4 - (OP7) Impact of Mindfulness-based Psychosomatic Health Course on Pregnant Women with Fear of Childbirth: A Multi-center Randomized Controlled Trial

Background: Fear of childbirth (FOC) is highly prevalent among pregnant women and is associated with adverse psychological experiences and increased medical intervention during labor. Although mindfulness-based interventions have shown promise in reducing childbirth-related distress, high-quality randomized controlled trials targeting women with clinically significant FOC remain limited, particularly in non-Western contexts.

Methods: A multi-center randomized controlled trial was conducted between April and November 2023 at three maternal and child health hospitals in China. A total of 114 nulliparous pregnant women (16–32 gestational weeks) with significant FOC (Wijma Delivery Expectancy/Experience Questionnaire, W-DEQ≥66) were randomly assigned to an intervention group (n=59) or a control group (n=55). The intervention group received a culturally adapted mindfulness-based psychosomatic health program consisting of a 2-day in-person course followed by 21 days of guided online mindfulness practice. The control group received routine antenatal health education of equal duration. Outcomes were assessed at baseline, post-intervention, and 3 days postpartum. The primary outcome was fear of childbirth measured by the W-DEQ; secondary outcomes included mindfulness level measured by the Five Facet Mindfulness Questionnaire (FFMQ). Mixed linear models were used to examine group, time, and group-by-time interaction effects.

Results: Baseline demographic and psychological characteristics did not differ significantly between groups. Significant group-by-time interaction effects were observed for both FOC and mindfulness (P < 0.001). Compared with the control group, the intervention group showed greater reductions in FOC scores after the intervention and at 3 days postpartum, along with significant increases in overall mindfulness levels. Subscale analyses indicated significant improvements in fear-of-childbirth-related dimensions, including lack of self-efficacy, concern for the child, loneliness, negative appraisal, and fear following the intervention. In terms of mindfulness facets, the intervention group showed significant increases in the observing, describing, non-judging, and non-reactivity facets after the intervention, with sustained improvements in observing and describing at postpartum follow-up. Regarding obstetric outcomes, no significant differences were found in delivery mode or labor duration; however, the intervention group showed lower use of labor analgesia, and among women with vaginal delivery, a reduced proportion of oxytocin use during the second stage of labor.

Conclusions: This mindfulness-based psychosomatic health program effectively reduced fear of childbirth and enhanced mindfulness among pregnant women with clinically significant FOC, with additional benefits in reducing certain medical interventions during labor. The findings support the integration of culturally adapted mindfulness-based interventions into routine antenatal care to promote holistic and equitable maternity care that addresses psychological needs.