Raquel Chinchetru, senior yoga therapist, shares her expertise on using yoga therapeutically to help women dealing with perinatal depression.
Perinatal depression is defined as depression encompassing pregnancy and the first postpartum year. It has potentially profound negative effects on mother and child. Perinatal depression is a serious public health issue that carries a significant disability burden. For some women, depression during pregnancy and in the early postnatal period heralds the onset of a recurrent and enduring mental illness and an increased risk of committing suicide. Depression may also adversely affect the physical, cognitive, and psychological development of children.
Perinatal depression was not defined in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM) until it was labelled as a Major Depressive Disorder with postpartum onset in the 4th edition of the DSM in 1994, and diagnosis of perinatal depression still utilizes the onset-specific format. Nevertheless, the specified criteria has changed to “with peripartum onset,” which is defined as the most current episode occurring during pregnancy as well as in the four weeks following delivery. The person must also experience at least four additional symptoms as listed below:
- Changes in appetite or weight
- Sleep and psychomotor activity
- Decreased energy
- Feelings or worthlessness or guilt
- Difficulty in thinking
- Difficulty in concentrating or making decisions
- Recurrent thoughts of death or suicidal ideation, plans or attempts.
To reach a diagnosis of Major Depressive Episode with peripartum onset symptoms must either be recently present or must have worsened compared with the person’s pre-occurrence status. The symptoms must persist for nearly all day nearly every day for at least two consecutive weeks.
Reasons that yoga therapy might be an interesting alternative
- Zlotnick, et al., (2001) found that most pregnant women reported they would not take antidepressants, even if encouraged by their doctor.
- Expansion of treatment options that are both effective and acceptable to childbearing women is a priority.
- The main role of yoga therapy is enhancing well-being rather than treating disorders. This may appeal to those concerned with the perceived stigma of mental health treatments. As a nonverbal approach, yoga may also circumvent emotional barriers to psychotherapy experienced by some women who are uncomfortable openly discussing problems. Prenatal yoga is also relatively inexpensive and available.
- Prenatal yoga may benefit women with depression during pregnancy and could, in fact, be more appealing than some existing treatment.
Components of yoga therapy for PND
- Psycho-education to encourage the practice and self-regulation
- Physical exercises according to individual needs and contraindications
- Baby yoga
- Breathing techniques
- Body scan
- Mindfulness meditation
- Individual assessments of 15 minutes after each session
- Babies are welcome in the class, except in cases of acute clinical depression
- Sensitive language (eg using ‘birth partner’ for single mothers)
- Including babies in the class. Baby yoga techniques create confidence for the new mother, creating awareness of her own and the baby’s needs.
Useful pranayama additional benefits
- Dirga (connection with the baby during pregnancy and new postnatal awareness of the abdominal muscles)
- Ujayii (settle and rest during pregnancy and after breastfeeding)
- Golden-thread exhalation (helps with anxiety and panic that may happen with the arrival of the baby and during labour)
- Alternate-nostril (lifeline during periods of emotional swings)
- Bhramari (promotion of acceptance and contentment)
Yoga therapy can play an important role in the management of PND. Yoga therapists are uniquely positioned to help women with PND and their babies as yoga therapy is a supportive confidence-building and connection-building intervention that does not carry with it the stigma of many mental health treatments or the added stress and health considerations of taking antidepressants while pregnant or nursing. This is especially true for yoga therapists who have the training and skills to work in partnership with the greater healthcare community.
Raquel Chinchetru is a senior yoga therapist qualified with both the Yoga Biomedical Trust and The Minded Institute (Heather Mason). She has trained with Mukanda Stiles in yoga and ayurveda, with Francoise Freedman in well-woman yoga, with Uma Dinsmore-Tuli in pregnancy and postnatal yoga, and with the Boston Trauma Center in yoga for post-traumatic stress disorder. Raquel also holds a degree in Psychology, an MSc in Human Resources, and an MSc in Health Psychology from the University of Westminster. She has recently finished a degree in Fine Arts. Her work is a fusion of years of structured practice illuminated with creativity and compassion. She can be reached at her website: www.breathingbeing.com.