| dc.description.abstract | Background: The importance of maintaining a healthy lifestyle and positive mental health during pregnancy are well publicised. Maternal stress, anxiety and fear of childbirth in pregnancy have been associated with an increased risk of preterm birth, low birth weight, pregnancy induced hypertension, pre-eclampsia and emergency caesarean section. Consequently, there is a need for evidence-based non-pharmacological interventions to promote wellness and reduce antenatal stress, anxiety and fear of childbirth. Yoga may be a suitable intervention as evidence from the literature suggests it is safe, widely used and can contribute to improvements in stress, anxiety and labour and birth outcomes. To date, research on pregnancy yoga has focused on in-person teaching and self-directed home practice with limited reproducibility of the programmes and lack of fidelity measurement. There is a need for studies of evidence-informed reproducible online pregnancy yoga programmes with robust fidelity measures. While the body of evidence documenting the benefits of pregnancy yoga is growing there are no studies in an Irish context.
Design: A convergent parallel, mixed methods design underpinned by the philosophy of pragmatism with equal weight given to the quantitative and qualitative phases.
Aim and objectives: The study aim was to develop a manual for an evidence-based pregnancy yoga class programme and test it for feasibility. The research objectives were:
(i) To conduct a systematic review and meta-analysis to identify the characteristics and effectiveness of pregnancy yoga interventions in RCTs and quasi-experimental studies.
(ii) To explore pregnant women and mothers, maternity care providers and yoga teachers experience of pregnancy yoga programmes and their understanding of their essential components.
(iii) To combine the evidence from RCTs, quasi-experimental studies, pregnant women, mothers, maternity care providers and yoga teachers to design an evidence-based manualised pregnancy yoga programme.
(iv) To design and conduct a feasibility study of an evidence-based manualised pregnancy yoga programme.
Methods: University ethical approval was granted. Following the guidelines of the UK Medical Research Council Framework for developing complex interventions, three studies were conducted to address five steps in the development and feasibility/piloting phases of this framework. In study 1 a systematic review was conducted to identify the evidence base related to the characteristics and effectiveness of pregnancy yoga. A qualitative study involving maternity care providers, yoga teachers and pregnant women/mothers aged ≥18 years with conversational English and experience of pregnancy yoga, was conducted in study 2 to develop an understanding of the core components of pregnancy yoga. Thematic analysis was the method used to guide the approach to data collection and analysis, and findings from study 1 and study 2 were integrated to support design of an evidence-based pregnancy yoga programme. In study 3, the manualised pregnancy yoga programme produced by the findings of study 1 and study 2, was tested. Healthy pregnant women with no medical, obstetrical or surgical complications preventing them from engaging in physical activity based on medical or maternity care advice were recruited through Rollercoaster.ie to participate in six sessions of live-streamed online pregnancy yoga. Pre and post programme surveys were purposively designed, and post programme one-to-one interviews conducted. Quantitative data were analysed using IBM SPSS for windows version 27.0 and qualitative data were analysed thematically. Interpretation of quantitative results and qualitative findings used a convergence coding matrix, and the overall feasibility of the study was reported in terms of acceptability and demand for the intervention, and the feasibility of the study design according to Bowen?s feasibility framework.
Sample: In study 2, one-to-one interviews were conducted with 21 pregnant women, mothers, maternity care providers and yoga teachers. In study 3, 43 pregnant women were recruited. Quantitative data from 39 women, one-to-one interview data from 10 women and qualitative free-text feedback from 33 women were included in the analysis.
Findings: In study 1, a total of 24 studies were identified in the systematic review and 22 were analysed in a meta-analysis. Findings supported a statistically significant beneficial effect of pregnancy yoga interventions for anxiety, depression and perceived stress. High heterogeneity across studies highlighted the need for more robust studies using transparent, reproducible yoga programmes. In study 2, data from 21 interviews offered rich descriptions of the components of pregnancy yoga classes that incorporated an initial class check-in, breathwork, posture work, relaxation and tools for labour and birth. Most participants suggested a minimum of six classes, each of one-hour duration and delivered weekly. In study 3, 39 pregnant women found the pregnancy yoga programme feasible, acceptable, worthy of recommendation and of excellent quality. Quantitative data on intended effects suggests improvements in perceived stress, state and trait anxiety following six sessions of pregnancy yoga. Fidelity to the intervention was excellent and the pregnancy yoga programme has been fully manualised for reproducibility.
Conclusion: Six sessions of live-streamed online pregnancy yoga are feasible and acceptable and can contribute to lower levels of stress and anxiety as well as supporting women to prepare physically and mentally for labour and birth. Further testing in a randomised trial with a larger cohort and a control group is recommended to validate these findings. | en |
