Mandala as a New Intervention for Reducing Fear of Childbirth: A Randomized Controlled Trial

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.