin threw herself into a "fix it" mode, trying to goad him into flipping. She tried therapies from traditional Chinese medicine and practiced gentle inversions. But when he refused to budge, she acquiesced to a cesarean section. "I had to accept the fact that it was the safest option for me and my baby," she says. She credits her prenatal yoga training with helping her let go of the disappointment. "I would have fallen apart if it weren't for the mental and emotional strength I had gained from my yoga practice," she says.In the end, childbirth, like parenting, comes down to trusting your intuition, feeling what's right, and not relying on what others think, Lasater says. "That's what the practice of yoga is all about...being fully, deeply, richly, and radically present with your own self."

Catherine Guthrie is a freelance writer who lives and teaches yoga in Bloomington, Indiana.