Effects of Nada Yoga Music and Mandala Coloring During Labor on Pain, Anxiety, and Maternal Outcomes

Evaluation of the Effects of Nada Yoga Music and Mandala Coloring During Childbirth on Pain, Anxiety, Labor Process, and Maternal Satisfaction

Aim:

The aim of this study is to evaluate the effect of mandala coloring on labor pain, childbirth experience, and maternal satisfaction in pregnant women.

Materials and Methods:

This study is designed as an experimental study planned to be conducted between May 1, 2025 and May 1, 2026. The study population will consist of pregnant women admitted for live birth to the Obstetrics and Gynecology Department of Ağrı Training and Research Hospital during the study period.

The sample size was determined based on a power analysis using an effect size of 0.80 (Cohen's d) obtained from a reference study, a significance level of 5% (α = 0.05), and a statistical power of 80% (1 - β = 0.80). According to the analysis conducted for four independent groups, it was determined that a total of 104 participants should be included in the study, with 26 participants in each group (mandala coloring group, Nada Yoga music group, mandala coloring + Nada Yoga music group, and control group).

Study Overview

• Status: Completed
• Conditions: Childbirth; Labor Process
• Intervention / Treatment: Other: NADA; Other: MANDALA; Other: MANDALA + NADA

• Study Type: Interventional
• Enrollment (Actual): 104
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ağri
    • Ağrı, Ağri, Turkey (Türkiye), 04100
      • Ağri İbrahim Çeçen Universty

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥18 years
• No communication barriers
• Pregnant women admitted to Ağrı Training and Research Hospital for vaginal delivery
• Willingness to participate in the study
• No contraindication to normal vaginal delivery (e.g., cephalopelvic disproportion)
• Term pregnancy (38-42 weeks of gestation)
• Absence of any chronic disease (e.g., diabetes, hypertension)
• No condition preventing mandala coloring (e.g., hand or finger injuries, structural impairments)
• No condition preventing listening to music (e.g., hearing impairment)

Exclusion Criteria:

• Pregnant women who prefer cesarean delivery despite having no contraindication to vaginal birth
• Failure to respond to the questionnaire items
• Presence of psychiatric disorders (e.g., social phobia, schizophrenia, bipolar disorder)
• Conditions requiring emergency cesarean section during the first stage of labor

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: CONTROL; Control
Experimental: NADA; Nada Yoga music	Other: NADA; Listening to Nada Yoga music
Experimental: MANDALA; Mandala coloring	Other: MANDALA; Mandala coloring
Experimental: NADA+MANDALA; Mandala coloring + Nada Yoga music	Other: MANDALA + NADA; Mandala coloring accompanied by Nada Yoga music

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale (VAS)	The Visual Analog Scale (VAS) is a one-dimensional instrument used to objectively assess the perception of pain in pregnant women. It enables the quantification of subjective experiences that cannot be directly measured numerically. Hayes and Patterson (1921) proposed that emotional states could be represented along a line. The VAS was first developed and applied by Bond and Pilowsky in 1966. The VAS consists of a 100 mm (10 cm) horizontal line, with one end representing "no pain" (0 = no pain) and the other end representing "the worst imaginable pain" (10 = severe pain). Participants are asked to mark a point on the line that corresponds to the intensity of their pain. The distance between the "no pain" anchor and the marked point is measured using a ruler and recorded in centimeters. The obtained numerical value represents the intensity of pain perceived by the participant. Pain intensity is categorized as follows: 0 cm = no pain, 0.5-3 cm = mild pain,	Baseline, Periprocedural (labor stages: first, second, third)
Personal Information Form	This form was developed by the researchers based on the relevant literature to collect data on the participants' sociodemographic characteristics.	Baseline
Birth Satisfaction Scale-Short Form (BSS-S)	The Birth Satisfaction Scale-Short Form (BSS-S) was originally developed by Hollins Martin and Fleming (2011) and later revised into its short form in 2013. The scale is a 10-item Likert-type instrument. It consists of three subdimensions: quality of care, personal attributes, and stress experienced during labor. The total score ranges from 0 to 40, with higher scores indicating higher levels of maternal satisfaction. The cut-off points are defined as follows: scores <13 indicate low satisfaction, scores between 14-27 indicate moderate satisfaction, and scores >28 indicate high satisfaction. The Turkish validity and reliability study of the scale was conducted by Göncü (2015). The Cronbach's alpha coefficient of the scale was reported as 0.74. In the present study, the Cronbach's alpha value was found to be 0.66 (Göncü, 2015; Martin and Fleming, 2011).	Baseline, Periprocedural (labor stages: first, second, third)
State Anxiety Inventory (SAI)	The State Anxiety Inventory (SAI) was developed by Spielberger et al. in 1964 to assess the state anxiety levels of both normal and clinical populations. The scale was adapted into Turkish by Öner and Le Compte (1983). It is a self-report instrument consisting of short statements. The State Anxiety Inventory is designed to measure how an individual feels at a particular moment and under specific conditions. It consists of 20 items that assess the individual's current level of anxiety. Responses are rated on a 4-point Likert scale based on the intensity of the expressed feelings or behaviors: (1) not at all, (2) somewhat, (3) moderately so, and (4) very much so. The inventory includes 10 reverse-coded items (items 1, 2, 5, 8, 10, 11, 15, 16, 19, and 20). The total state anxiety score is calculated by subtracting the sum of reverse-coded items from the sum of directly scored items and adding a constant value of 50. The total scores range theoretically	Baseline, Periprocedural (labor stages: first, second, third)
Labor Process Evaluation Form	The Labor Process Evaluation Form (Appendix 5) is a tool developed by the researcher based on the relevant literature (Tuncay, 2024) to assess the childbirth process of the participants.	Periprocedural (labor stages: first, second, third)

Collaborators and Investigators

• Sponsor: Agri Ibrahim Cecen University

Publications and helpful links

General Publications

• Göncü S. Adaptation of the Birth Satisfaction Scale-Short Form into Turkish and Determination of Its Psychometric Properties. Institute of Health Sciences, Department of Midwifery. Master's Thesis, Karabük: Karabük University; 2015.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2025
• Primary Completion (Actual): October 1, 2025
• Study Completion (Actual): May 1, 2026

Study Registration Dates

• First Submitted: March 22, 2026
• First Submitted That Met QC Criteria: April 9, 2026
• First Posted (Actual): April 16, 2026

Study Record Updates

• Last Update Posted (Actual): May 27, 2026
• Last Update Submitted That Met QC Criteria: May 22, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Childbirth; Mandala coloring; Pain during labor; Nada Yoga music
• Other Study ID Numbers: 2025/87

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be publicly shared due to ethical and confidentiality considerations, as the dataset contains sensitive personal and clinical information. However, de-identified data may be made available from the corresponding author upon reasonable request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No