Description of the MBCP Program
The MBCP course is held for 3 h once a week for 9 weeks. In addition, there is a 7 h silent Retreat Day on the weekend between Class 6 and Class 7 and a Reunion Class four to 12 weeks after all the women have given birth. The recommended class size ranges from eight to 12 expectant couples. Although the course is expressly designed for expectant couples to attend together, pregnant women without a partner or whose partner cannot attend are welcome and are invited to bring a support person, if so desired.
In the MBCP program, formal mindfulness meditation instruction is given and practiced in each class. In addition, participants are asked to commit to practicing meditation at home using guided meditation CDs for 30 min a day, 6 days a week, throughout the course. The teaching of mindfulness is fully integrated with the current knowledge of the psychobiological processes of pregnancy, labor, birth, breastfeeding, postpartum adjustment, and the psychobiological needs of the infant. A wide variety of mind–body pain coping skills for childbirth and awareness skills for coping with stress in daily life are also included. Course materials are
Full Catastrophe Living by Jon Kabat-Zinn (
1990), two guided meditation CDs and a workbook with selected readings and resource lists. The MBCP method of childbirth preparation is unique in its focus on teaching mindfulness meditation and the necessary commitment that participants must make to practice meditation outside of class.
In addition to teaching mindfulness practice, an essential element of the course is to encourage a sense of community among the expectant parents to reduce the potential negative impact of social isolation on the mental health of the new parents in the postpartum and early parenting period. Toward this end, each class includes a 15 min snack break to allow for relationship building among participants.
MBCP class one The first meeting is devoted to sharing the history of MBCP as an adaptation of MBSR and the beginning of themes that are interwoven throughout the 9 week course: that the capacity to be fully present for labor and delivery can support the normal physiology of childbirth, and that attentive, present-moment parenting can be key to the development of a healthy, empathetic relationship between parent and child. A definition of mindfulness is given—“paying attention in a particular way: on purpose, in the present moment, non-judgmentally” (Kabat-Zinn
1994), and the relationship between the stress appraisal process and change is explored. Group sharing provides couples the opportunity to normalize the stress they may be experiencing, such as changes in the physical body, living space, finances, work life, hormonal and emotional changes, self-identity, and couple and family relationships. The group process allows couples the chance to hear that these stressors are shared by others and to learn that, if they are approached as a challenge, they can provide an opportunity for self-learning and growth. Partner concerns, such as worry about how to support a woman during childbirth, are addressed.
A portion of this first meeting is devoted to an eating meditation in which one raisin is eaten mindfully. Using the senses of sight, smell, touch and taste, this exercise serves to demystify meditation practice through the participant’s direct experience of paying attention to one’s unfolding, moment-to-moment experience. The theme of interconnectedness is introduced through looking at the “bellybutton” (stem end) of the raisin, seeing that the soil, sun, rain, clouds, and workers who picked and trucked the raisins all contributed to the health and well-being of their body and the body of their unborn baby through the nutrients in the raisin. This exercise can heighten awareness of food and nutrition and begins the conversation about how many of life’s moments can be missed, including moments with our children, because the mind is pulled into thoughts about the future or past. Participants are taught that, with the practice of mindfulness, the choice to be more present in our lives becomes available.
MBCP class two Group bonding and community-building deepen in session two. A guided reflection on the question “Why are you here?” provides expectant parents an opportunity to share hopes and fears around pregnancy, childbirth, and parenting.
The first formal meditation practice, the Body Scan, is taught in session two. Not to be confused with progressive relaxation exercises that are often taught in childbirth education classes, the Body Scan is an awareness practice. The instruction is to slowly and systematically move one’s attention through the body from the top of the head down to the feet, becoming aware of physical sensations in various parts of the body. Whenever the mind wanders, the instruction is to bring the attention back to sensations in the body.
During the Body Scan unpleasant or painful sensations may arise. This experience offers an opportunity to begin developing the skill of uncoupling the sensory component of pain from its emotional and cognitive components right in the present moment. This skill enables participants to become aware of habitual, reactive patterns to discomfort or pain that add the mind’s layer of suffering to intense physical sensations. With repeated and regular practice of the Body Scan before childbirth, participants are encouraged to increase their capacity to “be with” and even accept that which is unpleasant, challenging, difficult, painful, or unwanted. Participants are taught that during labor, this skill is invaluable: with mindfulness, pain can be experienced as it is: intense physical sensation arising and passing, moment-by-moment. Moments between painful sensations (e.g., those experienced between contractions) can be experienced with calm and ease rather than with fear or worry about future pain or recalling the memory of past pain. The Body Scan is also intended to increase body awareness, concentration, and is an opportunity to connect with the unborn baby.
MBCP class three Class three is intended to prompt a fundamental shift in perception of the childbirth experience. The physiology of childbirth from a mind–body perspective is described with an emphasis on how present moment awareness can be a critical skill for supporting the normal physiology of labor. With this description, participants are encouraged to consider how fearful appraisals of pain by the mind may trigger the stress reaction during childbirth and negatively affect the labor process through psychophysiological pathways of the neuroendocrine system.
Participants are asked to describe their home experiences practicing the Body Scan during the previous week. Common challenges such as finding time to practice, falling asleep during meditation practice, and questions about what to do when pain or discomfort arises during the Body Scan are addressed.
In addition to the Body Scan, participants are asked to begin a daily sitting practice of 10 min per day and to begin to bring present moment awareness into the ordinary activities of daily living such as washing dishes, brushing teeth, and preparing meals. This sets the foundation for bringing mindfulness into everyday life as a more responsive and less reactive parent.
MBCPclassesfour, five, and six Yoga is introduced as a formal meditation practice in class four. Over the next 2 weeks, mindful movement/yoga practice is alternated with the Body Scan as the at-home formal meditation practice. Practiced mindfully, yoga is a meditative discipline. Noticing and moving into sensations during yoga practice, particularly sensations of stretching and contracting and noticing the times of ease and rest between poses, is mindfulness preparation for noticing the sensations of contractions and the moments of ease between sensations during the labor process. In class six, open awareness sitting meditation is taught. Sitting meditation is alternated with yoga or the Body Scan in the home practice assignment for the week.
Using ice cubes to induce unpleasant sensations, couples are taught a variety of pain practices in classes four, five, and six. They are taught that simple awareness of breathing, moving directly into the sensations, counting the breaths, and vocalizing low-pitched sounds are all ways to focus attention, accept and even welcome intense body sensations. Participants are encouraged to understand how the non-reactive, concentrated, calm, and focused state of mind that is being cultivated in meditation practice can be used to open to and allow unpleasant sensations to arise and pass, moment by moment. Partners are taught the pain practices along with the pregnant women, and in this way are able to bring empathetic understanding to their partners during the pain of childbirth.
In class five, the baby’s journey through the pelvis during childbirth is demonstrated and couples are taught and spend time practicing various positions for labor. Partners receive instruction in a variety of ways to use mindful touch to calm and support their partner. Class six focuses on making wise choices for childbirth, including selection of a care provider, place of delivery (home, hospital, birth center), and additional labor support such as the use of a doula. It is emphasized that the future is unknown, there is no one “right way” to give birth and that with practice, couples will have a variety of tools to work with pain and whatever comes their way during the birth process.
Throughout weeks four, five, and six, couples are asked to bring awareness to stressful experiences in everyday life, noticing how the body and mind “contract” in response to stress. They are asked to practice “being with” (or responding rather than reacting to) these stressful experiences, just as they are learning to do with the ice in the formal pain practices.
MBCP retreat day The day of silent practice is framed as an opportunity to deepen one’s meditation practice, increase awareness of one’s patterns of mind, and practice living in the present moment for an extended period of time, much as they will do during labor and birthing. All the practices are revisited—the Body Scan, mindful movement/yoga, sitting meditation, and mindful eating. Walking meditation is introduced and practiced. In the afternoon, silence is suspended and participants are led through a mindful speaking and listening practice around fears about the future. In this way, participants are encouraged to bring mindful presence into their most intimate relationships.
MBCP class seven In class seven lovingkindness meditation (Salzberg
1995) is introduced. Lovingkindness practice is a practice of open-hearted friendliness and well-wishing for oneself and others. As a variation on the traditional practice of lovingkindness meditation, in the MBCP course lovingkindness practice begins with extending well-wishing to one’s baby, then to oneself, followed by those nearest and dearest, then to all the babies and parents in the room, followed by well-wishing to a neutral person, a difficult person, to one’s neighbors, community, and finally to all beings everywhere.
Also in class seven, participants are invited to share their experiences of the Retreat Day including experiences that were inspiring or challenging, and any insights they had about themselves or mindfulness practice. Participants are reminded that just as they did not know how the day of silence would unfold, so too, they do not know how the day (or night) of labor will unfold. They are instructed that as with the Retreat Day, all that is needed during childbirth is to simply be present as fully as possible as the labor process unfolds, moment-by-moment.
The biological, emotional, and social needs of the newborn and the needs of the postpartum family are covered in this class and the couple’s plans for the postpartum period are reviewed. Sitting meditation is continued as the formal practice for the week.
MBCP class eight Class eight is devoted to reviewing the previous week’s experiences of meditation practice and exploring how mindfulness skills support the normal physiology of breastfeeding. Emphasis is on optimizing conditions for the establishment of the breastfeeding relationship and how mindfulness practice may be used to promote attachment and bonding in the immediate postpartum period. The symptoms of postpartum depression in both women and men are reviewed, including how to seek help if depressive mood is experienced. As practice for maintaining a sustained mindfulness practice after the class ends, participants are invited to practice without the CDs in the coming week.
MBCP class nine In class nine, an MBCP alumni couple and their new infant visit the current MBCP class to share how they used their mindfulness practice during childbirth and how they are continuing to use mindfulness in the often intense and challenging postpartum period. The remainder of the class is devoted to a course review and a closing graduation ceremony. Contact information is exchanged that serves to keep new parents connected between the time the course ends and the class reunion.
Participants are encouraged to continue their practice in the days and weeks before birth—and for the days, weeks, months and years after the birth of their child. Participants are referred to Myla and Jon Kabat-Zinn’s description of how mindfulness practices can be readily applied to parenting (Kabat-Zinn and Kabat-Zinn
1997) and they are also encouraged to continue meeting after the formal course ends to support each other and their continued practice of living and parenting mindfully.
MBCP class reunion The class reunion provides an opportunity for participants to reconnect with each other, meet each others’ babies, and reflect on what they learned from their birth experience. The couples are invited to share how they are learning and growing themselves as new parents, how they are applying mindfulness skills in parenting, and to express appreciation to and about their partner and themselves. MBCP participants are again encouraged to continue gathering, to provide support for each other and their continued use of mindfulness practice as a foundation for a way of parenting mindfully: with present moment attentiveness, nonreactivity, emotional awareness, nonjudgmental acceptance, and compassion for oneself and one’s baby (Duncan et al.
2009).