By John M. de Castro, Ph.D.
“Since mindfulness has a lot to do with being in touch with the sensations in your body, and being aware, new moms are in a prime state to learn it! In fact, pregnancy and early motherhood, nursing and sleep disturbance, weight gain and weight loss-these all in some way force you to be in your body. For those of us who live most of our lives above our necks, this can actually be a great blessing.” – Cassandra Vieten
The perinatal period, from the onset of pregnancy to the end of the infants first year, is a time of intense physiological and psychological change in both the mother and the infant. Anxiety and depression are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. Depression is characterized by a low or sad mood, loss of interest in fun activities, changes in eating, sleep, and energy, problems in thinking, concentrating, and making decisions, feelings of worthlessness, shame, or guilt, and thoughts that life is not worth living. It is difficult to deal with under the best of conditions but in combinations with the stresses of pregnancy can turn what could be a joyous experience of creating a human life into a horrible torment.
Depression occurring after delivery of a baby is well known, documented and discussed. Less well known but equally likely is depression during pregnancy. The American Congress of Obstetricians and Gynecologists suggest that between 14 and 23 percent of women suffer from some form of depression during pregnancy. Without treatment, prenatal depression can pose a serious threat to a mother-to-be, who may stop taking care of herself or, in extreme cases, become suicidal. This can cause a woman to want to terminate her pregnancy. There are no statistics on the matter but it has been speculated that prenatal depression can lead to abortion.
The psychological health of pregnant women has consequences for fetal development, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. It is also associated with higher levels of stress hormone in the mother and in the newborns, which can make them more stress reactive, temperamentally difficult, and more challenging to care for and soothe. Long-term there’s some evidence that the children have more social and emotional problems, including aggression and conduct problems and possibly child IQ and language.
It is clear that there is a need for methods to treat depression and anxiety during pregnancy. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Moderate exercise including yoga practice is also beneficial during pregnancy. Mindfulness training has also been shown to improve anxiety and depression normally and to relieve maternal anxiety and depression during pregnancy. So, it would make sense to study the effects of mindfulness training during the perinatal period.
In today’s Research News article “The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis.” See:
or see summary below or view the full text of the study at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868288/
Lever Taylor and colleagues review 17 research studies on the effectiveness of mindfulness training on the women’s psychological health during the perinatal period. They found that compared to before, after mindfulness training the women demonstrated significantly reduced levels of depression, anxiety, and stress, and increased mindfulness, all with moderate effect sizes. The effects appeared to be greater for women who had the greatest levels of distress prior to training. Unfortunately, when a control condition was included (7 studies), either usual care or a wait-list control, these women improved comparable amounts to the mindfulness trained women and there were no significant differences between the groups.
Hence, clear conclusions cannot be drawn regarding the effectiveness of mindfulness training for the psychological health of women during the perinatal period. The reviewed studies in general investigated the effectiveness of a variety of different mindfulness training practices. So, the lack of effectiveness in comparison to control conditions may well have been due to the employment of sub-optimal trainings. In addition, the majority of studies looked at healthy normal women and mindfulness training may only be effective in women with psychological distress. Needless to say, more research is needed to determine whether, under what conditions, and with what kind of training program that mindfulness training may be helpful for the psychological health of women during the perinatal period.
“But your job in this holding environment is to, well, hold what is happening. To tolerate his distressing moments, to recognize and reflect his feelings and their expressions in his body and on his face, even to be the target of and survive his anger, frustration, and aggression. You can do a kind of aikido with your baby. Mindful awareness can help you in this dance of attunement, synchrony, and consciously participating in co-creating the space through which both of you move through your days” – Cassandra Vieten
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Lever Taylor, B., Cavanagh, K., & Strauss, C. (2016). The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis. PLoS ONE, 11(5), e0155720. http://doi.org/10.1371/journal.pone.0155720
Abstract
Perinatal mental health difficulties are associated with adverse consequences for parents and infants. However, the potential risks associated with the use of psychotropic medication for pregnant and breastfeeding women and the preferences expressed by women for non-pharmacological interventions mean it is important to ensure that effective psychological interventions are available. It has been argued that mindfulness-based interventions may offer a novel approach to treating perinatal mental health difficulties, but relatively little is known about their effectiveness with perinatal populations. This paper therefore presents a systematic review and meta-analysis of the effectiveness of mindfulness-based interventions for reducing depression, anxiety and stress and improving mindfulness skills in the perinatal period. A systematic review identified seventeen studies of mindfulness-based interventions in the perinatal period, including both controlled trials (n = 9) and pre-post uncontrolled studies (n = 8). Eight of these studies also included qualitative data. Hedge’s g was used to assess uncontrolled and controlled effect sizes in separate meta-analyses, and a narrative synthesis of qualitative data was produced. Pre- to post-analyses showed significant reductions in depression, anxiety and stress and significant increases in mindfulness skills post intervention, each with small to medium effect sizes. Completion of the mindfulness-based interventions was reasonable with around three quarters of participants meeting study-defined criteria for engagement or completion where this was recorded. Qualitative data suggested that participants viewed mindfulness interventions positively. However, between-group analyses failed to find any significant post-intervention benefits for depression, anxiety or stress of mindfulness-based interventions in comparison to control conditions: effect sizes were negligible and it was conspicuous that intervention group participants did not appear to improve significantly more than controls in their mindfulness skills. The interventions offered often deviated from traditional mindfulness-based cognitive therapy or mindfulness-based stress reduction programmes, and there was also a tendency for studies to focus on healthy rather than clinical populations, and on antenatal rather than postnatal populations. It is argued that these and other limitations with the included studies and their interventions may have been partly responsible for the lack of significant between-group effects. The implications of the findings and recommendations for future research are discussed.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868288/