No one can argue with the fact that the cesarean birth rate is too high, especially in many industrialized countries. In the USA, the most recent data states 31.8% of all births occurred by cesarean surgery in 2020. (Hamiliton, et al., 2020)
A study published in the July 2021 issue of Birth, Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness-based childbirth and parenting with enhanced care as usual examined the impact of a childbirth education course focused on mindfulness on the rate of cesarean births in The Netherlands. The researchers hypothesized that if they could use a mindfulness-based childbirth and parenting (MBCP) program for pregnant people who had a high fear of birth , it would help to decrease their fear, and improve outcomes. It would also decrease the use of epidurals and the number of cesarean deliveries.
Who participated in the study?
141 low risk nullipara and multipara pregnant people, 18 or older, were included in the study. To be included, the pregnant people were identified as having a high fear of childbirth on the Wijma-Delivery Expectation Questionnaire and being seen by midwives in the Netherlands. The participants needed to agree to being randomized into the study group or the control group. Potential participants were excluded if they were currently experiencing severe psychological concerns, or had participated in a mindfulness or HypnoBirthing program in the past year.
How was the study conducted?
The participants were randomized into two groups. The experimental group participated in a face-to-face, group-based MBCP program for expectant couples published as “Mindful Birthing.” The program was modified for people who had a fear of birth and focused on management techniques for anxiety and fear, guided meditations, and enquiry. There were a total of nine weekly sessions that lasted three hours each and were delivered by experienced midwives certified in MBCP. Sessions included mindfulness meditation practice and enquiry (eg, participants sharing about meditation experiences to improve meditation practice), and teachings about psychobiological processes in the perinatal period for pregnant people, newborns, and the family. The participants were also asked to practice mediation at home, 30 minutes daily.
The control group participated in two individual 90-minute sessions of enhanced care as as usual, spread over a ten week period and the sessions were conducted by trained midwives. The information shared was designed to reduce the fear of birth by exploring the factors causing and maintaining fear and stress in the perinatal period and included trying to understand the fear and developing a plan for coping, including psychoeducation about fear, and making a coping plan.
What were the results?
The primary outcomes were assessed by a variety of evidence based psychological tests that looked at the fear of childbirth, labor anxiety, fear of pain and preferences for nonurgent obstetrical interventions during labor and birth. Secondary outcomes of the number and type of interventions, use of epidurals and cesarean births were gathered from medical records.
The fear of childbirth, the fear of pain and the level of anxiety was decreased in both groups but the study group who went through the mindfulness-based childbirth and parenting program experienced a significantly larger decrease in all those categories.
The group that participated in the MBCP were 36% less likely to receive an epidural and 51% less likely to give birth by cesarean. The 1-minute Apgar score in newborns was higher in the MBCP group than the control group, but no difference was seen in the 5-minute Apgar scores.
The researchers stated that results suggest that a mindfulness-based childbirth program is more effective than an enhanced care as usual course to reduce the fear of childbirth, catastrophizing labor pain, patient preferences for nonurgent obstetric interventions, and rates of self-requested cesarean birth, and in increasing acceptance of labor pain, and unmedicated childbirth.
Offering mindfulness training to pregnant people with a high fear of childbirth and their partners is effective in decreasing that fear and nonurgent obstetric interventions such as cesarean births and epidural use. The nine-week MBCP program appears an acceptable and effective intervention for midwifery care to improve outcomes.
Connecting the Dots has discussed mindfulness in labor and birth before:
Do you include any mindfulness practices in your perinatal classes? what has your experiences been if you do?
Hamilton BE, Martin JA, Osterman MJK. Births: Provisional data for 2020. Vital Statistics Rapid Release; no 12. Hyattsville, MD: National Center for Health Statistics. May 2021. DOI: https:// doi.org/10.15620/cdc:104993.
Irena K. Veringa‐Skiba et al, Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness‐based childbirth and parenting with enhanced care as usual, Birth (2021). DOI: 10.1111/birt.12571
Khwepeya, M., Huang, HC., Lee, G.T. et al. Validation of the Wijma delivery expectancy/experience questionnaire for pregnant women in Malawi: a descriptive, cross-sectional study. BMC Pregnancy Childbirth 20, 455 (2020). https://doi.org/10.1186/s12884-020-03146-w