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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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Cites
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267
The Pain Catastrophizing Scale: Development and validation.
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Kabat-Zinn, J. (1982) · General Hospital Psychiatry · doi:10.1016/0163-8343(82)90026-3 · Cited by 4,255 · cited 1×
“Mindfulness training – long used as a method for promoting coping with chronic pain [7, 8] and shown to be beneficial for acute pain [9, 10] – provides a novel and promising strategy for preparing women for childbirth.”
MethodThe validation of visual analogue scales as ratio scale measures for chronic and experimental pain
Price, D. D., McGrath, P. A., Rafii, A., & Buckingham, B. (1983) · Pain · doi:10.1016/0304-3959(83)90126-4 · Cited by 3,921 · cited 6×
“The VAS is one of the most commonly used pain measures and it has been used successfully to assess labor pain [22].”
MethodInfluentialThe effect of mindfulness based therapy on anxiety and depression: A meta analytic review
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0018555 · Cited by 3,846
Perinatal Depression: A Systematic Review of Prevalence and Incidence
Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000183597.31630.db · Cited by 3,282 · cited 9×
“A robust literature documents the negative impact of PPD on the quality of mother-infant interaction, with studies showing less reciprocal [35] and more intrusive, hostile, disengaged, and withdrawn behavior among mothers with PPD [36, 37].”
BackgroundInfluentialHölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011) · Perspectives on Psychological Science · doi:10.1177/1745691611419671 · Cited by 3,024
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008) · Assessment · doi:10.1177/1073191107313003 · Cited by 2,930 · cited 5×
“Mindfulness and mindful body awareness The Five Facet Mindfulness Questionnaire (FFMQ) [25] was used to assess levels of dispositional mindfulness (a tendency to avoid mindlessness in everyday life) at each time point (T1 - T3).”
MethodInfluentialMaternal depression and parenting behavior
Lovejoy, M. C., Graczyk, P. A., O'Hare, E., & Neuman, G. (2000) · Clinical Psychology Review · doi:10.1016/s0272-7358(98)00100-7 · Cited by 2,667 · cited 8×
“A robust literature documents the negative impact of PPD on the quality of mother-infant interaction, with studies showing less reciprocal [35] and more intrusive, hostile, disengaged, and withdrawn behavior among mothers with PPD [36, 37].”
BackgroundInfluential
Cited by
Sorted by citations
Galante, J., Friedrich, C., Dawson, A. F., Modrego-Alarcón, M., Gebbing, P., Delgado-Suárez, I., Gupta, R., Dean, L., Dalgleish, T., White, I. R., et al. (2021) · PLOS Medicine · doi:10.1371/journal.pmed.1003481 · Cited by 319
“Year, Country N Participants (category) Mean Age (SD) Women Outcomes Intervention (category) Control/s (category) Outcome Time Points Xu 2015 [277], China 90 Adults (1) 31 (8) 56% Dis, Mindf Mindfulness training (2) Waitlist (1) Post–int Yazdanimehr 2016 [278,279], Iran 80 Pregnant women (2) 26 (5.2) 100% Anx, Dep, Di…”
BackgroundInfluentialRelaxation techniques for pain management in labour
Smith, C. A., Levett, K. M., Collins, C. T., Armour, M., Dahlen, H. G., & Suganuma, M. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009514.pub2 · Cited by 307
Brief Mindfulness-Based Interventions for Acute and Chronic Pain: A Systematic Review
McClintock, A. S., McCarrick, S. M., Garland, E. L., Zeidan, F., & Zgierska, A. E. (2019) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2018.0351 · Cited by 107
Pan, W., Chang, C.-W., Chen, S.-M., & Gau, M. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2503-4 · Cited by 115
“Although the findings are consistent with previous research that has shown mindfulness to be effective at improving psychological well-being in different perinatal populations [14, 20, 21], the measurements in most of this research were conducted at 4–6 weeks postpartum.”
BackgroundResultWhen Fathers Begin to Falter: A Comprehensive Review on Paternal Perinatal Depression
Bruno, A., Celebre, L., Mento, C., Rizzo, A., Silvestri, M. C., Stefano, R. D., Zoccali, R. A., & Muscatello, M. R. A. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17041139 · Cited by 106
“It was shown that parents who learn mindfulness practice develop an attitude towards a high-quality relationship with their children [99,100].”
Background
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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