Mindfulness and Meditation in Pregnancy

By Anna Glezer, MD

There is an essential connection between the mind and body. We cannot think of one without the other, and most distress comes from an imbalance in both. More and more patients are turning to mind-body interventions to treat various conditions - from major medical illnesses to mental health conditions - and that includes women who are emotionally struggling or having physical pain during pregnancy. Mind-Body Interventions are plentiful and include yoga, hypnotherapy, imagery, biofeedback, relaxation therapy, and meditation, all of which are appropriate in pregnancy.

What is meditation?
Meditation is defined as a practice of intentional attention ' a focusing on particular aspects of one's inner or outer experience. There are many forms, the most common of which are transcendental meditation, where a person silently repeats a phrase, mantra, or word to quiet the mind, and mindfulness meditation, which I will discuss in depth below.

What is mindfulness?
Being mindful is a state of mind where you observe your feelings, thoughts, and perceptions in an open, non-judgmental, accepting and compassionate way. It encourages focusing your attention on the here and now rather than worrying about the past or the future. Often relaxation is a side benefit of a mindfulness practice.

What are specific mindfulness-based treatments?
Mindfulness-Based Stress Reduction (MBSR) is a program developed by Dr. Kabat-Zinn and colleagues in the 1980s that is effective in many diverse populations, including pregnant women. It is usually taught in 8-10 sessions. The skills are derived from Buddhist traditions and involve focusing on the present, being in the moment, and learning how to observe one's experience in a non-judgmental way. The goal is to achieve a relaxed or calm state of mind. Multiple research studies show MBSR as helpful for decreasing depression, pain symptoms, anxiety and stress and improving sleep and quality of life. More recent studies have begun to apply MBSR in groups of pregnant women, and the initial results are quite promising!

Mindfulness-Based Cognitive Therapy (MBCT) integrates the MBSR techniques above with cognitive-behavioral therapy (CBT). CBT is one of the most common forms of psychotherapy where the focus is on changing one's negative thoughts and behaviors to alleviate symptoms of stress and depression.

There are many other ways to practice being mindful. Mindfulness yoga, certain sitting or walking meditations, and body scanning are examples.

What are the 7 primary elements of mindfulness practice?
There are seven essentials that are taught in most classes/workshops (from Jon Kabat-Zinn). These are:

1. Acceptance: This means seeing things the way they are.
2. Non-judgment: This means looking at your experience with impartiality and without editorializing.
3. Letting go: This refers to allowing all things, pleasant and unpleasant, to be as they are ' not holding on to the positive and avoiding the negative. This includes our ideas, thoughts, hopes, and our experiences and life-events
4. Non-striving: The only goal is to be yourself, not anything else. This can be especially challenging in today's goal-driven society.
5. Beginner's mind: To be back at your beginning, without any expectations or uncertainties or worries based on past experiences. This is particularly important for a meditation practice ' starting each and every meditation as if the first.
6. Patience: All things take time, and allowing time for results rather than getting anxious for them. This means simply being complete in each moment.
7. Trust: This refers to trust in yourself and your emotions.

What about mindfulness for childbirth?
Mindfulness can help during the birthing process. Research of pregnant women who took mindfulness-based childbirth classes found that mother described feeling empowered by their experiences and more satisfied with their labor. For women who have fears of childbirth, this type of intervention has helped them feel more confident and in control, with less pain during labor.

What about mindfulness in parenting?
There has also recently been new develops in mindful parenting. This means experiencing being a parent with an attitude of acceptance towards yourself and your children, parenting in a non-judgmental way, focusing on the present moment, and being aware of your emotions and those of your child. It means focusing on compassion and empathy, self-regulation, and listening in an attentive way.

Mindful parenting promotes secure attachment between a parent and child. One small study found that women who completed a class on mindful parenting reported more self-efficacy as a parent, more self-compassion, and had lower levels of anxiety, stress, and distress. These benefits can then flow towards others in the family, including a partner or other caretakers, and of course the child.

Why should I consider mindfulness therapy?
One of the benefits of mindfulness based cognitive therapy is that results are seen quite quickly! Given that pregnancy is a time-limited condition, rapid solutions are most helpful. There are a number of small research studies that provide pregnant women with an 8-week MBCT class and note significant changes ' with decreases in stress, depression, and anxiety, and increases in self-compassion. Even better, these changes can be seen extending into the postpartum period. And, there is early evidence that mindfulness during pregnancy affects the neurodevelopment of infants in a positive way.

Mindfulness based therapy can also help prevent a recurrence of depression during pregnancy. In women with a prior history, the rate of depression recurrence during pregnancy is about 30%. However, many women are uncomfortable continuing medication during pregnancy, and so the rates of relapse are even higher in women who discontinue antidepressants for pregnancy. Women who have experience with mindfulness therapy are more aware of their triggers, can use their skills when mood gets low, and have the ability to get out of negative thought trains. All of this decreases the risk of relapse.

Take-home message
A mindfulness practice, which can take on many forms, is a good, side-effect free way to help manage symptoms of anxiety, stress, and depression during pregnancy. It can decrease your risk of depression during pregnancy, even if you are already vulnerable because of certain risk factors.

If you are already struggling emotionally during pregnancy, consultation with a mental health profession is important. Your clinician might recommend a course of mindfulness therapy, which can be a good time-limited treatment option and work in concert with medications and other therapies.

Consider also checking with your obstetrician's office or hospital to see if there is a mindfulness parenting or child birthing class offered.

About Dr. Glezer:
Dr. Anna Glezer is a Harvard-trained clinician with current joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center. She is the founder of Mind Body Pregnancy, a new online educational resource that helps women with their emotional well-being and mental health during pregnancy, delivery, and postpartum.

Selected References:
Dunn, C. et. al. Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women's psychological distress and well-being in the perinatal period. Arch Womens Ment Health (2012) 15: 139-143.

Goodman, J.H. et. al. CALM Pregnancy: Results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Womens Ment Health (2014): 17.5: 373-387.

Dimidjian, S. et. al. An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Arch Womens Ment Health (2015) 18: 85-94.

Perez-Blasco, J., Viguer, P. & Rodrigo, M.F. Effects of a mindfulness-based intervention on psychological distress, well-being, and maternal self-efficacy in breast-feeding mothers: results of a pilot study. Arch Womens Ment Health (2013) 16: 227-236.

Dimidjian, S. et. al. Staying well during pregnancy and postpartum: A pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence. Journal of Consulting and Clinical Psychology (2016) 84: 134-145.

Byrne, J. et. al. Effectiveness of a mindfulness-based childbirth education pilot study on maternal self-efficacy and fear of childbirth. J Midwifery Womens Health (2014) 59: 192-197.