Mindfulness-Based Interventions During Pregnancy to Support Perinatal Mental Health
With rising rates of perinatal mental illness, brief mindfulness interventions may come to play an
important role in reducing stress, anxiety, and depression.
Pregnancy and postpartum, or what health practitioners call the “perinatal period,” is a vulnerable time in a person’s life. For many, parenthood can cause conflicting emotions: joy, love, protectiveness, anger, exhaustion, and confusion. Child-bearers can experience a significant amount of stress as priorities shift to the all-consuming role of caring for a newborn. For some, the added stress can lead to mental health problems.
A recent report from the United States that examined pregnancies between 2014 and 2018 found that the number of women being diagnosed with postpartum depression is nearly one in 10, a jump of almost 30% from 2014. In Canada a 2018 survey found that almost one-quarter (23%) of mothers reported feelings consistent with a diagnosis of postpartum depression or anxiety.
There is growing evidence that mindfulness training may be effective in reducing the risk of perinatal mood and anxiety disorders. A 2017 systematic review of the scientific evidence for mindfulness-based interventions (MBI) found that mindfulness programs were associated with reductions in perinatal anxiety, although results for depression were less consistent.
“Following mindfulness-based interventions…[there is a] strengthening of non-reactivity,” says Marissa Sbrilli, a graduate student in the Clinical Community Psychology PhD program at the University of Illinois. Mindfulness practice can help foster a non-reactive attitude, openness to experience, and cultivation of self-compassion during stressful times. Sbrilli feels that this attitudinal shift is just as important as the attentional skills we learn during mindfulness practice, such as becoming aware of bodily sensations, thoughts, and emotions.
Mindfulness-Based Interventions in Childbirth
One program designed for child bearers is Mind in Labor (MIL), developed by Nancy Bardacke, CNM, Founder of the Mindful Birthing and Parenting Foundation. MIL is a condensed version of the Mindfulness-Based Childbirth and Parenting (MBCP) program and runs as a 2.5-day weekend workshop. “MIL teaches mindfulness-based strategies for coping with labor-related pain and fear, as well as psychoeducation and birth physiology education,” says Sbrilli.
Results from a pilot randomized controlled trial conducted by Dr. Larissa Duncan and colleagues at the University of Wisconsin-Madison that compared the MIL workshop to treatment as usual (TAU) found promising results for improvement in childbirth self-efficacy (feeling confident about the ability to give birth) and depression symptoms six weeks post-birth.
However, further work was needed to explore each component of the “perinatal distress umbrella”, which includes stress, anxiety, and depression. Postpartum depression is the disorder that gets the most attention from the media and medical community, yet individuals can experience symptoms other than depression or struggle with two or more of these components simultaneously. It’s also important to assess baseline symptoms and dispositional mindfulness (how much someone possesses the inherent quality of mindfulness), which may predict an individual’s level of distress once they have completed the MIL program.
Mindfulness-Based Child Prep vs. Childbirth Classes Without Mindfulness Training
To explore these knowledge gaps, Sbrilli and her mentor Dr. Heidemarie Laurent conducted a secondary analysis of the data from the MIL trial. The 30 participants were low-risk, healthy and were planning to give birth to a single baby in hospital. They were randomized to the MIL workshop or TAU (a standard childbirth class or a class suggested by the participant that did not incorporate mind/body practices) in their third trimester. “This small study offers preliminary evidence that a brief perinatal mindfulness-based childbirth prep class versus regular childbirth classes without mindfulness training, offers greater decreases in distress,” says Sbrilli. “And what’s really exciting is that we followed participants from before the program through post intervention, and up to 12 months postpartum.”
Another interesting outcome from the study was that the benefits of MIL were especially pronounced for those who started off with greater symptoms of distress. “So specifically, those with higher anxiety and/or lower [dispositional] mindfulness before the start of the program…might benefit even more,” says Sbrilli.
Given the lack of research examining the long-term effects of perinatal mindfulness programs, these preliminary results are promising. However, Sbrilli cautions that more research is needed to test whether these positive outcomes hold up, especially for different populations. The participants in the pilot study were predominately white. “It’s important to do further research with Black, Latinx, Indigenous, and child-bearers of colour ideally with an instructor from their community, so that people may feel safer or more comfortable attending a program facilitated by someone they identify with,” says Sbrilli.
Despite the study’s limitations, the results of this analysis offer hope for families and healthcare providers who are looking to address the risk of common mental health problems before and after childbirth. With rising rates of perinatal mental illness, brief mindfulness interventions may come to play an important role in reducing stress, anxiety, and depression.
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