MBCP is designed to promote family health and well-being through the practice of mindfulness during pregnancy, childbirth, and early parenting. Qualitative reports from participants expand upon the quantitative findings, with the majority of participants reporting perceived benefits of using mindfulness practices during the perinatal period and early parenting. Our future research will involve conducting a randomized controlled trial of MBCP to test effects on psychophysiological stress mechanisms and to examine effects on birth outcomes, family relationship quality, and child development outcomes.
The life course perspective on human development Elder suggests that each major period of development during the life span brings a unique set of opportunities and challenges.
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Human pregnancy is a remarkably dynamic period of growth and development that poses significant physical and psychological challenges for pregnant women and their partners. Under the framework of Stress and Coping Theory Folkman ; Lazarus and Folkman , when the challenges of the developmental transition to parenthood are appraised as stressful and are not met with adaptive coping, there is the potential for expectant parents to experience distress that poses a risk to their own health and well-being, as well as that of the developing child. Beginning with the earliest stages of development in utero, stress can have serious negative effects on the health of a pregnant woman and her infant Lupien et al.
Maternal stress is linked with adverse birth outcomes including preterm birth IOM , and although adverse birth outcomes have an etiology of multiply determined complex factors, maternal psychological and physiological stress mechanisms are consistently implicated as significant risk factors Hogue and Bremner ; Holzman et al.
In addition to its relation to adverse birth outcomes, maternal stress is a significant factor in the etiology of postpartum depression, postpartum increases in couple conflict, and the quality of mother-infant attachment Austin and Leader ; Austin et al. Further, parenting stress has been associated with a wide array of maladaptive parenting characteristics, is highly prevalent among abusive and neglectful parents Deater-Deckard , and has been linked to long-term adverse health outcomes for offspring, including morbidity and mortality.
An integrative approach to stress reduction that infuses mind—body practices into developmentally-appropriate behavioral interventions administered during the perinatal period may help promote healthier pregnancy and birth outcomes Beddoe and Lee This approach may also encourage qualities beneficial for promoting healthy parenting and overall positive child social-emotional development and physical health. Existing empirical evidence suggests that mindfulness-based interventions can reduce the impact of stress, improve psychological well-being and increase positive affect, alleviate anxiety and depression, prevent relapse or recurrence of major depressive disorder and substance abuse, and improve immune function when delivered to a variety of adult populations Astin ; Baer ; Davidson et al.
Mindfulness practices have been successfully applied in interventions for non-distressed married or cohabiting couples to enhance relationship functioning Carson et al. Studies of the effects of these applications of mindfulness have shown that mindfulness-based interventions can enhance interpersonal relationship functioning and stress coping efficacy among relatively happy couples Carson et al.
Furthermore, the study of dispositional mindfulness indicates that greater mindfulness is related to greater self-regulated behavior and mental health see Baer et al.
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This positive adaptation may in turn influence stress responses that can impact long-term physical and mental health outcomes for parents and their children. According to Stress and Coping Theory Lazarus and Folkman , not everyone has the same experience when faced with a stressful event. Some individuals make appraisals of an event as threatening or harmful while others may appraise the same event as a challenge. The stress appraisal of an event, such as the transition to parenthood, prompts the coping process and produces affective responses that are associated with physiological reactivity.
Threat appraisals tend to lead to negative affect, and exaggerated physiological stress reactivity hypothalamic-pituitary-adrenal axis and autonomic nervous system reactivity Maier et al. In contrast, if the same event is appraised as a challenge instead of a threat, the individual may experience more positive affect e.
For a pregnant woman, mindfulness practice may facilitate more challenge than threat appraisals, leading to more proactive and adaptive coping efforts, and more positive affect, thus reducing stress responses that can be harmful to her own well-being and that of the developing fetus. During pregnancy, positive affect may also prevent the mother from feeling overwhelmed and may result in her being more receptive to learning new stress coping strategies. Employing adaptive coping is particularly important in this critical and sensitive developmental period when maternal stress and anxiety can adversely affect fetal health and influence both short and long term developmental outcomes Bergman et al.
The goal of MBCP is to ameliorate the impact of stress related to the challenges of pregnancy, childbirth, and early parenting through the use of mindfulness meditation practices, with the ultimate aim of promoting family health and well-being. MBCP offers parents-to-be the opportunity to use the transformative time of pregnancy and childbirth to learn the practice of mindfulness for working with the stress, pain, and fear that are often a normal part of this developmental transition.
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MBCP is designed to reduce the perception of pregnancy, childbirth, and parenting-related stressors as threatening or harmful and to promote awareness from which to select appropriate coping strategies, including the use of mindfulness skills. As in the MBSR program, the MBCP program provides systematic instruction in mindfulness meditation as a self-regulation approach to physical and emotional health and well-being. Although fundamentally a normal, healthy process for most women, pregnancy itself has inherently challenging elements that may be perceived as stressful.
It is a time of rapid physical and emotional change with an irreducible element of uncertainty regarding the outcome of the birth process for the mother, the baby, the family, and life beyond. Depending on the physical and psychological health of a particular woman and the unfolding normalcy or lack thereof of a particular pregnancy and fetus, the pregnant state is more or less stressful.
The same can be said of the birth and postpartum experience. To have inner resources to navigate the physiological changes of pregnancy and birth, and emotional tools to navigate the developmental change in the life course may have benefit for both expectant parents and their care providers. The MBCP program is intended to help participants practice being in the present moment so that they may develop greater confidence and a deeper sense of well-being during this normative life transition. Mindfulness practice then becomes a resource for birthing, parenting, and living with awareness, kindness, connectedness, and care.
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The purpose of our pilot study was to describe the changes in the dimensions of the stress and coping process observed in pregnant women participating in MBCP with their partners during their third trimester of pregnancy. Using an evaluation framework based on revised Stress and Coping Theory Folkman , we expected participants to demonstrate a reduction in stress appraisals levels of perceived stress and pregnancy-related anxiety , increases in mindfulness and positive affect, and decreases in negative affect and depression.
We also anticipated that they would adopt the formal and informal mindfulness practices taught in MBCP as ways of coping with salient stressful aspects of pregnancy, childbirth, and the early postpartum period. We conducted a mixed-method observational pilot study of MBCP with four cohorts of expectant couples from an urban context who self-selected to participate in MBCP in All study procedures were approved by an academic medical center Institutional Review Board.
The course instructor invited all course enrollees to participate in the research study and informed consent procedures were conducted by study staff at the beginning of the introductory class meeting. Participants also provided qualitative descriptions of their experiences of pregnancy, childbirth, and early parenting and their use of course skills.
The developer of MBCP the senior author was the instructor for all four groups. Two groups were held in a university integrative medicine clinic and two were held in an off-site location that was more geographically proximal to participants. The recommended class size ranges from eight to 12 expectant couples. Although the course is expressly designed for expectant couples to attend together, pregnant women without a partner or whose partner cannot attend are welcome and are invited to bring a support person, if so desired.
In the MBCP program, formal mindfulness meditation instruction is given and practiced in each class. The teaching of mindfulness is fully integrated with the current knowledge of the psychobiological processes of pregnancy, labor, birth, breastfeeding, postpartum adjustment, and the psychobiological needs of the infant.
A wide variety of mind—body pain coping skills for childbirth and awareness skills for coping with stress in daily life are also included.
Course materials are Full Catastrophe Living by Jon Kabat-Zinn , two guided meditation CDs and a workbook with selected readings and resource lists. The MBCP method of childbirth preparation is unique in its focus on teaching mindfulness meditation and the necessary commitment that participants must make to practice meditation outside of class. In addition to teaching mindfulness practice, an essential element of the course is to encourage a sense of community among the expectant parents to reduce the potential negative impact of social isolation on the mental health of the new parents in the postpartum and early parenting period.
Group sharing provides couples the opportunity to normalize the stress they may be experiencing, such as changes in the physical body, living space, finances, work life, hormonal and emotional changes, self-identity, and couple and family relationships.
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The group process allows couples the chance to hear that these stressors are shared by others and to learn that, if they are approached as a challenge, they can provide an opportunity for self-learning and growth. Partner concerns, such as worry about how to support a woman during childbirth, are addressed. A portion of this first meeting is devoted to an eating meditation in which one raisin is eaten mindfully. Participants are taught that, with the practice of mindfulness, the choice to be more present in our lives becomes available.
MBCP class two Group bonding and community-building deepen in session two. The first formal meditation practice, the Body Scan, is taught in session two. Not to be confused with progressive relaxation exercises that are often taught in childbirth education classes, the Body Scan is an awareness practice. Whenever the mind wanders, the instruction is to bring the attention back to sensations in the body.
During the Body Scan unpleasant or painful sensations may arise. This experience offers an opportunity to begin developing the skill of uncoupling the sensory component of pain from its emotional and cognitive components right in the present moment. Participants are taught that during labor, this skill is invaluable: with mindfulness, pain can be experienced as it is: intense physical sensation arising and passing, moment-by-moment.
Moments between painful sensations e. The Body Scan is also intended to increase body awareness, concentration, and is an opportunity to connect with the unborn baby. MBCP class three Class three is intended to prompt a fundamental shift in perception of the childbirth experience. The physiology of childbirth from a mind—body perspective is described with an emphasis on how present moment awareness can be a critical skill for supporting the normal physiology of labor. With this description, participants are encouraged to consider how fearful appraisals of pain by the mind may trigger the stress reaction during childbirth and negatively affect the labor process through psychophysiological pathways of the neuroendocrine system.
Participants are asked to describe their home experiences practicing the Body Scan during the previous week. Common challenges such as finding time to practice, falling asleep during meditation practice, and questions about what to do when pain or discomfort arises during the Body Scan are addressed. This sets the foundation for bringing mindfulness into everyday life as a more responsive and less reactive parent. MBCP classes four, five, and six Yoga is introduced as a formal meditation practice in class four.
Practiced mindfully, yoga is a meditative discipline. Noticing and moving into sensations during yoga practice, particularly sensations of stretching and contracting and noticing the times of ease and rest between poses, is mindfulness preparation for noticing the sensations of contractions and the moments of ease between sensations during the labor process. In class six, open awareness sitting meditation is taught. Sitting meditation is alternated with yoga or the Body Scan in the home practice assignment for the week.
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Using ice cubes to induce unpleasant sensations, couples are taught a variety of pain practices in classes four, five, and six. They are taught that simple awareness of breathing, moving directly into the sensations, counting the breaths, and vocalizing low-pitched sounds are all ways to focus attention, accept and even welcome intense body sensations. Participants are encouraged to understand how the non-reactive, concentrated, calm, and focused state of mind that is being cultivated in meditation practice can be used to open to and allow unpleasant sensations to arise and pass, moment by moment.
Partners are taught the pain practices along with the pregnant women, and in this way are able to bring empathetic understanding to their partners during the pain of childbirth. Partners receive instruction in a variety of ways to use mindful touch to calm and support their partner.
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Class six focuses on making wise choices for childbirth, including selection of a care provider, place of delivery home, hospital, birth center , and additional labor support such as the use of a doula. Walking meditation is introduced and practiced.
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In the afternoon, silence is suspended and participants are led through a mindful speaking and listening practice around fears about the future. In this way, participants are encouraged to bring mindful presence into their most intimate relationships. Lovingkindness practice is a practice of open-hearted friendliness and well-wishing for oneself and others. Also in class seven, participants are invited to share their experiences of the Retreat Day including experiences that were inspiring or challenging, and any insights they had about themselves or mindfulness practice.
Participants are reminded that just as they did not know how the day of silence would unfold, so too, they do not know how the day or night of labor will unfold. They are instructed that as with the Retreat Day, all that is needed during childbirth is to simply be present as fully as possible as the labor process unfolds, moment-by-moment. Sitting meditation is continued as the formal practice for the week.
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