Abstract
BackgroundMindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth.MethodsOne hundred eleven pregnant women with high FOC were measured pre- and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section).ResultsIt was found that greater mindful awareness (18% R2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome.ConclusionsAn increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC.Trial registrationThe Netherlands Trial Register (NTR; 4302).
Highlights
Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in preg‐ nant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU)
We hypothesized that following MBCP, several mechanisms of change would contribute to natural childbirth: the change from high to lower FOC, the change from high to lower catastrophic beliefs about labour pain, and the change from low to higher mindful awareness
We found that the pre- and post-interventions pathways’ measurements were filled in by 113 (81.3%) participants for Wijma-Delivery Expectation Questionnaire (W-DEQ-A), 109 (78.4%) participants for the Catastrophizing Labour Pain (CLP), and 111 (79.9%) participants for the Five Facet Mindfulness Questionnaire (FFMQ)
Summary
Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in preg‐ nant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). MBCP, in comparison to enhanced care as usual (ECAU), was found to have a medium positive effect on the reduction of FOC and catastrophic beliefs about labour pain; a large effect on the reduction in willingness to undergo obstetric interventions in the absence of obstetric indications; a reduction in received self-requested caesarean section (sCS) and epidural analgesia (EA); and remarkably, women after MBCP were two times more likely to undergo natural birth (spontaneous vaginal birth without obstetric interventions) [7]
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