Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

Larissa G Duncan, Michael A Cohn, Maria T Chao, Joseph G Cook, Jane Riccobono, Nancy Bardacke, Larissa G Duncan, Michael A Cohn, Maria T Chao, Joseph G Cook, Jane Riccobono, Nancy Bardacke

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.

Trial registration: The ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Keywords: Childbirth; Fear; Labor; Mindfulness; Pain; Postpartum depression.

Figures

Fig. 1
Fig. 1
CONSORT flow chart
Fig. 2
Fig. 2
Childbirth Self-Efficacy scores (MIL = Mind in Labor; TAU = Treatment as Usual)
Fig. 3
Fig. 3
Pain Catastrophizing scores (MIL = Mind in Labor; TAU = Treatment as Usual)
Fig. 4
Fig. 4
CES-D depression symptom scores (MIL = Mind in Labor; TAU = Treatment as Usual)

References

    1. Alehagen S, Wijma K, Wijma B. Fear during labor. Acta Obstet Gynecol Scand. 2001;80(4):315–320. doi: 10.1034/j.1600-0412.2001.080004315.x.
    1. Laursen M, Johansen C, Hedegaard M. Fear of childbirth and risk for birth complications in nulliparous women in the Danish national birth cohort. Br J Obstet Gynaecol. 2009;116(10):1350–1355. doi: 10.1111/j.1471-0528.2009.02250.x.
    1. Ryding EL, Wijma B, Wijma K, Rydhstrom H. Fear of childbirth during pregnancy may increase the risk of emergency cesarean section. Acta Obstet Gynecol Scand. 1998;77(5):542–547. doi: 10.1080/j.1600-0412.1998.770512.x.
    1. Lobel M, DeLuca RS. Psychosocial sequelae of cesarean delivery: review and analysis of their causes and implications. Soc Sci Med. 2007;64(11):2272–2284. doi: 10.1016/j.socscimed.2007.02.028.
    1. Sorenson DL. Uncertainty in pregnancy. NAACOGS Clin Issu Perinat Womens Health Nurs. 1990;1(3):289–296.
    1. Hamilton BE, Martin JA, Ventura SJ, Division of Vital Statistics: Births . Natl Vital Stat Rep. Hyattsville: National Center for Health Statistics, Center for Disease Control and Prevention, U.S. Department of Health and Human Services; 2013. Preliminary data for 2012.
    1. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33–47. doi: 10.1016/0163-8343(82)90026-3.
    1. Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985;8(2):163–190. doi: 10.1007/BF00845519.
    1. Kingston J, Chadwick P, Meron D, Skinner TC. A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity. J Psychosom Res. 2007;62(3):297–300. doi: 10.1016/j.jpsychores.2006.10.007.
    1. Zeidan F, Gordon NS, Merchant J, Goolkasian P. The effects of brief mindfulness meditation training on experimentally induced pain. J Pain. 2010;11(3):199–209. doi: 10.1016/j.jpain.2009.07.015.
    1. Ferber SG, Granot M, Zimmer EZ. Catastrophizing labor pain compromises later maternity adjustments. Am J Obstet Gynecol. 2005;192(3):826–831. doi: 10.1016/j.ajog.2004.10.589.
    1. Pearlstein T, Howard M, Salisbury A, Zlotnick C. Postpartum depression. Am J Obstet Gynecol. 2009;200(4):357–364. doi: 10.1016/j.ajog.2008.11.033.
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169–183. doi: 10.1037/a0018555.
    1. Evans S, Ferrando S, Findler M, Stowell C, Smart C, Haglin D. Mindfulness-based cognitive therapy for generalized anxiety disorder. J Anxiety Disord. 2008;22(4):716–721. doi: 10.1016/j.janxdis.2007.07.005.
    1. Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, Chapleau M-A, Paquin K, Hofmann SG. Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev. 2013;33(6):763–771. doi: 10.1016/j.cpr.2013.05.005.
    1. Bardacke N. Mindful birthing: training the mind, body, and heart for childbirth and beyond. New York: HarperOne; 2012.
    1. Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacorte Press; 1990.
    1. SurveyGizmo []
    1. Lowe NK. Maternal confidence for labor: development of the childbirth self-efficacy inventory. Res Nurs Health. 1993;16(2):141–149. doi: 10.1002/nur.4770160209.
    1. Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524–532. doi: 10.1037/1040-3590.7.4.524.
    1. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45–56. doi: 10.1016/0304-3959(83)90126-4.
    1. Norvell KT, Gaston-Johansson F, Fridh G. Remembrance of labor pain: how valid are retrospective pain measurements? Pain. 1987;31(1):77–86. doi: 10.1016/0304-3959(87)90008-X.
    1. Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol. 1998;19(2):84–97. doi: 10.3109/01674829809048501.
    1. Radloff LS. The CES-D scale. Appl Psychol Meas. 1977;1(3):385–401. doi: 10.1177/014662167700100306.
    1. Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, Walsh E, Duggan D, Williams JMG. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15(3):329–342. doi: 10.1177/1073191107313003.
    1. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A. The multidimensional assessment of interoceptive awareness (MAIA) PLoS One. 2012;7(11):e48230. doi: 10.1371/journal.pone.0048230.
    1. Holzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6(6):537–559. doi: 10.1177/1745691611419671.
    1. Imai K, King G, Lau O. Toward a common framework for statistical analysis and development. J Comput Graph Stat. 2008;17(4):892–913. doi: 10.1198/106186008X384898.
    1. Zelig: Everyone’s Statistical Software, Version 5.0-9 []
    1. Honaker J, King G, Blackwell M. Amelia II: a program for missing data. J Stat Softw. 2011;45(7):1–47. doi: 10.18637/jss.v045.i07.
    1. Caton D, Corry MP, Frigoletto FD, Hopkins DP, Lieberman E, Mayberry L, Rooks JP, Rosenfield A, Sakala C, Simkin P, et al. The nature and management of labor pain: executive summary. Am J Obstet Gynecol. 2002;186(5, Supplement):S1–S15. doi: 10.1016/S0002-9378(02)70178-6.
    1. Byrne J, Hauck Y, Fisher C, Bayes S, Schutze R. Pilot study of mindfulness-based childbirth education shows improvements in self-efficacy and fear of childbirth. J Midwifery Womens Health. 2014;59(2):192–197. doi: 10.1111/jmwh.12075.
    1. Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S94–109. doi: 10.1016/S0002-9378(02)70185-3.
    1. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–1083. doi: 10.1097/01.AOG.0000183597.31630.db.
    1. Ferber SG, Feldman R. Delivery pain and the development of mother-infant interaction. Infancy. 2005;8(1):43–62. doi: 10.1207/s15327078in0801_3.
    1. Lovejoy MC, Graczyk PA, O’Hare E, Neuman G. Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev. 2000;20(5):561–92. .
    1. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J: Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment (Full Rep). 2007;(153):1-186.
    1. Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A. Staying well during pregnancy and the postpartum: a pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence. J Consult Clin Psychol. 2016;84(2):134–145. doi: 10.1037/ccp0000068.
    1. Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A. An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Arch Womens Ment Health. 2015;18(1):85–94. doi: 10.1007/s00737-014-0468-x.
    1. Musser AK, Ahmed AH, Foli KJ, Coddington JA. Paternal postpartum depression: what health care providers should know. J Pediatr Health Care. 2013;27(6):479–485. doi: 10.1016/j.pedhc.2012.10.001.
    1. Goodman JH. Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs. 2004;45(1):26–35. doi: 10.1046/j.1365-2648.2003.02857.x.

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