Abstract
BackgroundPregnancy and the postpartum period are times of great change for women and their partners, often bringing substantial challenges and stress. Approximately 10%–20% of women suffer from mood disorders such as depression in the perinatal period. There are risks involved in using psychopharmacological interventions to treat perinatal depression. Mindfulness and compassion-based educational programs could be efficacious and cost-effective options for the prevention and treatment of perinatal mood disorders. The aim of this study is to assess the efficacy of an adapted Mindfulness-Based Childbirth and Parenting (MBCP) program that includes compassion training for pregnant women in primary care (PC) settings in the Spanish National Health System to decrease perinatal depression.MethodsA multicenter randomized controlled trial (RCT) will be conducted. Participants will be pregnant women (n = 122) and their partners who wish to participate. They will be enrolled and assessed in PC settings and randomly assigned to either: (1) an adapted MBCP educational program tailored to the Spanish National Health System + treatment as usual (TAU); or (2) TAU only. The main outcome to be assessed will be depression, evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Secondary outcomes will include self-reported measures of perceived stress, affects, mindfulness, self-compassion, maternal self-efficacy, and use of health and social services. Patients will be assessed at four timepoints: baseline; post-treatment; and at three and six months after childbirth. Intention-to-treat and per-protocol analyses will be carried out using linear regression mixed models. Effect sizes will be estimated using Cohen’s d.DiscussionPerinatal depression is a significant health problem. An effective and low-cost childbirth education program that incorporates mindfulness and compassion practices may be a beneficial preventive complementary healthcare modality for expectant women and their partners. This study will be the first multicenter RCT in Spanish PC settings using adapted MBCP and compassion practices to reduce symptoms of depression during pregnancy and the postpartum period.Trial registrationClinicalTrials.gov, NCT03247491. Registered on 31 July 2017.
Highlights
The primary aim of the present study will be to compare the effectiveness of an adapted Mindfulness-Based Childbirth and Parenting (MBCP) program with compassion practices that includes treatment as usual (TAU) tailored for delivery in the Spanish National Health System (NHS) and implemented in the second trimester, with an active control group receiving TAU only, to assess possible improvements in depressive symptomatology in pregnant women. Study design This is a multicenter randomized controlled trial (RCT) with two parallel groups: (1) adapted MBCP educational course with compassion practices delivered for pregnant women and their partners + TAU; and (2) TAU only, which consists of a childbirth education course provided by primary care (PC) midwives
Mindfulness-based programs (MBPs) are effective alternative strategies for improving mental and physical health and wellbeing [65], for reducing symptoms of depression [22], for preventing depression relapse [68], and for managing pain and reducing stress [25, 26, 69]. They have been proposed as potentially beneficial for expectant parents preparing for childbirth for managing pain during pregnancy and labor, reducing the risk of Perinatal depression (PD), and increasing the availability of parental attention for the infant [70]
Several MBPs have been adapted for this population [32,33,34,35, 37,38,39]; some of them have included compassion techniques [40, 41]
Summary
Introduction to vocalizing SittingMeditation, Teaching about causes Alternate sittingContinue Awareness of low-pitched sounds as a including thoughts, way to focus attention and emotions and choiceless to work with intense body awareness sensations during the ice Mindful Yoga practiceCouples are encouraged to Pain Practice 3: Full use all the previousImmersion in very cold practices they have water learned in classes 4 and 5 to cope with the intense sensations of “ice contractions”and conditions and using meditation with either the mindful awareness forBody Scan or yoga making wise choices in One sequence of pain childbirth such as selection practices for 20–30 min of a care provider and integrating all the tools place of delivery learned in classes 4, 5, and Participants learn that the 6 future is unknown, and there is no one “correct way” to give birth and that with continued practice they will have a variety of skills to work with pain and whatever may come during the birth processBreathing practice 5–10 min every day and/or 3 Step Breathing Space Continue Being with Baby practice Continue Mindfulness of Routine Activities, including mindful pooping Continue informal pain practice when physical discomforts arise in daily life. 10%–20% of women suffer from mood disorders such as depression in the perinatal period. The aim of this study is to assess the efficacy of an adapted Mindfulness-Based Childbirth and Parenting (MBCP) program that includes compassion training for pregnant women in primary care (PC) settings in the Spanish National Health System to decrease perinatal depression. Prenatal depression is one of the main risk factors for postpartum depression It often goes undiagnosed and untreated, with serious consequences for the mother and, by extension, the infant, including growth delays in the developing fetus, prematurity, low birth weight, disorganized infant sleep patterns, and less responsiveness to the external environment [4]. Prenatal depression appears to affect men; the importance of the presence of the partner in interventions tailored to improve couple wellbeing during pregnancy and postpartum is encouraged [8, 9]
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