Is yoga safe in the first trimester of pregnancy?

Didi asked: Hi Sara do you have any evidence around when women can start yoga in pregnancy if they haven’t practiced before pregnancy? The only information I can find is on the RCOG and RCM sites that encourage exercise in pregnancy but don’t clarify this ‘magic’ time that women are ‘allowed’ to do pregnancy yoga. Most pregnancy yoga teachers won’t let women attend their classes until at least 16 weeks. Thank you! Didi

Well first of all, I really appreciate that you put the word allowed into scare quotes. And for anyone who is new to this site or such debates this is because those of us who take a woman-centred approach are keen to address and change the paternalistic language often used in relation to pregnant women.

Pregnant women are just as self-determining and capable of making their own decisions as anyone else, and they have the absolute right to do so.

In fact, many people believe that part of the pathway to a more woman-centred approach is to reconsider language and attitudes that restrict and confine, whether intentionally or otherwise.

Risk management again

Having said that, though, the majority of those who seek to impose such boundaries upon pregnant women, or who continually stress that we cannot be sure that such activities are safe during pregnancy are doing so because they genuinely believe that this is in the interests of the woman and/or her baby.

In our fear-filled, litigation-happy culture I can completely understand why some yoga teachers and others might be concerned.

The issues raised by this question apply to many areas and activities as well as yoga, of course, and women increasingly find themselves facing boundaries applied by others (often out of fear) and/or signs warning them that they undertake activity at their own risk.

This can be really unhelpful and unfair, because it implies that the activity is intrinsically dangerous, and that any woman who has a problem after undertaking such an activity should blame herself for doing so – especially as she was pre-warned.

But, there’s a but…

But life isn’t safe.

The sad reality is that a small proportion of women who become pregnant will lose their baby no matter what they do that day.

On the day that they lose their baby, and on the day or two leading up to that day, they will be doing things in the same way that we all do loads of different things every day.

But, unlike the rest of us, who will wake up the following day and do other things without too much analysis of what we did the day before, a woman who loses her baby in pregnancy will ask herself if the things she did that day – or the day or two before – could have caused her loss.

The chances are that they didn’t.

My understanding of early pregnancy loss is that, much of the time, this is unpredictable and unpreventable.

It gives some women comfort to focus on the possibility that nature stepped in because there was a problem and their baby wouldn’t have been born healthy and happy. Others will want to explore where things might have gone wrong. I wholeheartedly support their right to do so, yet this is where we can sometimes encounter problems. Because we have barely any research into whether activities like yoga are safe in early pregnancy or not.

What does the evidence say?

Research-wise, I’ve found lots of papers discussing yoga in pregnancy.

Most of them either take the view that you described above or skirt around the question of when yoga can be done in pregnancy.

Let’s also not forget, of course, that the term yoga includes many different styles and approaches, and that activities like yoga are generally better when individualised to the participant’s needs.

Such things need noting generally and defining when it comes to research.

I’ve also found a few trials (like this one and this one) that might have contained useful data.

Except that they have (fairly understandably given the context) all chosen not to include women who are in their first trimester.

As a result, we just don’t have good evidence.

So what do we do?

When there are things that we don’t know, or that we don’t have good evidence for, some people will tend to swing towards caution and others will decide to not worry unnecessarily.

When you’re in a position of feeling you need to make decisions for others (even though it’s actually not your job to do so for self-determining people), it really is hard to go against the grain of caution.

Even though there may not have been any evidence for it in the first place.

The problem with guarantees

The decisions that we make about our pregnancy and childbirth journeys can shape our experiences, health and lives, as well as those of our families. But those decisions can be complex. This book is a guide to the different perspectives and approaches that exist, and it offers tips, tools and ways of thinking which will help you make the decisions that are right for you.

No-one wants to say “yes, yoga is safe at any point in pregnancy and you can all go to classes with impunity.”

Because, again, the sad reality is that we can’t offer guarantees, or be certain about what is safe and in what context.

And a few of the women who lose their babies will do so within a day or three of going to a yoga class. The chances are that those babies might not have made it whatever their mums did, but this doesn’t stop their mums from questioning whether it was the hot bath / hot sex / second helping of chips / yoga class…

Kimberlee Bonura, who has both a PhD and a yoga teaching qualification, considered this very problem.

“Beyer-Nelson’s (2001) review provides good foundational understanding of both the benefits and challenges of integrating yoga into childbirth education. However, Beyer-Nelson’s assertion that yoga practice not begin during the first trimester seems rooted in liability concerns for hospitals rather than contemporary exercise guidelines. Hospitals may prefer this precaution to avoid liability in the event of first-trimester miscarriage; however, personal conversations with multiple obstetricians lead me to believe that gentle practices such as yoga or massage will not lead to miscarriage in a healthy pregnancy.” (Bonura 2014: 50-51)

Kimberlee also added a comment to this post when I first wrote about this, which you can see below.

Yoga IS effective

On a slightly different topic, we DO know that yoga is effective.

A systematic review and meta-analysis examined the characteristics and effectiveness of pregnancy yoga interventions.

“Twenty-nine studies with 2217 pregnant women were included for meta-analysis. Pregnancy yoga interventions reduced anxiety, depression and perceived stress. Yoga interventions also reduced duration of labour and, increased odds of normal vaginal birth and tolerance for pain. The quality of evidence (GRADE criteria) was low to very low for all outcomes. Twelve or more yoga sessions delivered weekly/bi-weekly had a statistically significant impact on mode of birth, while 12 or more yoga sessions of long duration (> 60 min) had a statistically significant impact on perceived stress.”

The researchers concluded that, “The evidence highlights positive effects of pregnancy yoga on anxiety, depression, perceived stress, mode of birth and duration of labour.” (Corrigan et al 2022)

A recent phenomenon

I phoned my favourite pregnancy yoga teacher while writing this post. She is very experienced and feels that this concern about yoga in the first trimester is a relatively recent phenomenon. Until recently, she told me, no-one even thought about miscarriage in relation to yoga. And she and her colleagues tell women to join the group whenever they want; to choose the time that’s right for them. These days, they encounter more and more women who have been told by other teachers that they can’t access a class until they are at least 12 or 14 weeks pregnant. My friend tells women that those teachers may be worried that if a woman has a miscarriage then she might blame the teacher. But she explains, again, to women that their approach is to encourage women to make their own decision about what’s right for them.

But I’ve also heard from yoga teachers who offer other perspectives. Some point out that the needs and ability of women in early pregnancy are really different from those who are nearing birth. Others discuss the possibility that there are some positions that should be avoided, which is why it is important to find a teacher who is appropriately educated and experienced, and not someone who has done a short course and is simply offering a few yoga poses as part of a childbirth education session. And, again, see Kimberlee’s comment below.

At the end of the day, the key is that women should be able to make the decisions that are right for them.

I hope this post has helped explain the issues.

Bonura KB (2014). Yoga mind while expecting: the psychological benefits of prenatal yoga practice. International Journal of Childbirth Education 29(4):49-54.

Corrigan L et al (2022). The characteristics and effectiveness of pregnancy yoga interventions: a systematic review and meta-analysis. BMC Pregnancy and Childbirth 22(250).