ORIGINAL ARTICLE
Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 13.
Number 2 : 212-218 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X Enhancing Prenatal Mindfulness Through Self-Affirmation and Yoga:
A Case Study Approach Yustina Tyas Kurniawati Department of Midwifery.
Poltekkes Kemenkes Semarang.
Indonesia Corresponding Author: yustinatyas@lecturer.
poltekkes-smg.
Article history:
Submitted, 2025/09/30 Accepted, 2025/10/20 Published, 2025/10/31 Keywords:
Mindfulness.
Prenatal Yoga.
Self-affirmation.
Cite This Article:
Kurniawati YT.
Enhancing prenatal mindfulness through self-affirmation and yoga: a case study approach.
J Ilm Kebidanan (The J Midwifer.
2025:13.
:212-218.
doi:10.
33992/jik.
ABSTRACT
Anchored in SDG 3Aos imperative to Auensure healthy lives,Ay but roughly 20% of women experience anxiety worldwide, including pregnant women.
To overcome it, they should deepen selfknowledge, bolster self-compassion, and enhance resilience against prenatal distress.
This study uses a one-group post-test only design with purposive sampling to assess the impact of combined selfAcaffirmation and prenatal yoga on mindfulness.
Employing a preexperimental, single-case design with healthy women at 20Ae 36 weeksAo gestation, the intervention was practiced by a midwife who is certified yoga facilitator.
After each weekly private yoga session, including breathing exercises, verbal self-affirmation, yoga sequences, and praying, participants completed the FFMQ to assess Among 18 pregnant women, most were primiparous.
Based on the FFMQ results, mean scores for Observing .
Describing .
, and Acting with Awareness .
were above the median values 29.
5, 24, 19.
5, while mean NonAcJudging .
closely approximated its median .
, and mean NonAcReactivity .
, while the median .
The combined prenatal yoga and selfAcaffirmation program improved key mindfulness facets:
Observing.
Describing, and Acting with Awareness, while preserving NonAcJudging and NonAcReactivity, thereby enhancing attentional focus and emotional labeling to buffer prenatal stress.
Good scores mean greater mindfulness.
This approach effectively fosters emotional resilience and wellAcbeing in pregnancy.
INTRODUCTION
About 20% of women, including pregnant women, experience anxiety during pregnancy, which may negatively affect both maternal and fetal health 1.
In order to support SDG Target 3 ensuring healthy lives and promoting well-being.
It is essential to adopt strategies that address the mental health of expectant mothers2.
Maternal anxiety is a common psychological issue during pregnancy, with significant implications for both maternal and fetal health.
Research shows that prenatal anxiety is associated with sleep disturbances, heightened stress, impaired maternal well-being, and an increased risk of preterm birth3.
Despite these risks, prenatal anxiety often remains under-recognized and insufficiently addressed in antenatal care.
Non-pharmacological interventions such as yoga and mindfulness-based practices have gained attention as safe and effective strategies for reducing maternal Prenatal yoga, in particular, has been demonstrated to lower anxiety, depression, and perceived stress among pregnant women4,5.
And midwives, as the closest partners of pregnant women, have a role Available online at: http://ejournal.
poltekkes-denpasar.
id/index.
php/JIK ORIGINAL ARTICLE Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 13.
Number 2 : 212-218 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X in promoting these non-pharmacological mental health interventions.
Similarly, self-affirmation and mindfulness programs strengthen maternal self-awareness, resilience, and emotional regulation, contributing positively to mental health during pregnancy 6.
Maternal mindfulness during pregnancy plays a crucial role in promoting psychological well-being and preparing for childbirth.
However, approximately 20% of women worldwide experience anxiety during pregnancy, which may affect maternalAefetal attachment and birth outcomes7.
Mindfulness-based interventions have emerged as promising strategies to reduce prenatal anxiety and enhance emotional regulation.
Among these, yoga and self-affirmation have shown consistent benefits, though their combined use in antenatal settings remains underexplored.
Prenatal yoga is widely recognized as a holistic mindAe body practice.
That fosters relaxation, interoceptive awareness, and parasympathetic balance through controlled breathing, gentle movement, and meditative focus8.
Neurobiologically, yoga will increasing activation in the prefrontal cortex and anterior cingulate cortex, regions involved in attention control and emotional regulation, thereby enhancing mindfulness and stress resilience 9,10.
Self-affirmation, conversely, functions at a cognitive level.
It encourages individuals to reflect on personal strengths and values, reinforcing a positive self-concept and reducing psychological defensiveness when faced with Neuroimaging studies indicate that self-affirmation activates the ventromedial prefrontal cortex and reward-related networks, supporting adaptive coping and emotional stability 11,12.
The integration of these two methods that yoga and self-affirmationoffers a synergistic framework that targets both the physiological and psychological dimensions of mindfulness.
Yoga strengthens body awareness and relaxation, while self-affirmation nurtures cognitive flexibility and positive self-perception.
Together, they may amplify the effects of mindfulness by promoting both embodied presence and mental resilience, creating a more comprehensive approach to supporting maternal well-being during pregnancy.
Recent evidence also suggests that multi-component mind body interventions yield greater improvements in stress reduction and mindfulness compared to singlemodality programs8,13.
Therefore, combining yoga with self-affirmation is theoretically justified not only by their shared goal of reducing anxiety but also by their complementary neuropsychological mechanisms.
This approach aligns with contemporary midwifery perspectives that emphasize holistic, preventive, and woman-centered care to enhance maternal mental health and childbirth readiness.
However, studies integrating self-affirmation with prenatal yoga remain limited, especially in low and middle-income Given this gap, it is essential to examine whether a combined intervention of self-affirmation and prenatal yoga can enhance mindfulness and psychological well-being in pregnant women.
The findings may provide a foundation for midwives and healthcare providers to incorporate these strategies into antenatal services.
Ultimately, this research aligns with the Sustainable Development Goals (SDG.
, particularly Goal 3, which seeks to ensure healthy lives and promote well-being for all at all The aim of this study was to determine the effect of self-affirmation and prenatal yoga interventions on mindfulness levels in pregnant women.
METHOD
This study used a pre-experimental method with a one-group post-test only design.
This design was used to measure the effect of self-affirmation and prenatal yoga interventions on the mindfulness and self-efficacy levels of pregnant women.
In this design, one group of participants was measured only after the intervention, without a control group.
The goal was to observe changes in the participants' condition after receiving a specific treatment .
The intervention was conducted on pregnant women aged 20Ae36 weeks .
he second trimester to the beginning of the third trimester is a safe and ideal period for light physical activity such as prenatal yog.
in community.
willing to participate in all intervention sessions in full and complete the Published by Midwifery Department of Health Polytechnic.
Ministry of Health.
Denpasar.
This is an Open Access (OA) article distributed under the terms of the Creative Commons Attribution Share-Alike 4.
0 International License .
ttps://creativecommons.
org/licenses/by-sa/4.
0/).
ORIGINAL ARTICLE
Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 13.
Number 2 : 212-218 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X questionnaire .
ommitted participation is important to ensure the validity of the interventio.
experiencing pregnancy complications requiring bed rest .
renatal yoga activities must be performed by pregnant women in stable conditio.
and aged 20Ae40 .
his is the general reproductive age range and minimizes bias from extreme age factor.
This study also excluded patients with a history of mental health problems or undergoing psychological/psychiatric therapy .
his could be a confounding factor affecting mindfulness scores or the effectiveness of self-affirmation.
experiencing severe pain, premature contractions, or medical conditions that limit movement .
, preeclampsi.
psychological interventions or prenatal yoga from other providers simultaneously .
his is to avoid duplicate interventions affecting the result.
The intervention was delivered privately once a week by a certified midwife as a yoga facilitator.
Each session included breathing exercises, self-affirmations, yoga movements, and prayer or reflective meditation.
Assessments were conducted using the Five Facet Mindfulness Questionnaire (FFMQ) to measure five aspects of mindfulness: observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience.
Data were analyzed using descriptive statistics, including means and standard deviations for each FFMQ dimension.
Given the single-group post-test design, the focus of analysis was on identifying general trends and patterns in mindfulness rather than hypothesis testing.
The findings were compared with results from previous studies involving yoga or mindfulness based interventions among pregnant women to assess relative consistency and contextual This study also received ethical approval from the Health Research Ethics Commission of the Semarang Ministry of Health Polytechnic, with the ethical approval number: No.
1092/EA/F.
XXi.
38/2025.
RESULT AND DISCUSSION
Descriptive analysis was performed to summarize participantsAo characteristics and mindfulness Mean, standard deviation, and median values of the Five Facet Mindfulness Questionnaire (FFMQ) subscales were calculated.
Data were analyzed using Excel and SPSS version 23.
Since the study employed a single-group post-test design, results were interpreted descriptively without inferential statistical tests.
Table 1.
Characteristics of respondents Variable Education level University Gravida Primigravida Multigravida Gestational age in first meet 2nd trimester 3rd trimester Gestational age in labour <37 weeks >37 weeks N (%) 18 .
Table 1 shows eighteen pregnant women completed the study.
All participants had a universitylevel education, indicating a homogeneously high educational background among respondents.
Most Available online at: http://ejournal.
poltekkes-denpasar.
id/index.
php/JIK ORIGINAL ARTICLE Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 13.
Number 2 : 212-218 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X were primigravida .
3%).
At first contact, the majority enrolled in the study in the third trimester .
2%), while the remainder entered in the second trimester .
8%).
Pregnancy progressed to term for most participants: 17 .
4%) delivered at Ou37 weeks and 1 .
6%) delivered before 37 weeks.
Respondents are homogeneously high educational level .
% universit.
likely influenced both recruitment and engagement: higher maternal education is commonly associated with greater uptake of antenatal education and non-pharmacological programs .
, prenatal classes, digital mindfulness tool.
, and with better comprehension of study procedures and adherence to home practice The predominance of primigravida .
%) is important because first-time pregnant women often show higher interest in childbirth preparation and in interventions that reduce anxiety and increase self-efficacy.
several recent studies report that primigravidae disproportionately seek prenatal education or mindfulness/yoga programs to prepare for labor and to manage pregnancy-related stress.
This composition should be considered when interpreting outcomes, since primigravida status may correlate with baseline anxiety and responsiveness to intervention .
ualitative and quasi-experimental evidenc.
Most participants were enrolled in the third trimester.
Late enrolment is common in pragmatic prenatal intervention studies .
any programs recruit in late secondAeearly third trimeste.
, but it limits exposure time to the intervention and therefore may attenuate effects on facets of mindfulness that require longer practice .
, acting with awareness, non-judgmen.
Randomized and longitudinal studies suggest earlier and longer exposure .
eginning in mid-pregnanc.
tends to produce larger and more durable psychological benefits.
Hence, the timing of enrollment in this sample should be noted as a potential reason why some mindfulness dimensions changed more than others 6,16 .
Then, the high rate of term births .
4%) provides a reassuring safety context: accumulated evidence indicates that prenatal yoga and mindfulness programs are generally safe when adapted for pregnancy and led by qualified facilitators, and they are not associated with increased risk of preterm birth in low-risk Nonetheless, as with all small samples, safety and obstetric outcomes should continue to be monitored in larger trials4.
After that, we investigate mindfulness dimensions using the Five Facet Mindfulness Questionnaire (FFMQ) after a prenatal yoga and self-affirmation intervention among 18 pregnant The results are shown in table .
Table 2.
FFMQ results when prenatal yoga and self-affirmation intervention Dimension Observing Describing Acting with Awareness Nonjudging Nonreactivity Mean Table .
shows that these findings indicate that the highest score was observed in the Observing dimension, while the lowest score was in Nonjudging.
The results suggest that prenatal yoga combined with self-affirmation practices can enhance mindfulness in pregnant women, particularly in the Observing and Describing dimensions.
The high mean score in Observing indicates improved awareness of internal and external experiences, which is consistent with recent studies highlighting yogaAos effectiveness in strengthening attentional control and body awareness during pregnancy 17.
The relatively lower score in Nonjudging suggests that pregnant women may still experience challenges in reducing self-critical attitudes and judgmental thinking.
This finding aligns with previous Published by Midwifery Department of Health Polytechnic.
Ministry of Health.
Denpasar.
This is an Open Access (OA) article distributed under the terms of the Creative Commons Attribution Share-Alike 4.
0 International License .
ttps://creativecommons.
org/licenses/by-sa/4.
0/).
ORIGINAL ARTICLE
Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 13.
Number 2 : 212-218 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X evidence that mindfulness-based interventions often improve awareness and observation more readily than emotional regulation dimensions such as nonjudgment18.
Nonetheless, the moderate score in Nonreactivity indicates a positive trend toward better emotion regulation, an important aspect of maternal mental health19.
Comparisons with previous studies demonstrate similar patterns.
A recent feasibility trial of prenatal yoga in ethnic minority women showed improvements in mindfulness and self-regulation, although variations across dimensions were also observed 20.
Furthermore, a systematic review reported that mindfulness-based interventions in pregnancy tend to improve psychological flexibility and stress management, with mixed effects on judgment-related facets21.
Taken together, the results reinforce the potential of yoga and self-affirmation as low-cost, non-pharmacological strategies to promote mindfulness and emotional resilience in pregnant women.
The findings highlight the potential application of prenatal yoga as part of antenatal care to promote maternal mental health.
Integrating yoga with reflective practices such as self-affirmation may help pregnant women manage stress, enhance self-awareness, and foster healthier maternal and fetal bonding.
Health professionals, especially midwives could incorporate structured mindfulness-based movement practices into prenatal education programs17,19.
From these findings, it also implies to clinical midwifery perspective.
Midwives have the opportunity to incorporate self-affirmation techniques within prenatal counseling to enhance maternal self-efficacy and emotional resilience.
During antenatal visits, they can encourage expectant mothers to articulate positive affirmations reflecting confidence in their abilities and trust in their bodies.
This approach aligns with recent evidence recommending the inclusion of mindfulness-based affirmations as part of standard antenatal education.
It could be alleviate anxiety and foster positive perceptions of childbirth22,23.
Furthermore, incorporating yoga interventions into antenatal care requires that midwives receive specialized training to ensure both safety and effectiveness.
Midwives should possess a clear understanding of pregnancy-adapted yoga postures, breathing methods, and potential contraindications to minimize risk and optimize maternal well-being.
Structured training opportunities such as workshops or professional development modules jointly designed by midwifery programs and certified prenatal yoga instructors can help midwives build these competencies24.
Through such preparation, yoga sessions can be delivered appropriately according to gestational age, maternal comfort, and individual health conditions.
The findings of this study reinforce the value of integrating mindfulness-based practices, particularly yoga combined with self-affirmation, within routine midwifery care to enhance maternal psychological health and childbirth readiness.
Further investigations with larger and more diverse populations, as well as control comparisons, are necessary to validate these results and to assess the long-term impact on maternal and neonatal outcomes.
CONCLUSION
This study demonstrates that prenatal yoga combined with self-affirmation is associated with higher mindfulness levels in pregnant women, particularly in Observing and Describing.
However, improvements in Nonjudging and Acting with Awareness appear less pronounced, suggesting the need for tailored intervention components to address these areas.
Midwives can integrate self-affirmation and yoga in antenatal classes to reduce anxiety.
The combination of prenatal yoga and self-affirmations shows potential in increasing mindfulness in pregnant women.
studies with more robust experimental designs are needed to confirm causal effects.
Future research should use larger and more diverse samples to improve generalizability.
Longitudinal designs are recommended to assess the sustainability of mindfulness outcomes across pregnancy and postpartum.
It can be combined with qualitative studies may provide insights into participantsAo lived experiences and barriers to practice.
Available online at: http://ejournal.
poltekkes-denpasar.
id/index.
php/JIK ORIGINAL ARTICLE Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 13.
Number 2 : 212-218 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864
p-ISSN: 2338-669X
ACKNOWLEDGMENTS
The authors would like to express sincere gratitude to all pregnant women who generously participated in this study and shared their time and experiences.
REFERENCES