Evaluating a Tailored Stress-Reduction Program Through the Lens of Mindfulness: A Component of Group Prenatal Care for Teens

Strong evidence demonstrates the association between maternal psychological stress and preterm birth, showing that mind-body interventions that emphasize the "connectedness" between our psychological and biological health are needed. Currently, there are only few interventional stress reduction programs used within maternal health that focus on the importance of psychological health to improve perinatal outcomes. In addition, no such programs specifically target the teen-mother population and their specific psychological needs throughout pregnancy. Mindfulness is the behavioral intervention and focus of the Mindfulness-Based Stress Reduction (MBSR) program started at the University of Massachusetts Medical Center by Jon Kabat-Zinn, PhD. Mindfulness is the act of being present and aware from moment to moment without judgment or bias. Rooted in Buddhist practices, mindfulness focuses on the development of self-control and a deep understanding of our lives through relaxation, awareness,and insight. This project aimed to incorporate a tailored stress- eduction program, using mindfulness, to teen-mothers in a group prenatal care setting and to evaluate their receptiveness to this integrative approach. The objectives were to develop the tailored stress-reduction curriculum using mindfulness exercises such as meditation, which could be implemented in combination with standard group prenatal care. Routine home study was encouraged from the book Mindful Motherhood, by Cassandra Vieten along with regular home meditation practice with prerecorded meditations on an Mp3 player given out to each of the teen-mothers. A group Facebook page was set up to allow the group to connect with each other and access meditations and regular mindfulness-based postings. Evaluation of receptiveness to the stress-reduction program was made through direct observation of in-class engagement, participation in the group Facebook page, and responses gathered in a brief post-group questionnaire. The tailored stress-reduction curriculum was developed in conjunction with content expert Vicki Kennedy Overfelt, a certified mindfulness-based stress reduction instructor. Successful curriculum implementation was completed for seven group prenatal care sessions with more than half of the group in attendance for each session. The curriculum was tailored for adolescents and revised throughout the group based on continuous observation of specific group needs. Early on, the decision was made to start each group session with meditation to set the tone and allow for mindfulness themes to intertwine more with prenatal teachings. The focus was to have cohesive integration between mindfulness and prenatal teachings and encourage more of a "mindful pregnancy" experience. Meditations were appropriately shortened for adolescents and in-class exercises were adapted to increase thoughtful reflection and positive attitude. Overall, the group participated positively in all in-class mindfulness-based stress reduction exercises. In a brief post group questionnaire, all of the teens reported they "liked" or "really liked" the in-class meditations; also reporting meditations as "relaxing". However, less than half of the group reported reading the assigned book and the majority reported "listening once" or "never listening" to pre-recorded home meditations. The general conclusion was the group had positive receptivity to in-class activities and showed less interest in recommended home study. Project limitations were trying to adapt mindfulness to the teen-mother population. One observation noted was the mindfulness text recommended for home study might not have been appropriate for this population. Future research is also needed to determine the benefits to in-class stress reduction activities within teen-mothers.