Mindfulness-based childbirth and parenting for pregnant women with high fear of childbirth and their partners: outcomes of a randomized controlled trial assessing short- and longer-term effects on psychological well-being, birth and pregnancy experience

A scoping review of effective health practices for the treatment of birth trauma

BACKGROUND

There is currently no consensus on the most effective health practices to manage or reduce the effects of birth trauma (BT) and childbirth-related posttraumatic stress disorder (CB-PTSD).

AIM

The aim was to map the current literature on effective health practices for BT/CB-PTSD, identify key elements (the what, when and how) important for effective health practices, and highlight gaps in maternity care.

METHODS

A systematic search was conducted across key nursing, allied, and medical databases (MEDLINE, Scopus, PubMed) for key terms related to (1) birth trauma and (2) intervention. Only peer-reviewed, English-language papers published since 2000 were included to ensure the relevance and timeliness of the findings. Following PRISMA-ScR guidelines, 6,347 articles were identified through databases/registers and citation searching. After removing 1,342 duplicates, 5,005 were screened by title and abstract. A further 4,544 were excluded, leaving 461 for full-text screening. Afterf excluding another 433, 28 papers met inclusion for this review.

FINDINGS

The first session delivered early (within the first 72 h of birth) by a clinician (midwife/psychologist/counsellor) significantly reduced BT/CB-PTSD in the short-term. Both trauma-focused and non-trauma-focused were supported at this stage, provided they were structured. If intervention is delayed (weeks to months post-birth), a trauma-focused, multi-session approach is recommended.

DISCUSSION

Early, structured interventions should be considered routine care for women with BT/CB-PTSD, with more intensive, structured, trauma-focused approach for persistent symptoms. The potential role of digital mental health tools is promising, particularly for women in low-resource settings, but requires further research to evaluate feasibility, acceptability, and sustainability.

Fathers' sleep in the first 24 months postpartum: A systematic review and meta-analysis of global data

Maternal sleep is significantly disrupted in the postpartum period, but changes in paternal sleep are less established. Here, we systematically review and meta-analyze available data on paternal sleep in the first 24months post birth, including self-report and objectively measured sleep outcomes. Scopus, PsycINFO, and PubMed were searched for original research articles published until end August 2024. We included studies reporting on quantitative summaries of sleep outcomes and data were pooled using random-effects models primarily. We included 47 studies from 17 countries (N=9684) with most data coming from fathers in North America (K=26), and reporting on a diverse range of sleep outcomes. Most data were available for sleep duration (398.29 minutes; 95% CIs 381.43-415.88), night awakenings (1.14; 95% CIs 1.12-1.16), and wake after sleep onset (36.57 minutes; 95% CIs 20.83-64.20). There was high heterogeneity across these three measures (I2 values >95%). While there were a small number of studies using the Pittsburgh Sleep Quality Index, our pooled estimate suggested poor sleep in fathers (5.93, 95% CIs 4.75-7.41, I2=91%). Overall, we found some evidence for sleep in few fathers being below the recommended levels, but the extent of any paternal deficit depended on the sleep measure. The US-centric dataset limits our understanding of fathers' sleep experiences postnatally, particularly considering the large relative differences between paternity leave access in the United States vs. other countries.

The effects of the Mindfulness-Based Childbirth and Parenting Program (MBCP) on prenatal attachment, depression, stress, and anxiety in pregnant women: A randomized controlled trial

BACKGROUND

Interventions to cope with emotional states (depression, stress, and anxiety) and strengthen attachment are important. This research aims to determine the effect of the Mindfulness-Based Childbirth and Parenting Program (MBCP) on pregnant women's prenatal attachment and their levels of depression, stress, and anxiety.

METHODS

This randomized controlled trial included 36 participants who were randomly assigned into two groups: the Mindfulness-Based Childbirth and Parenting Program (MBCP) group (18 participants), and the control group (18 participants). The Depression Anxiety Stress Scales-21 (DASS-21) and the Prenatal Attachment Inventory (PAI) were administered at the beginning of the study and again 8 weeks later.

RESULTS

In the follow-up, the MBCP group exhibited significantly higher mean scores on the PAI compared to the control group (p < 0.05). The interaction between group and time was significant for PAI scores (F = 15.979, p < 0.001). When comparing the scores of the DASS-21 between the MBCP and control groups at the follow-up, the MBCP group showed significantly lower median stress scores compared to the control group (p < 0.05). There was no statistical difference between the baseline and follow-up median scores for depression, anxiety, and stress in the control group in terms of within-group comparison (p > 0.05). However, there was a statistical difference between the baseline and follow-up scores for depression, anxiety, and stress in the MBCP group in terms of within-group comparison (p < 0.05).

CONCLUSION

This study has demonstrated that the MBCP program has positive effects on prenatal attachment, anxiety, depression, and stress. Therefore, it is considered that MBCP could be a tool for nurses, midwifes, child development specialists, and other healthcare professionals.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05866549.

A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies

BACKGROUND

Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders.

OBJECTIVE

This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention's design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes).

METHODS

Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders.

RESULTS

An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end.

CONCLUSIONS

This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women.

Psychometric evaluation of the wijma delivery expectancy/experience questionnaire for pregnant women in Taiwan

BACKGROUND

Fear of childbirth profoundly affects women's ability to cope during pregnancy and influences birth outcomes. In Taiwan, there's a lack of validated tools for assessing childbirth fear.

OBJECTIVE

To evaluate the psychometric properties of the Taiwanese version of the Wijma delivery expectancy/experience questionnaire version A (WDEQ-A) in pregnant women.

METHODS

We conducted a cross-sectional study with pregnant women, using the WDEQ-A and a Visual Analogue Scale to assess childbirth fear. We employed the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory, and Mindful Attention Awareness Scale to measure depressive symptoms, anxiety, and mindfulness, respectively. We evaluated internal consistency reliability and construct validity using exploratory factor analysis and Rasch analysis. Pearson correlations measured the association between childbirth fear and psychological variables. The receiver operating characteristic curve was used for determining the sensitivity and specificity indices.

RESULTS

The WDEQ-A demonstrated excellent reliability (Cronbach's alpha = 0.93) and revealed a three-factor structure, including fear, lack of positive anticipation, and isolation. Rasch analysis supported the dimensionality of each of the three revised factors. The total score significantly correlated with depression (r = 0.56), anxiety (r = 0.19), and mindfulness (r = -0.40) (Ps < 0.001). The optimal cut-off for WDEQ-A was established at 55.5, with a sensitivity of 83 % and a specificity of 65 %.

CONCLUSIONS

The Taiwanese version of WDEQ-A proved to be a reliable and valid tool for assessing fear of childbirth in pregnant women, demonstrating excellent psychometric properties.

IMPLICATION FOR PRACTICE

These findings can assist midwives in Taiwan in identifying and promptly providing effective strategies for women experiencing a high fear of childbirth.

Effectiveness of mind-body interventions in labour pain management during normal delivery: A systematic review and meta-analysis

BACKGROUND

Labour pain is a common experience among women and poses risks to both the mother and neonate. Mind-body interventions have demonstrated effectiveness in diverse contexts, but their effectiveness in labour pain management remains controversial.

OBJECTIVE

To identify the effects of each category of mind-body interventions on labour pain management, particularly pain intensity; the use of pharmacological pain relief medications; and the consequent outcomes, including the rate of caesarean section, duration of labour, and fear of childbirth.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search for related articles was conducted in 10 databases. Randomised controlled trials focusing on the effectiveness of mind-body interventions in labour pain management were included. Two researchers independently conducted methodological quality assessments, data extraction and grading the evidence. Meta-analyses were conducted when studies measured the same outcomes. Standardised mean differences were calculated for continuous variables, whilst risk ratios were calculated for dichotomous variables. All analyses were performed using RevMan version 5.3.

RESULTS

A total of 25 studies from 24 trials were included, and six categories of mind-body interventions, namely hypnosis, mindfulness, breathing skills, muscle relaxation techniques, guided imagery, and therapeutic touch, were identified. Specifically, hypnosis and mindfulness might be effective in relieving labour pain intensity, with large effect sizes (SMD: -1.45, 95 % confidence interval [CI] -2.34, -0.55, I2 = 91 %; SMD: -1.22, 95 % CI -2.07, -0.37, I2 = 93 %, respectively), but could not reduce the use of epidural analgesia. Mindfulness, in particular, yielded statistically significant reductions in the rate of caesarean section, with a small effect size (RR: 0.46, 95 % CI 0.21, 0.97, I2 = 49 %), and in fear of childbirth, with a medium effect size (SMD: -0.63, 95 % CI -1.09, -0.17, I2 = 65 %). Additionally, all categories of mind-body interventions were associated with a significantly decreased duration of labour compared with the control conditions.

CONCLUSIONS

Mind-body interventions may have potential benefits in terms of decreasing labour pain intensity, the rate of caesarean section, the duration of labour, and fear of childbirth, with small-to-large effect sizes. Particularly, hypnosis and mindfulness exhibited significant positive effects in terms of relieving labour pain intensity, with large effect sizes. These interventions could serve as complementary or alternative methods for labour pain management in clinical practice. Nevertheless, further rigorous randomised controlled trials are warranted to confirm our results.

REGISTRATION

CRD42024498600 (PROSPERO, January 15, 2024).

The effect of mindfulness meditation on depressive symptoms during the COVID-19 pandemic: a systematic review and meta-analysis

Currently, 280 million people worldwide experience depression, ranking it third in the global burden of disease. The incidence of depression has risen due to the COVID-19 pandemic, making it essential to examine evidence-based practices in reducing depressive symptoms during this unprecedented time. This systematic review and meta-analysis aim to analyze randomized controlled trials during the COVID-19 pandemic that evaluated the effect of mindfulness meditation on depressive symptoms in individuals with depression. Four databases (PubMed, Embase, Web of Science, and Scopus) were searched in November 2023 using search terms including meditation, mindfulness, depression, and depressive symptoms. The meta-analysis was conducted using Review Manager 5.4 software (Cochrane Collaboration). A random model and Standard Mean Difference analysis with 95% CIs were used for continuous variables. The systematic review included 26 RCT studies. The meta-analysis showed significant effects of mindfulness meditation interventions (SMD = - 1.14; 95% CI - 1.45 to - 0.83; P < 0.001) in reducing depressive symptoms compared to comparison groups. The findings suggest a positive effect of mindfulness meditation on depressive symptoms in individuals with depression during the COVID-19 pandemic.

Stress is not so bad-cortisol level and psychological functioning after 8-week HIIT program during pregnancy: a randomized controlled trial

Background

Amid extensive pregnancy exercise research, the impact of High Intensity Interval Training (HIIT) on pregnant women's mental health is underexplored. Despite exercise benefits, it can trigger stress responses like elevated cortisol. This study fills the gap by investigating correlations between hair cortisol levels, mental health, and HIIT effects in pregnant women.

Methods

We conducted a randomized control trial among 38 Caucasian women in uncomplicated, singleton pregnancy (age 31.11 ± 4.03 years, 21.82 ± 4.30 week of gestation; mean ± SD). The experimental group comprised 22 women engaged in an 8-week high-intensity interval training program (HIIT). The comparative group consisted of 16 pregnant women undergoing an 8-week educational program (EDU). Before and after the interventions, all women were evaluated using the following tools: Hair cortisol level measurements, Beck Depression Inventory - II for depressive symptoms assessment, Childbirth Attitudes Questionnaire for childbirth fear measurement, 12-item Short Form Health Survey to gage health-related quality of life, International Physical Activity Questionnaire for physical activity level estimation, and a Progressive maximal exercise test to evaluate maternal exercise capacity.

Results

The key finding of our study reveals that women engaged in the HIIT intervention exhibited a distinct cortisol production pattern in contrast to the EDU group practicing standard moderate intensity physical activity. In the HIIT group, there was an increase in hair cortisol levels, while the EDU group showed a notable decrease. Remarkably, HIIT stimulated cortisol production without adversely impacting fear of childbirth and psychophysical condition during pregnancy. In fact, only the HIIT group showed a significant enhancement in mental health.

Conclusion

No links were discovered between hair cortisol levels and the severity of depressive symptoms, psychophysical well-being, or fear of childbirth. Hence, based on our research, employing cortisol levels during pregnancy as an indicator of negative stress or depression risk appears unwarranted.

The effectiveness of mindfulness-based interventions on self-efficacy and fear of childbirth in pregnant women: A systematic review and meta-analyses

BACKGROUND

Mindfulness-based interventions are a relatively new and potentially useful psychological approach in prenatal care. This study aimed to determine the effect of mindfulness-based programs on pregnant women's fear of childbirth FOC and self-efficacy.

METHODS

The systematic search of PubMed, Scopus, Web of Science, Cochrane Library, Google Scholar, SID, and Magiran databases began on 11 November 2021 and ended on 17 December 2021 to obtain studies published in English and Persian without date constraints. Another search was conducted in March 2023. The Cochrane handbook tool was used to evaluate selected studies and their risk of bias.

RESULTS

From a total of 316 records obtained, after removing duplicate items, 16 full texts were evaluated for eligibility; and finally, 10 studies were included in the study and meta-analysis. Based on the results of meta-analyses, mindfulness-based exercises may improve childbirth self-efficacy (SMD = 1.34, 95 % CI: 0.39 to 2.30; P < 0.00001; 5 studies, 304 women; low-certainty evidence) and probably reduce the level of FOC (SMD = -0.71, 95 % CI: -1.14 to -0.27; P = 0.001; 5 studies, 424 women; moderate-certainty evidence) in the intervention group compared to the control group.

LIMITATIONS

Different duration of interventions across studies, different gestational ages at the time of enrollment, and large heterogeneity in the meta-analysis of results were the limitations of this study.

CONCLUSION

Mindfulness-based interventions probably reduce FOC and may promote self-efficacy. More randomized controlled trials with stronger designs and adequate power samples are required to verify the effectiveness of mindfulness-based interventions, especially on self-efficacy in pregnant women.

PROSPERO ID

CRD42021294056.