Birth Equity: Could “Ma Circles” Be the Solution?

The United States continues to be one of the “most dangerous developed nations” for childbirth, according to a new report released Thursday by March of Dimes, a nonprofit organization focused on birth equity – improving the health of pregnant people and babies.1

According to the National Institutes of Health, up to 45% of new mothers experience birth trauma—and the effects can continue long after the birth itself.²

Infant mortality increased by 3% over the past year, and our maternal death rate doubled from 2018 to 2021.

And Black and Native American women are two to three times more likely to die from pregnancy-related causes.³

Ma Yoga was founded in 2009 with a vision of a “Ma Circle” in every neighborhood.

A Ma Circle combines yoga with nurturing support, wellness education and connection to medical resources for pregnant people and new parents.

More than 20,000 mamas have participated so far, relieving physical discomforts and stress, creating new friendships, receiving birth education, preparing for labor, and gaining tools to support postpartum recovery.

But can Ma Circles really make a difference?

I put together the latest research so you can decide for yourself:

Birth Equity Problem #1: Postpartum Depression

• 1 in 7 women experience depression in the year after they give birth.^{4 5}
• Not only can Postpartum Depression be experienced anytime in the 12 months around birth, but it is often a continuation of Perinatal Depression. In fact, rates of depression tend to be even higher during pregnancy than in the first year following birth.⁶
• Less than 10% of the people who have Pre/Postnatal Depression receive adequate treatment.⁷
• Postpartum depression creates an environment that is not conducive to the personal development of mothers or the optimal development of a child. These harmful consequences include preterm birth and low birth weight and excessive gestational weight gain.⁸
• Women don’t seek help, for some common reasons: The lack of knowledge about postpartum depression or the acceptance of myths are both barriers to seeking help, and often render mothers unable to recognize the symptoms of depression.⁹
• It therefore seems important to detect and treat depression as early as possible during the perinatal and postnatal period to avoid negative outcomes for baby and mother.¹⁰

Birth Equity Problem #2: Pre- and Postpartum Anxiety

• During pregnancy, stress can increase the chances of having a baby preterm (born before 37 weeks of pregnancy)¹¹
• Stress also increases the risk of birthing a low-birthweight baby (weighing less than 5 pounds, 8 ounces)¹². Babies born too soon or too small are at increased risk for health problems.¹³
• Stress and anxiety are actually beginning to surpass the rates of Postpartum Depression for pregnant women and new moms.¹⁴
• The estimated rate of high anxiety was 35% during pregnancy, and 20% six weeks postpartum. Anxiety and Postpartum Depression was experienced together in the 75% of the cases.¹⁵
• Anxiety is a common psychological challenge for pregnant women and new moms. The prevalence of maternal anxiety varies depending on which disorders are included in the estimate but can be as high as 13%. Anxiety symptoms often coincide with PPD but sometimes appear on their own, indicating that screening for postpartum symptoms should include both depression and anxiety.¹⁶

Birth Equity Problem #3: It’s Worse for Black and Native Women

• Black women are 27 percent more likely to experience severe pregnancy complications¹⁷
• Rates of depression in inner cities for pregnancy and postpartum are double the rates for middle class populations¹⁸.
• Studies are beginning to show signs that racism-related stress contributes to negative birth outcomes.¹⁹
• According to the NIH, Black women report higher levels of psychological stress than White women and carry a disproportionate burden of chronic conditions associated with psychological stress, including obesity. Research also suggests that Black women experience both race- and gender-related stress.²⁰ 

Birth Equity Solution #1: Prenatal and Postpartum Yoga

Yoga reduces depression in pregnancy and postpartum.

Yoga has been shown to reduce depression in pregnant women – in study…²¹

after study…²²

after study…²³

after study.²⁴

Have I mentioned…

Postpartum yoga significantly improves postpartum depression²⁵?

In one study, 78% of postpartum women experienced improvement in depression and anxiety after doing yoga twice a week for eight weeks.²⁶

Yoga has been shown to be an effective treatment alternative or augmentation to pharmacotherapy for pregnant women at high risk for depression.²⁷

Even for those with lifetime diagnoses, yoga provides a greater reduction in negative affect than treatment-as-usual.²⁸

One study looked at both massage and yoga for pregnancy, and found not only did both have a greater positive impact on depression and anxiety, they both had greater birthweight and gestational age than the control group.²⁹

Similarly, both a prenatal yoga intervention and perinatal-focused health education in pregnant women with depression equally decreased depression.³⁰

A study in the Journal of Psychiatric Practice recommends next steps in the study of yoga as a treatment for depression.³¹

Yoga Reduces Anxiety and Stress, Pre and Postpartum.

• Research has shown that people who practice yoga regularly have low cortisol levels.³²
• Yoga and social support equally reduce depression and anxiety.³³
• A new study found that yoga was significantly more effective for generalized anxiety disorder than standard education on stress management, but not as effective as cognitive behavioral therapy (CBT), which many women do not have access to.
• Mindfulness-based interventions reduce perinatal anxiety.³⁴
• Yoga has been shown to reduce anxiety.³⁵
• Yoga and social support reduce prenatal depression, anxiety and cortisol.³⁶

Prenatal Yoga is a Safe Way to Reduce negative Birth Outcomes.

• An NIH systematic review showed that yoga is well indicated for pregnant women and leads to improvements on a variety of pregnancy, labour, and birth outcomes.³⁷ 
• The safety of performing yoga for the first time in pregnancy and fetal tolerance has been demonstrated, and some studies show that in high-risk pregnancies it improves outcomes.³⁸
• Prenatal yoga reduces back pain³⁹
• Yoga is associated with reduced risk of low birth weight and preterm labor.⁴⁰
• Yoga reduces the induction of labor, duration of labor, preterm labor and low birth weight⁴¹

Birth Equity Solution #2: Social Support

Our birth inequity crisis is getting worse, and even when researchers address education level, access to healthcare and other factors, the numbers can’t be explained.

And yet, we know that stress is the #1 risk factor for negative birth outcomes.

We know that women of color experience racism and gender related stress.

Pregnant women with limited social support are at high risk for depression, and limited social support during pregnancy is predictive of postpartum depression.⁴²

The consensus among researchers is that an increased level of social support is associated with less Postpartum Depression.⁴³

Perceived social support creates positive change in anxiety and depressive symptoms.⁴⁴

An exercise intervention that includes social support may be an effective treatment for postpartum depression.⁴⁵

A Ma Circle Combines Yoga and Social Support

A Ma Circle combines social/emotional support, yoga and connection to community resources. We train teaches and coach them as they identify local businesses that might benefit from a partnership, and negotiate a revenue share.

We had ten locations in Southern California when quarantine happened, and all of them closed.

Here’s our very first one, in Studio City, California, with founder, Jessica Jennings, MS:

Isolation, lack of birth education, and birth trauma increase the risk of postpartum depression for pregnant people.

Both yoga and social support reduce stress and anxiety, and specifically during pregnancy, and reduce the risk of negative birth outcomes including postpartum depression.

We don’t pretend to be able to get rid of institutional or cultural racism this year, or the inequities in birth outcomes.

But providing all people with the tools to let go of the stress, reduce aches and pains, and connect to their bodies’ power and wisdom – plus education about their choices and resources, new mom friends and support throughout their “Ma” journey – seems like a really good place to start.

If you’re convinced – as we are – that Ma Circles in underserved communities can make a difference, you can be part of the Ma Circle Project. Your donation of $25 covers two free prenatal yoga classes for moms-to-be who can’t afford them. Larger donations go toward scholarships to train teachers in areas where nurturing prenatal care is needed. Get more info about donating to our nonprofit, the Ma Collective, and the Ma Circle Project here.

References

1. https://abcnews.go.com/GMA/Wellness/us-earns-grade-preterm-birth-maternal-infant-care/story?id=104909605 ↩︎
2. https://www.marchofdimes.org/find-support/topics/postpartum/toll-birth-trauma-your-health# ↩︎
3. ↩︎
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