A qualitative study on the experiences of pregnant women undertaking mindfulness training

Xiao-Fei Li,Zhong He,Yin Sun,Su-Han Zhang,Na-Na Liu,Ya-Xin Wang,Hang Lin,Liang-Kun Ma*

1School of Humanities and Social Sciences,Peking Union Medical College,Beijing,China.

2National Clinical Research Center for Obstetric & Gynecologic Diseases,Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,China.

Abstract Purposes:This study uses the method of qualitative research to conduct in-depth interviews with pregnant women,explore the experiences of pregnant women undertake mindfulness training.Methods:The study adopts a qualitative,in-depth interview method.Semi-structured interviews were conducted with 10 pregnant women.Data from semi-structured interviews were analysed by qualitative content analysis using QSR NVivo 12 software.Results:Four themes were generated to show how pregnant women experiences of the mindfulness training.They are Emotion management,Benefits of mindfulness training for childbirth,Challenges and influencing factors of mindfulness training and Different attitudes toward mindfulness training.Conclusions:Pregnant women undertaking mindfulness training can effectively reduce stress and has positive effects on work and life.Mindfulness training can be used as a way to improve the mental health of pregnant women.

Keywords:Mindfulness,Qualitative study,Pregnant women

Introduction

Mindfulness originated from the Eastern meditation technology.Kabat Zinn established the mindfulness center at the University of Massachusetts School of Medicine in 1979 and constructed the mindfulness decompression courses.Although there is no unified definition of mindfulness,but different scholars give different meanings to mindfulness.For example,Baer regards mindfulness as a method of concentration[1];Kabat Zinn Teasdale regards mindfulness as a purposeful awareness of current experiences[2];Davidson conceptualizes mindfulness as a psychological feature,which refers to the tendency to maintain mindfulness in daily life[3].However,the widely accepted definition is"an awareness that focuses on the present moment"proposed by Kabat Zinn[2].Seligman,the founder of positive psychology,also regarded mindfulness as one of the three elements to enhance physical and mental pleasure[4].In the current mindfulness study,mindfulness has great changes on people's psychological level,including reduce stress,relieve anxiety and depression,and enhance happiness.

At present,under the background of great social pressure and complex social relations,there are more and more studies on the negative emotions of pregnant women.Family conflicts and social problems will lead to the negative emotional experiences of pregnant women.Several quantitative studies illustrate the power of mindfulness-based approaches in reducing pregnant women’s psychological symptoms such as stress,anxiety,depression and the fear of childbirth[5].However,as relaxation,stress relief and experiences of a phenomenon can be very subjective,quantitative research methods lack the ability to describe in-depth experiences in any details.Therefore,this study uses the method of qualitative research to conduct in-depth interviews with pregnant women,to explore the real experiences of pregnant women in mindfulness training.

Research objects and methods

Qualitative research methods

This study adopts the qualitative research method.It is an activity that takes the researcher himself as the research tool,uses a variety of data collection methods to explore the social phenomenon as a whole in the natural situation,uses the inductive method to analyze the data and form the theory,and obtains the explanatory understanding of the meaning through the interaction with the research object[6].Qualitative research focuses on the in-depth and detailed description and analysis of problems and phenomena at the micro level.Its purpose is not to manipulate variables and test hypotheses,but to pay attention to the perspectives of the parties[7].This study requires researchers to go deep into the inner world of pregnant women and explore their real experiences of undertaking mindfulness training.Therefore,the qualitative research method is suitable for the research problems of this study.The Ethics Committee of Peking Union Medical College Hospital reviewed and approved the project(I-22PJ122).

Participants

Using the method of purposeful sampling,the researchers selected 10 pregnant women who had participated in the 8-week mindfulness training in a Class A tertiary hospital in Beijing.The study was conducted from February to April 2022.The average age of the participants was 37 years old.All participants signed the written consent form.The basic information is shown in Table 1.

Table 1 The demographic and clinical data of the participants

Data collection

The researcher used the method of unstructured interview to obtain the experiences and inner thoughts of the participants,made on-site recording and transcripts with the consent of the participants,and prepared the interview outline.The researcher did not prepare for the specific content of the conversation,but took the interview outline as a hint.During the interview,the researcher always fully followed the emotional feelings of the participants,and conducted questioning and interaction in time,so as to get more understanding of the inner experiences of the participants.In the in-depth process of the interview,gradually focus on the research questions,and let the participants freely explain their specific ideas on the research questions,so as to obtain comprehensive information.

In order to determine the size of the sample size,this study uses the method of data saturation.That is,the researcher determines that the data collected from the interview is repeated until she believes that including more research objects will not add new research topics.After that,the recorded text materials were read and analyzed word for word,and the information on the focus issues was verified with the participants again to determine the accuracy of data until there were no new topics about the purpose of the study.

During the interview,the researcher used the practical methods of cooperative dialogue in postmodern psychology founded by Harlene Anderson to establish the interview on a comfortable and equal relationship.The purpose of asking questions is to understand the thoughts of the participants.At the same time,avoid inducement in questioning and make the information more authentic.

Data Analysis

After obtaining the co nsent of the participants,the researcher recorded the whole interview process.Then,after transcribing the recorded data word by word into text,it is about 80000 words,and the interview data are analyzed with qualitative analysis software NVivo 12 plus.The data were analyzed by three-level coding method in qualitative research.

Table 2 Interpretive themes and sub-categories

Primary coding is the process of conceptualizing the original text data.In the stage of primary coding,it is mainly to conceptualize all the words and sentences available for coding and find their conceptual categories and analyzing the text.Secondary coding is the classification of the initial concept category analyzed by primary coding.The way of classification is to analyze the relationship between conceptual categories,such as causal relationship,type relationship,so as to establish the logical relationship between codes.At this stage of three-level coding,after the relationship between each group of conceptual categories is established.We need to find the category framework in a wider range,analyze which are the main categories and which are the secondary categories,and further clarify the logical relationship between conceptual codes.At this stage,as the main category is analyzed,the theory is constructed accordingly.In this process,10 initial categories are analyzed in this study,as shown in Table 2.

Secondly,the generic analysis of all the analyzed codes is carried out,and the concepts with the same attributes are classified into a unified category to form logical relations and conceptual categories.During the operation of secondary coding analysis,the researcher formed four main categories belonging to secondary coding:1.Emotion management;2.Benefits of mindfulness training for childbirth;3.Different attitudes towards mindfulness training;4.Challenges and influencing factors of mindfulness training.Finally,in the process of forming three-level coding,the researcher should consider each analyzed concept in combination with the relevant information in the text,so as to realize the theoretical interpretation of coding.

Results

Emotion management

Many participants said that they will have a lot of negative emotions during pregnancy,such as mood swings,fear of childbirth,anxiety,and depression.Training helped them to reframe how they managed emotional issues,such as feel being present,keep emotional stability,accept,calm down,control personal emotion and find way to deal with matters.The experiences of undertaking the training was that pregnant women always found that mindfulness training to be an enjoyable experiences[8].They felt it helped equip them to deal with negative emotions and stress.The ability that they learnt from mindfulness training was a valuable tool in managing their emotions.Being present.In the generic analysis of the theme of"being present",it is found that paying attention to the present can be understood from three levels:Paying attention on purpose,accepting the present and enjoying the present.

First of all,paying attention on purpose means encourage nonjudgmental and emerging levels of self-awareness.Paying attention to one's breath and body feelings in mindfulness practice.This is actually a manifestation of paying attention to the present.

"Like breathing exercises,body scanning exercises and three-dimensional space exercises,you are basically required to think nothing and do nothing,only focus on your own emotions and thoughts,so it is difficult not to calm down."(participant 1)

"Paying attention to the present means paying attention to your feelings in the present.Don't make too many predictions and assumptions about the future."(participant 5)

The second is to accept the present.Although some of the current difficulties are not so pleasant,practicing mindfulness can make people calmly accept and decrease in daily life pressures.

"After practicing mindfulness,I feel less stressed.I think imperfection is acceptable."(participant 3)

"I can accept the baby's current situation now.When he is crying,I won't be so upset.Then I can tell myself to calm down and accept the baby's situation at that time."(participant 6)

Enjoying the present is a sublimation stage of understanding life.Some participants said that after undertaking mindfulness training,they experiences the"feeling the present,living in the present,enjoying the present and not being pessimistic"(participant 2).The participant had been hospitalized for fetal protection during the second trimester of pregnancy.During the period of hospitalization,she suffered from massive hemorrhage for three times and signed the confirmation of giving up rescuing the aborted baby.She had been practicing mindfulness during his pregnancy,and she thought it was mindfulness practice that supported her through difficult times.

Calm down and peaceful.The training also helped pregnant women to reframe how they managed emotional issues,such as keep emotional stability and accept,calm down.In the study,the participants mentioned the most are the mindfulness training allowed them calm down and peaceful.The frequencies of these two keywords are the highest in analysis.

"It's easy to calm down.When we undertake mindfulness training,we basically do mindfulness practice every day.I think it plays a very important role in calming down.For example,when I have negative emotions,I use mindfulness breathing or mindfulness awareness to adjust it,which will be of great help to calming down.Especially when I'm tired during pregnancy and when I feel inexplicably agitated,I will practice mindfulness breath awareness for about 5 minutes,and after that,I will be much calmer."(participant 8)

"After learning mindfulness,I feel calm and strong inside and can accept any result"(participant 2)

"I think the biggest change from practicing mindfulness to me is that it can make me calm.I have a lot of work pressure.I usually arrive at the company early in the morning and then practice mindfulness for about half an hour.After that,I will feel that my work all day is relatively smooth,or I feel more peaceful."(participant 4)

Release pressure.The experiences of undertaking the training was that pregnant women always found that mindfulness training to be an enjoyable experiences,they felt it helped equip them to deal with negative emotions and stress.Taking mindfulness training can effectively release their pressure.Some described“it is great”,“it was nice”and“feel more comfortable”.This experiences had the effect of the training led to some pregnant women re-evaluating how they approached stress and negative emotions.After taking mindfulness training,participants generally believe that training can help them relieve stress.

"For me,these ten minutes of mindfulness practice are particularly important and useful,that is,I can recover a lot of energy,feel much more comfortable,and release some pressure."(participant 4)

"Now my baby has been born.I have to get up once every two hours to feed baby.I feel so tired,both mentally and physically.Now in the morning,I wake up and do mindfulness exercises,even for 5 minutes or 10 minutes,which will be of great help to relieve the pressure and fatigue."(participant 8)

Mrs. Conroy looked out the window. It was a warm afternoon. Though she tried to keep her eyes open, the gentle rocking of the bus had a lulling2 effect. Within a few minutes her eyes closed. Her head dropped to her shoulders. In spite of herself, Mrs. Conroy fell fast asleep.

Keep emotional stability.Mindfulness training keep participants emotional stability.They believe that they can learn"acceptance"from mindfulness practice and enhance their ability of control their personal emotion and find way to deal with matters.

"I don't need to suppress any irritability,anxiety or pain now,but accept it.For example,in the past,I may feel that why others can't do what I say,and I will be angry.But after I practice mindfulness,I can understand that people are different from each other,and I have to accept the difference between them and me."(participant 8)

Benefits of mindfulness training for childbirth

In the study,the participants believed that mindfulness training can not only reduce stress during pregnancy,but also provide certain psychological support during childbirth,such as alleviating the pain of childbirth to a certain extent,providing psychological support during childbirth,let them reducing the fear of childbirth.

Ease pain.“Mindfulness breathing exercises make me more focused on my own body feelings,that is,I can accept the pain.After practicing mindfulness breathing exercises,I will take the pain of childbirth as a verynatural process and accept it.I feel that the labor pains will be relieved during the whole process of focusing on breathing."(participant 6)

“I think mindfulness exercise will relieve the pain to a certain extent.Of course,it is also because of the psychological support."(participant 6)

Relieving fear of childbirth."Mindfulness exercise will also generate huge psychological support for the fear of childbirth.After I finish mindfulness exercises,I feel that I am not facing many unknowns,I have confidence in childbirth,I feel much better and less fear."(participant 8)

Different attitudes towards mindfulness training

Positive attitude.From the study,the participants’attitude towards mindfulness training can be basically divided into positive attitude,neutral attitude and negative attitude.Most of them viewed mindfulness training as an effective and enjoyable training experiences,include that practicing mindfulness can improve their sense of well-being,obtain psychological support,and reduce their stress after practicing mindfulness training.

"Mindfulness training is like spiritual salvation.It is mindfulness training that accompanies me through the long night.The anxiety and uncertainty about the future of the second trimester of pregnancy make me on the verge of collapse.It is mindfulness training that supports me when I am helpless.When I can't sleep at night,the mindfulness practice,such as body scanning practice,practice with your baby and kindness practice helped me a lot,I practice day-to-day.Finally,I successfully gave birth to a 2580g female baby at 34 weeks."(participant 4)

Neutral attitude.Neutral attitude mainly means that the participants think that the learning of mindfulness course is a new attempt and experiences,but they do not think that undertaking mindfulness training has a very positive impact on themselves during pregnancy."The whole learning process does have some new experiencess that I have not been experiencesd before,but because the training is relatively short and elementary,so I think there is no obvious effect after the course for me.It is a nice process and a new experiences."(participant 1)

Participants have sense of worry in an unfamiliar field when she just came into contact with mindfulness training.

"When I first came into contact with the mindfulness practice,I had many questions,and I also had many worries,that is,about practicing mindfulness."(participant 4)

Challenges and influencing factors of mindfulness training

Different people have different effects after practicing mindfulness training.After data analysis,it is found that,there are at least two factors that could affect the effect of mindfulness training.Long and frequent practice and trust in mindfulness pose challenges to the effect of mindfulness practice.

Exercise frequency.Mindfulness courses take a long time,a commitment to the course,making it a regular habit in daily life seemed difficult and challenging.Some participants said they occasionally lacked motivation without someone to guide and prompt them.So,from the perspective of exercise frequency,it can be found that those who practice more often have positive experiencess with mindfulness training and those who practice less often have relatively general effect on the practice of mindfulness training.

"I keep practicing every day.I think it will be of great help in improving my mindfulness ability.Whether it's 3 minutes,5 minutes or 10 minutes of practice are OK."(participant 4)

"I think we should practice more.Mindfulness is a good method,but if we don't practice enough,we won't understand mindfulness thoroughly,and then we don't use it very well."(participant 7)

Mindfulness practice often requires long time,and a day-to-day practice,so lack of practice will affect the effect of mindfulness training."When I do yoga,I can measure the increase of muscle content in almost two months,but for mindfulness,it may be that I don't get a benefit,so I don't practice much."(participant 1)

Recognition and acceptance in mindfulness.From the study,pregnant women who undertaking mindfulness training have different effects.Generally speaking,those pregnant women who more recognize and accept the concept of mindfulness practice more frequently and have positive effect;and for those pregnant women who don’t agree or believe in mindfulness,the practice effect is not so good."I think people's recognition and acceptance of mindfulness should be further improved"(participant 7)

In the study,it can be found that participants'previous learning experiences,especially the knowledge related to mindfulness,will affect their recognition and understanding of mindfulness.From the study,in China,if someone believes in Buddhism or has practiced yoga before they undertaking mindfulness training,they usually have a higher degree of recognition with mindfulness training.Accordingly,they practice more and have positive practice effect.

"I learned a lot from mindfulness practice.Because I have practiced yoga for many years,and there are similar meditation exercises and breathing exercises in yoga.I feel that mindfulness practice is very similar to yoga.So I feel great when I undertake mindfulness training."(participant 5)

"I learned about Buddhism before I taking mindfulness course.I feel that there are very similar parts between the two.For example,the cognition of emptiness and impermanence advocated by Buddhism actually has a great correlation with mindfulness,but the ideas of the two are different.For example,Buddhism believes that people will have pain because they pay too much attention to themselves,Buddhism teaches people not to pursue this obsession too much,and to be calm.Therefore,when I learn mindfulness later,I find the similarities between the two.So,I have higher acceptance and trust in mindfulness and practice more carefully."(participant 8)

Discussion

The study shows that pregnant women have positive experiencess with mindfulness training and that it does have some level of effectiveness in enabling them to manage their emotions,like experiences the present,accepting themselves,calmness and relieving stress.The study shows that being present,acceptance,are the two most frequent dimensions in the study,which shows that the participants basically agree with the basic concept of mindfulness and think they are influenced by the concept of mindfulness regardless of their acceptance and practice of mindfulness.Research shows that pregnant women undertaking mindfulness training make them better manage their emotions,which is conducive to emotional regulation and stress relief.

The study found that the frequency of practice is positively correlated with the effect of mindfulness training.Generally speaking,people who practice for a long time will more agree with mindfulness;And those who neglect the practice will have less recognition of mindfulness.At the same time,the practitioners'early knowledge reserve will also affect their acceptance and trust in mindfulness.If the practitioners'recognition of mindfulness is high,it will further enhance the frequency of practice and improve the effectiveness of mindfulness training.

One of the most controversial points in phenomenological research is that the researcher is also a part of the research and cannot be absolutely objective.This study is also difficult to avoid in this regard,but this study has achieved the control of reliability in every link as far as possible.In addition,the number of participants involved in this study is relatively small,and all participants had volunteered for interviews.Thus,a potential for intrinsic bias must be raised.

Conclusion

The study explored pregnant women’s experiences of the effects of undertaking mindfulness training and revealed that experiences consisted of four interpretive themes:1.Emotion management;2.Benefits of mindfulness training for childbirth;3.Different attitudes towards mindfulness training;4.Challenges and influencing factors of mindfulness training.Together these themes demonstrated how pregnant women’s experiences were linked to their views on the effectiveness of mindfulness training.Mindfulness training was positively evaluated by those pregnant women who had participate in the training.Many participants were able to find ways to manage their negative emotions better in their daily life.Therefore,mindfulness training can be used as a way to improve the mental health of pregnant women.For pregnant women,mindfulness training is a strategy to effectively prevent and manage depression,anxiety and other negative emotions and promote mental health[9].However,it also revealed the challenges in training.Long time and frequent practice and recognition of mindfulness are the challenges of mindfulness training.The outcomes of studies remain extremely subjective.More work may be needed to persuade sceptics of the value of mindfulness-evidence of its efficacy and acceptability is an important way of doing this.