How to reduce anxiety & stress during pregnancy

By Carolyn Tallents

The practice of mindfulness has been scientifically proven beneficial for pregnancy, labor & delivery, as well as postpartum adjustment.  The dictionary defines mindfulness as:

  • “The quality or state of being conscious or aware of something”
  • “A mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique”

Pause for a moment, and consider what percentage of the time you find yourself in this state of being present.

For millennia, anecdotal evidence of meditation, and other forms of mindfulness practice, has shown that we human beings can achieve the focus that brings presence, or mindfulness, as well as subsequent health and wellness. And now incredibly, scientific evidence is proving the historical evidence, and providing basic suggestions of how to begin your practice.

Stress, fear, and one’s mental interpretation are examples of things that mindfulness-based interventions help improve. They are also things that, if left unchecked, permit anxiety, worsen sleep, and cause “adverse pregnancy outcomes”, as well as a more challenging postpartum journey.  And now with recent evidence of the epigenetic effects that the state of one’s mind has on the health of the unborn baby,, now is the best time to make a positive change.

This is some of what scientific research shows:

  1. Prenatal stress is now proven to be harmful:  “A growing body of research shows that prenatal stress can have significant effects on pregnancy, maternal health and human development across the lifespan. These effects may occur directly through the influence of prenatal stress-related physiological changes on the developing fetus, or indirectly through the effects of prenatal stress on maternal health and pregnancy outcome which, in turn, affect infant health and development.” 
  2. Fear of childbirth directly affects labor & delivery:  “Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment.” 
  3. Mental interpretation of one’s experience influences life after birth: “Subjective childbirth experience” – a birthing person’s interpretation for how her labor & delivery unfolds, is “a risk factor for postpartum depression and childbirth-related posttraumatic stress symptoms” and is very much affected by her “innate capacity of paying and maintaining attention to present-moment experiences with an open and nonjudgmental attitude.” 

Research shows this, and yet childbirth preparation for the vast majority of pregnant people is rather lacking when it comes to guidance on the perceptions & interpretations that lead to stress, anxiety, and fear.

 

RESEARCH SHOWS THAT MINDFULNESS CAN BE A POWERFUL PRACTICE!

A 2017 study in BMC Pregnancy and Childbirth found that just one weekend (18 hours) of mindfulness-based childbirth education improved:  “Childbirth-related appraisals and psychological functioning in comparison to standard childbirth education.”  The same study reported:

  • “greater childbirth self-efficacy and mindful body awareness”
  • “lower post-course depression symptoms that were maintained through postpartum follow-up”
  • “a trend toward a lower rate of opioid analgesia use in labor”

That same weekend course was studied again in 2020, revealing further details, that the effects of mindfulness training are pronounced for “pregnant people higher in anxiety and/or lower in mindfulness” at the start of the study.  (In fact, those with already-existing low anxiety and high mindfulness show an “opposite trend”, actually experiencing “higher ending distress compared to their [treatment as usual] counterparts.” The authors of this study rationalized that it’s possible these participants simply became more accurately aware of their distress thanks to the mindfulness program, but it’s also possible that mindfulness programs should simply be offered more exclusively to those who initially rank as highest in anxiety and/or lowest in mindfulness.)

A 2018 study in the Journal of Midwifery & Women’s Health found “Mindfulness skills helped class participants cope with physical and emotional challenges postpartum and fostered positive meaningful relationships with partners and newborns.”  

A 2022 study in Asian Nursing Research concluded that mindfulness-based interventions helped the participants “accept their childbirth process.”  This study used 3 hours per week for 8 weeks of activities including childbirth education, and partner support,  as well as “the mindful attitudes of nonstriving, kindness and compassion, beginner’s mind, patience, trust, nonjudging, acknowledging or accepting, and letting go.” 

A 2013 study in the Journal of Midwifery & Women’s Health found that a mix of both mindfulness and childbirth “was associated with improvements in women’s sense of control and confidence in giving birth.”

In a 2020 report in JMIR Mental Health, women reported benefits they felt from practicing mindfulness: “improved stress management, reduced anxiety, improved sleep, and increased physical activity and techniques for managing stress in stressful moments (eg, baby crying).”

“Individuals can change the way that they feel, believe, and act.”

Tang, et al. Nature Reviews Neuroscience

 

STATE vs TRAIT MINDFULNESS

A 2021 study in the Archives of Women’s Mental Health specifically pointed out that a person’s interpretation is a critical factor, saying, “childbirth experience is influenced not only by characteristics of the childbirth itself but also by maternal characteristics.” “Trait mindfulness (or sometimes called dispositional mindfulness) is perhaps the most relevant personality trait to date for meditation-based interventions. It refers to the innate capacity of paying and maintaining attention to present-moment experiences with an open and nonjudgmental attitude”  

Research in this area suggests that mindfulness practice elicits a temporary “state” change in the condition and activity pattern of the brain, but then eventually an altered personality “trait” with longer periods of practice. The take-home message is that “heightening state mindfulness in meditation practice over time increases trait mindfulness, which benefits psychological health.”

This research is so compelling because it was previously assumed that personality was fixed.  These studies showed instead that mindfulness practice can alter one’s personality itself, demonstrating that, “individuals can change the way that they feel, believe, and act.” 

This 2021 study identified a significant association with a “more positive perception of childbirth” when the birthing person practiced the two skills of “acting with awareness” and “non-reacting”.  This study used a 15-question Mindful Attention Awareness Scale (MAAS) developed by Kirk Warren Brown, PhD, and Richard M. Ryan, PhD.

 

TECHNIQUES USED TO ACHIEVE MINDFULNESS RESULTS

Literally anything can be done “mindfully” but the studies discussed in this article used things like seated meditation, body scanning, mindful movement, walking meditation, mindful eating, mindful breathing, partner touch, and vocal toning. In addition, a “pain induction activity” using ice was part of the studies, with the intention being to “learn how to be more aware of their own body and fearful reactivity to pain.”

Ice Cube Test: Testing your willpower to hold a piece of ice for one minute or more can reveal your coping strategy that you will use in labor, as well as provide practice for mindfulness. What does your inner voice say to you while you’re enduring the ice? Do you feel the need to move or remain still? Do you make sounds? Do you change your breathing? Do you want your partner to help, or stay away? What do you focus on? How do you make it through?

Enduring the mental and physical intensity of the ice cube test is just like enduring the mental and physical intensity of exercise.  Many of us know what it’s like to “get into the zone” or “flow” during exercise, as this helps us make it through the mental and physical discomfort. Even more, exercise is the most scientifically validated way to improve virtually every pregnancy, childbirth and postpartum outcome desired, from significantly reducing pain and medical interventions to feeling physically and mentally sound throughout the perinatal time of change. Exercise rivals the ice cube test in that it teaches you to “mindfully” endure the challenge.

In the research on mindfulness, important themes for participants included learning to be aware of mind and body, strengthening family relationships, conquering childbirth pain with confidence, and accepting unexpected situations. In addition, “audio recordings of formal and informal mindfulness practices,” were intended to be used 30min per day.

“You should sit in meditation for twenty minutes every day – unless you’re too busy; then you should sit for an hour.”

Zen Proverb

 

A PLAN TO HELP YOU BECOME MORE MINDFUL

Being mindful is being aware moment by moment, regardless of whether or not you sit in a formal meditation, or are doing any activity of daily life!  In other words, you need not add another task to your schedule, although many will find it super helpful to do exactly that. Remember the Zen proverb: “You should sit in meditation for twenty minutes every day – unless you’re too busy; then you should sit for an hour.”

Achieving focus like this can often require legitimate work, sometimes tiring work. During those times, remember that your mediation is successful every time you catch yourself not being mindful. That is the moment that the neurons in your brain experience a “pattern interrupt,” leading them to etch slightly different connections every time you catch yourself in mindless thinking. 

Once you get the hang of it, the benefits are quite often self-propelling.

 

REFERENCES

Mindfulness. Oxford Dictionary. Retrieved 8/7/22 from https://www.google.com/search?q=definition+of+mindfulness&oq=definition+of+mindfulness&aqs=chrome..69i57j0i512l9.3349j0j7&sourceid=chrome&ie=UTF-8

  1. Traylor, et al. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. American Journal of Obstetrics & Gynecology MFM. Retrieved 8/7/22 from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513755/

“Acute stress, chronic stress, and allostatic overload have all been associated with a variety of adverse pregnancy outcomes, including spontaneous PTB, preeclampsia, neonatal morbidity, and low birthweight”

  1. Schwab-Reese, et al. Associations of Social Support and Stress with Postpartum Maternal Mental Health Symptoms: Main Effects, Moderation, and Mediation. Women Health. Retrieved 8/7/22 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097234/ 

“Exposure to stressful events (stressors) and the individual responses to these challenging situations (stress), may contribute to poor maternal mental health during the postpartum period.”

  1. Kundakovic, Marija. Jaric, Ivana. Genes. The Epigenetic Link between Prenatal Adverse Environments and Neurodevelopmental Disorders. Retrieved 1/30/23 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368708/
  1. Blackburn & Epel. The Telomere Effect: A revolutionary approach to living younger, healthier, longer. Book. Orion Publishing Group Ltd. 
  1. Coussons-Read, Mary, PhD.  Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstetric Medicine. Retrieved 8/7/22 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052760/
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  1. Hulsbosch, et al. Trait mindfulness during pregnancy and perception of childbirth.  Archives of Women’s Mental Health. Retrieved 8/6/22 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979659/
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  1. Sbrilli, et al. Effects of prenatal mindfulness-based childbirth education on child-bearers’ trajectories of distress: a randomized control trial.  BMC Pregnancy and Childbirth. Retrieved 8/6/22 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559171/ 
  1. Kantrowitz-Grodon, et al. Experiences of Postpartum Women after Mindfulness Childbirth Classes: A Qualitative Study. Journal of Midwifery & Women’s Health. Retrieved 8/6/22 from https://onlinelibrary.wiley.com/doi/10.1111/jmwh.12734
  1. Pan, et al. Applying Mindfulness Techniques to the Management of Depressive Tendencies in Women in Taiwan in the Perinatal Period: A Qualitative Study. Asian Nursing Research.  Retrieved 8/6/22 from https://www.sciencedirect.com/science/article/pii/S1976131722000299
  1. Byrne, et al. Journal of Midwifery & Women’s Health. Effectiveness of a Mindfulness-Based Childbirth Education pilot study on maternal self-efficacy and fear of childbirth. Retrieved 1/30/23 from https://pubmed.ncbi.nlm.nih.gov/24325752/
  1. Avalos, et al.  JMIR Mental Health. Mental Health Journal of Medical Internet Research. A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study. Retrieved 1/30/23 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691085/
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  1. Hulsbosch, et al. Trait mindfulness during pregnancy and perception of childbirth.  Archives of Women’s Mental Health. Retrieved 8/6/22 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979659/
  1. Tang. The Neuroscience of Meditation. Science Direct. Retrieved 8/6/22 from https://www.sciencedirect.com/topics/psychology/trait-mindfulness
  1. Tang, et al. Traits and states in mindfulness meditation. Nature Reviews Neuroscience. Retrieved 8/6/22 from https://www.nature.com/articles/nrn.2015.7
  1. Kiken, et al. From a state to a trait: Trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Personality and Individual Differences. Retrieved 8/6/22 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404745/
  1. Tang, et al. Traits and states in mindfulness meditation. Nature Reviews Neuroscience. Retrieved 8/6/22 from https://www.nature.com/articles/nrn.2015.7
  1. Hulsbosch, et al. Trait mindfulness during pregnancy and perception of childbirth.  Archives of Women’s Mental Health. Retrieved 8/6/22 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979659/

(n.d.) Mindful Attention Awareness Scale. Positive Psychology Center. The Trustees of the University of Pennsylvania. Retrieved 8/9/22 from https://ppc.sas.upenn.edu/resources/questionnaires-researchers/mindful-attention-awareness-scale

2017. Duncan, et al.  Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison. BMC Pregnancy and Childbirth. Retrieved 8/6/22 from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1319-3

(n.d.) How you will cope with labor. Allina Health. Retrieved 8/9/22 from https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/beginnings/preparing-for-labor/at-home/how-you-will-cope-with-labor

  1. Pan, et al. Applying Mindfulness Techniques to the Management of Depressive Tendencies in Women in Taiwan in the Perinatal Period: A Qualitative Study. Asian Nursing Research.  Retrieved 8/6/22 from https://www.sciencedirect.com/science/article/pii/S1976131722000299
  1. Pan, et al. Applying Mindfulness Techniques to the Management of Depressive Tendencies in Women in Taiwan in the Perinatal Period: A Qualitative Study. Asian Nursing Research.  Retrieved 8/6/22 from https://www.sciencedirect.com/science/article/pii/S1976131722000299

(n.d.) Daily Meditate. Retrieved 8/9/22 from https://dailymeditate.com/meditation-quote-3-you-should-sit-in-meditation-for-twenty-minutes-every-day-unless-youre-too-busy-then-you-should-sit-for-an-hour-zen-proverb/

(n.d.) Daily Meditate. Retrieved 8/9/22 from https://dailymeditate.com/meditation-quote-3-you-should-sit-in-meditation-for-twenty-minutes-every-day-unless-youre-too-busy-then-you-should-sit-for-an-hour-zen-proverb/