I chose to undertake this is a piece of research in order to find out if emotional wellbeing in pregnancy could be affected by taking part in regular Hatha Yoga classes whilst pregnant. My interest in this topic came about during my own pregnancy with my second child five years ago. This coincided with the terminal illness of my mother and was a stressful time in my life during which I attended regular Hatha Yoga classes. When I reflect on that period I had a moment of epiphany in realising my mind and body could work together in creating a calm place for me and my unborn baby. It became a weekly practice for me during, and following pregnancy, and still is as I write this Research. I wanted to know if others experienced feelings of wellbeing in pregnancy when attending weekly hatha yoga classes.
I have used qualitative phenomenological research methodology as I found that this method of research is not widely published regarding yoga in pregnancy and its effects on emotional wellbeing. It was also conducive to a small research project such as this one and used the skills acquired within my training as a psychotherapist at the Manchester Institute for Psychotherapy. I conducted a 50-minute interview with a pregnant lady currently taking part in ante-natal Hatha Yoga classes to gain an insight and examine the lived experience of how these sessions are impacting her emotional wellbeing whilst being pregnant.
This is the first time I have carried out a Research project and I approached it with apprehension being unfamiliar with the requirements of the task. I was confident that I was capable of discovering and conveying the lived experience of my Emma, co-researcher. I was also excited to explore the topic of pregnancy and yoga further and find other Researchers material whilst challenging myself in a new venture.
Always in my thoughts when reviewing the literature and writing the review has been to demonstrate what have I read to become an expert in the field of emotional effects of yoga on pregnant women. My main questions were; How does what I have read inform my research? Are there missing parts, or contradictory findings and limitations?
In a google scholar search looking for Yoga, Pregnancy, Anxiety I found an article entitled, ‘The Effects of Mindfulness-Based Yoga During Pregnancy on Maternal Psychological and Physical Distress.’(Beddoe et al, 2009) I contacted one of the researchers, Amy E. Beddoe to ask for a copy of the article as it seemed really relevant to the research I was carrying out and she emailed it to me. The study carried out a 7-week mindful yoga intervention on 16 second trimester singleton pregnancy women having their first baby. The hypothesis was to see if the yoga would reduce cortisol levels, perceived stress, anxiety and pain, also to see how the yoga intervention was accepted by the women.
The first thing that interested me was that this research establishes the link between psychological distress during pregnancy and adverse perinatal outcomes. It also discusses the links between physical pain during pregnancy, such as lower back pain and how pain is often a cause of sleep disturbance. ‘Approximately 70% of pregnant women experience low back pain (LBP)’ (JOGNN, 38, p310). Both physiological and psychological distress can converge in pregnancy increasing risk of negative emotions and somatic complaints. Having found this article after I conducted my interview it informed me of the important link in being physically comfortable, not in pain and able to sleep on emotional wellbeing. Emma discussed back pain, getting comfortable, sleep problems and feeling happy. Sleep was a big subject of discussion among her and her fellow pregnancy yoga classmates. Interestingly at the time of writing, 2009 this article states that although prenatal yoga is popular, ‘no published studies have evaluated its effectiveness for reducing perceived street, anxiety or pain during pregnancy.’ (Beddoe et al, 2009, P311) This was encouraging as it felt my topic had a relevant need.
The yoga intervention itself in this study combined elements of lyengar and MBSR mindfulness-based stress reduction developed by Jon Kabat-Zinn (Kabat -Zinn, 1990) This although similar in many elements to the Hatha yoga Emma attends it is not the same and does indicate limitation in comparison to the experience Emma describes. The subject of mindfulness meditation came up in my interview as being beneficial to relaxation and a feeling of connectedness towards the baby. The facilitator of the yoga practice will also have specific training and experiences, ways of teaching that will be individual to the them. In this study the facilitator had had 20 years of lyengar yoga practice and extensive MBSR training which is not consistent with my research. Another significant difference was that this study used some ‘walking meditation, involving slow and observant walking.’ (Beddoe et al, 2009, p313)
Informing my research also form this study are the results in physical pain experienced by women in the second trimester, as Emma is 25 weeks pregnant and has been participating in the yoga class for more than 7 weeks. This study reports that ‘Women in the second trimester of pregnancy had significantly less hours of pain and less pain interference with activity from baseline to post intervention as they moved into their third trimester.’ (p316) This was not the case for the women in the third and later stages of pregnancy. As pain will affect sleep, normal daily activities, work attendance it may have an impact on emotional wellbeing also. The study suggests starting yoga and mindful techniques earlier in the pregnancy can create good postural habits, awareness of movement, a more mindful attitude to pain. In my own data Emma discussed using the skills she has gained when experiencing back pain outside the class when unable to sleep. Emma used the terms skills, tools in your tool kit and being in control which may also aid a participant who is earlier in gestation to cope with the later more physical challenges of pregnancy.
The results of this study show that the women in the third trimester showed greater reductions in perceived stress post intervention. As Emma wasn’t at that stage it suggests the findings in this study do not support stress reduction at her stage, (25 weeks) and shows the limitations of my study being only on one person’s experience. Another difference and missing element in this study are the effects on being part of a supportive, accepting group who are all going through the process together. This was a theme in my data which seemed to aid stress reduction and give reassurance to Emma. This was not specifically mentioned in this research although Acceptability of the Group Intervention was really positive. 94% satisfied with the class and 81% said the class had been important to them.
I found the book Psychology for Pregnancy (Chen, 2017) online searching www.amazon.co.uk. It gathered a lot of research regarding maternal psychological health in pregnancy and how this directly affects the foetus and children’s developmental outcomes. Yoga was cited 8 times in the Index of Psychology for Pregnancy. Emma described her anxiety and low mood in the first trimester, as being linked to hormones and her worry as it was an IVF baby. The list of strategies Chen lists (Chen, 2017, p40) were also findings in my data. Yoga, relaxation, music, meditation, being mindful, being grateful, making plans, getting support from partner and others. Emma was aware and already doing these activities which may have helped her stay positive and happy.
Chen stated that many physical symptoms of depression are mistakenly linked to being pregnant such as lack of appetite and sleep disturbance. Partner Support had a big influence on maternal psychological wellbeing according to Chen, (Chen, 2017, p95) Interestingly Emma didn’t live with her partner at the time of my interview and was moving in with her a number of weeks later. I got the impression that her partner was very supportive and involved, they are a same sex couple and from her comments seemed equally excited about the pregnancy. Relaxation, the technique often used to promote the development of mindfulness, alone, is beneficial for pregnant mothers and their unborn infants. (Chen, 2017 p113) ‘Yoga, a form of meditation, combined with breathing techniques and physical postures, is also beneficial for pregnant mothers and their infants.’ (Chen, 2017 p114)
Chen’s book also stated that 6-8 weeks of regular relaxation during the 2nd or 3rd trimester had been found to reduce maternal stress, anxiety, depression, admissions to hospital, and less post-natal complications. Emma’s Yoga classes used relaxation as a major component. There is an absence of data in Psychology for Pregnancy around the first trimester when Emma felt in a lower mood than in later weeks. This anxiety related to the viability of the pregnancy appears to be absent. There is a limitation around this stage as the classes recommend starting at 14 weeks, and the pregnancy isn’t often realised until week 4 of the first trimester. The author I feel doesn’t focus on this period in her book. Chen had a chapter on how music has been employed as a therapy to treat depression clinically, (Chen, 2017, p118) It informed me that it may not be solely the Yoga itself, but many of the components of the overall experience, music being one of them that supported good maternal psychological wellbeing.
In a google scholar search looking for Yoga, Pregnancy, Anxiety I found an article entitled, ‘Effects of Antenatal Yoga on Maternal anxiety and Depression: A Randomized controlled trial.’ (Newman, 2014) I contacted the author, James Newman to ask for a copy of the article as it seemed really relevant to the research I was carrying out and he emailed it to me. This was the first UK study to test the efficacy of antenatal yoga on measures of mood and as an intervention for reducing maternal anxiety during pregnancy. It concluded that Antenatal yoga was associated with significant reductions in fear of childbirth, and is potentially preventative against depressive symptoms increasing. This directed my interest to a finding in my data about feeling in control when in labour and empowered for the birth. Emma discussed what she’d learnt in Yoga said, ‘it’s just something like portable that you can take away with you so it makes you feel kind of empowered for the labour as well.’ (CoR 24)
59 pregnant women were assessed on various anxiety and depression questionnaires before attending an 8-week antenatal yoga course (31) or treatment as usual (28), and both groups repeated the questionnaires at follow up. The women were in their late second to early third trimesters, having uncomplicated pregnancies and first-time mums. This was the same stage as Emma who was late 2nd trimester. Interestingly I hadn’t considered that a second-time mum would have either lower or higher rates of anxiety about the birth based on their experience first time round. This didn’t inform my selection of a Co-Researcher, however did make this particular research article more relevant.
The participants in this study attended an Antenatal Yoga class based on Hatha Yoga, which is mild rather than strenuous. This appeared to be the same as the class Emma was attending. The description of the classes had similarities but didn’t make reference to the foetal bonding, connection to baby which was a part of Emma’s class. I concluded that as no class, or teacher can be the same the experience would always be different. The main findings in this study were positive showing that yoga sessions reduced anxiety and that the effects remain after repeated sessions when compared to the group that didn’t attend yoga classes. This study looked at the effects of multiple sessions, which is similar to Emma who had been attending regularly for at least ten weeks. The researcher lists the limitations of his research in making the comparisons with the treatment as usual (TAU) group and there are elements other than the Yoga itself that may aid anxiety reduction. I was interested in the social benefits, of being part of the group itself which may reduce maternal anxiety. This may also have been the case for the TAU women who may have attended ante natal classes and bonded with other mums. This has informed me of the many elements involved in an Ante Natal Yoga class, physical, mental, social, the teacher themselves, the knowledge gained, the location, atmosphere created. There is a limitation on outcome as each experience will never be the same.
Searching google scholar, I found a relevant Article, The Efficacy of Yoga as a Form of Treatment for Depression, (Bridges, Sharma, 2017). This article was not specifically pregnancy related, however I did find it informative making the link that yoga interventions were effective in reducing depression. It looked at 23 interventions aimed at yoga improving depressive symptoms published between 2011 and 2016 and reviewed them. It gave a good recent summary, and some of the review did look at data on pregnant women. The studies reviewed on pregnant women all concluded that yoga had a positive impact on reducing depressive symptoms in pregnant women.
I also found under Implications for Practice in this article an acknowledgement that behavioural theories and techniques should be utilised with yoga intervention. ‘This is imperative as psychotherapy techniques are used in managing depressive symptoms and stress management.’ (Bridges, Sharma, 2017, p11) Stating this made a good link between yoga and psychotherapy showing that the philosophies of both could work together to heal and develop mental wellbeing. It informed me to look for Transactional Analysis philosophies such as I’m OK, You’re OK and Richard Erskine’s theories within my data. It informed me also that the teacher of the class and their own personal outlook and self-understanding could have a big impact upon the ladies who attended.
The above article then led me to explore further publications, specifically, The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. (Bershadsky et al. 2014.)
While levels of cortisol increase naturally with pregnancy, yoga was found to minimize the mean levels compared to the days the subjects did not participate in yoga. After a single 90-minute yoga session, during which breathing was emphasized throughout the session, women had higher positive affect; but, the cortisol level was not significantly different from the control group. Overall, the authors concluded yoga had potential to minimize depression and cortisol levels in pregnancy.
Searching the Transactional Analysis Journal, I found a relevant article entitled, Listening to the Voices of Women Suffering Perinatal Psychological Distress. (Haynes, 2017) This article looked at Transactional Analysis theories specific to the depression of pregnant women. It did not look at Yoga as an intervention so was limited in that respect. Looking at the philosophies and themes of psychotherapy present in my data I hoped to be informed in the techniques this article shared as useful to see any correlation in Emma’s experience. The article also highlighted the impact of anxiety in pregnancy on the unborn baby, specifically low birth weight and preterm birth. Haynes also stated there was an increase in the child’s likelihood of having depression itself in later life, effect on maternal attachment, prevalence to Post Natal Depression, and cost to society.
This article informed me about the co-created relationship in the therapy room and the modelling of a caring, nurturing involved therapist who helped model how to be a caring parent for their baby. The theme of feeling cared for emerged in my data too from the Yoga teacher to my Co Researcher. This research was based on the authors client work and experience on a placement at a mother baby psychiatric unit which was very different to the current mental health of Emma. Pregnancy and motherhood could trigger the clients own lack of being mothered and cared for which may not have been positive. My interview didn’t discuss Emma’s own experience of being mothered so the comparison is limited in that area. ‘Offering a relational transactional analysis gives the therapist powerful tools in treating this distress.’ (TAJ, Vol 47. (2) 2017 p133)
When reading the book, The Body Keeps the Score, there was a specific chapter entitled, ‘Learning to inhabit your body: Yoga.’ (Van Der Kolk, 2014, p263) This looked at Yoga as an aid to treatment of Post Traumatic Stress Disorder. It stated that good Heart Rate Variability readings, could be controlled by breathing steadily and rhythmically and specifically relevant to Yoga that, ‘Good heart rate variability is a measure of basic wellbeing.’ (Van Der Kolk, 2014 p267) This informed me of the importance of the breath in Hath Yoga practice, and good techniques of breathing to aid labour. This book didn’t look at pregnancy related yoga and its effects on stress so didn’t inform me regarding pregnancy and yoga.
I enjoyed challenging myself on the literature review by making contact with other researchers and asking for their studies. I was reassured by their responses and got encouragement for my project which was welcomed. I was really moved by the research on pre-natal stress and its effect on unborn babies. Having had two children and dealing with significant life events at the same time, it was concerning to read. I wondered if my children were adversely affected by pre-natal stress. Reviewing the literature gave me new insight to the importance of psychological wellbeing, not just physical wellbeing in expectant mothers. The research did answer my question that yoga does positively affect psychological wellbeing. What I didn’t find were studies hearing other women’s experiences, or any other qualitative research on the subject. The quantitive researches were also minimal in number. (2750)
This research is Qualitative Research and a phenomenological enquiry of one person’s lived experience of doing regular Hatha Yoga during pregnancy. Reading the document, Autoethnography: An Overview, (Ellis, C et al 2011) I considered, and discounted autoethnography in my approach to the research. It was appealing, and I liked the idea of telling my story which and how I navigated through an intense emotional experience using Yoga as a support to my own mental wellbeing during pregnancy. It was certainly when I reflect on that time, a period of epiphany in realising my mind and body could work together in creating a calm place for me and my unborn baby. When reading this article, the approach of Reflexive, dyadic interviews caught my attention as a mixture of the participants experience and also my own in terms of my emotional reaction to the interview. In this approach, it isn’t my experience that is the main focus it is the co-researchers, and my own would give more levels, reflection and depths to the research process.
I did have an uncertainty on how this approach was so different to Qualitative Research and a phenomenological enquiry of one persons lived experience of doing Yoga during pregnancy. This method also had a consideration for my own feelings, bias, history and viewpoint on the subject. I felt some resistance and apprehension towards the process of advertising, recruiting and carrying out the interview with a co-researcher. This, looking at my own history was a resistance to be seen, be bold, be professional and confident in the world and have the belief that I am good enough to research. This was a historical outdated belief for me and to test it further I felt that keeping the research solely autobiographical would offer less opportunity to grow and challenge myself.
Reading the various approaches to research (Bell, J 2005), the Qualitative Research was appealing on one persons lived experience of something.
I discounted a research method due to the size and scale of the Research Project required. It had also been done before as listed in my literature review. I was also encouraged by James Newman, who published a quantitive research article on the effects of yoga in pregnancy who wrote to me saying, ‘I think a lot of research is needed to explore the qualitative experiences of women and wish I had incorporated some in my PhD.’ (See appendix IV.) This persuaded me further to do a qualitative project as there seemed a need for this method of research on my topic.
I submitted a proposal for my research and gained approval of my project before I started the process of approaching a potential participant. I got permission from Pregnancy Yoga teacher Kate Brunt to advertise on her Facebook page for a co-researcher. This is her website. http://www.yogaforpregnancykbrunt.co.uk/About-Me.html Kate was my current Yoga teacher and I attended her post-natal classes for mother and baby. I have known her since 2014 in a professional capacity. I put together an Advert in pdf format (see appendix V), and shared on this instructor’s Facebook page, and also gave printed copies to her to be handed out in the next pregnancy yoga class she taught.
Two days later I received interest from a previous attendee of the class offering to be a participant. This was also someone I knew who was pregnant at the same time as me. For ethical reasons in knowing the person and that she wasn’t currently living the experience I was researching I declined her offer. The second response came from the Co-Researcher I chose, Emma. She had been attending the class for approximately 10 weeks and was in her second trimester which informed me she had enough experience of attending the yoga class, she also said yoga had made a big difference. I didn’t know anything about this lady and had never met her before. We communicated via email and as it suited us both I arranged to meet her after her evening yoga class. (See appendix VII). I arranged with Temple Moor Infant and Nursery School in which the yoga class was held and gained permission to use a side room which was free that evening.
The questions I prepared were as follows.
- Describe how the practice of Hatha Yoga has supported your emotional wellbeing during pregnancy?
- How have you been feeling emotionally during your pregnancy?
- What’s the experience of attending this class like for you?
- Can you describe how you feel before and after the class, is there a difference?
I prepared open, non-directive questions to facilitate Emma being able to tell me how practicing yoga in pregnancy is for her and how she is feeling to get to the essence of her experience. I emailed Emma a week prior to the meeting sending a copy of the questions and a copy of the proposal form. On the evening I prepared the room with water, a comfortable chair and some fresh fruit. I had set up the recording already using a mobile phone that was password protected and checked for no planned interruptions.
I had printed copies on the table of the Research Proposal (see appendix I), the UKCP Ethical Principles and Code of Professional Conduct, my questions and the Participant Consent Form. I gained my Co-researcher’s consent for recording and discussed her right to withdraw, have her identity hidden, and that all information would be confidential. I also said I would email her within 3 weeks of this interview to check if any further questions had come up and that all was ok. This was adhered to and a signed consent form confirming this was attained. (See appendix II.)
The interview took approximately 40 minutes and I gave plenty of time at the end for Emma to ask questions and gain clarification on the process. By the end of the meeting I felt a connection with her and appreciation for her time and all the information she had shared.
I listened once to the full transcript three weeks after the interview. I then began typing the transcript and at the same time made notes on my thoughts and reflections as they arose.
Personal reflections, bias and observations.
During the interview I felt a little nervous. I was very aware of having the questions in front of me and that this was a pivotal moment in my research project to do a good job. Having set questions and an agenda was a different experience being a psychotherapist where the client comes usually with an area of discomfort to discuss and explore. I was conscious that Emma may feel she wanted to give me some good information and make this a good interview for my project and we were both trying hard. I wanted to make the interview a positive experience for Emma and ensure she felt comfortable in the process, not pushed or probed too much. As soon as we met Emma appeared really happy and vibrant and I remember instinctively mirroring her enthusiasm and optimism. I also unconsciously mirrored her phrases, ‘y’know’ – ‘sort of’ ‘erm,’ which I then heard back on the recording. During the interview we had similar mirroring body languages, facial expressions and laughed at the same time.
On reflection I realised my bias of having been pregnant and through two births myself in the last 9 years. I have had lots of conversations with pregnant women and discussed some of the pregnancy worries my researcher is bringing up at other times in my own life. I observed when listening back that I was in a familiar role of supportive, reassuring friend who’s already had a baby and has experience of what’s to come. The transference for me was seeing Emma as a pregnant friend. Out of my awareness in the interview she was like someone I may have met at a class when I was having my second child and them their first. Reflecting back on the interview I was aware of remembering what it was like for me being pregnant and attending pregnancy yoga classes. This would potentially distract me from seeing the experience wholly from Emma’s perspective. I am critical of not being as inquisitive as I’d have like to have been when I listen to the recording. I also knew the yoga teacher the Emma was discussing and have my own bias and experience of how it felt to be taught by her. Potentially choosing a co-researcher from a class I have attended in the past does not eliminate my bias as much as I could have.
I really resonated with Emma’s experience of feeling cared for by her yoga teacher. I was attending Kate’s classes weekly through the terminal illness of my mother and her subsequent death. I experienced her attention and caring nature in the class, which was common practice to her, and at this time it felt really important to me. The image of being tucked in, having the blanket pulled over your feet to keep them warm was my experience also. A nurturing parent, act of caring, noticing that there may be some discomfort that she can alleviate before you’re even aware of it yourself was soothing. It reminded me of the caring of a mother and early attunement to a baby’s needs. This acceptance and nurturing compassion was being modelled to the participants of the class. This became an emergent theme in my data. I felt really moved when Emma spoke about this. The phrase I used, ‘Like a caring mum tucking you in.’ (R102) had an impact on me when I heard myself say it as I was transcribing. I do not know if Emma felt an emotional impact on herself and I would’ve liked to have asked more on how she experienced that. My own process and memory, perhaps grief distracted and diverted me. In my transaction, I say ‘you kind of forget where you are’ (R104), and in the context of my experience it has meaning as well as the experience Emma was describing. I did forget where I was. The interview drew to a close here, and this may have impacted me on questioning further.
In the process of transcribing the recording, I resisted listening to the last five minutes and gave myself a break of a number of weeks. I remember I felt anxious at this point in the interview and worried if I had asked enough questions. I was concerned that I had run out of material to talk about, and this process was also repeated during the transcribing. It was difficult to hear back. I wished I had asked more phenomenological, open questions such as, ‘and what was that like?’ Tell me more about that? I felt critical of myself and was conscious of thinking I hadn’t been inquisitive enough. I was also conscious of Emma getting home late and that she may have been tiring or wanted to get home. After typing up the transcript and recording my own observations and feelings during this process I gave myself some space from the data and had a month away from reading and listening to the work.
I was interested in analysing common words that came up in the data and found an online tool at, https://www.online-utility.org/text/analyzer.jsp. This enabled me to copy the whole transcript and paste the data into the web site for word frequency and phrase analysis. The results (see Appendix VI) are categorised in phrases of 8 words or more, down numerically to one-word frequencies and a count of them with highest first. Limitations were that it looked at absolutely every word used. For example, ‘it’ was used 207 times in the data, which is not indicative of a theme. My interest was of patterns, themes, adjectives, interesting words. Searching down the lists was a good way to see analytically the number of times words were mentioned. It was interesting how much I recorded Emma laughing in the data. Laughing 19, and laughs 17 times was recorded. I was glad that the interview seemed joyful and light-hearted and hopefully an enjoyable experience. This brought me to one of the themes in my findings, joy. I then decided to take out my own responses. This was to get a clearer analysis of the frequency and words used solely by my Co-Researcher. I deleted from the transcript all my own questions and responses, and again pasted the data into the analysis tool on the web site. This gave a different list. (see Appendix VIII)
In my Word document I used the search tool to look for words that came up during my Literature Review. For example, looking for the word relaxation I was able to quickly find all the times it was mentioned and read the transaction it related to. This helped me link where the existing literature was relevant to my data and gain my emergent themes. I also printed out my data in portrait view on A3 paper with the lines double spaced. I wanted a visually larger view of the work to see what naturally drew my interest and attention. I spaced out the pages over the floor and scanned through the transactions seeing what drew my attention and what I returned to more often. I made notes on the pages of themes such as, groups, nurture, acceptance, caring, parental, and colour coded these in highlighter to see how often I noted them. I then decided on my three main themes of Joy, Connection and Acceptance to explore in my findings.
Through listening to the transcript, reading it, looking at the words in the text analysis document and seeing what emerged in the subsequent months after the interview, themes emerged. I took guidance from the ‘Guidelines for the Research Project’ document from MIP and aimed to feel Emma’s situation and her world. TA themes did come to mind on first reading, and I wanted to be guided by her words first before any theory. I decided on these three major themes
On first meeting Emma my impression was someone full of life, smiles, energy, joy and excitement. She was talkative, fast paced in her language, lively, and full of expression. I was drawn to her energy and positive outlook. She also seemed excited to be taking part in the research, and I too was excited to be doing the interview. Excitement was definitely in the room.
R ‘So is this your first baby’
CoR ‘Yes’ (Smiling)
R ‘Oh I’m thrilled for you, how exciting’
CoR (laughing) ‘Thank you’ (smiling)
R ‘You are too aren’t you I can see’
CoR ‘I’m very excited yes.’ (15-17)
Emma had just finished her yoga class, we had arranged the interview directly after it finished in a side room of the school back offices. I had wondered if following the relaxation at the end of the class Emma may have been tired and sleepy, however she actually seemed more lively and enthusiastic, very awake and present. Her outlook was one of enjoying her pregnancy and the new opportunities it was giving her, such as meeting new people at pregnancy yoga.
Emma’s excitement and ability to relax and look forward to the baby had come from the early days of fear and anxiety over the viability of the pregnancy conceived through IVF. We spoke about how she’d been feeling emotionally throughout her pregnancy so far. Emma described this as a ‘high stakes pregnancy’ (17) with no eggs in reserve, finances used and age considerations she states, ‘I met my partner 18 months ago erm, female partner we both wanted, knew we wanted kids but I’m 38 so it was like if we’re gonna do this y’know we need to do this.’ (66) I sensed an urgency and anxiety as she spoke of being paranoid in the first trimester of doing anything wrong that would risk the outcome. She also worried about bonding with the baby before safe milestones were achieved and didn’t want to start pregnancy yoga too soon in case anything went wrong. Her mood at this time, before twelve weeks she described as, ‘I was a nightmare in terms of my mood.’ (2) ‘grumpy and angry all the time,’ (4) I thought this was a fear of the potential loss of this longed-for dream that both of them wanted so much. It sounded such a relief to Emma to get through this apprehensive early time.
I think the excitement she now felt was through her feeling safe and secure that the baby was healthy and well. She’d had reassuring scans and was at the end of her second trimester. Safety and security seemed allow her excitement to flourish. Safe in the knowledge too that the baby was healthy, growing normally, and scans have confirmed no complications. Secure in her partner and the joint excitement of the child they are about to have. When she told me about the Yoga class she sounded confident that she was safe. The physical safety provided in the class seemed relevant.
‘this is designed for pregnant women it’s y’know it’s gonna be gentle, y’know there’s gonna be other pregnant women there … so it just feels quite caring and a safe space.’ (10)
Excitement, happiness, and great joy is the emotion I mostly experienced from Emma. In the transcript I recorded ‘laughing’ 19 times, and ‘laughed’ 17 times, ‘smiling’ 8 times and ‘excited’ 6 times. Transactional Analysis themes of Physis, the force and life energy that drives people to grow and progress and make change possible came to my awareness in the changes Emma had made recently to get what she wants in life. She and her partner achieved their aspirations to conceive through IVF and now nearing the end of her second trimester this was joyously attained. Here, a positive decision and huge personal change had occurred in Emma’s life, which needed self-agency, determination and drive. I am aware of admiring how much Emma and her partner realised what they both wanted and made it happen. It reminded me of the desire for personal growth and pursuit of ambition.
Tony Tilney’s definition of physis is below,
‘Physis a drive towards wholeness and health that Berne (1975, 1972) symbolised by a vertical arrow passing through all three ego-states. This closely corresponds to the self-actualising principle of humanistic theory, implying both the possibility of personal growth and a natural tendency to pursue it.’ (Tilney, 1998, p91)
Having a new life growing inside her body, Emma was the embodiment of nature, growth, change and life energy. Eric Berne had a belief in a person’s inner drive to heal and grow and devised the term Physis to describe this unconscious force of human life which in this research seemed really fitting to Emma’s current situation.
‘the growth force of nature, which makes organisms evolve into higher forms, embryos develop into adults, sick people get better, and healthy people strive to attain their ideals. (Berne, 1981, p369)
Linking the Yoga in pregnancy to the feeling of joy being experienced, a Ken Mellor article, (2017) discusses Life Energy and how grounding activities, such as mindfulness and yoga aid fulfilment. ‘grounding makes daily life much easier and more fulfilling because it produces palpable physical, emotional, cognitive and spiritual balance.’ (Mellor, 2017, p54) The feeling of being energised Emma also commented on after her yoga sessions end following a mindful relaxation sequence, ‘I’m always quite energised by it actually,’ (59). She was certainly full of energy when I first met her after finishing her relaxation. I made a link to the description in the Mellor article as he describes grounding below.
‘When grounded, it is as if a highly trained and powerful healer-therapist takes over. Whatever this enlivening process is in us, it clearly draws on the wisdom of years of human evolution and acts with breath-taking acuity.’ (Mellor. K, 2017, p62)
Emma had relaxation at the end of each yoga class, and in Psychology for Pregnancy, (Chen, 2017) the author sites the technique of mindful Relaxation as a main factor in reducing maternal stress, anxiety, depression, admissions to hospital, and fewer post-natal complications. Chen also has a chapter on how music has been employed as a therapy to treat depression clinically, (Chen, 2017, p118) Music was used in the Yoga class Emma attended and she stated, ‘I like the fact that it’s sort of dim lights there’s music, y’know there’s all that kind of atmosphere as well.’ (45) This atmosphere enhanced her emotional wellbeing in the yoga class.
When reflecting on themes, the theme of excitement and joy came to me late in the research project when linking TA theory. As a trainee psychotherapist, seeing clients in a placement, and attending supervision the process is about understanding difficulties, problem solving, blockages, impasses and unhelpful script decisions from the past. Using my skills from training during the interview using open questions, reflections, enquiry, attunement and being non-judgemental I didn’t at first link the theme of Joy to Transactional Analysis theory. As most people who come for psychotherapy have discomfort and challenges in their life and something to overcome to achieve their joy. It was a reminder for me to focus on where the Joy and happiness is in clients experience too. As the anxiety over the viability of her pregnancy lifted around the same time as Emma started pregnancy yoga, it is not conclusive that these feelings of emotional wellbeing are fully connected to the practice of yoga, more a combination of various reasons.
The word, connect, connecting, connection and connected came up in the transcript 11 times during our interview. Being connected emotionally to her baby was really important to Emma and the practice of the yoga class was described as reinforcing the importance of this connection. Emma described the experience in the class and the yoga teacher’s instruction.
‘You can kind of slow your heart rate down with how you move and the movements that she teaches you no matter how you are feeling you can connect with your body in that way and you can connect with your baby in that way. And, so that was quite powerful for me like emotionally.’ (21)
Connecting with herself and with her unborn baby was creating a bond during the class, and an opportunity of awareness of the presence of the new life within. Emma’s description of being connected, and having connection with new life did enhance the feeling of wellbeing in her pregnancy. Emma was attuning to her baby physically through gentle movement, emotionally by noticing her feelings at the time, and behaviourally with breathing with awareness. She was able to verbalise the process, to cognitively link the different parts of her experience which brought emotional and physical wellbeing and deeper connection. The Richard Erskine psychotherapeutic term ‘Attunement’ can be applied to the deepening of this unspoken connection to the baby.
‘Attunement goes beyond empathy: it is a process of communication and unity of interpersonal contact. It is a two-part process that begins with empathy-being sensitive to and identifying with the other person’s sensations, needs, or feelings; and includes the communication of that sensitivity to the other person. (Erskine, 2015, p29)
I had a real sense of this unspoken felt experience between Emma and her baby, like the relationship and attunement had already begun. There was communication through the breath described by Emma, which would reduce cortisol levels in her body, and pass through the placenta. The pregnancy yoga class placed breathing as central to the experience of the practice, to aid feel good chemicals in the body and reduce anxiety. The baby, having all its needs met, facing no resistance, no hungers, no external intruding influences was at the optimal state of bliss and oneness during this process.
I am also aware of the attunement of the yoga teacher to the needs of the pregnant ladies in her class as Emma described her safety and acceptance in what felt right. This extract from the transcript discussed what the yoga teacher introduced in exercises to include the unborn baby.
‘CoR I think it, I think it, I really like the little touches where she talks about y’know hugging baby and sending messages, so there’s one thing where you sort of you go like this (reaching down to belly) and you go in and you hug baby and you do this and sort of metaphorically hugging baby, obviously not actually but erm it’s quite sweet. And then she makes you visualise breathing. So you have one hand on your belly, one hand on your heart and you visualise breathing down to baby, baby breathing up to your heart so its lovely.
R That’s lovely
CoR It’s really lovely you do feel kind of connected
R Connected to the baby inside?
CoR Connected to the baby yes. ‘ (82-84)
I also found this exercise recommended by Cassandra Vieten, in Mindful Motherhood, she advised, ‘When you feel like you’ve lost contact with yourself and with your baby.. to bring you back into presence with your body and your baby.’ (Vieten, 2009, p166)
This description of connection I also found to resonate with Erskine’s material on attunement, feeling connected and resonating with the other. This particular yoga practice and teacher encouraged exercises that gave this positive emotional experience. Visualising the baby, and the travelling of the breath down to the baby and up to her heart sent an inclusive message of love and was an emotional, imaginative technique of connection. I found the following description by Erskine relevant to the way Emma described the exercise.
‘More than just understanding or vicarious inspection, attunement is a kinaesthetic and emotional sensing of the other – knowing their rhythm, affect, and experience by metaphorically being in their skin, and going beyond empathy to create a two-person experience of unbroken feeling connectedness by providing a reciprocal affect and/or resonating response. (Erskine, 2015, p29)
This experience of connection is also creating a secure attachment pattern between mother and baby. Emma described reaching down and metaphorically hugging the baby as if she could reach inside herself and touch the unborn child. This was a moving description of a connection between the two. The love for the child could be seen on her face as she sat mimicking the movements made in the class to explain the process to me. It did move me to hear this and it was a beautiful gesture of caring. The breath, central to Hatha yoga practice, in this description had taken on an even greater significance. The breath now connected the baby to the heart space of Emma, as if the baby was breathing up to her heart and she was breathing down into baby. The breath, like an umbilical cord of life energy was supplying nurture, life, love and growing a bond before they met. The beauty of this description was so primitive and uncomplicated to me, her body was meeting all the unborn baby’s needs. Slowing down and experiencing the basics of breath and connection seemed all that was needed in that moment for life and love to grow.
A recurrent theme that came up in the data was the descriptions Emma gave of being accepted in her pregnancy yoga class. I sensed her freedom and enjoyment of being allowed to move within her own ability. She described feeling comfortable in a group of other pregnant ladies who discussed their various stages and symptoms. Also, being able to make mistakes in the yoga moves if she was not able to get into a position, and it being OK however she was. When I asked what it’s like being in the class, Emma described how significant the Yoga teacher, Kate is to her experience of feeling comfortable. I linked the themes of feeling accepted, sharing similar experiences with others, feeling nurtured, content in her limitations and being OK in a group to some TA themes.
Nurturing Parent. ‘The Parent has been described as having two attitudes: nurturing and prohibitive.’ (Berne, 1961, p240) This concept from Berne, is diagrammed in the Functional Ego State model below:
(Stewart, I, Joines, V (1987, p21)
The behaviour of the Yoga teacher I linked to the process of feeling nurtured by a caring, accepting parent in a positive way. The teacher’s description was conveyed as guiding, allowing mistakes, has total concern for wellbeing and safety whilst allowing individual ability. There seems an absence of judgement and criticism in the class, which I really felt in the following description by Emma.
‘from the outset Kate’s very, y’know if you’re not, if it feels wrong don’t do it and she’s very much like if you’re not quite standing right she’ll be right on it so you don’t get any injuries, so it just feels quite caring and a safe space.’ (10)
This acceptance and care during the class and feeling nurtured seemed to add to the sense of Emma’s emotional wellbeing when taking part. She states how important it is not to have a critical teacher and to be somewhere where she doesn’t feel self-conscious.
‘..like the number of times she’s just sort of gone, ‘other leg Emma ha ha ha’ y’know and it feels like a light hearted thing like it really doesn’t matter if you make mistakes and that is a massive thing for me, erm because I think .. had someone been critical I wouldn’t have necessarily had a good experience. ‘ (45)
This is much like the experience of childhood when trying something new and being encouraged by an actual parent who is respecting and concerned to let their child explore, make mistakes and be OK to get it wrong. Emma used the phrase, ‘a massive thing for me’ and it seemed so pivotal to her good experience in the class to have a teacher like this. I find here that it is not just the act of the yoga itself, but the attitude and approach of the individual teacher that impacts the feeling of emotional wellbeing when taking part in yoga in pregnancy. A critical approach here would make the experience less positive for emotional wellbeing.
The description of the yoga teacher’s behaviour is also modelling how to nurture to Emma, and how she may then nurture herself and her new baby even before it is born. The caring relationship that exits between teacher and yoga participant was conveyed by Emma in the interview. In my literature review, the Emma Haynes article on treating pregnant women who have depression discussed her treatment approach through the relationship with her clients where their own mothers have not given good enough role modelling.
‘The formation of this relationship, the cocreatedness of it helps to model the creating of relationship for my client with her infant.’ (Haynes, 2017, p130)
This article states that the not being shown how to be a nurturing mother, and having feelings of shame, guilt and not being good enough can often be at the root of depression in pregnancy. I do not think that Emma was depressed in pregnancy, however the behaviour of the yoga teacher has similarities to the treatment of someone who had been. This positive role modelling and relational aspect to the yoga class would aid feelings of wellbeing.
‘..if our own modelling of motherhood was dysfunctional, how are we to know what to do or how to cope? I find the depth and breadth of relational transactional analysis to be helpful when working with mothers who feel a lack in their own experience of being mothered and mothering their own child.’ (Haynes, 2017, p130)
There was a passage in the interview where Emma described the teacher tucking her in during relaxation which was particularly poignant I felt to a nurturing mother role. It was also like the tucking in of a baby that will soon be being done by Emma herself.
R 100 Yeah, do you feel cared for?
CoR Yeah (sighs) and even at the end cause y’know we do erm the relaxation and she comes round and it’s almost like she tucks you in, you can imagine that you have a blanket and that she’d actually tuck you in.’ (100)
Being accepted within a group was discussed as important to Emma in this interview. Past experience of groups at school came up in our discussion. Interestingly, the school hall where she attended her yoga class, and where we were carrying out the interview used to be Emma’s actual Infant school, some 30 years ago. There was certainly opportunity within a school sports hall to re-experience a negative situation from the past and project it onto the current one. When describing previous experiences in groups for sport in school, it didn’t sound a positive memory for Emma.
‘I’ve never been that great in group settings, never been a group sport person or anything like that. I’m not someone that likes kind of too much attention in a group or anything like that..’ (43)
I was aware that she then moved away from those negative past experiences and described how different and positive the current class was. Emma went on to talk about the acceptance of the yoga teacher and the group of similar women sharing pregnancy yoga together. I reminded her how different it could’ve been if she hadn’t felt accepted and she then described her childhood experience in groups,
‘Yes, and my childhood experience of school like y’know groups and whatever I’ve never been someone who was top of the class for that kind of thing or always been y’know (smiles) the one you didn’t really want to be paired off in various group activities. I’m a little more introverted in that way I suppose.’ (49)
There is a sense of not feeling OK or accepted in the past during group sport and activities in Emma’s childhood. Not top of the class, not chosen to be a pair, and self-conscious of standing out was a memory that she brought into awareness during our discussion. I found it positive and impressive that she had not let this previous experience influence her experience in this present class. She had created an opportunity to realise her worth, her place, and value in a new group activity setting. The recognition of past experience and a more positive present one may have had an impact on her emotional wellbeing. This statement shortly after her description of previous groups reaffirms that she was in the present and enjoying how she felt within this pregnancy yoga group.
‘I feel comfortable, I come out of my shell and I’m much more chatty and I definitely feel like that with this group.’ (50)
Having people around who were experiencing being pregnant at the same time as Emma was a positive experience in the yoga class. I got the impression that there was much dialogue between them on pregnancy symptoms, movements of babies, stages, hope, anxieties and aspirations. This sharing of a common experience was powerful in aiding being accepted and feeling comfortable. There was mutuality.
‘CoR …it’s really nice that it’s the only space that I have with other pregnant women’
R Oh really?
CoR Yeah, like a social sort of setting, cause there’s no-one at work that’s pregnant, I don’t have any friends that are pregnant so it’s kinda the only time that I’m like, oh what stage are you at, what have you experienced? (12-13)
Emma also described seeing the women in her class each week at different stages of their pregnancy and seeing what was to come. She had been attending the class for more than 10 weeks at the date of our interview. She was getting reassurance from seeing other women at various stages in their pregnancy.
‘it’s just really nice to see women at different stages as well as how they are coming back, y’know for weeks and weeks …there’s like continuity, and y’know it’s bringing value every week.’ (47)
I thought when listening to Emma how reassuring this must have been to watch women in their later stages and seeing that they are still OK, returning, and enjoying the yoga and their pregnancy. I also thought of the Richard Erskine term, Normalisation used in Integrative Psychotherapy to give clients reassurance that what they are experiencing is a normal human response to their past or present situation.
‘The purpose of normalisation is to counter these self-denigrating beliefs and to help clients to realise that their behaviours and their internal experiences are normal to predictable responses to their life situation, their environment, and their genetic makeup.’ (Erskine, 2014, p95)
Overall the positive group, the sharing of experience, the acceptance and normalisation of pregnancy in this class helped enhance emotional wellbeing.
Considerations for further Research
If I was researching this topic further, I would recommend also interviewing a co-researcher who had, or was currently suffering with depression in pregnancy. Finding a co-researcher who was then prescribed yoga classes to alleviate these feelings and being able to interview them some weeks into their regular classes may show a more direct influence on their emotional being from the yoga classes. This research was only one person’s lived experience. It was very unique and specific to that one person so cannot be assumed to have the same impact for another person in a similar position to Emma.
Reflecting on my role as the researcher and how this may have impacted my findings I considered how I was impacted by what Emma discussed in the interview. There was counter transference with me when she discussed being nurtured by the yoga teacher. I had had this experience with the same teacher at a time in my life when my mother was dying. I felt I got some nurture from the class during this time, and as Emma spoke about this I really remembered how I felt some years ago. Interestingly one of my transactions after she spoke about this was, ‘yeah, you kind of forget where you are a little bit don’t you?’ (R 104) This was when I did move away from her experience into my own. It may have distracted me from enquiring further into her experience. It affected my bias that I knew the pregnancy yoga teacher and had been in her classless for the last four years. I knew first-hand how she worked and Emma’s description of her care were very familiar to me. Someone who didn’t know this may have enquired further into Emma’s subjective experience and not had my preconception.
On reflection, the interview felt comfortable, enjoyable and very friendly. It was lovely building rapport with Emma and encouraging her to talk freely. Having been pregnant twice myself in the last 9 years, the invertiew did feel familiar to other conversations with pregnant friends and family in recent years. I have attended pregnancy yoga myself, ante natal classes and made many long terms friends in my life through being pregnant. The limitation here is that I may have assumed her frame of reference and not been detached enough to probe further into her specific meaning.
This qualitative research study was carried out to explore if attending regular Yoga classes whilst pregnant effects emotional wellbeing. I was hoping to find out that it had been beneficial to my co-researcher, as it had been to me in my own pregnancy. What I discovered in my research were so many more positive elements that attending the yoga class brought to the experience of Emma in her pregnancy. It was not the physical moves of the yoga specifically, but a combination of environment, ambiance, imagination, acceptance, and the caring of the teacher which gave feelings of joy, connection and nurture.
Similarities with many TA theme were drawn upon, and as a treatment plan for someone with emotional difficulties, Emma’s particular experience would offer a wonderful aid to increasing mental health and wellbeing. I was quite surprised to discover that the ingredients of this class had many similarities to positive psychotherapeutic interventions. Connection, attunement, nurturing parent, physis, acceptance, relaxation, breath, mutuality, positive group experience, relationships, modelling of caring, normalisation, and being OK in whatever way you can be.
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Appendix I: Project Proposal Form
Appendix II: Participant Consent Form
Appendix III: Transcript of Invertiew
Appendix IV: Emails to authors for Research Literature
Appendix V: Advert for Co-Researcher
Appendix VI: Text Analysis Tool Results Whole Transcript
Appendix VII: Emails to Co-Research and Responses
Appendix VIII: Text Analysis Tool Results Co-Researcher Responses