The mindful pregnancy and mother-baby relationship project

The online weekly 9-week Prenatal Mindfulness- Relationship-Based (PMRB) program a) Informational materials used The PMRB program draws upon the eight-week Mindfulness-Based Stress Reduction (MBSR) developed by Dr Kabat-Zinn in the early 1980s at the University of Massachusetts Medical Center, the first and perhaps the most well-known mindfulness-based intervention to gain empirical support in the treatment of psychological symptoms. The background of the program is described in my book (Routledge, 2021). In the PMRB program, the teaching of mindfulness is integrated with the following knowledge: • Breathing technique and meditation, mind-body pain and stress coping strategies for childbirth and awareness skills for coping with daily life stress. • Prenatal and perinatal education, including prenatal development and the baby as a sentience being, basic knowledge of psychobiological processes of pregnancy, childbirth, postpartum adjustment, breastfeeding/feeding, psychobiological needs of the baby, and mother-baby sensorimotor modulation techniques during pregnancy using maternal touch, vocalization, and infant’s movements. b) Procedures and activities. Formal mindfulness meditation instruction is given by the program conductor (myself) and practiced in each class for the last 20-25 minutes, followed by the participants feedback of their experience. A key innovative element of the PMRB is the focus on mother-baby connection from a new mind-body perspective based on the mother’s awareness of her body (interoception) as well as of her unborn baby as a sentient being, capable of engaging in bidirectional interactions. This reflects a new concept of prenatal attachment based on shifting attention from when “the baby arrives to the baby is already here and I am connected to my baby”. In addition to attending the online classes, participants are asked to commit to practicing some home exercises, including free of charge guided mindfulness meditation videos from YouTube or created by me and particularly designed for pregnancy throughout the course. Furthermore, as part of the home exercises, participants are invited to write a diary of their perceptions of the baby’s movements and cues, and a dialogue with the baby to further enhance interoception (embodied awareness and inward focus), sense of presence, sensitivity and reflective functioning, connection with the baby, and relaxation. In addition, they are invited to reflect upon these experiences and practice mindfulness and baby connect whenever possibly in their daily life activities. The recommended amount of daily home exercises is approximately 30 minutes, 6 days a week. The benefits of these exercises and the importance of continued practice are explained during the sessions. Table 1 Components of the Prenatal Mindfulness Relationship-Based (PMRB) program. Sessions Focus of session number 1 Discovering the present moment 2 Everything is mindfulness 3 Discovering embodiment, stress and how it affects us 4 Learning acceptance and emotional availability 5 Self-compassion, self-love and intentionality 6 Cultivating nurturing emotions and conscious communication in the womb 7 Letting go 8 A mindful pregnancy, birth and life 9 Post-partum reunion and birth story c) Who will deliver the intervention The intervention is delivered by myself, the program creator, who is also the PhD candidate piloting it. I am a certified Youth Mindfulness practitioner, clinical psychologist, MA, and author. d) Mode of delivery The PMRB program is delivered on an online platform (Zoom). e) Number of times the intervention is delivered and over what period of time The program is delivered in 9 sessions. The traditional number of weekly sessions of a mindfulness-based intervention – eight - has been kept, and the length of each weekly session from 20+ weeks to approximately 36-week gestation is two hours. A group reunion session was supposed to be held 10-12 weeks post-partum, before the third survey, but the proposed time was not suitable for all the new mothers busy with their newborn infants. Hence, individual and pair sessions are offered. f) The location/setting where the intervention occurs Online, Zoom, Australia. g) Strategies used to assess or monitor adherence or fidelity of the intervention Fidelity was not monitored using audio or video recording to ensure confidentiality. Transcripts were used for the qualitative analysis. Compliance was measured by noting participant attendance and by questions about the frequency and length of the mindfulness practice during the last week. It was recommended not to miss more than two sessions. Most participants missed 1 or 2 sessions and all participants completed the prenatal program. Only one participant did not attend the postpartum session and completed the follow-up due to unknown reasons. The importance of continued practice and a minimum period of six weeks to induce brain and habitual pattern changes and mental health improvements was explained (Bowen et al., 2014; Guardino et al., 2014; Woolhouse et al., 2014). References: Bowen, A., Baetz, M., Schwartz, L., Balbuena, L., & Muhajarine, N. (2014). Antenatal group therapy improves worry and depression symptoms. The Israel Journal of Psychiatry and Related Sciences, 51 (3), 2260231. Guardino, C.M., Dunkel Schetter, C., Bower, J.E., Lu M.C., & Smalley, S.L. (2014). Randomised controlled pilot trial of mindfulness training for stress reduction during pregnancy. Psychology and Health. 29 (3), 334-49. doi: 10.1080/08870446.2013.852670. Epub 2013 Nov 1. PMID: 24180264; PMCID: PMC4160533. Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher K.E., Pbert, L., Lenderking, W.R., & Santorelli, S. F. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry. 149 (7), 936-43. Sansone, A. (2021). Sansone, A. (2021). Cultivating mindfulness to raise children who thrive: Why human connection from before birth matters. Routledge. Woolhouse, H., Mercuri, K., Judd, F., & Brown, S. J. (2014). Antenatal mindfulness intervention to reduce depression, anxiety and stress: a pilot randomised controlled trial of the MindBabyBody program in an Australian tertiary maternity hospital. BMC Pregnancy and Childbirth, 14, 369.