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Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison
Open accessAbstract
BACKGROUND: Childbirth 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. METHODS: This 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. RESULTS: In 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. CONCLUSIONS: This 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 REGISTRATION: The ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.
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“Given the demonstrated benefit of mindfulness training in pregnancy for improving depression symptoms and preventing depression relapse [12, 20], mindfulness may be especially suited, in combination with CBT-I, for treating insomnia in pregnant women with a history of depression.”
From Online prenatal trial in mindfulness sleep management (OPTIMISM): Protocol for a pilot randomized controlled trial (2020) · cites this paper as [20]
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“Further, several brief adaptations of mindfulness-based childbirth and parenting programs exist (e.g., a weekend workshop, 4 vs. 9 weeks [105, 107]), thereby enhancing the accessibility of these interventions.”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [107]
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GEBELERDE DOĞUM KORKUSUNUN BELİRLENMESİ: RANDOMİZE KONTROLLÜ ÇALIŞMALARIN SİSTEMATİK DERLEMESİ
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The Effect Of Pregnancy Follow-Up On Birth Expectations In Primary Health Care
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EFEITOS DA PRÁTICA DE MINDFULNESS EM GESTANTES E PARTURIENTES ATENDIDAS NO AMBIENTE HOSPITALAR
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“Antenatal classes have unanimously proved to enhance childbirth self-efficacy and ability to handle the birth process, with fewer women feeling low confidence in their ability to cope at home during labor [1,6,10,11].”
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“As a result, pregnant women see cesarean delivery as an alternative to vaginal delivery (11) or they are exposed to birth interventions such as epidural anesthesia (12,13).”
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Kvasnak, K., Brunton, G., Lemonde, M., Chyzzy, B., & Dick, J. A. (2021) · International Health Trends and Perspectives · doi:10.32920/ihtp.v1i2.1438 · Cited by 1
Intervenciones basadas en mindfulness para el manejo de pacientes con dolor
Schuler, G. S. R., & Badoui, N. (2021) · Universitas Médica · doi:10.11144/javeriana.umed62-4.mind · Cited by 1
Ritonga, J. S., & Hidayat, A. (2023) · Poltekita Jurnal Ilmu Kesehatan · doi:10.33860/jik.v17i1.2145 · Cited by 1
Mahmalat, N., Ostermann, T., & Fetz, K. (2020) · doi:10.21203/rs.3.rs-36611/v1 · Cited by 1
“The intervention group participated in the program called Mind in Labor (MIL): Working with Pain in Childbirth [31], which is a 2.”
BackgroundMethodInfluentialLaifer, L. M., Ramsdell, E. L., Stasik-O’Brien, S. M., Martin, R. C. B., & Brock, R. L. (2024) · Depression and Anxiety · doi:10.1155/2024/5164261
“Further, several brief adaptations of mindfulness-based childbirth and parenting programs exist (e.g., a weekend workshop, 4 vs. 9 weeks [105, 107]), thereby enhancing the accessibility of these interventions.”
Oxenham, F. (2017) · USF Scholarship Repository (University of San Francisco)
Jayasingam, S., Omar, S. B., Mustamil, N. M., Hashim, R. C., & Bakar, R. B. A. (2020) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-83982-692-420201005
Intervenciones enfermeras para reducir el miedo al parto. Estudio de revisión bibliográfica
Terensi, M. A. (2021) · MUSAS Revista de Investigación en Mujer Salud y Sociedad · doi:10.1344/musas2021.vol6.num1.5
Widhiarta, K. D., & Askandar, B. (2021) · Majalah Obstetri & Ginekologi · doi:10.20473/mog.v29i22021.57-62
Dare, K. A. (2021) · Cronfa (Swansea University) · doi:10.23889/suthesis.58164
Thiesen, A. B. T., Thiesen, L. D. C. T., & Maia, T. P. D. A. (2022) · International Journal of Health Science · doi:10.22533/at.ed.1592192208049
Direitos Humanos e Emancipação
Kunz, S. A. D. S., da Silva, A. A., Antunes, J. C. F., & Lima, D. K. F. (2019) · Culturatrix eBooks · doi:10.4322/978-85-94325-12-9
Kermack, A. (2022) · Cambridge University Press eBooks · doi:10.1017/9781009025270.004
Nutzungswahrscheinlichkeit von Gesundheitsprogrammen während der Schwangerschaft
Ney, R., Spalteholz, H., & Kriwy, P. (2022) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-022-00995-5
Mindfulness-Based Interventions during Pregnancy and Labour
Merchante, M. S., & Martinez-Hurtado, E. D. (2022) · Recent advances in anesthesiology · doi:10.2174/9789815051841122040022
Mindfulness-Based Interventions and Their Application to the Pregnant Population
Lane, M., Morosky, C. M., & West, A. M. (2021) · Topics in Obstetrics & Gynecology · doi:10.1097/01.pgo.0000725704.50048.64
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Santiago, L. D., Janzen, D. C., da Silva, E. F., Barreto, L. V., & Silva, L. C. P. (2023) · Enfermagem Brasil · doi:10.33233/eb.v22i5.5264
Tuğba, S., & Nermin, G. (2023) · Journal of Family Medicine and Disease Prevention · doi:10.23937/2469-5793/1510158
DECISION-MAKING REGARDING LABOR AND BIRTH: AN ANALYSIS OF ONLINE SYSTEMS FOR EXPECTANT PARENTS
Leite, C. V., de Oliveira, R. F. F., & Oliveira, C. L. A. A. P. (2023) · IADIS International Conferences on ICT, Society and Human Beings, e-Health, Connected Smart Cities and Big Data Analytics, Data Mining and Computational Intelligence (ICT/EH/CSC/BigDaCI) · doi:10.33965/mccsis2023_202305l019
Enfermagem Materna e Obstétrica: cuidar no parto e no pós-parto
Frias, A. M. A. (2023) · Editora Científica Digital eBooks · doi:10.37885/978-65-5360-504-6
Gomes, C., Gambín, M. M., Oliveira, P., & Frias, A. M. A. (2023) · Editora Científica Digital eBooks · doi:10.37885/231014743
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Effect of Interventions to Reduce Fear of Childbirth in Pregnancy: Meta-Analysis
Sarı, T., Gürhan, N., & Uzun, S. (2024) · International Journal of Childbirth · doi:10.1891/ijc-2023-0038
Effectiveness of Online Mindfulness-Based Intervention on Depression in Pregnancy
Kundarti, F. I., Titisari, I., Kiswati, K., Jamhariyah, J., & Rahayu, D. E. (2023) · JURNAL INFO KESEHATAN · doi:10.31965/infokes.vol21.iss2.1186
“MBSR and Mindfulness-based interventions (MBIs) are effective in reducing symptoms of depression and anxiety in pregnancy and postpartum (Dimidjian et al., 2015) and prevent relapse of depression (Duncan et al., 2017).”
BackgroundHasemann, L., Elkenkamp, S., Müller, M., Bauer, A., Wallwiener, S., & Greiner, W. (2024) · Health Economics Review · doi:10.1186/s13561-024-00537-z
“Due to their efficacy, low costs and low-threshold accessibility, mindfulness-based interventions (MBIs) have become increasingly popular in mental health care [14, 15] and represent a promising approach for women suffering from anxiety and depression during the peri-partum period [16–19].”
BackgroundCoping strategies in pregnancy and perinatal period in times of COVID-19
Polanco-Muñoz, R., Torres-Luna, E., Cuadros-López, A., Hinojosa, C. L. M., Albán-Terán, M. G., Chavez, C. B. E., Barahona-Fuertes, G., Larrea-Legarda, N., & Polanco-Verduga, J. (2024) · Salud Ciencia y Tecnología · doi:10.56294/saludcyt20251111
Testing the Birth APP: a Randomized Controlled Trial (Preprint)Preprint
Ängeby, K., Johansson, M., Børøsund, E., Varsi, C., Iwaya, L. H., & Nordin, A. (2025) · doi:10.2196/preprints.72807
Sareh, E., Borghei, N. S., Ozouni‐Davaji, R. B., & Rajabi, A. (2025) · Research Square · doi:10.21203/rs.3.rs-6320037/v1
Lü, J., Chen, X., McAra‐Couper, J., Ye, Y., Huang, K., Zheng, C., Pan, M., & Qiu, P. (2025) · Women and Birth · doi:10.1016/j.wombi.2025.102076
Metadata
- Authors
- Duncan, L. G., Cohn, M. A., Chao, M. T., Cook, J. G., Riccobono, J., & Bardacke, N.
- Affiliations
- University of Wisconsin–Madison (US)
- University of California, San Francisco (US)
- Corresponding author
- Duncan, Larissa G.
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2017-05-12
- Volume
- 17
- Issue
- 1
- Pages
- 140-140
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC5427564
- OpenAlex
- W2613725497
- Cited by
- 224
- References
- 44
- Citations by year
- 2026: 17 · 2025: 29 · 2024: 25 · 2023: 38 · 2022: 32 · 2021: 32 · 2020: 26 · 2019: 13 · 2018: 9 · 2017: 3
- FWCI
- 17.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Center for Complementary and Integrative Health (K01AT005270, K01AT006545)
- Mt. Zion Health Fund
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- fear of childbirth, labor pain, postpartum depression, childbirth self-efficacy, maternal mental health, primiparous women, childbirth education
- MeSH terms
- Adaptation, Psychological, Adult, Fear, Female, Humans, Labor, Obstetric, Pregnancy, Treatment Outcome, Depression, Postpartum, Self Efficacy, Parturition, Delivery, Obstetric, Pregnant People, Labor Pain, Prenatal Education, Mindfulness
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