Improve Pregnancy and Birthing with Mindfulness
By John M. de Castro, Ph.D.
“There could not be a better time to learn mindfulness than during pregnancy and early motherhood. For one thing, this is a time when most people have a strong motivation to become the best person they can be in a relatively short period of time. When you realize the full enormity of the responsibility you have taken on by becoming a mom, the primary source of care for another whole human being, not to mention one that you love more than you thought you could ever love, there is a really high level of motivation to try your best to get yourself into the best mental and emotional shape possible.” – 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, depression, and fear are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. A debilitating childbirth fear has been estimated to affect about 6% or pregnant women and 13% are sufficiently afraid to postpone pregnancy. It is difficult to deal with these emotions 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 worrisome, torment.
The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. Childbirth fear is associated with “low childbirth self-efficacy, greater use of pain medication during labor, more unwanted obstetric interventions in labor, as well as increased risk of postpartum depression.” Hence, it is clear that there is a need for methods to treat childbirth fear, 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. Mindfulness training has 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 “Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427564/, Duncan and colleagues recruited women who were pregnant with their first child, in their third trimester, and planning on having a hospital birth. They received standard childbirth education and instruction and were then randomly assigned to receive either an additional childbirth course or Mind in Labor training; “a brief intervention for pregnant women and their partners specifically designed to target labor-related fear and pain by teaching tailored mindfulness-based coping strategies.” Training was conducted over a weekend for a total of 18 hours of instruction. It included body scan, yoga, and meditation practices. The women were measured at baseline before treatment on average at 29.4 weeks gestation, at the completion of training, and around 4-6 weeks after birth for childbirth self-efficacy, maladaptive pain, perceived pain in labor, use of pain medications in labor, birth satisfaction, depression, interoceptive awareness, and mindfulness.
The mindfulness group but not the control group had a marked and significant increase in childbirth self-efficacy and body awareness and decrease in pain catastrophizing after the intervention. The control group had a significant increase in depression from baseline to post-treatment and a further significant increase at the post-birth follow-up while the mindfulness group has a significant decrease in depression after treatment that was maintained at the post-birth follow-up. There was also a trend for the mindfulness group to be less likely to use opioid analgesics.
These are interesting and significant results that suggest that the addition of mindfulness training to standard birth education improves the women’s psychological state prior to and after birth. It decreases depression and worries about pain and makes the women feel more aware of their bodies and in better control of the childbirth process. Mindfulness training is known to decrease depression, and improve emotion regulation. It also focuses the individual on what is transpiring at the present moment which is much more manageable than the worst fears of the women. By focusing on now rather than the scary future, catastrophizing is minimized. These are important benefits that may have consequences for the later health and well-being of not only the mother but also the child.
So, improve pregnancy and birthing with mindfulness.
“Cue the spotlight on mindfulness. When nausea or aching ligaments can’t be alleviated with medication, or I can’t get away for a much-needed nap, or even just get through the morning without eight trips to the restroom, I try to dwell less on my misery and choose to be mindful instead.” – Ashley Jonkman
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Duncan, L. G., Cohn, M. A., Chao, M. T., Cook, J. G., Riccobono, J., & Bardacke, N. (2017). Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison. BMC Pregnancy and Childbirth, 17, 140. http://doi.org/10.1186/s12884-017-1319-3
Abstract
Background
Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education.
Methods
This study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected.
Results
In a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls.
Conclusions
This study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects.