Duncan Larissa G, Cohn Michael A, Chao Maria T, Cook Joseph G, Riccobono Jane, Bardacke Nancy
School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
BMC Pregnancy Childbirth. 2017 May 12;17(1):140. doi: 10.1186/s12884-017-1319-3.
Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education.
This study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected.
In a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women's childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls.
This study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects.
The ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.
分娩恐惧与较低的分娩疼痛耐受性及较差的产后适应能力有关。对于面临这一问题的孕妇而言，缺乏经过实证验证的分娩准备方案。目前广泛传播的正念疗法能够缓解慢性和急性疼痛症状，并改善心理调适能力，这表明将其应用于分娩教育可能会带来益处。
本研究即产前减轻分娩压力教育（PEARLS）研究，是一项随机对照试验（RCT；n = 30），该试验针对一个为期2.5天、时间紧凑、基于正念的分娩准备课程，该课程作为一个周末工作坊提供，即分娩中的正念（MIL）：应对分娩疼痛，其基于正念分娩与育儿（MBCP）教育。妊娠晚期的初产妇被随机分配参加MIL课程或不注重身心调节的标准分娩准备课程。参与者在干预前、干预后和产后完成自我报告评估，并收集病历数据。
在一个人口统计学特征多样的样本中，这项小型RCT表明，与标准分娩教育相比，基于正念的分娩教育改善了女性与分娩相关的评估和心理功能。MIL课程参与者表现出更高的分娩自我效能感和正念身体意识（但特质正念没有变化），课程结束后的抑郁症状较低，并在产后随访中持续存在，且分娩时使用阿片类镇痛药物的比例有降低趋势。然而，与对照组相比，她们在回顾性报告中并未称感觉到的分娩疼痛更低或硬膜外麻醉的使用频率更低。
本研究表明，精心定制的、旨在应对分娩恐惧和疼痛的正念训练可能会给产妇心理健康带来重要益处，包括改善与分娩相关的评估以及预防产后抑郁症状。也有一些迹象表明，MIL课程参与者可能会使用正念应对方式来替代全身性阿片类镇痛药物。有必要进行一项大规模RCT，以捕捉分娩期间的实时疼痛感知和分娩时长，从而对这些效果进行更明确的测试。
PEARLS研究在ClinicalTrials.gov上的标识符为：NCT02327559。该研究于2014年6月23日进行回顾性注册。
