Promoting Mother-Baby Bonding Through a Relaxation Routine During Pregnancy
Condition: Psychological Stress in Pregnancy
MeSH terms: Stress, Psychological
Study type: Interventional

Summary: 
      The aims of this study are to determine if:

        1. during pregnancy, a progressive muscle relaxation and abdominal touch ritual involving a
           pleasing scent (i.e. a "relaxation ritual") can, acutely, reduce maternal stress and
           affect the fetus (in terms of movement, changes in heart rate and heart rate
           variability);

        2. a progressive muscle relaxation and abdominal touch ritual involving a pleasing scent
           (i.e. a "relaxation ritual") during pregnancy can have an effect on mitochondria
           functioning in the placenta through reducing maternal stress during pregnancy (based on
           our recent findings (Monk et al, 2016));

        3. the scent will come to function as a conditioned stimulus such that exposure to the
           scent postpartum will induce greater maternal relaxation, which will have an effect on
           the mother-infant interaction and infant physiology;

        4. prenatal maternal exposure to scent combined with abdominal touch will lead to mothers'
           increased likelihood of utilizing infant massage with a lotion of the same scent
           postpartum;

        5. the prenatal ritual and the increased likelihood of engaging in infant massage will lead
           to a maternal perception of greater mother-infant bonding, attachment and parenting
           efficacy, and improved maternal mood;

        6. the prenatal ritual and the increased likelihood of engaging in infant massage will lead
           to improved performance on the conjugate reinforcement paradigm conditioning task
           administered to infants at 4 months of age
    

Detailed description: 
      Some women will randomly be assigned to perform the prenatal relaxation ritual both in our
      lab and at home (Coached Intervention (CI)); some to make prenatal visits to the lab but
      perform the prenatal relaxation ritual at home only (Home Intervention (HI)); and some to
      make prenatal visits to the lab but never to perform the prenatal relaxation ritual (Control
      Group (CG)). In addition, a fourth group of participants will participate in postpartum
      sessions only (Postpartum Only Group (PO)); the only prenatal experience these participants
      will have in the laboratory will be the informed consent session. Participants in all four
      groups (CI, HI, CG, PO) will participate in an informed consent and demographic information
      session prenatally, during which demographic information and medical history will be
      collected. At the informed consent and demographic information session, women who participate
      in prenatal sessions (those in CI, HI and CG) will smell three scent sticks and select their
      favorite scent. Women in the relaxation ritual groups (those in CI and HI) will utilize the
      scent in the relaxation ritual during pregnancy. Women in the CG will not be exposed to the
      scent again until the postpartum period (as detailed in the description of postpartum
      sessions, below). After the informed consent session, women who participate in prenatal
      sessions (those in CI, HI and CG) will come into the lab three times for the prenatal
      sessions, during which participants will be administered questionnaires about background
      information, moods and stress; collect hair samples for analysis of the stress hormone
      cortisol; collect blood and saliva samples for analysis of the hormone oxytocin, which plays
      a role in social interaction, bonding and lactation; and conduct fetal sessions to
      simultaneously collect maternal and fetal heart rate, as well as maternal blood pressure and
      respiration and fetal movement. Women in the group that performs the relaxation ritual in the
      lab (CI) will perform the ritual during the fetal sessions; this will allow assessment of any
      acute affects of the ritual on mom and fetus. In order to assess if the relaxation ritual
      during pregnancy can have an effect on mitochondria functioning in the placenta, placentas
      will be collected from all participants post-delivery and stored for future analyses.

      All women will participate in a postpartum session in the hospital within 36 hours of birth.
      At this session, women in the PO group will have the opportunity to smell the same scent
      sticks that the other groups smelled prenatally, and select a favorite scent. All women will
      be given a scented lotion, matching the scent participants were exposed to either prenatally
      (CI and HI), that participants chose prenatally for postpartum use (CG) or that participants
      had just selected postpartum (PO). All women will apply the scented lotion and pick up their
      babies at this session. During this holding period, the investigators will monitor mother and
      baby heart rate and respiration and baby brain activity via EEG to assess maternal and infant
      relaxation. Afterwards, all women will be given information on how to use the lotion to give
      a gentle infant massage.

      All dyads will also participate in a 6-week taped diapering and lotion session; the tape will
      be coded for quality of mother-infant interaction to assess dyadic affect and bonding.
      Participants will also participate in a session 4-months postpartum where infants engage in a
      neurocognitive test that assesses memory through a kicking task (conjugate reinforcement
      paradigm conditioning task). Women will answer questionnaires about their moods, how
      participants feel about their babies and their babies' daily routines at both of these
      sessions.
    

Intervention name(s): Relaxation Exercise
Intervention type(s): Behavioral
Intervention description(s): Groups receiving the intervention will be asked to engage in the relaxation protocol every day. Participants will be asked to continue practicing the relaxation protocol for the remainder of their pregnancy. Participants will be instructed to listen to the 7 minute guided muscle relaxation tape and engage in the 3 minute abdominal touch routine in the presence of the scent stick. Participants will be provided with a scent stick of their selected scent to take home. For the duration of the study, participants will be loaned standard headphones and an iPod Touch that contains only the guided progressive muscle relaxation audio recording to facilitate this at-home protocol.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care