Topcu Tuğba, Bingöl Fadime Bayri
Marmara University Hospital, Istanbul, Turkey.
Health Sciences Faculty, Midwifery Department, Marmara University, Maltepe, Istanbul, Turkey.
J Midwifery Womens Health. 2025 May-Jun;70(3):414-421. doi: 10.1111/jmwh.13722. Epub 2024 Dec 11.
Fear of childbirth is common in nulliparous women. More accessible and less costly interventions such as mandala are needed to reduce fear of childbirth. The purpose of this study was to test the efficacy of mandala coloring added to antenatal education to reduce fear of childbirth.
An open, randomized controlled trial with a parallel group design was conducted at a tertiary care hospital in Turkey (ClinicalTrials.gov registration NCT05217368). Nulliparous pregnant women without pregnancy complications, between 24 and 32 weeks' gestation, and with increased fear of childbirth were included in the study. A total of 140 pregnant women were allocated to the intervention (mandala coloring plus antenatal education) and control (antenatal education alone) groups, and 100 participants completed the study. Fear before childbirth was measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A at baseline and after completion of antenatal education with or without mandala coloring. Fear during childbirth was measured with the W-DEQ version B retrospectively within one week of giving birth.
At baseline, the intervention and control groups experienced similar fear of childbirth (57.1 vs 57.0; P = .978). After completing antenatal education, the mean fear of childbirth decreased more in the intervention group than in the control group (42.6 vs 50.1; P = .018). In the postpartum period, the intervention group reported less fear during childbirth than the intervention group (68.5 vs 58.0; P = .030). Perinatal outcomes were statistically similar between the 2 groups.
Adding mandala coloring to antenatal education significantly reduced fear of childbirth before and during birth. More studies examining the effects of mandala coloring on perinatal mental health should be conducted.
初产妇中普遍存在对分娩的恐惧。需要更易获得且成本更低的干预措施，如曼陀罗，来减轻对分娩的恐惧。本研究的目的是测试在产前教育中加入曼陀罗涂色以减轻对分娩恐惧的效果。
在土耳其的一家三级护理医院进行了一项开放、随机对照试验，采用平行组设计（ClinicalTrials.gov注册号NCT05217368）。纳入了妊娠24至32周、无妊娠并发症且对分娩恐惧增加的初产妇。总共140名孕妇被分配到干预组（曼陀罗涂色加产前教育）和对照组（仅产前教育），100名参与者完成了研究。在基线时以及完成有无曼陀罗涂色的产前教育后，使用Wijma分娩预期/体验问卷（W-DEQ）A版测量分娩前的恐惧。在分娩后一周内，采用W-DEQ B版回顾性测量分娩期间的恐惧。
在基线时，干预组和对照组对分娩的恐惧程度相似（57.1对57.0；P = 0.978）。完成产前教育后，干预组分娩恐惧的平均降幅大于对照组（42.6对50.1；P = 0.018）。在产后阶段，干预组报告的分娩期间恐惧低于对照组（68.5对58.0；P = 0.030）。两组围产期结局在统计学上相似。
在产前教育中加入曼陀罗涂色可显著降低分娩前和分娩期间对分娩的恐惧。应开展更多研究来考察曼陀罗涂色对围产期心理健康的影响。
