Dr. Rebecca Dekker – 00:00:00:
Hi everyone. On today’s podcast, we’re going to talk with Dr. Shilpa Babbar about integrative obstetrics and breathing techniques for relaxation in pregnancy and birth. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi everyone, and welcome to today’s episode of the Evidence Based Birth® Podcast. Today, I’m so excited to welcome Dr. Shilpa Babbar, a double board certified maternal-fetal medicine and obstetrician, gynecologist, physician, researcher, and yoga instructor. From 2020 to 2024, Dr. Babbar was at Children’s Mercy Hospital in Kansas City, where she served as medical director of maternal-fetal medicine specialists at Advent Health Shawnee Mission in Kansas, and Dr. Babbar was associate professor at the University of Missouri, Kansas City. Dr. Babbar has been publishing on prenatal yoga research for more than 10 years, and she’s a nationally recognized leader on this topic. She served as guest editor for the clinical obstetrics and gynecology symposium on Complementary and Alternative Medicine in Obstetrics, published in 2021. This publication included the first in-depth review of research evaluating the impact of meditation in pregnancy. Following her most recent pregnancy herself, her research expanded to investigate the effects of various pranayamas, which she’ll talk with us about, and related complementary and alternative therapies during pregnancy. Welcome, Dr. Shilpa, to the Evidence Based Birth® Podcast.
Dr. Shilpa Babbar – 00:02:00:
Thank you so much. It’s such a pleasure to be here.
Dr. Rebecca Dekker – 00:02:03:
So I was, you know, we’ve been in communication for several years, ever since you did your symposium and you reached out to us at Evidence Based Birth® asking us, if we could contribute to that. So that was like an incredible experience. And you’re, you know, one of the few obstetricians who has really, you know, proactively reached out to us and Evidence Based Birth®. So that really impressed me. And then we were able to work together on your conference last year. So I am so excited to bring you onto the podcast and let you share your story because it’s really impactful. So can you start off by like talking with us about your journey into the field of maternal-fetal medicine? Maybe start off by like defining what that is for people who don’t know, and then kind of go into your interests in yoga and complementary and alternative therapies and how that evolved.
Dr. Shilpa Babbar – 00:02:53:
Yeah, absolutely. Well, it’s such a pleasure to be here. And I’ve been definitely a big fan of yours since a long time since you’ve been doing this. And it’s so wonderful to be able to connect at different points in both of our careers and on this path. So thank you again. So let’s start by defining what a maternal-fetal medicine physician is. Essentially, it is a high risk pregnancy specialist. So we have obstetricians and gynecologists. And to become one, you have to complete four years of residency training. And then you can choose to specialize. And so maternal-fetal medicine is a three-year fellowship program that typically people will complete after they finish their residency. And essentially, you are specializing in high risk pregnancies. You know, one can call you the expert in the fields for obstetrics dealing with all aspects of pregnancy.
Dr. Rebecca Dekker – 00:03:44:
Wow. That’s. College, medical school, you said four years of obstetrics and gynecology residency, and then another three years of maternal medicine, correct?
Dr. Shilpa Babbar – 00:03:54:
Yes. Yeah.
Dr. Rebecca Dekker – 00:03:55:
And it’s my understanding that you do a research project as part of that maternal-fetal medicine fellowship.
Dr. Shilpa Babbar – 00:04:00:
Yes, yes. We actually get about half of the time or 18 months dedicated to conducting research. And so during my fellowship, I also completed a master’s in bioinformatics simultaneously. So that also gave me a really good foundation to conduct research as well.
Dr. Rebecca Dekker – 00:04:16:
How did you get interested in how yoga can be used in pregnancy and then other aspects of complementary medicine?
Dr. Shilpa Babbar – 00:04:23:
Oddly enough, my journey on the yoga path started in a local gym in New Jersey. I had just come back from completing medical school in India, the birthplace of yoga, and didn’t even think twice about it when I was in India. But my sister and I joined a local gym and just started going to yoga classes. And we were immediately hooked and we fell in love. So a few years later, when I was doing my obstetrics and gynecology residency, I was dragging one of my colleagues to yoga classes with me because I loved it so much. And I was like, you got to come with me to this. One day, her and I were just kind of talking. Next thing you know, she was like, have you ever thought about prenatal yoga? And I was like, what prenatal yoga? And like, that’s when like the light bulb kind of clicked in my head. And I was like, okay, prenatal yoga. Yeah, that’s a thing. I went to my favorite search engine, PubMed, tried to look up what’s the literature that’s out there to support this practice. Interestingly enough, there wasn’t much out there at the time. So my mentor and I during my residency, wrote up a research, I’m sorry, a review article on prenatal yoga as the first of its kind at the time. We also conducted a survey study of the local pregnant women that I was serving in our community at the time, just to kind of understand what are the exercise practices, including yoga for the women that we were serving. Our survey study demonstrated that only about 7% of women were engaging in prenatal yoga at the time. So there’s definitely a clear, clearly enough space for growth. A few years later, once I finished residency, soon after I finished residency, I joined my maternal-fetal medicine fellowship.
During my fellowship, I conducted a randomized controlled trial looking at the acute fetal response to prenatal yoga. So I wanted to see, does the practice of prenatal yoga affect the fetus at any point? So it was a one-time only intervention. We were able to look at fetal heart rate, blood flow to the baby, and a couple of the maternal parameters, and we were able to show that the baby tolerates the practice of prenatal yoga just fine, showing that it is a safe practice to engage in during pregnancy. I started deepening my own practice, my own yoga practice. So I was going to a local yoga studio and practicing Ashtanga yoga. And also during my fellowship, I started deepening my own meditation practice. When I was moving on to my first job after fellowship, I wanted to kind of get a better understanding of what is the data that supports meditation during pregnancy. And again, went back to PubMed and realized that there really wasn’t much out there when it came to meditation alone. There’s a lot of information out there on mindfulness practices for pregnancy. And I know often meditation, mindfulness kind of go hand in hand or sometimes we’re interchanged terms. For those people who do research, you’re not trying to find a home for an article sometimes can be a daunting experience. And so it essentially led me to being invited to be a guest editor for the clinical obstetrics and gynecology symposium on complementary alternative therapy in obstetrics. And so that’s where we found the home for our meditation review article. And like you mentioned earlier, that’s where you all contributed to the aromatherapy chapter. So it was a 10 chapter symposium addressing different complementary therapies that can be applied easily to pregnancy. So it included aromatherapy, acupuncture, acupressure, chiropractic care, herbalism, hypnosis, massage, our meditation article, other mind body techniques. And we included two relatively new topics for pregnancy. Which included Ayurvedic practices as well as spirituality. So the symposium has been really well received by the research community. And it was just kind of the beginning of expanding my horizons to applying these therapies in pregnancy.
Dr. Rebecca Dekker – 00:08:11:
That must have been incredibly intense and stressful training to be an OB/GYN and maternal-fetal medicine specialist. How did the yoga and also the meditation impact your mental health during that time?
Dr. Shilpa Babbar – 00:08:26:
Yeah, I believe it helped me tremendously. Like you mentioned, there was definitely a lot of stress during those times. And I will say when I was doing my OB/GYN residency, that is when I did my yoga teacher training. So the 200-hour yoga teacher training. It was a 10-month program at the time. And so really any free weekend that I had in my third year of OB/GYN residency was dedicated to my yoga teacher training. So it was intense in itself, but it was totally worth it. And I felt the immediate benefits of my own yoga practice. And it definitely helped me along my whole journey, my professional journey of just being able to think clearly and to be more relaxed and trying to, you know, like stress will come my way. But I was able to deal with it in a much better way.
Dr. Rebecca Dekker – 00:09:18:
I’m also fascinated by the research project you chose to do. So I’m assuming you took… people who are pregnant at what point and then you put them on monitors to measure different things before and after the yoga and before and after a control period? Or did you measure it during the yoga? Tell us more about this study.
Dr. Shilpa Babbar – 00:09:37:
Yeah. So like I mentioned earlier, it was a one-time only study, but we took women who were in their third trimester of pregnancy and they were also brand new to yoga. So there are people that have never tried yoga. And the best part was that where I recruited these patients from was from one of our safety net hospitals. So I love that I was able to introduce the concept of yoga to people who may not have really, you know, been following it or, you know, looking for it or kind of exploring it on their own. And I got a lot of positive feedback as a side note, but patients who were involved in the study really loved it. And it kind of helped break down some of the barriers and different thoughts that they had about what yoga was. And they’re like, wow, that was really good. And that made me feel really good. Can I come back for another class? And unfortunately there was, it was a one-time only intervention, but yeah, so we did an ultrasound and we did something called a non-stress test, which are two belts that go across the mom’s belly. One looks at baby’s heart rate and one looks to see if they’re having any contractions. And so we did that before and after a one-hour yoga class. And we also looked at like maternal vital signs, like blood pressure, heart rate, and again, before and after. And then our control group was an educational control group. So I sat down with our control group. And we had like a little PowerPoint presentation, but reviewed different topics like exercise, obesity, briefly on nutrition. And then they were kind of able to ask me as an OB/GYN, like any questions that they had with regards to pregnancy. So it was a nice opportunity, even for our control group, where they can just, you know, they were free to ask anything that they wanted and get extra information. And then they also had the same testing done before and after.
Dr. Rebecca Dekker – 00:11:14:
So you found that compared to the control group, the prenatal yoga one-time session was safe. Have you seen any further research that’s come out since then kind of expanding on the benefits potentially?
Dr. Shilpa Babbar – 00:11:26:
So benefits of yoga practice, yes. So there’s a lot of literature out there with regards to showing the benefits of yoga. I will say that there is, at this point, we have a fair amount of literature to show that a prenatal yoga practice can reduce stress, anxiety, and depression during pregnancy, and even into the postpartum period as well. I will say that there’s another study that looked at very similar parameters that was published around the same time as our study as well. And they were also showing the same things, that there’s no significant changes from the fetal standpoint. And I will say also something that’s really fascinating to me with regards to prenatal yoga literature is that there’s more and more studies that are looking at different labor outcomes. At this point, there’s about seven studies that have shown that a prenatal yoga practice can reduce the duration of labor, and specifically in the first stage of labor. So the first stage of labor is essentially where the onset of contractions or onset of labor until it could be completely dilated. That, for many women, can take… sometimes a day or two, especially if you’re a primip or it’s your first pregnancy. The studies have shown that a prenatal yoga practice can reduce that duration by around two to three hours. So it might not sound like a long time, but for anyone who’s gone through labor, if they told me that we can reduce this by about two to three hours, I would definitely sign up for that.
Dr. Rebecca Dekker – 00:12:46:
What do you think causes it to be shorter?
Dr. Shilpa Babbar – 00:12:49:
I think it’s a combination, right? So I think during a prenatal yoga practice, we’re definitely prepping our bodies and, you know, stretching out different muscles that probably don’t get routinely stretched out, right? So a little bit in my personal experience, the prenatal yoga practice that I was engaging in, there was a lot of like pelvic floor preparation as well. And so you’re kind of priming or trying to get your body ready for the process that’s about to happen towards the end of pregnancy. And I do think that the deep breathing component of it also probably goes a long way. And once you start practicing something, you kind of, your body kind of will sometimes automatically engage in that practice when it needs to. And that’s where a prenatal yoga practice, even deep breathing practices that people like literally practice during their pregnancy can help them, like their body might automatically like engage or try to, you know, do those postures, even deep breathing exercises when they feel like. Their body’s under stress or in pain or anything like that. So I think.
Dr. Rebecca Dekker – 00:13:47:
Yeah. So maybe the decreased anxiety, decreased pain can also make labor progress. Like in a more productive way. It was also interesting to me when I attended your conference and you had a speaker about prenatal yoga, just, it reminded me of how prenatal yoga instructors are so connected in their communities with doulas, with childbirth educators, with hypnosis instructors, with acupuncture professionals. So it’s kind of like a holistic place to go to meet other people, gain social support and education.
Dr. Shilpa Babbar – 00:14:22:
Yeah. I agree 100%.
Dr. Rebecca Dekker – 00:14:25:
Yeah. So you mentioned India is the birthplace of yoga. Where does that originate from? And how can it be used in pregnancy?
Dr. Shilpa Babbar – 00:14:33:
So pranayamas, that term also originates from India. It’s a Sanskrit word. The word prana means life force, essentially our breath, and yama means to control. So the control of our life force or breath control is another way of putting what that term means. It’s a practice that is typically part of yoga, but obviously can be practiced separately as well. So there’s fast breathings or fast pranayamas, like bastrika pranayama. And then there’s slower breathing techniques like alternate nostril breathing, brahmari pranayama. And then there’s also breath holding patterns. Generally are not recommended for pregnant women. I will say that if you hold your breath for a few seconds, I don’t think that’s going to cause any harm. But some of these deep breathing exercises are prolonged breath holding, which are generally not recommended. Even the faster breathing techniques are generally not recommended in pregnancy. And the reason for that is because… it’s based off on our autonomic nervous system. So our autonomic nervous system is divided into two categories, the sympathetic nervous system and our parasympathetic nervous system. Whenever somebody gets anxious or stressed out, or even pregnancy, so pregnancy is a natural state of hyperactivity of the sympathetic nervous system, there are changes that need to go on in the body, just to accommodate a growing fetus. Whenever you’re anxious or anything like that your sympathetic nervous system gets activated. Typically the first thing that someone will do is tell you to take a deep breath. And then why is that? Because deep breathing activates our parasympathetic nervous system or our vagal nerve. That helps to kind of slow the body down, slow down the physiological parameters of our body. So the deep breathing, the slower deep breathing exercises will help stimulate the vagus nerve and help slow things down, so that’s where we kind of recommend avoiding the faster pranayamas just because pregnancy is already a state of sympathetic hyperactivity so engaging that further stimulating that further might not be as comfortable.
Dr. Rebecca Dekker – 00:16:38:
Yeah, I don’t think anybody who is listening who is pregnant wants to become more anxious, on purpose. And, thank you for that primer on the sympathetic nervous system and parasympathetic nervous system. I remember in nursing school one way I memorized kind of the differences is sympathetic “s” stands for stress, at least that’s how I remembered it. And that’s like the fight or flight, adrenaline epinephrine, those sorts of things where your body is kind of like geared up to protect itself or maybe to flee. And then the parasympathetic nervous system, when that’s activated, I always thought of the word peace and like calming. That’s how I remembered it. If that’s helpful for anyone. Breathing techniques, our breath or our life-force can activate either of those systems, depending upon how we use it.
Dr. Shilpa Babbar – 00:17:28:
Correct, yeah.
Dr. Rebecca Dekker – 00:17:26:
Okay. I would love it if you could share, you know, your personal story on how you became convinced that there was something to look at with researching using breathing techniques in pregnancy. I know we’ve heard a lot over many years, people may have heard of like different breathing techniques for labor, but you were teaching us at the conference about breathing in pregnancy. Can you talk about that?
Dr. Shilpa Babbar – 00:17:48:
Absolutely. Yeah. So in January of 2020, I, my husband and I moved to Kansas City. I was just starting a new job and I was, it was a new position for me as well. And then March in 2020, we all know what happened, the pandemic hit. And so right before the pandemic hit, we both found out that we were pregnant. Needless to say, my stress levels were kind of through the roof, just with a new move, a new job, a pandemic, being pregnant. So there’s a lot going on. And unfortunately, my body was starting to show it. My prenatal yoga practice and my first trimester no longer felt comfortable to me. There was times where I was doing a forward fold and I felt blood rushing to my head. And I was like, this is just, this doesn’t feel right. This is not what I felt like before. And I’m not feeling comfortable. I started to keep a close eye on my blood pressure and noticed that my blood pressure started to increase at a point in my pregnancy where it’s normally supposed to decrease. And so I was keeping a close eye on it and seeing how I was feeling. And I was getting symptoms. I was getting headaches that were…
Dr. Rebecca Dekker – 00:18:49:
So you were doing home monitoring of your blood pressure?
Dr. Shilpa Babbar – 00:18:52:
Yeah. That was just, you know, the physician slash nerd slash researcher in me that was just kind of keeping an eye on things. There was a point around 18 weeks of my pregnancy where I started getting really high blood pressure numbers that if I saw a patient come into my office with those numbers at 18 weeks, I would say, you need to start a blood pressure medication. So I practiced what I was preaching and I started blood pressure medication under the guidance of my physician. Simultaneously, though, I was also engaging in alternate nostril breathing. And so that was something that I was just kind of doing since the beginning of pregnancy and just doing a few cycles of it every night or every day when I can remember. But once my blood pressure started to go up, I started engaging more and more into alternate nostril breathing, And so I would do it every night before going to bed and was getting to a point where I was doing about 10 to 15 cycles of it before going to bed. After I started the blood pressure medications and continued this practice, my blood pressure was in better control. One point when I was around 30 weeks in my pregnancy, my little routine was I would sit down on my bed and I had my medications next to my bed and my blood pressure cuff. So I would sit down first with my blood pressure just to see where it was. I’ll take my medication and then, you know, lay down and do my deep breathing. One night I accidentally took a double or extra dose of my blood pressure medication. I was just deep in conversation with my husband, just wasn’t paying attention. Next thing you know, I was like, oh, I just took an accidental extra dose. And so I flipped out a little bit because I was like, oh my God, what is this going to do to my blood pressure? Luckily, though, I did fine. And I just monitored my blood pressure the next day really closely just to make sure that it wasn’t dropping or anything was happening. And my blood pressure stayed well, and it did really good. And I said, okay, well, let me just hold off on my blood pressure medication the next night and see how I do. And again, monitoring my blood pressure really closely, and I was feeling fine, and my blood pressure did well.
So I stopped taking my blood pressure medication, but like I said, simultaneously, I actually started increasing the number of times I was doing my alternate nostril breathing techniques. Towards the end of pregnancy, I was almost at around like 40 to 50 cycles, which doesn’t take a very long time, but I was doing about 40 to 50 cycles between like the evening and then also in the morning when I woke up. And I did great in the rest of my pregnancy, delivered 38 plus weeks, no issues with preeclampsia, no problems with blood pressure, anything like that. After delivery as well. And so granted, I know that’s just an N of one. This was just my personal experience, but that’s where I really started to believe that there’s significant benefit in pranayamas or deep breathing exercises. Also specifically doing them regularly and routinely in a pregnancy can go a long way. So that’s what led me to conduct this study, my most recent study, looking at three different deep breathing techniques in pregnancy, looking at alternate nostril breathing, Bromary pranayama, and also Shitali pranayama, which is a cooling breath. And we had two cohorts in the study. One was people with normal blood pressure, and the other cohort was people who had high blood pressure. So we did the normal cohort because interestingly enough, there’s no literature on the different pranayamas or deep breathing techniques in pregnancy at all. And so we needed to know what would happen with people with normal blood pressure and understand what their response is to deep breathing exercises. But I felt like the people who had high blood pressure would probably have a bigger benefit. Those results are still pending. And as soon as we get all the data in, we’ll be publishing that data.
Dr. Rebecca Dekker – 00:22:30:
That’s amazing. Can you define those three types of breathing? Because you said altered nostril breathing, and people might kind of guess what that means, but they don’t really know. And then you had two other names that I didn’t catch.
Dr. Shilpa Babbar – 00:22:42:
Sure.
Dr. Rebecca Dekker – 00:22:42:
Yeah.
Dr. Shilpa Babbar – 00:22:42:
So alternate nostril breathing is the first one. There’s a few other names for it. Anulom Vilom is another name. Anadi Shodhana is another name for it as well. That technique in itself is essentially you’re blocking off one of your nostrils and inhaling, exhaling through one side and then closing that side off and inhaling and exhaling through the opposite side. So you’re just forcefully, I don’t want to use the word forcefully, you’re just intentionally breathing with one nostril at a time. And a fun fact is that we have a dominant nostril that alternates throughout the day. So our body is already kind of doing this at a physiological level on its own.
Dr. Rebecca Dekker – 00:23:24:
It’s about every four hours, right? I only know, and some of you may have had this happen before when you have a sinus infection and your nose gets really swollen, that there’s one side you might be able to breathe out a little bit and the other side is completely blocked. And then all of a sudden, out of nowhere, it switches.
Dr. Shilpa Babbar – 00:23:39:
Yeah.
Dr. Rebecca Dekker – 00:23:40:
Right. So that’s when you can really feel it happening.
Dr. Shilpa Babbar – 00:23:43:
Yeah. Yeah, exactly. You’re right. And so, yeah, so your body’s already kind of doing this on a physiological level, even like when you’re not sick or if you’re not congested. If you were to put like a mirror underneath your nose and just exhale, you’ll see one side might fog up, you know, more than the other. And then if we did a little bit later in the day, then it might be-
Dr. Rebecca Dekker – 00:24:01:
What’s the physiological reason for that?
Dr. Shilpa Babbar – 00:24:05:
So I think it’s more so. There’s a thought that our nostrils and our breathing is coordinated with our hemispheres of our brain. So our left nostril, for example, is coordinated to the right hemisphere of our brain and vice versa. And so I’m thinking, again, I don’t know the depths of that, but I think it’s more that there’s a correlation with regards to our autonomic nervous system and connections to our brain.
Dr. Rebecca Dekker – 00:24:33:
Okay. Okay. And can you, do you mind leading us through like one cycle or whatever that means or two cycles if that’s too fast to do one of alternate nostril breathing? So people who are listening, if they’re able to do this, I’m assuming you can’t do it while you’re driving probably because you have to have one.
Dr. Shilpa Babbar – 00:24:51:
Yeah.
Dr. Rebecca Dekker – 00:24:52:
So you need to be in a safe place.
Dr. Shilpa Babbar – 00:24:54:
Yes. Yes. It’s definitely not advised to do any of these deep breathing techniques when you’re driving or needing to concentrate or focus on something.
Dr. Rebecca Dekker – 00:25:01:
Okay.
Dr. Shilpa Babbar – 00:25:04:
The best way to engage in deep breathing techniques is either in a seated position or even lying down is usually an option as well. And so, yes, you want to just kind of take some time out where you can be in ideally a quiet place where you can focus your attention on your deep breathing. So, yes, definitely advised against doing it while driving.
Dr. Rebecca Dekker – 00:25:24:
Okay, so assuming someone pressed pause and then is coming back to try this, how would you verbally walk us through doing this?
Dr. Shilpa Babbar – 00:25:30:
Yeah, absolutely. So first few things that I always like to bring attention to before just starting the deep breathing technique. First thing is our posture. So it’s really, really important to sit up nice and straight. It’s much, much easier to breathe when you have a nice, long, straight spine versus a curved spine. Sometimes just as we’re sitting, you know, we’re not paying attention to our posture. And it’s really easy just to kind of, you know, hang loose type of a thing. So sitting up nice and straight, actively drawing your shoulders away from your ears and keeping your shoulders above your hips is the first step. With regards to, we’re going to be using our right hand for the deep breathing technique. So with our left hand, I usually like to just take my thumb and my first finger together and then just relax it face up onto my knee or my thigh, wherever it lands comfortably. So we’re going to take our right hand and we’re going to use our right thumb and then a couple of variations with regards to our fingers. So some people like to use their first two fingers. Some people will use their middle and their ring fingers, resting the first finger into the forehead. So any variation that works best for anybody works. So you’re going to take the right thumb and place it just right above the right nostril where the curvature of your right nostril is. So you’re going to gently press onto that side. You’re going to inhale through the left side. And then take either two fingers, cross it over, block off the left side, and release the right and exhale to the right. Good. Keeping everything where it is, inhale to the right. Block it off with the right thumb, release the left and exhale to the left. So that is one cycle. Let’s do that again. Inhale to the left. Block it off, exhale to the right. Inhale to the right. Lock it off, back to the left. One more time. I will last time. Inhale to the left. Release, exhale to the right. Inhale through the right. Block it off. Exhale to the left. So that was three cycles of alternate nostril breathing. So a couple more pointers. With your gaze, you can either lower your eyes or close your eyes if that feels comfortable. That just also helps to kind of turn inwards and to focus your attention onto your breath. Always keeping in mind with regards to your posture, just because the more you do, again, the more relaxed you get, it’s really easy just to kind of, you know, release that nice, long, straight spine. So just drawing your attention back to that. And with regards to the duration of your inhales and exhales. So some advice that I give to my, my, my, when I teach yoga or deep breathing is that there’s no competition here. So you’re just, you’re just deep breathing to the point that feels good for you. There’s no counting. If you want to count, you can, but you don’t have to count. You can just inhale to the point that feels good for you and then exhale to the point that feels good for you. Ideally, our exhales should be twice as long as our inhales. But for someone who’s just starting out, that might not be the case and that might not feel comfortable. So the more you practice, the easier it will get. And you will typically see that your exhales might be longer than your inhales. And so, but that’s how we do out alternate nostril breathing.
Dr. Rebecca Dekker – 00:28:52:
That’s amazing. And if you go to our YouTube channel and watch this podcast there, you’ll see Dr. Babbar showing it, demonstrating with her hands. It’s so fascinating to me. And how do people normally report feeling after doing this for several minutes?
Dr. Shilpa Babbar – 00:29:09:
Yeah, relaxed, calm. They feel good, you know. And it’s kind of very similar to like a prenatal yoga practice or even a yoga practice. I feel like at the end of a class, you feel good. You feel a little bit different than where you felt when you first came in. So very similar with deep breathing. And it just takes a few cycles. So it’s not something I need to do for, you know, 20 minutes or 30 minutes or an hour and feel like that. Just literally doing a few cycles of it can just change how you feel almost instantly.
Dr. Rebecca Dekker – 00:29:37:
Okay. And what about the other two topics that you mentioned?
Dr. Shilpa Babbar – 00:29:41:
Yeah. So the next one is called Bramre Pranayam, which is also called humming bee breath. And the way that that deep breathing technique is done, it’s essentially blocking off your senses, which includes your hearing and your vision. And you’re going to inhale through the nose and you exhale with a humming sound. So I’ll go ahead and demonstrate that. So we start by taking our thumbs and placing it either, some people place it inside their ears, or some people will just kind of place it just right in front of their tragus and just kind of pressing a little bit onto it just to kind of help to block off your hearing. The next thing is your first fingers. So your first fingers can either be touching each other and resting onto your forehead. Some people, that doesn’t work that way. So even if you have a little bit of space, that’s perfectly fine. You just want to rest your first fingers. The next thing you do is taking the rest of your three fingers and just the tips of the middle and your ring finger, just resting them onto the bridge of your nose. And essentially, you’re going to close your eyes. And so you’re not putting any pressure from your fingers onto your eyes. Instead, you’re just kind of trying to block out any light with your fingers that might be coming through. Your eyes are closed under here and then you inhale through the nose and on your exhale, you create a humming sound. So I’ll demonstrate that now. So as you inhale. Hmmmmm. One more time. Hmmmmm. So that was essentially two cycles of it. A couple of pointers for that one as well is to make sure that your jaw is nice and relaxed and that your tongue is sitting at the bottom of your mouth. So really easy just to kind of like keep everything nice and tense. So a couple of things to keep in mind there. And then also keeping your shoulders against it, seeing that nice, long, straight spine. And then ideally keeping your elbows out to the side. Now, the more you do this, again, the more relaxed you get. Sometimes the elbows just start to kind of fall down perfectly fine if that’s the case. But ideally, just keeping the shoulders down away from the ears and the elbows out to the side.
Dr. Rebecca Dekker – 00:32:01:
What feeling does that evoke then with this kind of breathing?
Dr. Shilpa Babbar – 00:32:05:
Yeah, same really deep relaxation. Like I said, we studied this and we got a lot of positive feedback of people just saying, wow, that just felt really good. And just kind of focusing inward, you know, and being able to like, especially in pregnancy, where you can focus inward on yourself and also on your baby. And so just a lot like a really, really deep relaxation. With just a few cycles of that.
Dr. Rebecca Dekker – 00:32:27:
That’s amazing. And what was the third one technique you mentioned?
Dr. Shilpa Babbar – 00:32:31:
The third one is called shitali breathing, and that’s also called a cooling breath. And so being pregnant, we know that many women feel very warm, right? Just again, that sympathetic hyperactivity can lead to just constantly feeling warm at any point of the year. And so the shitali breathing is a cooling breath. And same thing with that, sitting up nice and straight. But good news with this one doesn’t involve any hands, so it’s just rolling of your tongue. Interestingly enough, I found out that a lot of people can’t roll their tongue when I was doing our study. And the way that you roll your tongue is kind of side to side like a taco. So it looks like this. And so there’s a variation for that. So people who can’t roll their tongue, they can place the tip of their tongue behind your teeth. So we’ll do both variations today. So even, like I said, our hands are not involved in here, but I still like to use a mudra, which is just keeping your thumb and your first finger together and then releasing them onto the tops of your legs, your knees. And then you inhale through that rolled tongue. And as you exhale, you breathe out through your nose. So we’ll do that real quick. One more time. So you should, if you, did you notice any change in the air that you’re breathing in through the rolled tongue?
Dr. Rebecca Dekker – 00:34:03:
Yeah. And I know naturally the nostrils, they warm and humidify the air, right? So it definitely feels cooler to take a breath like that.
Dr. Shilpa Babbar – 00:34:12:
Yeah.
Dr. Rebecca Dekker – 00:34:13:
Yeah.
Dr. Shilpa Babbar – 00:34:13:
Yeah. So yeah. So that’s the best part of that. Like you feel it instantly that the air coming in through the rolled tongue feels a little bit cooler. And the other variation, like I was mentioning, is where you place the tip of your tongue. So you’re kind of in like a, like a smiley face type of a thing. So I’ll show you how that goes. So tip of the tongue on the back of your top teeth, and then you’re in a smiley face and inhaling that way. So it goes. How did that feel?
Dr. Rebecca Dekker – 00:34:55:
It definitely felt cool. Actually, cooler for me with that one.
Dr. Shilpa Babbar – 00:34:58:
Yeah. That one, I feel like, again, making sure not to like clench your jaw. It’s a little bit harder to do. But yeah, that’s a great alternative to still get the benefits of that deep breathing technique.
Dr. Rebecca Dekker – 00:35:10:
So you can do that one during pregnancy if you’re feeling warm or, okay.
Dr. Shilpa Babbar – 00:35:15:
Yeah. And really all of these deep breathing techniques can be engaged at any point. So you don’t have to do it specifically like, oh, I’m feeling stressed out right now. I’m feeling anxious or anything like that. Ideally incorporating this into a daily practice would be my recommendation. And again, just because your body will sometimes naturally hold these techniques out or engage in them whenever, whenever you need to, you know, so if you do this routinely and like, then you have a moment of being stressed or anxious and have that, like you’re, you might just randomly or automatically do it, you know? So I think the practice is where, where the big benefit is.
Dr. Rebecca Dekker – 00:35:51:
Okay. What about during labor? Would any of these be helpful? Any point, particular point of labor?
Dr. Shilpa Babbar – 00:35:57:
Yeah, absolutely. I believe so. I’ll say there’s no…
Dr. Rebecca Dekker – 00:36:00:
No research on it?
Dr. Shilpa Babbar – 00:36:01:
Not yet. That out there soon. But, but yeah, I mean, you know, in the past, people would recommend like a Lamaze breathing, right? And so, so Lamaze is a pranayama, essentially, at the end of the day, right? You’re controlling your breath, you’re doing it a specific breathing technique. So I do believe that different pranayamas and all of these would be beneficial in the labor process just to help, you know, relieve any, any pain or pressure waves that you might be feeling. And just kind of helps take your mind off of, you know, of focusing on, on the pain that you’re experiencing.
Dr. Rebecca Dekker – 00:36:35:
You can imagine if you’re feeling really hot during labor, the cooling breath might be helpful. If you’re feeling anxious, you could try a few minutes of the alternate nostril breathing. So it makes sense. It’s something that is simple and has been done probably for many thousands of years and, and. You know, it might not relieve pain significantly, but it could help make you feel calmer or focused or take your attention off the pain briefly. Exactly. Yeah. Looking ahead, where do you see the future of research in practices like this? I mean, before you started initiating this study, so there wasn’t even a single study on these kinds of pranayamas in pregnancy. And what do you see happening in the future?
Dr. Shilpa Babbar – 00:37:23:
Yeah, so I’ll say my goal, my hope is that we can offer these integrative therapies to every pregnant person. And it’s not just when, you know, they have an issue or back pain or something that comes up that we’re like, okay, now go apply these techniques. You know, my hope for the future of obstetric care is to have these integrative therapies woven into standard prenatal care. So creating a new normal, maybe having massage readily available at prenatal visits or as a part of prenatal care. We have a lot of things that we do in prenatal care that are standardized. So we will draw prenatal labs at a first visit. We recommend prenatal vitamins. We screen for gestational diabetes at a specific point. So I would love for the future to show, to integrate these therapies into standardized prenatal care.
Dr. Rebecca Dekker – 00:38:21:
And so it makes sense, like at a specific point in early pregnancy, maybe you’re part of your practice to teach stress reducing techniques such as breathing, yoga, et cetera.
Dr. Shilpa Babbar – 00:38:34:
And different acupressure points, acupuncture. Acupuncture is obviously a little bit harder because somebody has to do that for you. But if you learn some great acupressure points that can help with pain relief during pregnancy, during labor, etc. So it’s just really teaching and empowering women to learn these tools and to create that toolbox so that whenever they get to any point of pregnancy, they can just pull out the techniques that will work best for them. I know, you know, every technique won’t work for every single person, but learning about them and being engaged in them and understanding what does work best for your body will be the best thing.
Dr. Rebecca Dekker – 00:39:08:
I love your vision. And I feel like a lot of our listeners probably share like, wow, that would be an amazing world where this is just part of standard prenatal care. And maybe in some places, it already is incorporated, not so much in the US. So with that being said, can you talk a little bit about how you hosted the Integrative Obstetric Care Conference in 2024? What inspired you to do that? And what did it turn out to be like?
Dr. Shilpa Babbar – 00:39:34:
Yeah. So, yeah, that conference was essentially an extension of the symposium that we published in 2021. So when I had moved to Kansas City, as a person who really is interested in these therapies and being able to offer this to my patients, I wanted to know who in the community was really interested in this work or even just collaborating or just knowing who to refer to in our community to say, okay, you need a chiropractor. Here’s a person to go to that wants to work with pregnant women. So it was a goal or vision that I had for a while and essentially when I moved to Kansas City in 2020. But then obviously the pandemic hit and in-person conferences weren’t really happening. And so everything was just kind of put on hold. When I was about eight weeks postpartum with our second daughter, my husband and I were talking and I was like, I really want to see if we can get this up and running and moving it forward because I’m still really interested in this, even though I’ve been in the area for several years now. But I still want to connect and try to get the people who are in the community doing this work in the same room with the health care providers that are giving the obstetric care to our patients. And so I was about eight weeks postpartum and we made the decision to move this forward. My husband had the bandwidth to do it at that point. I was like, okay, I’m going to help with this. But he had the bandwidth to essentially move it forward. So we had less than nine months to plan the conference. But we were able to get about 60 people who attended the conference. And you were our guest speaker, which we’re very grateful to have you there as well. And just getting the conversation going, with the people in Kansas City to understand what are the other options? What are the therapies? Who are the providers that want to offer this to their patients and to collaborate and get that moving forward? And also, I will say that as someone who’s interested in this, I was looking on the internet to see, are there any Integrative Obstetric Care conferences? Is there anywhere I can go to learn more about this? And it didn’t exist. And so that was another reason that I wanted to host this conference and hopefully to do it again in the future. But I just wanted to get that conversation started and get people thinking about this and really uniting our community in Kansas City, but then hopefully expanding it to uniting a bigger community as well.
Dr. Rebecca Dekker – 00:42:04:
Yeah. And as someone who’s in the room, it was really powerful to have, I think, people from practically every profession or career or advocacy role possible in the room from dietitians, midwives, doulas, obstetricians, maternal fetal medicines, pediatricians, lactation, nurses. I mean, the list just goes on and on. Massage therapists. Everybody was there. Not everybody, but there’s a lot of representation of the different fields, chiropractors. And it was really empowering to see the connections happening too between folks in the room who didn’t know that other folks were practicing in that area. And it just really goes to show the power of community and connection and sharing information.
Dr. Shilpa Babbar – 00:42:52:
Yes.
Dr. Rebecca Dekker – 00:42:52:
For sure. Do you have plans to repeat it at any point?
Dr. Shilpa Babbar – 00:42:57:
We do. So I will say Alejandro and his team are, you know, working on some future events. So definitely stay tuned. We would like to either repeat the conference, whether it’s at a local level versus expanding it out further. So yes, so stay tuned. There is some great projects that are coming up and would love to share with your community. It’ll be on my website, drshilpababbar.com. And we also have different social media channels for the Integrative TetraCare Conference that we hosted in 2024. So that’s also available for review too.
Dr. Rebecca Dekker – 00:43:31:
And I believe that on Instagram, it’s @IOBCare, correct?
Dr. Shilpa Babbar – 00:43:36:
Correct. Yeah.
Dr. Rebecca Dekker – 00:43:36:
Standing for Integrative Obstetric Care. So, well, thank you, Dr. Babbar, for coming on the podcast and teaching us and sharing all this information with us. We really appreciate you and the work you’re doing, not only in Kansas City, but that’s, you know, really reaching parents around the world.
Dr. Shilpa Babbar – 00:43:52:
Yes, thank you. Such a pleasure to be here. Thank you again so much.
Dr. Rebecca Dekker – 00:43:57:
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