Mindfulness for Midwives: Supporting Health and Well‐Being for Our Clients and Ourselves

Abstract

Mindfulness has a natural affinity with midwifery practice. By attending to the holistic care of our patients, we have an interest in helping our patients cope with life stressors in addition to physical and mental health conditions and normal life changes across the lifespan. The use of mindfulness meditation as a therapeutic approach to reduce stress, improve mental health, manage pain, and improve physical health is expanding. Over the past twenty years, the number of research articles indexed on PubMed with mindfulness in the title or abstract has dramatically increased from 22 in 2003 to 2276 in 2022. Mindfulness is a flexible practice that transcends cultural boundaries and can be embraced and adapted by people from different races, cultures, and countries. Mindfulness-based interventions have shown benefits for various life challenges, including stress, anxiety, cancer, diabetes, and perinatal depression.1 It can be used as a primary treatment or adjunct to other behavioral or pharmacologic treatments. When patients are introduced to mindfulness to address a particular concern, they may find it beneficial in other aspects of their lives. While being mindful has become synonymous with paying attention, mindfulness is so much more. Mindfulness has been defined as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally”.2(p4) Mindfulness originates in Buddhist traditions but has been adapted to the secular world. The ability to pay attention mindfully is developed through meditation or practices that can be taught through structured classes such as Mindfulness-Based Stress Reduction (MBSR) in 8 weeks, with daily practice.3 Mindfulness-Based Childbirth and Parenting classes have adapted MBSR to the specific context of the perinatal year.4 Recorded meditations are available online, and people find opportunities to practice mindfulness while doing daily activities such as walking and chores. Cultivating mindfulness can help with compassion for self and others and prevent overidentification with experiences and emotions, leading to better emotional regulation. Acceptance in mindfulness is about being aware of reality as it is, even if it involves difficulties or challenges. This does not mean that one must passively resign themselves to their circumstances; rather, it provides a foundation for responding to situations with clarity and a sense of balance. The Journal of Midwifery & Women's Health has published various original research articles incorporating mindfulness-based interventions in the past 5 years.5-9 In this issue of the Journal, we are pleased to present two original research articles describing findings from small randomized controlled trials of mindfulness group interventions to address common issues in sexual and reproductive health. Şener Çetin and Şolt Kırca10 tested MBSR in women aged 20 to 30 years with premenstrual symptoms. Women who completed an eight-week MBSR group class had significantly reduced physical and psychological premenstrual symptoms compared to a control group. Cengizhan and Uçar11 investigated mindfulness-based counseling for a more complex phenomenon, body image, and sexuality in pregnant women with sexual distress. Women who completed 8 group counseling sessions over 4 weeks had significantly improved measures of sexual distress, body image concerns, and attitudes about sexuality. The effect sizes, a standardized way to measure the quantity of change, were large in both studies. While promising, these studies need to be repeated with larger samples in diverse populations. Menstrual symptoms and sexual distress are phenomena that can only be understood by accounting for cultural attitudes, gender constructs, and social expectations. As the interest in adapting mindfulness interventions for different contexts and conditions grows, challenges exist in making these interventions accessible. Group in-person classes enable participants to form stronger connections with other participants and instructors than online and asynchronous classes. Barriers to attending in-person classes include schedule conflicts and financial costs, especially for marginalized groups. Limited availability of instructors has driven the development of asynchronous online programs.12 Health systems and insurers are less likely to cover behavioral interventions. Research has yet to determine the ideal length of mindfulness-based interventions, how to support ongoing mindfulness practice, and the sustainability of benefits in the long term. In group interventions, it is also unclear how much of the benefit is derived from the mindfulness components as opposed to the peer support and instruction attention effects. As new interventions are implemented, there is a need to attend to cultural context and fit. Mindfulness is not for everyone – those with past trauma may be unable to safely increase their awareness of feelings and experiences. Others may not be interested or able to commit the time and effort for daily mindfulness practice and introspection necessary to receive benefit. In addition to being used as a therapeutic tool in clinical practice, mindfulness can be used by midwives for their own personal benefit. Mindfulness has been examined for health care professionals as well as health professions learners aiming to improve well-being for individuals known to work in stressful environments. A recent systematic review of midwife burnout globally identified working conditions as key contributors to burnout; skilled leadership and a caseload practice model were found to be protective.13 Similarly, a new survey of American Midwifery Certification Board-certified midwives described burnout among approximately 2 in 5 practicing midwives and critical workplace factors associated with burnout, particularly leadership and support for the midwifery care model.14 Two recent systematic reviews of mindfulness and health care professionals examined 118 studies and more than 6000 participants, including nurses, physicians, social workers, psychologists, and multiple types of learners. A variety of mindfulness interventions and outcome measures were included in the many studies analyzed. Overall, mindfulness-based interventions seemed to have small to medium effects on various measures demonstrating improved well-being (e.g., reduced anxiety, depression, stress) and, while more equivocal, may also improve work-related burnout.15, 16 Additional research is needed, especially well-designed randomized controlled trials with larger samples. While not a replacement for modifying stressful employment conditions, mindfulness may be helpful at the individual level for various stressors, including workplace stress or burnout, personal situations, and improving general well-being. An accompanying Ask the Midwife handout is available in this issue and online.17 Several resources are included; many more are readily available. We hope these resources inspire midwives in their research, offer support in partnering with their clients in practice, and offer options to sustain themselves every day.