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British Journal of Midwifery
Warriner S, Dymond M, Williams JMG.(2013) Mindfulness in maternity..
British Journal of Midwifery 21(7): 520–2
www.britishjournalofmidwifery.com
Reprints: www.intermid.co.uk
Subscriptions: www.magsubscriptions.com/bjm
© 2013 MA Healthcare Ltd
520 British Journal of Midwifery • July 2013 • Vol 21, No 7
comment
© 2013 MA Healthcare Ltd
Mindfulness in maternity
The University of Oxford Mindfulness
Centre (OMC) in conjunction with
the Oxford University Hospitals
NHS Trust (OUH) maternity service have
an ongoing collaboration to develop the
introduction and evaluation of Mindfulness
Based Childbirth and Parenting (MBCP)
throughout the UK. This innovative project
involves the development of a MBCP-
focused training programme and, for the
first time, the delivery of MBCP to antenatal
groups in the UK.
Mindfulness
‘Mindfulness is the awareness that
emerges through paying attention
on purpose, in the present
moment, with compassion, and
open-hearted curiosity.
‘Through cultivating mindful
awareness, we discover how to
live in the present moment rather
than brooding about the past
or worrying about the future.’
[oxfordmindfulness.org]
Mindfulness-based approaches in health
care began in the USA with Jon Kabat-
Zinn’s pioneering Mindfulness-Based
Stress Reduction (MBSR) programme
(1990; 2003). Cultivating mindfulness
involves an integrative, mind–body based
training that enables people to change
Sian Warriner
Consultant Midwife
Oxford University Hospitals NHS Trust
Maret Dymond
Clinical Psychologist
Oxford Mindfulness Centre, University
of Oxford
Mark Williams
Director, Oxford Mindfulness Centre;
Wellcome Principal Research Fellow
and Professor of Clinical Psychology
University of Oxford
the way they think and feel about their
experiences, especially those which are
stressful. The evidence suggests that people
gain longlasting physical and psychological
stress reduction. Studies have found that
people who learn mindfulness are less likely
to get depressed and experience positive
changes in wellbeing. Mindfulness-based
interventions do not target symptom
reduction as a goal, but rather their primary
aim is to increase people’s ‘psychological
flexibility’ (Dunn et al, 2012). Psychological
flexibility refers to an individual’s
capacity to make choices in accordance
with their authentic values, despite the
symptoms they may be experiencing. It
also helps participants to be calm, resilient,
compassionate and empathic (Baer, 2003;
Salmon et al, 2004). Paradoxically, research
continues to demonstrate that often as a
result of improved psychological flexibility
there is a reduction in symptoms (Williams
et al, 2007).
Qualities of mindfulness
lNon-judgemental
lBeginner’s mind
lTrust/self reliance
lNon-striving
lAcceptance
lLetting go
Brain imaging studies on adults are
showing that mindfulness meditation reliably
and profoundly alters the structure and
function of the brain to improve the quality
of both thought and feeling (Davidson,
2008). Although the most striking changes
are observable in long-term meditators, brain
changes are clearly observable in people who
have only been meditating for 8 weeks for an
average of 30 minutes a day.
As previously reported (Warriner et al, 2012)
these are important findings; for although
mental health is key at all stages of life, we
know that women are particularly vulnerable
during and immediately after pregnancy, with
one in ten women being affected by postnatal
depression (Department of Health (DH),
2007; Patients Association, 2011). Postnatal
depression is similar to depression at other
times, involving low mood and affecting
a mother’s ability to look after herself or
her baby. Infant sleep routines and a baby’s
cries for attention and care may become
difficult to cope with, along with other
symptoms such as loss of appetite, irritability,
sleeplessness, lack of energy, self-blame and
terminating breastfeeding early (Patients
Association, 2011). It is well documented that
this unrecognised and untreated distress can
have long-term implications for bonding,
attachment and outcomes for children (DH,
2010; DH, 2011):
Mindfulness and childbirth
The MBCP programme (Bardacke, 2012) is
a 9-week class-based antenatal intervention
adapted from MBSR. Classes incorporate
antenatal education and discuss how to
apply mindfulness skills to enhance coping
with the fear, pain, physical symptoms and
distress that may accompany pregnancy,
childbirth and the early postnatal period,
as well as exploring how mindfulness can
be used to cultivate joy and wellbeing in
pregnancy and parenting.
In MBCP, participants learn to pay
attention to present moment experiences
(sensations, thoughts and feelings)
deliberately and non-judgementally by
practising in classes and at home. Because
mindfulness practices help participants
to see more clearly the patterns of the
mind, it helps to both halt the escalation
of negative thinking that might compound
pain or depressed mood, and deals with the
tendency to be on autopilot. Mindfulness
has the potential for parents preparing for
childbirth to reduce the risk of postpartum
depression and increase ‘availability’ of
attention for the infant (Hughes et al, 2009).
Preliminary evidence for the efficacy of
mindfulness-based interventions during
pregnancy is emerging; Duncan and
Bardacke’s (2010) pilot study, conducted in
the USA, showed that MBCP successfully
decreased anxiety and depression in
pregnant women. Recurring themes
emerging from qualitative investigations
into participants’ experience of the
change processes in mindfulness-based
interventions include the value of a shared
group experience, living in the moment and
adopting an accepting attitude (Vieten and
‘
521
British Journal of Midwifery • July 2013 • Vol 21, No 7
comment
© 2013 MA Healthcare Ltd
Astin, 2008; Dimidjian and Goodman, 2009;
Duncan and Bardacke 2010; Dunn et al,
2012). In their pilot study based in Australia,
Dunn et al (2012) concluded that women
who learn mindfulness during pregnancy
use those skills to manage stressful aspects
of pregnancy, childbirth and parenting,
resulting in reductions in psychological
distress and improvements in psychological
wellbeing. Teaching mindfulness in the
perinatal period seems to have the effect
of broadening women’s personal repertoire
of coping strategies, and this has potential
to improve the developmental trajectory of
parents and infants.
The Oxford Project
With the support of a British Journal of
Midwifery Innovating for Life award the
OMC in conjunction with OUH NHS Trust
has an ongoing project to introduce and
evaluate a MBCP programme.
Training
Alongside this, the OMC offers one-day
masterclasses in MBCP, and has developed
an experiential training programme for
MBCP based on its MBCT foundation
course (oxfordmindfulness.org/train/
master-classes/#parent).
MBCP course
To date, two MBCP courses have been run
in Oxford, the first to be completed in the
UK, attended by 21 mothers and 16 partners.
The two courses were open to all expectant
parents in Oxfordshire and were advertised
at the hospital, local children’s centres and
by community midwives. The MBCP course
involved nine weekly antenatal classes, one
antenatal all-day practice and one postnatal
reunion class.
Essential elements of the MBCP course
lNormal physiology of labour: pain, fear
and mindfulness
lFormal meditation practices with CDs
lInformal mindfulness practice
lMindful pain coping skills for labour
lBreastfeeding, postpartum care
lSocial and emotional needs of infants
(attunement)
lMindful parenting/couple communication
Both of the Oxford MBCP courses
have been evaluated with the hypothesis
that there will be significant decreases in
depression, anxiety and perceived stress, and
an increase in mindfulness from pre- to post-
course. Preliminary analyses indicate that
there have been decreases in self-reported
depression, perceived stress and trait anxiety;
and increases in total mindfulness scores.
Participants report significant
personal benefit from having undertaken
the course for pregnancy and childbirth:
‘Accepting that labour was harder
than I’d anticipated but particularly
accepting my own reactions to this
... not beating myself up for finding
it hard when I was having the type
of birth I wanted; I think the use of
acceptance also helped me go into
labour by letting go of the ideal that
was in my head.’
‘It helped in so many ways; coping
with a last minute change of plan
and induction of labour. Staying in
the moment with each contraction
meant I could use breathing to
cope with pain and fear, I was
much more aware of my thoughts
and the “stories” I told myself than
I would have been without the
practice of mindfulness.’
‘I was not prepared for the difficulties
associated with breastfeeding and
mindful breastfeeding helped us
to keep going. I have had to make
significant changes to my diet as a
result of milk protein intolerance
and using the “acceptance” aspect
of mindfulness has helped me in
not resenting.’
With the benefits extending into their
lives in general:
‘The sense of liberation that
accepting and being in the present
moment brings to all areas of life.’
Policy implications
There is now a growing interest in the
application of mindfulness in many areas
of health and social care. Recently senior
practitioners and researchers within the
mindfulness field met with government
policy advisors to explore the possible
application of mindfulness in the fields of
mental and physical health, education and
other public services, for both recipients of
these services (such as children and young
people, and older adults) and the wellbeing
of staff who look after them.
Conclusion
Research continues to evolve demonstrating
that the practice of mindfulness can generate
improvements in a wide range of psychological
and physiological health conditions. As well
its impact on specific problems, mindfulness
has been shown to have effects on underlying
emotional and social skills; these include the
ability to feel in control, to make meaningful
relationships, to accept experience without
Mindfulness-based interventions aim to increase people’s ‘psychological flexibility’
THE COGNITIVE BEHAVIOUR THERAPY PARTNERSHIP
‘
522 British Journal of Midwifery • July 2013 • Vol 21, No 7
comment
© 2013 MA Healthcare Ltd
denying the facts, to manage difficult feelings,
and to be more resilient and compassionate
towards self and others. Although these skills
are applicable to pregnancy, childbirth and
parenting, perhaps more importantly they are
transferable skills for life. BJM
Acknowledgement: The Oxford Mindfulness Centre
and Oxford University Hospitals NHS Trust Mindfulness
Based Childbirth and Parenting programme has been
supported by an Innovating for Life award
Image originally published in The Socks of Doom
by Henck van Bilsen. Reproduced here with
permission from The Cognitive Behaviour Therapy
Partnership (www.cbt-partnership.org)
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