The Effect of Postpartum Mandala Coloring on Anxiety, Fatigue, Maternal Attachment and Breastfeeding Self-efficacy

The Effect of Mandala Coloring on Anxiety, Fatigue, Maternal Attachment, and Breastfeeding Self-Efficacy in the Postpartum Period: A Randomized Controlled Experimental Study

The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and mother-infant bonding in postpartum mothers. The sample consists of women who have had a cesarean section at Kayseri City Hospital within the last year. Data will be collected using a Personal Information Form, the Postpartum Specific Anxiety Scale, the Short Form of the Breastfeeding Self-Efficacy Scale, the Chalder Fatigue Scale, and the Maternal Attachment Scale. Mothers meeting the inclusion criteria will be randomly assigned to intervention and control groups. Mothers in the intervention group will be informed that they will begin mandala coloring one week after their cesarean delivery. They will be asked to color a mandala twice a week for a total of 5 weeks, with each coloring session lasting 30 minutes. To eliminate the possibility of mothers forgetting to color the mandala, the researcher will send reminder messages twice a week starting from the end of the first week. The Personal Information Form will be collected through face-to-face interviews while the mothers are in the hospital. Mothers in the control group will receive routine hospital care and will not paint mandalas. Researchers will call all mothers at the end of weeks 1 and 2 to administer the Postpartum Specific Anxiety Scale and the Short Form of the Breastfeeding Self-Efficacy Scale, and at the end of weeks 4 and 6 to administer questions from the Postpartum Specific Anxiety Scale, Short Form of the Breastfeeding Self-Efficacy Scale, Chalder Fatigue Scale, and Maternal Attachment Scale, recording their responses.

The postpartum period is a time of physiological changes as well as the assumption of new roles and responsibilities. Postpartum anxiety has been relatively neglected in recent years. Defined as a condition that causes anxiety and depression of unknown origin, anxiety is seen as a normal reaction to the birth of a new baby in the postpartum period. Clinically, the prevalence of anxiety symptoms in the postpartum period ranges from 12-20%. High levels of anxiety negatively affect the bonding between mother and baby, as well as the baby's behavioral, social, and emotional development. Postpartum fatigue causes women to feel more negative and less competent than usual. Postpartum fatigue negatively impacts the mother's functional recovery, maternal behavior, infant care, relationships with family members, work performance, and self-actualization. While fatigue is common and even expected after childbirth, severe postpartum fatigue can have significant effects on women's health and activities; It has negative effects such as deterioration of maternal health, delayed return to daily life activities, early cessation of breastfeeding, and delayed infant development. Since cesarean delivery is a surgical procedure, postpartum fatigue, pain, and anxiety are higher compared to vaginal delivery. Consequently, the time to start breastfeeding is later, especially in the first 24 hours after cesarean delivery, mothers have lower breastfeeding self-efficacy, and their need for support from healthcare personnel is higher. Art therapy is reported as an effective support method that addresses the physical, mental, social, and emotional aspects of the individual and helps in coping with difficulties. Mandala, one of the art therapy methods, is defined as a method used to transfer emotions and thoughts onto paper, usually in a round shape. Studies conducted on different sample groups have found that mandala painting is effective on anxiety and fatigue. A literature review revealed that anxiety and fatigue are common in the postpartum period, negatively impacting breastfeeding self-efficacy and maternal attachment. Studies have also shown that mandala coloring is effective in reducing anxiety and fatigue. However, the effects of mandala coloring on mothers' anxiety, fatigue, breastfeeding self-efficacy, and maternal attachment in the postpartum period have not been investigated. The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and maternal attachment in mothers in the postpartum period.

Inclusion Criteria:

• Being 18 years of age or older
• Having had a cesarean delivery after the 37th week of gestation
• The baby being with the mother and the mother being able to breastfeed
• Volunteering to participate in the study
• Having a planned cesarean section

Exclusion Criteria:

• The mother is currently or has previously received psychiatric treatment.
• The mother has a physical disability in her upper extremities.
• The mother has a vision problem.
• The newborn has a congenital anomaly.
• The newborn experienced an obstetric complication requiring immediate hospitalization after birth (hemorrhage, infection, bladder damage, preeclampsia, etc.).

Criteria for terminating the study:

• The baby or mother has a medical condition requiring hospitalization within 6 weeks postpartum.
• Communication with the mother is not possible within 6 weeks postpartum