Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial

BACKGROUND: Mindfulness-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. METHODS: One 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). RESULTS: It was found that greater mindful awareness (18% R(2) = 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. CONCLUSIONS: An 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 REGISTRATION: The Netherlands Trial Register (NTR; 4302). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-022-04380-0

Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness-based childbirth and parenting with enhanced care as usual

OBJECTIVE: To investigate whether mindfulness‐based childbirth and parenting (MBCP) or enhanced care as usual (ECAU) for expectant couples decreases fear of childbirth (FOC) and nonurgent obstetric interventions during labor and improves newborn outcomes. DESIGN: Randomized controlled trial. SETTING: Midwifery settings, the Netherlands, April 2014‐July 2017. POPULATION: Pregnant women with high FOC (n = 141) and partners. METHODS: Allocation to MBCP or ECAU. Hierarchical multilevel and intention‐to‐treat (ITT) and per‐protocol (PP) analyses. MAIN OUTCOME MEASURES: Primary: pre‐/postintervention FOC, labor anxiety disorder, labor pain (catastrophizing and acceptance), and preferences for nonurgent obstetric interventions. Secondary: rates of epidural analgesia (EA), self‐requested cesarean birth (sCB), unmedicated childbirth, and 1‐ and 5‐minute newborn's Apgar scores. RESULTS: MBCP was significantly superior to ECAU in decreasing FOC, catastrophizing of labor pain, preference for nonurgent obstetric interventions, and increasing acceptance of labor pain. MBCP participants were 36% less likely to undergo EA (RR 0.64, 95% CI [0.43‐0.96]), 51% less likely to undergo sCB (RR 0.49, 95% CI [0.36‐0.67]), and twice as likely to have unmedicated childbirth relative to ECAU (RR 2.00, 95% CI [1.23‐3.20]). Newborn's 1‐minute Apgar scores were higher in MBCP (DM −0.39, 95% CI [−0.74 to −0.03]). After correction for multiple testing, results remained significant in ITT and PP analyses, except EA in ITT analyses and 1‐minute Apgar. CONCLUSIONS: MBCP for pregnant couples reduces mothers’ fear of childbirth, nonurgent obstetric interventions during childbirth and may improve childbirth outcomes. MBCP adapted for pregnant women with high FOC and their partners appears an acceptable and effective intervention for midwifery care

Evaluating Mindful With Your Baby/Toddler: Observational Changes in Maternal Sensitivity, Acceptance, Mind-Mindedness, and Dyadic Synchrony

Studies on the effectiveness of mindful parenting interventions predominantly focused on self-report measures of parenting, whereas observational assessments of change are lacking. The present study examined whether the Mindful with your baby/toddler training leads to observed changes in maternal behavior and mother-child interaction quality. Mindful with your baby/toddler is a 8- or 9-week mindful parenting training for clinically referred mothers of young children (aged 0-48 months), who experience parental stress, mother-child interaction problems, and/or whose children experience regulation problems. The study involved a quasi-experimental non-random design including a sample of 50 mothers who were diagnosed with a mood disorder (n = 21, 42%), an anxiety disorder (n = 7, 14%), post-traumatic stress disorder (n = 6, 12%), or other disorder (n = 7, 14%). Mothers completed a parental stress questionnaire and participated in home observations with their babies (n = 36) or toddlers (n = 14) during a waitlist, pretest, and posttest assessment. Maternal sensitivity, acceptance, and mind-mindedness were coded from free-play interactions and dyadic synchrony was coded from face-to-face interactions. Sensitivity and acceptance were coded with the Ainsworth's maternal sensitivity scales. Mind-mindedness was assessed by calculating frequency and proportions of appropriate and nonattuned mind-related comments. Dyadic synchrony was operationalized by co-occurrences of gazes and positive facial expressions and maternal and child responsiveness in vocal interaction within the dyad. Coders were blind to the measurement moment. From waitlist to pretest, no significant improvements were observed. At posttest, mothers reported less parenting stress, and were observed to show more accepting behavior and make less nonattuned comments than at pretest, and children showed higher levels of responsiveness. The outcomes suggest that the Mindful with your baby/toddler training affects not only maternal stress, but also maternal behavior, particularly (over)reactive parenting behaviors, which resulted in more acceptance, better attunement to child's mental world, and more "space" for children to respond to their mothers during interactions. Mindful with your baby/toddler may be a suitable intervention for mothers of young children with (a combination of) maternal psychopathology, parental stress, and problems in the parent-child interaction and child regulation problems.Stress and Psychopatholog