Abstract
BackgroundChildbirth 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.MethodsThis 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.ResultsIn 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.ConclusionsThis 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 registrationThe ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559. The study was retrospectively registered on June 23, 2014.
Highlights
Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment
Childbirth education courses are the primary mechanism by which pregnant women learn strategies for coping with labor pain, yet childbirth education has limited efficacy for reducing childbirth fear and in some cases may even cause women to doubt their ability to cope with childbirth [5], increasing fear
Previous interventions for childbirth pain and fear have focused almost exclusively on: a) pharmacologic pain management strategies that are important to provide as available options under the standard of care and pose health risks for the mother and fetus [31], and b) childbirth education that is geared toward increasing factual knowledge about the stages and mechanics of labor and birth, potential problems faced in labor and delivery, and medical interventions that are available to address those problems
Summary
Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Data from the Danish National Birth Cohort of over 25,000 nulliparous women indicate that fear of childbirth during pregnancy, in late pregnancy (around 31 weeks), was related to a higher risk of emergency Cesarean section, controlling for other risk factors (i.e., weight gain, birth weight, head circumference, and duration of pregnancy) [2]. These findings suggest the potential utility of intervening with first time mothers in the 3rd trimester to reduce childbirth fear and pain and improve perinatal outcomes
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