The Contractions of Labor and the Contractions of Life:

Mindfulness Skills for Childbirth and Parenting UCSF Osher Center Mini Medical School

June 2, 2016

Nancy Bardacke, CNM, MA

Director, MBCP Program, UCSF Osher Center for Integrative Medicine Assistant Clinical Professor, UCSF School of Nursing

UCSF Medical Center, San Francisco, CA

“The awareness that arises from paying attention, on purpose, in the present moment, and non-judgmentally.” ~Jon Kabat-Zinn, PhD

What Is Mindfulness?

Mindfulness-Based Stress Reduction “The Stem Cell”

• 1979 UMass Medical Center • Systematic and intensive training in

mindfulness meditation • Medical and psychological diagnoses • Over 20,000 patients at UMass • US and abroad (30 countries) • Subject of numerous clinical trials over last

decade+

Mindfulness Research

(Black, 2014) http://www.mindfulexperience.org/mindfo.php

Growth of Interest in Mindfulness Meditation

Evidence-based Benefits of Mindfulness Meditation

• Reduces stress • Decreased depression, anxiety • Reduction in chronic and acute pain • Acceleration of post-surgical recovery • Bolsters immune system • Improved social and emotional intelligence • Increased empathy

Proliferation of Mindfulness Programs

MBCT

MBRP MB-EAT M for ADHD Mindful Parenting Mindful Schools MBSR-Teens

• 1998 Formal Adaptation of MBSR • 71 Classes over 15 years >1500 participants • 2007 UCSF/OCIM • Clinical/Research Partnership

Mindfulness-Based Childbirth and Parenting (MBCP)

Perinatal Stress: A Contributing Factor

• Low birth weight • Preterm birth • Less than optimal childbirth experience • Postpartum depression • Decreased quality of mother-infant

attachment • Child abuse/neglect • Postpartum increases in marital conflict • Autism, ADHD?

Looking Upstream

Stress during Pregnancy: Mother and Baby

Ph oto cred it: specialneedsdigest.com

Impact of Stress in Pregnancy on Adult Physical and Mental Health

• Cardiovascular disease

• Obesity

• Diabetes (Type 2)

• Prenatal programming of the hypothalamic-pituitary-adrenal axis

Stress and Long-term Mental Health of Child

“14 independent prospective studies have shown a link between antenatal maternal anxiety/stress and cognitive, behavioral, and emotional problems in the child. The magnitude of the long-term effects of antenatal maternal anxiety/stress on the child is substantial. Programs to reduce maternal stress in pregnancy are therefore warranted.”

Van den Bergh et al., 2005

“The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will... An education which should improve this faculty would be the education par excellence.” ~William James, 1890

Time for a New Look at “Childbirth Education”?

MBCP as Primary Prevention Four Intentions

• To teach mindfulness as a life skill for decreasing stress during pregnancy and beyond

• To offer mindfulness skills for working with pain and fear before and during childbirth

• To sow seeds for parenting with wisdom, compassion and attuned connection from the moments of birth

• To make mindfulness skills available for interrupting intergenerational patterns of suffering

Course Format

• 9 week course x 3 hours • Daily home practice:

30 min/day 6 days/week

• Silent daylong retreat

• Reunion after birth

Mindfulness Practices

• Body Scan

• Sitting Meditation

• Yoga

• Walking Meditation

• Loving-kindness Meditation

• Mindfulness in daily life

Practices for Pregnancy and Childbirth • Being with Baby

• Physiology of Labor

• Mindful Pain Practices

• Causes and Conditions

• Mindful Speaking and Listening Inquiry

• Newborn needs, breastfeeding and mindfulness

• Thread of mindful parenting woven throughout MBCP

• Creation of community

Moment by moment, Breath by breath

TThe Untrained MindReacting or responding

to the contractions of labor – and the contractions of life

Health Disparities

“Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”CDC 2015

Racial Disparities in Perinatal Outcomes in the US

•Increased preterm births

•Increased low birth weight

•Increased infant mortality

•Increased maternal mortality

Evidence-base for MBCP

Elizabeth C. Davies Chair in Child & Family Well-Being, School of Human Ecology, University of Wisconsin-Madison Associate Professor, Human Development & Family Studies Associate Professor, Family Medicine & Community Health Associate Director, Center for Child and Family Well-Being Faculty Leadership Team, Center for Healthy Minds Healthy Minds, Children & Families Specialist, UW-Extension

Larissa Duncan Ph.D.la rissa .dunca n@wisc.edu

MMBCP Pilot Observat ional SStudyDuncan and Bardacke, Journal of Child & Family Studies, 2010

INCREASED: DECREASED:

Positive emotions Negative emotions

Mindfulness ~ attention/awareness

~non-judging~non-reactivity

Depressive mood

Pregnancy anxiety

MBCP Pilot Observational Study Pre-Post Course Improvements

(p < .05)

Duncan & Bardacke (2010)

MMindfulness Meditat ion as a Form of Coping

Proportion of sample

using meditation to

cope with a stressful aspect

of pregnancy

37%

85%

Duncan & Bardacke (2010)

Did you use what you learned in the program to help you during your birth experience?

Duncan & Bardacke (2010)

“Absolutely! I was on pitocin and went from 3cm to 10cm in 1 hour and 15 minutes. During that time period I just kept staying in the moment and affirming that as long as I could be in this moment, right now, that I could do this. It worked!”

Duncan & Bardacke (2010)

“Absolutely! My husband helped me focus on my breath by saying, “Come back to your breath” at times when the labor got intense. I also remembered that each contraction was getting me closer to delivery and that it was part of a cycle. There would be a time of joy between contractions and I was able to experience that.”

Duncan & Bardacke (2010)

Was anything you learned helpful for managing emotional states, such as fear, during labor, delivery, or postpartum?

Duncan & Bardacke (2010)

“Yes, I am definitely aware of trying to be in the moment and that each moment, good or bad, will pass. When I got really worried about the birth, I would try to just breathe to stop my mind from going to all sorts of bad places. And in postpartum, I have tried to use the practice to deal with stressful situations whether it be a crying baby or just accepting my new role as a mother who doesn’t have much time for herself. Being mindful is always at the back of my mind now, no matter what I am doing, even if it isn’t a formal practice”

Duncan & Bardacke (2010)

MBCP Impacting Known Risk Factors for Postpartum Depression?

• Clinical depression during pregnancy • Anxiety during pregnancy • Family hx depression & bipolar • Stressful life events during pregnancy (or soon after the birth) • Poor social support • Marital conflict • Demographics: low income, immigrant status, young

age

NIMH; Pearlstein et al. 2009 AJOG

The Mind in Labor: Working with Childbirth Pain and Fear

Fear of Childbirth Effects of Brief Mindfulness

Training for Acute Pain Brief mindfulness training (6 one hour sessions vs. guided imagery)

increased pain tolerance (Kingston, Chadwick, Meron, & Skinner, 2007)

Very brief mindfulness meditation training (three 20 minute sessions) a reduction in pain sensitivity (math distraction was also beneficial) increased pain tolerance

(Zeidan, Gordon, Merchant, & Goolkasian, 2010)

PEARLS Study Results

• Improved childbirth self-efficacy (Decreased fear of childbirth)

• Trend toward lower use of pain medication during labor despite equally high use of epidural

• MIL: Depression sx decreased post-course, stayed low post-birth and continued to be significant 1-2 yrs post birth compared to controls • Controls: Depression sx increased post-course,

continued to increase post-birth, recovered somewhat but remained higher than MIL group

(Duncan et al., under review)

CenteringPregnancy with Mindfulness Skills (CPMS)

(NIH/NCCIH K01 AT005270; PI: Duncan)

MBCP for All Communities

“I need this in my life.” “This is me at 7 cm… Spectacular.”

The Long View • 2nd trimester course: nutrition, environmental factors,

mindful movement/yoga, choices for prenatal care • Post MBCP Program: Mindful parenting through first

year • Child outcomes

• Developmental • Epigenetic processes • Immune function

• Long-term family functioning • CenteringPregnancy with Mindfulness Skills (CPMS) • Mindfulness Skills for Midwifery Practice (MSMP)

It Takes a Village • Jon and Myla Kabat-Zinn, Saki Santorelli, Ferris Urbanowski, Bob Stahl and community of

mindfulness teachers and researchers worldwide

• Shelley Adler, Kevin Barrows, Rick Hecht, Judy Cuneo and all staff at the UCSF Osher Center

• Researchers Larissa Duncan, Irena Veringa, Katrina Tsang, Olga Sacristan

• MBCP Faculty: Judy Cuneo, Larissa Duncan, Maret Dymond, Jane Gerlach, Eluned Gold, Jen Averill Moffitt

• Mark Williams, Maret Dymond, Sian Warriner, Oxford Mindfulness Centre (OMC), U of Oxford, UK

• Eluned Gold, Rebecca Crane, Center for Mindfulness Research and Practice, Bangor University

• Sharon Rising, Centering Healthcare Institute (CHI)

• Dedicated MBCP instructors worldwide

• MBCP expectant parents, parents and their babies

Thank you for your kind attention!TThhaannkkk yyyyooooouuuu ffforr yyyyyoooouurrrr kkkkiiiinnnnnddddd aatttttteeeennntttiiioonnn!!!Thank you… nancy@mindfulbirthing.org Nancy.Bardacke@ucsf.edu