Enhancing Prenatal Group Medical Visits with Mindfulness Skills: A Pragmatic Trial with Latina and BIPOC Pregnant Women Experiencing Multiple Forms of Structural Inequity

Abstract

Objectives

Prenatal mindfulness programs can improve mental health, yet access to and cultural and linguistic relevance of existing programs in the United States are limited for people who do not speak English and/or face major life stressors such as migration, housing instability, limited income, and racism. In response, mindfulness skills training drawn from Mindfulness-Based Childbirth and Parenting (MBCP) was integrated into Medicaid-covered CenteringPregnancy (CP) group prenatal healthcare, delivered in Spanish and English by certified nurse-midwives and community co-leaders, and tested in a pragmatic pilot trial.

Method

A provider survey of 17 CP clinics informed development of the enhanced program. Next, it was tested with 49 pregnant people who chose CP prenatal care. All of the sample identified as women; 4% as LGBTQ + ; 90% as Black, Indigenous, and People of Color (65% as Latina/e/x); 10% as White; and 63% as Spanish-speaking. Groups were allocated 1:1 to CenteringPregnancy or CenteringPregnancy with Mindfulness Skills (CP +).

Results

Intent-to-treat analysis of self-report interview data indicated CP + yielded lower postpartum depression (the a priori primary study outcome) with a large effect size (Cohen’s d = 0.80) and a trend toward lower postpartum anxiety (Cohen’s d = 0.59) compared to CP. Hypothesized effects on mindfulness, positive/negative affect, and perceived stress were only partially supported at post-birth follow-up. Satisfaction with care was high across conditions.

Conclusions

Augmenting group prenatal healthcare with mindfulness training in Spanish and English appears feasible, did not reduce satisfaction with care, and may have additional mental health benefits. Key questions remain about structural supports for perinatal well-being.

Preregistration

This trial was registered with ClinicalTrials.gov (NCT01646463).