Effects of Awareness-based Parenting and Birth Preparation Education Given to Couples on Materna-paternal Bonding, Birthparameters and Postpartum Harmony
Phase: NA
Conditions: Mindfulness, Mindfulness Based Stress Reduction
Sponsor: Kayseri Training and Research Hospital

 
i
TR 
ERCIYES UNIVERSITY 
INSTITUTE OF HEALTH SCIENCES 
Department of Nursing 
Obstetrics and Gynecology Nursing 
 
 
 
EFFECTS OF AWARENESS-BASED PARENTING AND BIRTH 
PREPARATION EDUCATION GIVEN TO COUPLES ON 
MATERNAL-PATERNAL BONDING, BIRTH PARAMETERS AND 
POSTPARTUM SLEEP 
 
 
 
Preparer 
Merve Gul TİREN 
 
 
Advisor 
PROF. DR. SALIME MUCUK 
 
 
DOCTORATE THESIS 
 
 
JULY 2025 
KAYSERI 
22.06.2025 

 
ii
TR 
ERCIYES UNIVERSITY 
INSTITUTE OF HEALTH SCIENCES 
Department of Nursing 
Obstetrics and Gynecology Nursing 
 
 
 
 
EFFECTS OF AWARENESS-BASED PARENTING AND BIRTH 
PREPARATION EDUCATION GIVEN TO COUPLES ON 
MATERNAL-PATERNAL BONDING, BIRTH PARAMETERS AND 
POSTPARTUM SLEEP 
(Doctoral Thesis) 
 
 
 
Preparer 
Merve Gul TİREN 
 
 
 
Advisor 
Prof. Dr. Salime MUCUK 
 
 
JULY 2025 
KAYSERI
 

 
3
 
COMPLIANCE WITH SCIENTIFIC ETHICS 
  
I declare that this thesis is my own work, and that all information has been obtained in 
accordance with academic and ethical rules. I also state that I have fully transferred all 
materials and results as required by academic and ethical rules, and that in case of use 
of the works of others, I have referred to the relevant works in accordance with 
scientific rules and shown them in the list of sources. 
   
    
Name-Surname  
: Merve Gül TİREN 
      
Signature : 
 
 
 
 
 
 
 
 
 
 

 
4
 
 
APPROVAL OF COMPLIANCE WITH THE DIRECTIVE 
The Doctoral Thesis titled “The Effect of Mindfulness-Based Parenting and Childbirth 
Preparation Education Given to Couples on Maternal-Paternal Attachment, Birth 
Parameters and Postpartum Sleep” was prepared in accordance with the Erciyes 
University Graduate Thesis Proposal and Thesis Writing Guidelines. 
   
   
   
  
   
Thesis  
Advisor 
Merve Gül TIREN Prof. Dr. Salime MUCUK 
 
 
                                       
 
Head of Department of Nursing 
Prof. Dr. Handan Zincir ??? 
 
 
 

 
5
 
This study titled “The Effect of Mindfulness-Based Parenting and Childbirth 
Preparation Education Given to Couples on Maternal-Paternal Attachment, Birth 
Parameters and Postpartum Adaptation” prepared by Merve Gül TİREN under the 
supervision of Prof. Dr. Salime MUCUK has been accepted by our jury as a PhD thesis 
in the Department of Nursing at Erciyes University, Institute of Health Sciences. 
…/07/2025 
JURY  Signature 
  
Member : …. 
Member : …. 
Member: Assoc. Prof. Dr. İlknur ÇÖL MADENDAĞ 
(Kayseri City Training and Research Hospital, Gynecology and Obstetrics Clinic) 
Member: Assoc. Prof. Dr. Tülay BÜLBÜL 
(Erciyes University Faculty of Health Sciences Department of Nursing) 
Advisor: Prof. Dr. Salime MUCUK 
(Erciyes University Faculty of Health Sciences Department of Nursing) 
APPROVAL  
The acceptance of this thesis has been approved by the Institute Board of Directors 
with the decision numbered ……….… dated ………. 
… /..…/….  
 
 
Prof. Dr. Aydin ALAN 
Institute Director 
THANKS 

 
6
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Merve Gul TİREN 
 
 
 
 
 
 
 
KAYSERI, JULY 2025 

 
7
EFFECTS OF AWARENESS-BASED PARENTING AND BIRTH 
PREPARATION EDUCATION GIVEN TO COUPLES ON MATERNAL-
PATERNAL BONDING, BIRTH PARAMETERS AND POSTPARTUM 
SLEEP 
 
Merve Gul TİREN 
Erciyes University Health Sciences Institute 
Department of Nursing 
PhD Thesis, July, 2025 
Advisor: Prof. Dr. Salime MUCUK 
SUMMARY 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
8
THE EFFECT OF MINDFULNESS-BASED CHILDBIRTH AND 
PARENTING EDUCATION TO MATERNAL AND PATERNAL 
ATTACHMENT, BIRTHING PARAMETERS AND  
POSTPARTUM ADAPTATION 
Merve Gul TİREN 
Erciyes University Graduate School of Health Sciences 
Department of Nursing 
Doctoral Thesis, July, 2025 
Supervisor: Prof. Dr. Salime MUCUK 
ABSTRACT 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
9
CONTENTS  
                                                                                      
 
  Page 
number 
INSIDE COVER 
COMPLIANCE WITH SCIENTIFIC ETHICS 
APPROVAL OF COMPLIANCE WITH THE DIRECTIVE 
APPROVAL 
THANKS 
SUMMARY 
ABSTRACT 
CONTENTS 
ABBREVIATIONS 
LIST OF TABLES AND FIGURES 
1. INTRODUCTION AND PURPOSE 
2. GENERAL INFORMATION 
2.1.Childbirth Preparation Education and Its Historical Process 
2.2.Philosophies of Childbirth Preparation Education 
2.2.1. Dick Read 
2.2.2. Lamaze 
2.2.3. HypnoBirthing-Mongan Method 
2.2.4. Active Labor 
2.2.5. Bradley 
2.2.6. Kitzinger 
2.2.7. Instinctual Birth-England Model 
2.2.8. Odent Model 
2.2.9. Leboyer Method 
2.2.10. Awareness-Based Birth 
 
2. 3. Conscious Awareness (Mindfulness) 
2.3.1. Conscious Awareness Attitudes 
2.3.1.1. Being in the Moment 
2.3.1.2. Realizing Our Judgments 
2.3.1.3. Acceptance 
2.3.1.4. Patience 
2.3.1.5. Compassion 
2.3.1.6. Letting Go 
2.3.1.7. The Spirit of Beginning 
 
2.3.2. Conscious Awareness Based Applications 
2.3.2.1. Mindfulness Based Stress Reduction Program [MBSR] 
2.3.2.2. Mindfulness Based Cognitive Therapy (MBCT) 
2.3.2.3. Acceptance and Commitment Therapy (ACT) 
2.3.2.4. Mindful Self Compassion (MSC) 
2.3.2.5. Mindfulness Based Childbirth Education (MBCE) 
2.3.2.6 . Mindfulness Based Childbirth and Parenting Program [MBCP] 
 
2. 4. Conscious Awareness in Pregnancy 
2.4.1. MBCP Training and Birth Experience (Pain, Fear, Self-efficacy, 
Self-compassion, Awareness) 

 
10
 
 
2.4.2. MBCP Education and Delivery Method 
2.4.3. MBCP Education and Maternal/Paternal Attachment 
2.4.4. MBCP Training and Postpartum Adjustment 
 
2.5. Conscious Awareness-Based Interventions and Nursing 
 
3. MATERIALS AND METHODS 
 
3.1 . Problem 
 
3.2. 
3.3. 
3.4. 
 
3.5. 
 
4. FINDINGS 
 
5. DISCUSSION 
 
6. CONCLUSION AND RECOMMENDATIONS 
 
7. RESOURCES 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
11 
1. INTRODUCTION AND PURPOSE 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
12 
1.1 . Problem Status 
The research question was formulated as “What is the effect of Mindfulness-
Based Parenting and Childbirth Preparation Education on maternal-paternal 
attachment, birth parameters and postpartum sleep?” 
1.1.1. Sub Problems 
 What is the effect of mindfulness-based parenting and birth preparation 
education on parents' conscious awareness levels? 
 What is the effect of mindfulness-based parenting and childbirth 
preparation education on prenatal maternal and paternal attachment? 
 What is the effect of mindfulness-based parenting and childbirth 
preparation education on postpartum maternal and paternal attachment? 
 What is the effect of mindfulness-based parenting and childbirth 
preparation education on fear of childbirth in parents? 
 What is the effect of mindfulness-based parenting and childbirth 
preparation education on pain during birth? 
 What is the effect of mindfulness-based parenting and childbirth 
preparation education on the type of birth that occurs? 
 What is the effect of mindfulness-based parenting and childbirth 
preparation education on postpartum sleep? 
1.1.2. Hypotheses of the Research 
H 01 : Mindfulness-based parenting and birth preparation training has no effect 
on parents' conscious awareness levels. 
H 11 : : Awareness-based parenting and birth preparation education has an effect 
on the conscious awareness levels of parents. 
H 02 : Mindfulness-based parenting and birth preparation education has no 
effect on prenatal maternal and paternal attachment. 
H 12 : Mindfulness-based parenting and birth preparation education has an 
effect on prenatal maternal and paternal attachment. 

 
13 
H 03 : Mindfulness-based parenting and birth preparation education has no 
effect on postpartum maternal and paternal attachment. 
H 13 : Mindfulness-based parenting and childbirth preparation education has an 
effect on postpartum maternal and paternal attachment. 
H 04 : Awareness-based parenting and childbirth preparation education has no 
effect on the fear of childbirth in parents. 
H 14: Mindfulness-based parenting and childbirth preparation education has an 
effect on the fear of childbirth in parents. 
H 05 : Mindfulness-based parenting and childbirth preparation education has no 
effect on pain during childbirth. 
H 15 : Mindfulness-based parenting and childbirth preparation education has an 
effect on pain during childbirth. 
H 06 : Awareness-based parenting and childbirth preparation education has no 
effect on the type of birth that occurs. 
H 16 : Mindfulness-based parenting and childbirth preparation education has an 
impact on the type of birth that occurs. 
H 07 : Mindfulness-based parenting and childbirth preparation education has no 
effect on postpartum sleep. 
H 17 : Mindfulness-based parenting and childbirth preparation education has an 
effect on postpartum sleep. 
 
1.2. Purpose of the Research 
The aim of the study is to evaluate the effects of Mindfulness-Based Parenting 
and Childbirth Preparation Education given in childbirth preparation classes on 
maternal-paternal attachment, birth parameters and postpartum sleep. 
 
 

 
14 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
2. GENERAL INFORMATION 
2.1.Childbirth Preparation Education and Its Historical Process 
Pregnancy, birth and the postpartum period are physiological processes, but 
they are also periods when health care needs increase. Prenatal care services 
meet this increasing need (Demirci and Şimşek, 2018; Ferguson et al., 2013). 
Prenatal care includes education, counseling, screening and treatment to 
provide the best possible health care for the mother and baby, and provides an 
opportunity for systematic monitoring and evaluation of mothers during this 
process ( Al Ateeq and Al Rusaiess, 2015 ; Aji et al., 2019 ) . 

 
15 
Birth preparation training given during the antenatal period is of primary 
importance among prenatal care services (AlDughaishi et al., 2023). 
Healthcare workers providing prenatal care are expected to conduct childbirth 
preparation education activities in order to achieve positive pregnancy and 
birth outcomes, to ensure early diagnosis and timely treatment of pregnancy-
related diseases, to prevent complications during pregnancy, birth and the 
postpartum period, to develop strategies to cope with negative situations such 
as anxiety, fear and worry experienced throughout the process, to increase self-
efficacy regarding the birth process, and to help couples adapt to parenthood 
by raising awareness on their journey to becoming a parent (Agrati & Lonstein, 
2016; AlDughaishi et al., 2023; Gluck et al., 2020; Herval et al., 2019; Levett 
et al., 2020; Okumuş & Mete, 2014; Özgan Çelikel, 2022; Rashed et al., 2023; 
Sezgin & Aydın Kartal, 2021; Gökçe İsbir et al., 2016; Serçekuş & Başkale, 
2016). It has been reported that couples who receive childbirth preparation 
training feel safer during birth, prefer vaginal birth more, feel competent in 
parenting and baby care, and the bond between parent and baby is strengthened 
(Soğukpınar and Karaca Saydam, 2018). 
Childbirth preparation education is an important component of prenatal 
care services and enables couples on their way to becoming parents to adapt to 
the prenatal, birth and postnatal process and to complete the process with 
positive experiences (Sezgin & Aydın Kartal, 2021). According to the 
recommendations of WHO (2018), NICE and RCOG (add source), effective 
childbirth preparation education goes beyond measuring the physiological 
changes in pregnancy and enables the formation of a safe pregnancy, birth and 
postpartum process. Thanks to the education provided, pregnant women make 
conscious decisions during this process, advocate for their unborn babies, and 
develop their self-confidence by understanding how to manage the process. 
The most important gain of positive experiences is that it contributes to the 
reduction of perinatal morbidity and mortality ( Grussua & Quatraro, 2020 ; 
Lothian, 2016 ; Levett et al., 2020 ; Janicka-Kubiak et al., 2022; Setyaningsih 
& Zakiyah, 2019 ). Most maternal and infant deaths in developing countries 
can be prevented with prenatal care (Sevil and Ertem, 2016). It has been 

 
16 
reported that qualified childbirth preparation training has the potential to 
reduce the neonatal mortality rate by 10-20% (Tekelab et al., 2019). According 
to studies, childbirth preparation training reduces fear of childbirth (Hong et 
al., 2020; Buran et al., 2020; Serçekuş and Başkale, 2016), increases 
postpartum adaptation (Doğan and Merih, 2017), maternal self-efficacy (Hong 
et al., 2020) and vaginal birth rate (Buran et al., 2020; Esencan et al., 2018). In 
studies conducted with fathers, it has been concluded that fathers increase their 
functional status and marital harmony by activating their support systems 
(Güngör, 2015; Şayık et al., 2019). It has been concluded that positive 
outcomes will occur with the participation of couples in the training together 
(Başgöl and Koç, 2021). According to the Turkey Demographic and Health 
Survey (TDHS) data, almost all women (96%) received prenatal care from 
expert healthcare personnel in their last birth. Although the data show us that 
prenatal care in Türkiye is sufficient, the cesarean section rate of 52% 
contradicts this situation (TDHS, 2018). In the same report, a cesarean section 
decision is made before labor pains begin for 38% of births. The World Health 
Organization (WHO) reports the ideal cesarean section rate as 10-15% (WHO, 
2024). According to 2022 data, Turkey has the highest cesarean section rate in 
the world. While the rate is 78% in private hospitals and 75% in university 
hospitals, it has exceeded 46% in Ministry of Health hospitals despite 
preventive measures (Topaktaş and Beylik, 2024). In order for cesarean section 
rates to be at the desired level, it is important to manage fear of birth and stress. 
Childbirth preparation education is the most common intervention used for this 
purpose (Kahyaoğlu Süt et al., 2025). 
Although antenatal education and services are provided through standard 
programs in developed countries, well-established programs currently do not 
exist in many developing countries (Heen et al., 2022 ; Isbir et al., 2016 ). 
Childbirth preparation education, which has such importance in the 
prenatal, birth and postnatal processes, has gone through a historical process. 
Childbirth preparation education classes were established in the early 1900s in 
America in order to educate women about health care, hygiene and baby care 
during pregnancy and to enable women to cope effectively with labor pain 

 
17 
without the use of analgesia or anesthesia (Barimani et al., 2018). Prenatal 
preparation classes began to be opened in the 1930s and have increased in 
number since the 1970s (Coşar et al., 2012; McKee et al., 2018; Sevil and 
Ertem, 2016). The founder of the first formal course was the British doctor 
Grantly Dick Read. Dick Read, who introduced the concept of “Educated 
Childbirth”, emphasized that fear could negatively affect labor pain and 
suggested that relaxation exercises had a positive effect on labor pain. Towards 
the end of the 1940s, this method was used by Robert Bradley and Margaret 
Gamper. In 1970, Dr. Robert Bradley founded the Department of Childbirth 
Coaches at American University and drew attention to the key role of fathers-
to-be in childbirth. In the same years, the philosophy of active childbirth was 
introduced by Janet Balaskas. In 1951, French obstetrician Fernand Lamaze 
developed a method that provided muscle relaxation with respiratory control 
and developed the method he called the “Psychoprophylactic Method” by 
observing the techniques used by women giving birth (Rathfisch, 2018; Sevil 
and Ertem, 2016). In the 1980s, the philosophy of water birth was put forward 
by Dr. Michel Odent (Odent, 2014). The Mongan method (hypnobirth), which 
is the product of nearly 40 years of work and special interest, was introduced 
by hypnotherapist Marie Mongan in the early 1990s to provide women with a 
comfortable and natural birth experience free of fear and anxiety (Mongan, 
2020). In 1999, Pam England introduced the philosophy of internal birth, which 
emphasizes creativity and choices and advocates that couples participate in 
training together (England and Horowitz, 2019). 
In Turkey, childbirth preparation education began in the 1980s and became 
widespread in the 2000s (Serçekuş and Yenal, 2015). Childbirth preparation 
education classes in Turkey emerged to increase maternal and child health and 
to increase women's right to receive qualified care during pregnancy and 
childbirth . The first studies in this area were carried out under the leadership 
of Oktay Kadayıfçı, Ayşe Öner and Hülya Okumuş. The first educations were 
given at the Gynecology and Obstetrics Clinic of Çukurova University Faculty 
of Medicine and at the Incirlik Air Base Hospital in the United States based on 
the Lamaze philosophy (Okumuş et al., 2015). The first childbirth preparation 

 
18 
center consisting of antenatal classes was established in Istanbul in 1991 under 
the name of Pregnant Education Center. Then, after the 2000s, the number of 
childbirth preparation education classes was increased by opening pregnancy 
schools in centers affiliated with private hospitals and clinics. The Ministry of 
Health emphasized the importance of childbirth preparation training for the 
first time in the 2000s under the title of “Safe Motherhood”. However, the 
trainings could only be implemented in 2011 with the mother-friendly hospital 
practice initiated by the Ministry of Health to reduce cesarean rates (SHGM, 
2024; Uzun Aksoy and Gürsoy, 2016). Later, the “Ministry of Health, Public 
Health Agency of Turkey, 2014/28 numbered Pregnant Information Class 
Circular” was published in order to provide these trainings within the 
framework of certain standards. In line with this circular, the aim of the 
pregnant information classes was to inform all pregnant women about the 
pregnancy and birth process, to gain awareness that they can play an active role 
in their birth, and to acquire knowledge and skills regarding newborn care 
(Sökmen, 2025). Today, the training provided in childbirth preparation classes 
continues to be provided within the scope of the "Working Procedures and 
Principles of Pregnant Information Classes, Pregnant Schools and Childbirth 
Preparation and Counseling Centers in Health Services No. 2018/23 of the 
General Directorate of Health Services of the Ministry of Health" in order to 
ensure standardization and ensure that the training is of the same quality and 
condition (SHGM, 2024). 
2.2.Philosophies of Childbirth Preparation Education 
Preparation for birth Although their training is based on models based on 
different philosophies, all models are based on breathing exercises that support 
natural birth, active participation of the pregnant woman in the act of birth, 
fearless, painless and intervention-free birth, and adaptation to the transition to 
parenthood (Mongan, 2020).  
2.2.1. Dick Read Model 
British doctor Grantly Dick Read watched a mother give birth silently 
without anesthetic in London in 1913 and was very impressed by the mother's 
experience. His studies show that when there is no fear during birth, there is no 

 
19 
pain. Based on this, he defined the fear-tension-pain triangle. In this method, 
he emphasizes the importance of deep relaxation so that the expectant mother 
can get rid of her fears of birth and discover her instincts for giving birth 
(Mongan, 2020; Dick Read, 2004). 
2.2.2. Lamaze Model 
Arguing that birth is a completely controlled process, French obstetrician 
Fernand Lamaze developed the controlled breathing technique. Lamaze 
developed this model following Russian scientist Ivan Pavlov’s conditioned 
response theory. Lamaze’s application of this theory to the field of birth went 
down in history as the first major success for women who wanted to have a 
non-invasive birth. This method consists of techniques based on regulating 
breathing during contractions during birth. Lamaze called this method 
psychoprophylaxis, or mental prevention. By including education in the birth 
process, he provided women with the opportunity to learn about their bodies’ 
reactions. Today, the modern Lamaze method encourages women to do what 
they already know how to do, namely, birth, by trusting their instincts 
(Rathfisch, 2018). 
2.2.3. HypnoBirthing-Mongan Model 
The Mongan method is a method that is the result of nearly 40 years of 
work and special attention. 
Developed by Marie Mongan in the early 90s, the aim of this method is to 
enable women to experience a comfortable and natural birth without fear or 
anxiety, and to allow partners to take part in the process. Arguing that fear of 
birth lies in the person's subconscious, Mongan stated that the sympathetic 
nervous system is activated, causing tension and pain. The aim of teaching self-
hypnosis before birth is to get rid of fears of birth and have a comfortable and 
positive birth experience. This philosophy, which is now called hypnosis birth, 
includes a mixture of education about the process, imaging, hypnosis, 
relaxation techniques, touching and breathing assistance, and pushing the baby. 
It consists of four lessons in total and the lessons last two and a half hours. In 
order to be qualified to provide training, it is necessary to receive certified 

 
20 
training from HypnoBirthing International (Mongan, 2020; Rathfisch, 2018; 
Shorey, 2022). 
2.2.4. Active Birth Model 
The active birth philosophy, developed by British childbirth educator Janet 
Balaskas, is based on creating an environment where women can feel safe by 
protecting their privacy during birth, allowing hormones to be secreted 
effectively, and ensuring that birth occurs comfortably in the correct position. 
She also argues that emotional and physical support for women and eliminating 
their lack of information contributes significantly to this process. She states 
that when women are not given enough support during birth, when the 
environment is not conducive to birth, and when women are not allowed to 
choose their own birth position, stress hormones called catecholamines come 
into play, causing vasoconstriction that reduces uterine blood flow and can 
slow down labor. (Balaskas, 1992). 
2.2.5. Bradley Model 
The philosophy, which emerged by American obstetrician Robert Bradley, 
has now become a 12-week training program. It was created to teach fathers 
how to take an active role in birth and how to coach their wives. In this way, 
wives will provide both physical and emotional support during birth. Bradley 
argued that giving birth is like swimming and that the person who delivers 
should only intervene when necessary, just like a lifeguard. He argued that birth 
has its own timetable and that it should not be interfered with, and that the birth 
environment should be quiet and dim. (Rathfisch, 2018; Varner, 2015). 
2.2.6. Kitzinger Model 
This model, developed by Kitzinger , has developed a psychosexual 
approach in prenatal education by seeing birth as an individual, sexual and 
social situation. Therefore, it is also called the Psychosexual Method. This 
model, which is based on teaching women how to express their feelings, also 
focuses on the use of sensory memory, body image, relaxation techniques and 
breathing exercises. Adapting to birth contractions, control ability and 
concentration, as well as actively responding to pain have been adopted (Şeker 
and Sevil 2015). 

 
21 
2.2.7. Instinctual Birth-England Model 
In the model developed by Pam England, individuals' creativity, choices, 
past births, fears, knowledge level and needs are prioritized, and a holistic 
approach is adopted regarding preparation for birth and the postpartum period. 
Since information about birth is learned from the environment, observation and 
trial and error methods are frequently used. In addition, an external perspective 
is provided by what the professional narrator teaches during the training. 
Training is usually given to couples ( England and Horowitz, 2019 ). 
2.2.8. Odent Model 
This model, developed by Michel Odent, is completely instinctive and 
health professionals are in the position of observers, not intervening in the 
physiology of birth. According to Odent, birth is a special experience and 
couples should live this experience with love in a suitable physical environment 
(Odent, 2020). 
2.2.9. Leboyer Model 
This model, developed by Frederick Leboyer, is applied to reduce the 
negative effects of practices that can cause pain and trauma to the baby, such 
as light, sound, interventions for the baby, and early cutting of the umbilical 
cord. It advocates wrapping the newborn in a blanket and making the delivery 
room suitable for the newborn (Şeker and Sevil, 2015; Uzun Aksoy and 
Gürsoy, 2018). 
2.2.10. Mindfulness-Based Birth and Parenting Model 
The basis of the model known as Mindfulness-Based Childbirth and 
Parenting, developed by Nancy Bardacke in 1985; It is an innovative program 
developed to reverse the negative effects of high stress and fear on maternal 
and newborn outcomes, to improve the mental health of both parents, to support 
self-efficacy at birth, to improve partner relationships and parental sensitivity, 
and to keep the baby's development at an optimum level (Duncan and 
Bardacke, 2009; Çiçek, 2021). The application includes awareness 
development, meditation and yoga, coping with stress, focus, breathing, group 
dialogues and natural birth (Duncan and Bardacke, 2009; Onat Bayram and 
Hotun Şahin 2010). 

 
22 
2.3. Conscious Awareness (Mindfulness) 
Conscious awareness (mindfulness) is a seemingly simple way of relating 
to experiences that has been practiced for more than 2,500 years to alleviate 
human suffering, and has continued to develop from ancient times to the 
present day, encompassing Eastern and Western cultures. As used by Western 
psychotherapists , mindfulness is a psychological term based on Buddhism. It 
is used as a translation of the Pali words sati and smriti , which were used in 
the teachings of Buddha, the founder of Buddhism, and sati includes the effects 
of the words awareness, attention, and remembering (Pollak et al., 2021; Uzun, 
2020). Smriti, on the other hand, means to call something or to remind the mind 
in Sanskrit. These terms were translated into English by Tomas Williams Rhys 
Davids in 1881 (Lucena et al., 2020). 
Mindfulness is being aware of the present experience by accepting it 
(Germer, 2013) and paying attention to our experiences that develop from 
moment to moment in a conscious and non-judgmental manner (Kabat Zinn, 
2003). It states that consciousness and attention are focused on the moment, 
and remembering is related to remembering consciousness and attention in the 
moment (Gündüz, 2016). The acceptance attitude underlying mindfulness, 
which has a special importance in psychotherapy, means embracing 
experiences that occur here and now without judgment (Hayes, 2004). 
Mindfulness was first introduced into literature by American Doctor Jon 
Kabat-Zinn by combining words meaning “full mind” (Çatak and Ögel, 2010). 
According to Kabat-Zinn (2015), among all the meditative wisdom practices 
developed in traditional cultures throughout the world and throughout history, 
mindfulness is perhaps the most basic, most powerful, most universal, easiest 
to grasp and incorporate, and arguably the most needed practice right now. 
Awareness is nothing more than the capacity we all already have to know what 
is really happening as it is. Vipassana teacher Joseph Goldstein describes this 
as “the quality of mind that notices what is present without judgment or 
intervention, a mirror that clearly reflects what comes before it.” Another 
vipassana teacher, Larry Rosenberg, calls this “the mind’s power of 

 
23 
observation, a power that changes according to the maturity of the practitioner” 
(Kabatt-Zinn, 2015). Buddhist scholar and priest Nyanaponika Thera explained 
the concept of mindfulness as “the infallible key to knowing the mind and 
therefore the starting point, the perfect tool for shaping the mind and therefore 
the focal point, and the supreme manifestation of the freedom achieved by the 
mind and therefore the culmination point” (Kabat-Zinn, 2015). According to 
Flavell, conscious awareness consists of concepts such as seeing, noticing and 
bringing together (Akın et al., 2007). 
Kabat-Zinn defined the concept of mindfulness as a meditative state 
defined as the conscious bringing of the mind to the moment and focusing on 
it. Awareness is an innate quality of the mind and can be developed through 
systematic practice. With the systematic and conscious development of 
awareness, wisdom and compassion emerge, and the delusions and permanent 
blindness of the mind and emotions are liberated (Kabat-Zinn, 2015). With this 
meta-awareness area, cognitive flexibility increases (Shapero et al., 2018). The 
essence of mindfulness is universal and is related to the nature of the human 
mind rather than ideology, belief, philosophy or culture (Baer, 2003; Kabat-
Zinn, 2015). 
The concept of mindfulness is briefly defined as focusing on the moment, 
the focus of attention or internal rotation. In addition, attention being aware of 
breath, focusing on physical perceptions, feelings and thoughts is seen as a 
healing intervention (Çatak and Ögel, 2010). Mindfulness emerges as the 
ability to strengthen a person's awareness of not only their skills but also what 
they can do. In this context, the individual becomes aware of their own power 
and has the ability to move themselves without any stimulus (Akın and Çeçen, 
2015). In summary, conscious awareness is a skill that allows a person to 
question what they know, control their cognitive skills, take responsibility for 
themselves, strengthen their self-management skills and manage the process in 
the best way (Bağçeci et al., 2011). 

 
24 
Conscious awareness is a very applicable intervention, but it is necessary 
to focus on it and develop it like doing brain exercises or a sport. For this, 
practice is essential (Aktepe and Tolan, 2020; Kabat-Zinn, 2003). 
Clinical interventions related to mindfulness were first performed by Prof. 
Dr. Jon Kabat-Zinn at the Massachusetts Institute of Technology in 1979. 
Kabat-Zinn is also the person who created the Mindfulness-Based Stress 
Reduction (MBSR). According to Kabat-Zinn, a person needs to develop 
certain attitudes in order to get out of automatic pilot and stay in the moment 
and effectively benefit from mindfulness practices (Kabar-Zinn, 2013). 
2.3.1. Conscious Awareness Attitudes 
Conscious awareness teaches us experientially how to handle what we 
notice. In other words, it includes noticing our judgments, seeing the past and 
future effects of our perceptions, being compassionate towards ourselves and 
others in times of pain, and acceptance. The seven basic attitudes for awareness 
are; being able to stay in the moment, noticing our judgments, acceptance, 
patience, compassion, letting go, and the spirit of beginning (Atalay, 2021; Hall 
et al., 2016). 
2.3.1.1.Being Able to Stay in the Moment 
Mindfulness aims to not stay in the present moment all the time, but to notice 
our attention, which tends to go to the past and the future, and to gently bring 
it back to the present moment, to live the present moment. Some moments are 
neutral moments, outside the category of pleasant or unpleasant. Especially 
moments in which daily life activities are performed are spent thinking about 
another moment. Stopping at such times, realizing that we are on automatic 
pilot and gently bringing our attention back to the present moment is an 
important mindfulness practice (Atalay, 2021). 
2.3.1.2.Noticing Our Judgments 
The term used in the mindfulness literature as non-judgment has been updated 
by Atalay (2021) as noticing our judgments. The mind tends to categorize 
everything it sees. This categorization tendency of the mind can facilitate the 

 
25 
recognition of perceived events, but it is also necessary to be aware of 
judgments in order to clarify the perspective. It is important to be aware of 
automatic reactions resulting from the habit of judgment. Non-judgment does 
not mean not expressing an opinion about anything, loving everything, not 
criticizing anything, or not seeing the bad aspects. It is noticing judgments and 
noticing our reactions to situations we like or dislike. Non-judgment is the 
ability to ask the question “How would I perceive it?” if I were experiencing 
this experience for the first time right now, without the influence of the past 
and future (Atalay, 2021). Conscious awareness helps to see thoughts, even the 
thoughts that a person judges himself, as mental events that appear and 
disappear like clouds in the sky. This perspective allows us to understand that 
we are not made up of thoughts, and this is an extremely liberating insight. One 
antidote to the judgmental mind is to be kind to oneself and others (Bardacke, 
2017). 
2.3.1.3.Acceptance 
Acceptance adds sincerity and compassion to conscious awareness. 
Processing experiences with an accepting attitude is perhaps the most difficult 
and important aspect of mindfulness practices. In order for a person to change, 
they must accept themselves as they are. Acceptance makes it easier to be 
equally open to pleasure and distress, to accept gain and loss in the same way, 
and to stop before overreacting to mistakes. In other words , it allows accepting 
both the ever-changing life and existential realities. Acceptance is a 
prerequisite for being able to realize life as it is (Atalay, 2021 ; Bardacke, 
2017). 
2.3.1.4.Patience 
Patience is accepting and understanding that events happen according 
to their own timing, not according to a timetable chosen by the person. In the 
process of life, everyone has an impatience to get what they want as soon as 
possible. There is always patience in mindfulness practices. In meditation, 
there is patience, waiting, tolerating emptiness, and being patient with the 
shortcomings of development and change. Even if there is no result from 

 
26 
mindfulness practices, the process should be continued with patience (Atalay, 
2021; Kabat-Zinn, 2013). 
2.3.1.5.Compassion 
In order to cope with challenging life experiences, an attitude is taken 
to eliminate the difficult situation or replace it with a more pleasant one. 
Compassion offers an alternative path to these, an attitude of understanding the 
pain and its nature and staying with it. Pain is universal and the person who 
suffers is not deficient, different, disadvantaged or unlucky. Compassion is the 
ability to accept challenging emotions and situations that cause distress without 
suppressing, ignoring or identifying with that situation. This attitude includes 
being compassionate not only towards others but also towards ourselves. Being 
able to receive help from others during difficult times without closing ourselves 
off also nourishes compassion (Atalay, 2021). 
2.3.1.6.Letting it flow 
One of the important points of acceptance and making peace with the 
way things are in time is to let go. There is a tendency to hold on tightly to 
things in life, to get stuck on certain thoughts, feelings or situations, and to be 
dependent. Letting go is to see that everything is temporary, not to think, forget 
or not feel, but to not identify with whatever we are holding on to. Letting go 
is not to let go or not to care, but to be able to realize whatever is being held on 
to, to understand the past and future connections and to distance ourselves from 
them. The way to do this is to focus on the present moment. Instead of thinking 
too much about the experiences we have, it is to be in the flow of the present 
moment (source). 
2.3.1.7.Spirit of Beginning 
In order to get out of automatic pilot in conscious awareness and stay 
connected to the present moment, it is necessary to have the ability to live each 
experience as if it were the first. The captivity of knowing the experiences we 
live can go beyond understanding and enjoying them better. This can lead to a 
transition from awareness to automatic pilot. Having a beginner's mind helps 

 
27 
develop a fresher, more unprejudiced and open perspective on the moments 
experienced. By directing curiosity towards what is being experienced at that 
moment, a mind that is less filled with fear about the future or sad thoughts 
about the past is achieved. The most important motivation for exploring the 
present moment is curiosity. The spirit of being a beginner is a purposeful 
process of wondering as if discovering many things in life for the first time 
(Atalay, 2021; Bardacke, 2017; Kabat-Zinn, 2013). 
2.4. 
Conscious Awareness Based Practices 
The concept of mindfulness has gone beyond the framework 
conceptualized by Sati and has become a broad concept that includes areas such 
as health and industry. The Dalai Lama, one of the leading names of Buddhists 
living in Tibet, has contributed to the scientific development and spread of 
mindfulness with his leadership in opening the Mind and Life Institute (Moniz 
& Slutzky, 2015). Prof. Dr. Jon Kabat-Zinn, one of the scientific pioneers of 
mindfulness, opened the Mindfulness-Based Stress Reduction Clinic in the late 
1970s, which allowed the concept to go beyond the eastern borders and the 
boundaries of religious teachings and increase its popularity in the west 
(Schmidt, 2011). The Mindfulness Center at Oxford University has been 
conducting research and education activities since 2008 under the department 
of psychiatry. In addition, Mindfulness-Based Cognitive Therapy (MBCT) was 
developed by researchers at Oxford University. The University of Exeter has 
also been providing education and research services at the university's 
Mindfulness Center since 2004. The Bangor University Mindfulness Center 
was established in 2001 by Prof. Mark Williams at Bangor University and 
operates under the Department of Psychology. There are also Mindfulness 
application and research centers at Stanford, UCLA, Nottingham, Utah, New 
Castle and IOWA Universities. In Turkey, there is a YÖK-approved 
mindfulness application and research center at MEF University, directed by 
Zümra Atalay (Atalay, 2021). With the increasing prevalence in the West, there 
are many structured mindfulness-based applications that can be used in 
different situations and populations, such as the Mindfulness-Based Stress 
Reduction Program, Mindfulness-Based Cognitive Therapy, Acceptance and 

 
28 
Commitment Therapy, Self-Compassionate Awareness, Mindful Awareness-
Based Childbirth Education, Mindful Awareness-Based Childbirth and 
Parenting Program (Davis & Hayes, 2011). 
 
 
 
 
 
 
 
 
2.4.1. Mindfulness Based Stress Reduction Program [Mindfulness 
Based Stress Reduction (MBSR)] 
MBSR is a group program that focuses on teaching mindfulness within 
meditation teachings. MBSR is applied to patients with different characteristics 
who have physical or mental complaints. In addition to being able to manage 
stress and difficulties in daily life, it is used to be able to cope with anxiety, 
anger or many other challenging situations and emotions, to regulate emotions, 
to accept life difficulties and to provide well-being (Atalay, 2021) . This 
program was developed by Prof. Dr. Jon Kabat-Zinn and was first implemented 
in 1979 at the Massachusetts Institute of Technology (MIT) Mindfulness 
Center. It first emerged as a program that focused on healing patients with 
chronic pain and changing their relationship with pain rather than reducing 
their pain. It was later used to cope with stress, challenging situations or 
emotions. The MBSR program can be used as supportive, preventive, 
complementary or as a method in itself. When this capacity is integrated into 
daily life, it becomes easier to cope with physical symptoms and difficult 
emotions (Kabat-Zinn, 2003; Kabat-Zinn, 2013; Atalay, 2021). The program 

 
29 
aims to be more aware of what is happening at any given moment through an 
accepting attitude. It helps people avoid negative thoughts, feelings and 
behavioral patterns that have become habits. Increased awareness and 
acceptance help create new ways of responding and help people cope with their 
own and wider world (Atalay, 2021). 
Mindfulness training is linked to changes in brain regions responsible 
for emotion regulation and stress responses. These changes in turn affect 
biological processes such as breathing, heart rate, and immune function 
(Davidson et al., 2003; Lazar et al., 2005; Hölzel et al., 2010). 
MBSR is currently offered in many health care institutions in the United 
States and Europe. Target groups include those experiencing chronic physical 
pain, cancer patients, and those experiencing anxiety, depression, and burnout. 
The program has also been applied to non-clinical students, therapists, and 
prisoners (Atalay, 2021; Santamaria-Pelaez et al., 2021). 
The MBSR program is a group program that is created within an 
education-oriented, individual-centered and systematic plan, varying between 
10 and 40 participants, consisting of 2.5 hours each week and implemented for 
8 consecutive weeks. There is a 6-8 hour silence (retreat) day between the 6th 
and 7th weeks. Repeating all meditation practices applied throughout the 
program on this silence day contributes to the deepening of the understanding 
of mindfulness. MBSR includes a series of physical, spiritual and mental 
practices and homework. Audio recordings are given to participants to guide 
their routine meditation studies, and according to the program protocol, 
homework is done through yoga and meditation sessions that last 45 minutes a 
day, 6 days a week, and they are encouraged to do their daily activities with 
awareness (Atalay, 2021; Grossman et al., 2004; Santorelli, 2014; Srour and 
Keyes, 2024). People with active substance addiction, suicidal ideation, 
psychosis, post-stress trauma disorder, acute depression or major psychiatric 
disorders are not suitable for participation in the MBSR program. The practices 
applied in the program flow are divided into two as formal and informal. 
Formal practices include body scan, mindful movement (yoga), focusing on 

 
30 
breath, breathing and body exercises, sitting meditation, mindful walking, 
compassion meditation, pleasant and unpleasant moments calendar, and vision 
exercise. Informal practices include daily life activities such as mindful eating, 
mindful communication, mindful teeth brushing (Atalay, 2021; Bailey et al., 
2018). The aim of the practices is to enable the person to stay in the moment. 
When the person's attention is directed to any emotion or thought other than 
their breath, they are expected to accept all emotions and thoughts as they are, 
without judgment, with compassion, and direct their attention back to the 
breath (Atalay, 2021). 
 
Figure 1. Conscious Awareness-Based Education Scheme (Srour and 
Keyes, 2024). 
 
When the literature is examined, it is seen that MBSR is effective in 
behavioral regulation, especially for psychological problems such as stress, 
anxiety, and depression (Zarenejad et al. 2020, Güney et al. 2022), developing 
mindfulness and compassion (Huberty et al., 2019), relieving pain due to 
chronic diseases and improving health and preventing diseases in healthy 
individuals (Khoury et al., 2015; Khoo et al., 2019); relieving cancer-related 
fatigue and pain (Ngamkham et al., 2019; He et al., 2020), reducing depressive 
and sleep disorder symptoms by alleviating rumination and anxiety in patients 

 
31 
with breast cancer (Shao et al., 2021), reducing systolic and diastolic blood 
pressure in people with hypertension (Solano Lopez, 2018; Intarakamhang et 
al., 2018); It is reported to play an effective role in improving symptoms of 
irritable bowel syndrome (Gaylord et al., 2011), multiple sclerosis (Grossman 
et al., 2010), attention deficit and hyperactivity disorder (Zhang et al., 2018), 
cognitive disorder (Farhang et al., 2019), fibromyalgia (Schmidt et al., 2011), 
and eating disorders (Turgon et al., 2019). A meta-analysis examining the 
effect of MBSR on cortisol levels was found to have a beneficial effect on 
healthy adults (Sanada et al., 2016). The number of randomized controlled 
trials and meta-analyses revealing that MBSR provides significant and 
persistent reductions in generalized anxiety disorder symptoms has increased 
(Blanck et al., 2018; Kim et al., 2022). It indicates that it provides not only 
symptom reduction but also long-term improvement in areas such as emotional 
regulation, cognitive flexibility, self-compassion and general quality of life 
(Guendelman et al., 2017; Blanck et al., 2018). Many mechanisms have been 
proposed to explain the effect of mindfulness-based interventions on 
psychological disorders. The most important of these are emotional regulation, 
cognitive 
flexibility, acceptance, self-compassion and 
metacognitive 
awareness (Guendelman et al., 2017). It has been shown that the constant and 
repetitive anxiety cycle is broken with mindfulness practices, and the 
individual can continue his/her existence without identifying with them by 
observing negative automatic thoughts (Roemer and Orsillo, 2008). At the 
neurobiological level, mindfulness practices have been reported to reduce 
amygdala reactivity, increase prefrontal cortex activity and provide regulation 
in the level of stress hormones. In addition, functional brain imaging studies 
have shown that it leads to improvements in the ability to maintain attention, 
shift attention to different stimuli, and self-regulation skills (Hölzel et al., 2011; 
Hoge et al., 2013). 
2.4.2. Mindfulness Based Cognitive Therapy (MBCT) 
MBCT emerged from the study of cognitive processes that make 
depressed individuals vulnerable to relapses (Teasdale et al., 2000). It has been 
presented as the best method for preventing depression from recurring in the 

 
32 
National Institute for Health and Clinical Excellence (NICE), which is 
affiliated with the international health system in England and includes the best 
examples (NICE, 2009). MBCT integrates the elements of cognitive-
behavioral therapy for depression with the MBSR program. (Sipe & 
Eisendrath, 2012). MBCT teaches how to get out of the ruminative thinking 
(repetitive negative thoughts) pattern. It primarily does this by consciously 
focusing on body sensations, ensuring that we are not here and now, and 
shifting the source of our attention away from ruminative thoughts. It provides 
the ability to observe thoughts without identifying with them and to notice 
avoided experiences (Atalay, 2021; MacKenzie & Kocovski, 2016). Studies 
have concluded that MBCT is as effective as maintenance antidepressant 
medications in reducing the risk of recurrent major depression (Piet and 
Hougaard, 2011; Kuyken et al., 2015; McCartney et al., 2021). MBCT has been 
found to contribute to significant improvements not only in the recurrence of 
depression but also in secondary outcomes such as health anxiety (Surawy et 
al., 2015), insomnia (Heidenreich et al., 2006), reduction of anxiety and mood 
disorders, increase in quality of life and social functioning and a significant 
decrease in the relapse rate (Kim et al., 2022), self-compassion, and emotional 
regulation (Craigie et al., 2016). The NICE (2020) guideline also states that it 
would be more beneficial to prefer non-pharmacological approaches such as 
MBCT in the treatment of depression seen in the perinatal and postpartum 
period. However, studies have reported that these interventions not only reduce 
psychological problems in the perinatal and postpartum period, but also have 
positive effects on mother-baby health (Liu et al. 2022, Safi-Keykaleh et al. 
2022). 
MBSR and MBCT are mostly referred to as first generation 
mindfulness-based programs with evidence-based mindfulness practices 
(Crane et al., 2017). MBSR and MBCT are group intervention programs. 
MBCT consists of 75% MBSR and 25% Cognitive Behavioral Therapies. 
MBSR practitioners in the world are generally experts in meditation, yoga and 
spiritual practices that come from the practice. MBCT, on the other hand, 
consists of clinicians since it emerged in the mental health center affiliated with 

 
33 
Oxford University. MBCT is applied in more clinical contexts compared to 
MBRS. Although it is applied with all kinds of groups today, its main focus is 
on relapse of depression. MBSR, on the other hand, is used in wider 
applications and contexts. MBCT consists of 2-hour applications per week, 
while MBSR consists of 2.5-hour sessions. While MBSR can be applied to 
larger groups, it is recommended that MBCT consists of a maximum of 12 
people, especially in clinical applications. Since MBCT is applied in clinical 
settings and by clinicians, the psycho-educational process and theoretical 
information including cognitive processes and mechanisms in its content are 
more than MBSR. MBSR is more traditional and presented with applications, 
the theoretical part is more implicit (Atalay, 2021). 
2.4.3. Acceptance and Commitment Therapy (ACT) 
ACT is a psychotherapy model developed by Hayes, Strosahl, and 
Wilson in the late 1980s (Hayes et al., 2011). The aim of ACT is to increase 
the psychological flexibility of individuals by accepting negative emotions and 
thoughts without judgment, based on the concepts of conscious awareness and 
acceptance. ACT consists of processes such as acceptance, contact with the 
present moment, self, cognitive deficit, determined action, and values (Harris, 
2022; Kul & Türk, 2020; Yavuz, 2015). 
With ACT, unwanted emotions, thoughts, impulses and sensations are 
seen as guests and allowed to come and go. Being in touch with the moment 
and being conscious of the moment experienced is provided (Harris, 2022; 
Hayes et al., 2011; Kul and Türk, 2020). It allows individuals to determine their 
own value by choosing actions that are in line with their life values and to take 
action for this value. The person who takes action lives a more satisfying life 
when they achieve their goals (Harris, 2022). 
2.4.4. Mindful Self Compassion (MSC) 
Compassion is a term that refers to how to behave when suffering. Self-
compassion is the directing of compassion towards oneself when faced with a 
life challenge, feeling inadequate, or making a mistake. In this way, a person 

 
34 
can deal with failures in a gentle and understanding way, instead of harshly 
judging and criticizing oneself for various inadequacies or flaws ( Germer & 
Neff, 2019). 
MSC is a program developed by Kristin Neff and Christopher Germer 
in 2010 as a combination of mindfulness and compassion training, personal 
development training, and psychotherapy. Learning to be self-compassionate 
is a process of progress towards embracing one’s experiences and the person 
one is rather than trying to change oneself. The feelings of security and self-
worth provided by self-compassion are more stable; at the same time, self-
compassion plays a redemptive role in situations where one’s self-esteem has 
decreased. MSC aims to put aside self-criticism, which reduces the quality of 
life, and to teach one how to be kinder to oneself (Germer & Neff, 2019; Han 
& Kim, 2023). When the literature was examined, it was found that the MSC 
program was effective in reducing depression, anxiety, and stress (Luo et al., 
2023). 
2.4.5. Mindfulness Based Childbirth Education (MBCE) 
The MBCE program was developed by Fisher and colleagues in 2012 
as a program that combines two distinct areas of evidence-based practice, skill-
based education and mindfulness, to improve emotional functioning and well-
being in pregnancy, birth, and early parenting. Parent-centered pedagogy 
guided the development of workshop-style sessions rather than didactic 
presentations about pregnancy, birth, and early parenting information. MBCE 
actively engages pregnant women and their partners during education through 
group work, role-playing, and decision-making ( Fisher et al., 2012 ). 
The 8-week program, consisting of 2.5-hour weekly sessions, includes 
a workbook and homework CD to guide potential parents in their daily practice 
of mindfulness meditation (Hauck et al., 2016; Shorey et al., 2019). 
2.4.6. Mindfulness Based Childbirth and Parenting Program [MBCP] 
Pregnancy is a remarkably dynamic period of growth and development 
that can present significant physical and psychological life challenges for 

 
35 
pregnant women and their partners. There is variability in how people respond 
to the same situations, and individual interpretations or assessments of chronic 
or acute stressors can shape the physiological stress response. When the 
developmental challenges of the transition to parenthood are evaluated as 
stressful and are not met with effective coping, expectant parents have the 
potential to pose risks to their own health and well-being, as well as the health 
and well-being of their developing child (Duncan & Bardacke, 2010). Learning 
about coping with stress and other challenging emotions from pregnancy 
onwards, receiving prenatal education, and receiving support during and after 
birth supports the parenting experience (Öztürk & Aydın, 2018) and is an 
important factor in increasing prenatal attachment and reducing anxiety, 
depression, and worry. One of the birth preparation programs created for this 
purpose is the Mindfulness-Based Birth and Parenting Program (MBCP) 
(Fındık et al., 2025). 
in traditional birth preparation programs , is a guided and formal birth 
preparation program specific to the birth preparation and early parenting 
process developed by Nancy Bardacke in 1998 and adapted from the MBSR 
program, in order to contribute to both mothers and their partners experiencing 
this process in a more conscious, acceptance-oriented and compassionate way 
(Duncan & Bardacke, 2010). 
The aim of MBCP is to improve the health and well-being of families 
by enabling parents to cope with challenging and stressful situations through 
mindfulness meditation practices during pregnancy, birth, and the first weeks 
of parenthood and to support expectant parents in preparing for birth and 
parenthood through mindfulness practices. The aim is to increase mental 
flexibility, stress coping skills, and awareness of parenting in the birth 
preparation process (Duncan & Bardacke, 2010; Shorey, 2019). Childbirth 
education and parenting practices are intertwined with MBCP training (Van 
der Meulen et al., 2023). Existing research has shown that MBCP reduces 
perceived stress levels and depressive symptoms in pregnant women and 
expectant fathers; It has been concluded that it increases positive mood, 
mindfulness skills, self-compassion levels, self-efficacy for parenting and body 

 
36 
awareness (Duncan and Bardacke, 2010; Duncan and Shaddix, 2015; Lönnberg 
et al., 2020; Lönnberg et al., 2018; Pan et al., 2019; Sacristan-Martin et al., 
2019; Sarbandi, 2015). Mindfulness-based practices during pregnancy include 
protective skills that allow parents to better regulate their emotions during 
parenting and establish a secure relationship with their babies. MBCP practices 
applied starting from the pregnancy process are very important in improving 
the quality of parent-baby interaction in the postpartum period and positively 
affecting the child's development (Fernandes et al., 2022). 
MBCP is a group education program consisting of 9 sessions, each 
lasting approximately 2.5 hours. Eight sessions are administered during 
pregnancy, while the last session is held as a postpartum meeting after all 
women have given birth. A full-day silent mindfulness retreat, approximately 
7 hours, is also part of the program between weeks 6 and 7. Participants can 
begin MBCP at the end of the second trimester or the beginning of the third 
trimester. The recommended class size is 8–12 couples. Although the course is 
specifically designed for couples to attend together, pregnant women who are 
not partners or whose partners are unable to attend are also welcome to attend 
and may invite a support person if they wish. In addition to teaching 
mindfulness practice, a key element of the course is to foster a sense of 
community among parents in order to reduce the potential negative impact of 
social isolation on the mental health of new parents during the postpartum and 
early parenthood period. To this end, each class includes a 15-minute snack 
break to allow for relationship building among participants (Duncan & 
Bardacke, 2010). 
In each session, formal mindfulness meditation training is provided, 
including sitting meditation, body scan, mindful yoga, and loving-kindness 
meditation, all designed to pay attention to the mental and physical aspects of 
pregnancy. Throughout the program, couples learn to observe their mental and 
emotional processes by practicing mindfulness-based practices both 
individually and together (Duncan & Bardacke, 2010). During the training, 
parents are taught formal and informal practices and are provided with the 
opportunity to practice them. Formal practices are structured and focused on a 

 
37 
specific period of time. They focus on meditation and include exercises such 
as body scan, sitting meditation, mindful movement (mindful yoga), breathing 
meditation, and compassion meditation. Informal practices are designed to 
develop the ability to maintain awareness during daily life activities, such as 
mindful walking, mindful eating, mindful teeth brushing, mindful listening, 
and communicating. These applications enable the integration of formal 
practices into life (Cigolla and Brown, 2011; Duncan and Bardacke, 2010; 
Goyal et al. 2014). 
MBCP training consists of intertwined themes applied for 9 weeks. The 
first session includes getting to know each other, introducing awareness, 
sharing the training content, and mindfulness practices (breath awareness 
meditation, raisin meditation, being with the baby practice). The second session 
focuses on understanding labor, pain, fear, and hormones from a mind-body 
perspective, and mindfulness practices (body scan practice, breath awareness 
practice, being with the baby practice) are performed. The third session 
discusses methods for coping with pain, and mindfulness practices (body scan 
practice, pleasant events calendar) are performed. The fourth session covers the 
role of the spouse/partner during birth, pain management, and mindfulness 
practices (yoga practice, three-minute breathing break, unpleasant events 
calendar). The fifth session covers the needs of the newborn and new parents, 
secure attachment and baby development, and mindfulness practices (yoga 
practice, formal pain practice). The sixth session includes mindful 
communication and mindfulness practices (yoga practice, formal pain 
practice). A one-day silent meditation practice is applied between the sixth and 
seventh sessions. The seventh session included mindful breastfeeding, the 
effects of stress and anxiety on breastfeeding, and mindfulness practices 
(compassion meditation, yoga practice). The eighth session included reviewing 
the training, the importance of using mindfulness practices in the postpartum 
period, setting a reunion date, and ending the session with mindfulness 
practices (compassion meditation). The ninth session included meeting after 
birth and sharing birth and early parenting experiences and mindfulness 

 
38 
practices (endings and beginnings: last lesson) (Bardacke, 2017; Fındık et al., 
2025). 
Throughout the course, parents are asked to practice meditation at home 
with guided meditation audio recordings for 30-45 minutes a day, 6 days a 
week (Duncan & Shaddix, 2015). 
2.5. Conscious Awareness During Pregnancy 
2.5.1. MBCP Training and Birth Experience (Pain, Fear, Self-efficacy, 
Self-compassion, Awareness) 
Labor pain, a common but subjective experience, is a positive 
experience for some women, while for others it is the most painful and 
challenging event in their lives, causing much more intense pain than they 
expected (Boorman et al., 2014; Ngai and Xiao, 2021). Although labor pain is 
defined similarly to acute pain, it is different from acute pain (Madden et al., 
2016). Labor pain has visceral components related to uterine contractions and 
cervical dilation, and somatic components resulting from distension of the 
pelvic floor, perineum, and vagina, and fetal descent (Labor and Maguire, 
2008). The intensity of labor pain increases with increasing frequency and 
intensity of regular uterine contractions (Hu et al., 2021).  
Uncontrollable severe labor pain poses a risk for both the mother and 
the newborn. Labor pain can evoke sympathetic activity and neuroendocrinal 
stress response, the hypothalamic axis can be stimulated, and pathological 

 
39 
corticotropin-releasing hormone (CRH) secretion can lead to ineffective and 
maladaptive uterine contractions, leading to a more intense perception of pain. 
It can also prolong the duration of labor. These conditions can lead to a series 
of physiological conditions, including increased oxygen consumption, 
increased cardiac activity, hyperventilation, respiratory alkalosis, and 
metabolic acidosis (Ebirim et al., 2012; Koutras et al., 2021; Zagami et al., 
2015). This, in turn, causes dystocia and labor complications, increasing the 
risk of perinatal mortality (Martínez-Burnes et al., 2021). Prolonged labor is 
the primary indicator for instrumental delivery or emergency cesarean section 
(Issac et al., 2023) 
(Figure 2. Hormonal Effects of Stress on Birth. Mete, 2013). 
 
 
 
 
 
 
 
 
 
Beyond clinically indicated cesarean delivery, labor pain itself has 
become an important factor in women’s decision to have a cesarean delivery 
(Colomar et al., 2021). Reduced self-efficacy due to pain and fear leads to 
increased elective cesarean delivery (O’Connell et al., 2019) and complications 
such as maternal anesthesia complications, hematoma, infection, premature 
birth, low birth weight, respiratory distress in the newborn, delayed 
development of mother-infant bonding, and behavioral and neurological 
developmental delays in children may develop (Smith et al., 2019 ; Huizink et 
al., 2003; Nicholls and Ayers, 2007; Accortt et al., 2015; Grigoriadis et al., 
2018; Dencker et al., 2019; Faleschini et al., 2019; Grigoriadis et al., 2019; 
Nath et al., 2019). 

 
40 
Since labor pain is a process that cannot be fully controlled and 
predicted, it not only affects the physiological well-being of the mother and the 
newborn, but also has psychological effects such as fear of birth, anxiety, and 
post-traumatic stress disorder (Martínez-Burnes et al., 2021; Uçar and Gölbaşı, 
2019). Therefore, effective management of labor pain is very important for 
women's health. Women experience fear, anxiety and negative birth 
experiences due to frequent vaginal examinations, induced labour, instrumental 
delivery, emergency and unplanned cesarean delivery and inadequate support 
system during birth, lack of trust, fear of the unknown (especially first-time 
mothers), negative experiences in previous births, feeling of lack of control and 
inadequate information about birth ( Berhanu et al., 2022; Fenwick et al., 2015; 
Hosseini Tabaghdeehi et al., 2020; Imakawa et al., 2022).  Based on a 
systematic review conducted by Nilsson et al. (2018) that included 24 articles 
measuring fear of childbirth in nine countries in Europe, Australia, Canada, and 
the United States, the authors found prevalence rates of fear of childbirth to be 
between 6.3% and 14.8%. In Turkey, one study found that women had a fear 
of childbirth of 42.4% (Gökçe İşbir et al., 2024), while another study found that 
women had a fear of childbirth of 82.6% and their husbands had a fear of 
childbirth of 54.3% (Serçekuş et al., 2020). Since childbirth is a physiological, 
psychological, and social event, it is normal for rates to differ between 
countries (Huang et al., 2021). Despite the increasing fear of childbirth and the 
parallel increase in elective cesarean section rates, the World Health 
Organization has called for a reduction in non-emergency obstetric 
interventions (WHO, 2018). At the same time, high fear of childbirth also 
affects adaptation to pregnancy and mother-baby bonding (Golmakani et al., 
2021; Challacombe et al., 2021). 
High rates of fear of childbirth are reported to be due to labor pain. A 
prospective cohort study showed that women with higher fear of childbirth 
tended to experience more intense labor pain and were more likely to choose 
epidural analgesia and elective cesarean section (Haines et al., 2012). 
Additionally, cognitive factors such as fear, anxiety, and self-efficacy (e.g., 
belief in the ability to successfully manage labor pain) may influence women's 

 
41 
perception of labor pain (Asselmann et al., 2021; Whitburn et al., 2019). 
Transforming the cognitive functions of childbirth from a challenging and 
threatening event to a productive and satisfying experience may help women 
cope with the pain of childbirth (Whitburn et al., 2019). 
Women's ability to recognize their perception of labor pain appears to 
be a factor that can affect a positive pregnancy and birth experience (Hulsbosch 
et al., 2021 ; Oskoui et al., 2023). It has been reported that preparation with 
awareness from pregnancy to birth increases control during birth (Fisher et al., 
2012), awareness levels (Duncan, 2017; Pan et al., 2019) and self-efficacy 
(Byrne et al., 2014; Pan et al., 2019 ; Rasmusson, 2022). It has been 
hypothesized that increased mindfulness reduces fear of childbirth (Byrne et 
al., 2014; Veringa-Skiba et al., 2022) and acts as a protective buffer against 
negative perceptions of childbirth (Hulsbosch et al., 2021; (Lönnberg et al., 
2020). 
The implementation of mindfulness-based programs such as MBCP in 
the perinatal period is also recommended by the National Institute of Health 
and Clinical Excellence (NICE) guidelines (NICE, 2009). MBCP training 
increases self-confidence and reduces fear of birth, provides access to deep 
inner resources to cope with pain, improves communication, connection and 
collaboration between couples, and provides stress-reducing skills for greater 
joy and well-being (Mindfulbirthing, 2025). In this way, the person can have a 
positive birth experience by trusting their strength and ability to give birth 
together with their support systems (Karsltrom et al., 2015). Women who act 
with mindfulness can have a more positive birth experience (Hulsbosch et al., 
2021). 
Evidence has shown that mindfulness-based programs facilitate 
women's ability to overcome adverse situations by increasing awareness and 
improve perinatal mental health markers (Lönnberg et al., 2020; Oyarzabal et 
al., 2021). The potential benefits of these programs extend to the birth itself. 
Feelings of being overwhelmed by pain, fear of not being able to cope, or fear 
of losing control are commonly reported by women during labor. Conversely, 

 
42 
there are women who are able to manage their pain during labor without the 
need for analgesia. These women appear to have more positive experiences 
than those who are resistant to labor pain. These experiences describe the 
phrases “going with the flow,” “an emotionally transformative experience,” 
“being in the moment,” “being present,” “working with the pain,” and “pain is 
your friend instead of your enemy” (Walsh, 2007; Walsh, 2008; Walsh & 
Byrom, 2009; Leap, 2008). When the literature is examined, the MBCP 
program has been reported to have outcomes such as reducing the fear of 
anticipated birth, paying attention to present-day experiences during birth, 
increasing acceptance of labor pain, reducing non-emergency obstetric 
interventions , increasing psychological well-being levels, and higher birth 
satisfaction (Abdolalipour et al., 2023; Van der Meulen, 2023). At the same 
time, it was found that women increased their vaginal birth rates, experienced 
less labor pain, and therefore used less analgesic medication (Veringa-Skiba et 
al. 2021a, Oskoui et al. 2023). 
An important indicator of women's coping skills during labor and birth 
is childbirth self-efficacy. Therefore, increasing self-efficacy during childbirth 
is extremely important. Studies have shown that psychoeducational 
interventions such as MBCP statistically improve childbirth self-efficacy and 
alleviate pregnant women's fears about childbirth (Toohill et al., 2014; Duncan 
et al., 2017; Byrne et al., 2014; Tanke et al., 2025). Studies have found that 
mindfulness-based interventions applied to women in the perinatal and 
postnatal period increase the levels of mindfulness, self-compassion, and 
psychological well-being (Byrne et al., 2014; Pan et al. (2019), Duncan and 
Bardacke (2010) and Duncan et al. (2017) found that women's awareness and 
childbirth self-efficacy levels increased significantly as a result of MBCP 
training. It is known that childbirth preparation training, especially for first-
time mothers, increases birth success and maternal satisfaction (Gottfredsdottir 
et al., 2016; Wang et al., 2023).  Shorey et al (2019) systematically reviewed 
studies evaluating both the physiological and psychological effects of 
mindfulness interventions implemented in pregnancy education classes to 
improve maternal outcomes and found that the mindfulness intervention 

 
43 
implemented by nurses in pregnancy education classes had positive effects on 
maternal well-being. 
In a study of women who received MBCP training, significant 
improvements in mindfulness levels were seen, and this level of mindfulness 
continued to increase six weeks after the completion of the intervention 
(Beattie et al., 2017). Pan et al. (2019a), Zarenejad et al. (2020), Lönnberg et 
al. 2021, Veringa-Skiba et al. 2022b, Zhang et al. 2023b , Warriner et al., 2018 
and Guo et al. (2020) The study also supports the increased level of awareness. 
Negative emotions during pregnancy have a strong negative impact on the 
quality of life of pregnant women, while positive emotions and an optimistic 
attitude are associated with increased quality of life and self-compassion 
(Lagadec et al., 2018). In the study conducted by Hulsboch et al. (2023), it was 
found that the levels of conscious awareness and self-compassion increased 
significantly as a result of the training given to pregnant women with high 
symptoms of depression and pregnancy distress. 
Partners may also experience fears related to the effects of birth on their 
partner's well-being and their partner's death during childbirth (Hanson et al., 
2009). Mindfulness-based training increases the psychological and spiritual 
well-being of women and their partners and improves the birth experience 
(Shorey & Ng, 2020). A study found a significant difference in the mean 
mindfulness scores of fathers who received MBCP training before and after the 
training (Sian Warriner, 2018). 
 
2.5.2. MBCP Education and Delivery Method 
There is a need for policies and practices to be developed within the 
scope of the statement of the World Health Organization, which has been 
saying for almost 30 years that “there is no justification for the cesarean rate to 
be above 10-15% in any region”, and it is anticipated that studies to be 
conducted within this framework will contribute to the literature. Cesarean 
section constitutes more than 1 in 5 of all births worldwide (21%), and this 
number will continue to increase in the coming years, and approximately one-
third of all births (29%) will be by cesarean section by 2030 (WHO, 2021). The 

 
44 
total number of births recorded in Türkiye between 2018 and 2023 was 
6,161,976, and the cesarean rate was 57.55% (National Health Data, 2023). 
The cesarean rate determined per 1000 live births in Türkiye was reported as 
573, making it the country with the highest cesarean birth rate in Europe 
(OECD, 2023). The increasing fear of childbirth worldwide (Nilsson et al., 
2018) may be a contributing factor to the increasing cesarean requests globally 
(Olieman et al., 2017; Smith et al., 2019; Vogel et al.,2015). Induction of labor, 
emergency cesarean, elective cesarean, and instrumental delivery are more 
common in women with severe fear of childbirth (Mortazavi and Agah, 2018). 
There are two opposing behavioral responses to fear of childbirth: 
avoidance and approach (Veringa et al., 2016). An example of avoidance, 
which is a maladaptive and harmful behavior, is when women request a 
cesarean section due to fear of childbirth. This behavioral response is strongly 
supported by empirical findings showing that women with high fear of 
childbirth are more likely to request interventions such as cesarean section or 
epidural anesthesia (Dencker et al., 2019; Badaoui et al., 2019). They also hold 
myths about labor pain (Rondung et al., 2019; Kwissa-Gajewska and 
Dołęgowska, 2017) and focus on potentially threatening aspects of childbirth 
(Kwissa-Gajewska and Dołęgowska, 2017; Veringa et al., 2011). On the other 
hand, balanced emotions, realistic beliefs, increased awareness, and 
approaching birth difficulties with positive emotions lead to more adaptive 
behaviors for natural birth to occur (Veringa et al., 2016).  
Women’s perceived low self-efficacy, or their confidence in their 
ability to handle certain situations, is another important reason for wanting to 
have a cesarean delivery (Soltani et al., 2017). While people with high self-
efficacy fantasize about success, those with low self-efficacy visualize failure 
and focus on what could go wrong (Bandura, 1997). Given the difficulties of 
childbirth for women, MBCP training is particularly helpful in approaching 
rather than avoiding the challenges of natural birth (Veringa et al., 2011). In 
studies of MBCP applied to pregnant women with high levels of fear of 
childbirth, it was found that women in the intervention group had a better birth 
experience (Van der Meulen et al., 2023; Hassanzadeh et al., 2021; Hong et al., 

 
45 
2021), increased vaginal birth rates (Veringa-Skiba et al., 2022a, Veringa-
Skiba et al., 2022b; Guo and Lei, 2022; Zhang et al., 2023; Hassanzadeh et al., 
2021; Hong et al., 2021), had less labor pain and therefore less analgesic use 
(Veringa -Skiba et al. , 2022a; Hassanzadeh et al., 2021; Hong et al., 2021), 
and gave birth with less medical intervention. (Veringa-Skiba et al., 2022). The 
results of these studies suggest that awareness interventions can be effective in 
increasing natural birth rates. The World Health Organization (2018) has also 
emphasized the need for non-clinical interventions to reduce cesarean sections. 
2.5.3. MBCP Education and Maternal/Paternal Attachment 
Parental love and care are fundamental to optimal child development. 
Maternal health, behavior, and well-being during pregnancy shape fetal growth 
and provide a foundation for the child’s lifelong physical, social, and emotional 
development (Berg, 2016; Armstrong-Carter, 2020). By implementing 
strategies (redirecting attention, providing reassurance during distress), a 
caring parent develops their infant’s capacity to understand and self-regulate 
emotions, adjust their behavior, be empathetic, and establish and maintain 
relationships with others (Rutherford et al., 2015; Behrendt et al., 2019). 
Nurturing compassionate feelings and thoughts toward the infant supports the 
child through healthy prenatal behavior (Lindgren, 2001) and positive 
parenting after birth (Medina et al., 2021). 
Attachment describes the emotional bond between parent and child. It 
is the first relationship in which a newborn baby develops a sense of trust 
(Lang, 2018). The first study in history on attachment experiences that are 
passed down from generation to generation through narrative was conducted 
by Bolby (Bowlby, 1969). Mary Ainsworth stated that in order for newborns 
and young children to be able to maintain healthy interactions and relationships 
with the external environment in an unfamiliar environment and to be ready for 
this, they must first establish a bond of trust with their families and be sure of 
this trust relationship (Ainsworth, 1979). 
Attachment is not a situation in itself but a process. In this process, 
parents are affected by their own upbringing styles as well as their experiences 
during pregnancy, birth, puerperium and the first months of infancy. In a 

 
46 
biological sense, the bond between parents and their children is the most 
important and strongest bond in a person's life. The strength of the attachment 
depends on the newborn's lack of ability to meet their own needs. The bond 
between the parent and child becomes so strong that it allows them to fulfill all 
the sacrifices required for child care (Lang, 2018). A successful parent-child 
relationship affects the child's social, emotional and cognitive development in 
later life, which in turn affects the child's relationship with their own child. The 
way the newborn is cared for and raised will determine how they will care for 
their own child in the future (Murray, 1993 ; Stanley et al., 2004). 
The body protects the mother and baby from great pain by secreting its 
own opiates and endorphins during birth and prepares the ground for bonding. 
Thus, good birth support develops in coping with pain during birth and assumes 
a key role in bonding (Lang, 2018). The highest beta-endorphin level is reached 
after vaginal birth without analgesic intake (Vogl et al., 2006). If analgesics are 
given during birth, the body's own endorphin secretion is suppressed and the 
secretion of hormones necessary for bonding by the mother and baby is 
prevented. Effective contractions cannot occur and serotonin and noradrenaline 
are suppressed, increasing the level of pain perception. In epidural anesthesia 
applications where labor contraction pain is absent, oxytocin release in the 
blood is low. The low number of oxytocin receptors, which is the bonding 
hormone, also prevents mother-baby bonding (Lang, 2018). Studies have also 
found high oxytocin levels in fathers in the postpartum period. This supports 
the father's bonding with the baby (Lang, 2018; Bowen and Miller, 1980). 
Changes begin to occur in the hormonal balance of men due to living with their 
partners during pregnancy. It is believed that body odors, also called 
pheromones, emitted by pregnant women are responsible for this situation. It 
has been proven that prolactin, cortisol and estrogen levels increase in the 
salivary secretions of fathers in the pre- and post-natal period. All three 
hormones support maternal care and bonding. For this reason, testosterone 
levels of fathers were found to be significantly lower in the first weeks after 
birth (Lang, 2018; Hüter, Krens, 2005). Fathers who attended the training 
together with mothers felt more confident and secure about baby care after 

 
47 
birth. They participated more actively in the care and upbringing of the child, 
played more with their children, exercised more control and made learning 
suggestions to their children with more emotional attention (Wöckel et al., 
2007). 
Neurobiologists, behaviorists, psychologists and stress researchers 
draw attention to the results of their studies that mental development begins in 
fetal life. The fetus can respond to stimuli given through the abdomen during 
pregnancy. Many fathers state that the fetus slides under their hands when they 
touch the mother's abdomen. Babies can perceive the voices of their mothers 
and fathers before they come into the outside world. The fetus has the ability 
to learn before it is born and its brain development continues in parallel with 
its experiences (Lang, 2018). The fetus also has the ability to be emotional. 
Thanks to maternal fetal circulation, it is affected by the mother's stress 
hormones as well as the release of oxytocin and endorphins. In other words, it 
can learn different emotions by being affected by the mother's emotional state. 
When a woman experiences and copes with all human emotions during 
pregnancy, she teaches this to the baby in her womb and enables it to gain 
emotional competence (Deyringer, 2008; Lang, 2018). 
Attending childbirth preparation courses is a good start to establishing 
a relationship with the newborn. Couples are preparing for the unborn baby, 
the birth and the first days they will spend with the baby after birth. Even 
experiencing this situation encourages bonding. In childbirth preparation 
courses, health professionals can provide bonding by having families do 
practices such as guiding journeys to feel their babies. For example; “Can you 
feel your baby under your hands? Is he/she moving or sleeping right now? Now 
imagine the inside of your belly, this is your baby’s house right now. Now go 
to your baby in your thoughts and tell him/her: when the time comes and you 
want to be born, I will help you, I will open myself and push you out of me.” 
In this way, parents can be directed to talk to their unborn babies regularly. At 
the same time, childbirth preparation courses provide an opportunity for 
expectant mothers and fathers to share information and experiences in terms of 
different interactions and seeing that similar fears and anxieties are actually 

 
48 
normal and that many families experience this. In studies, parents who came to 
childbirth preparation classes were given certain practices to establish contact 
with their babies, and after the practices, these mothers showed signs of 
attachment such as a significantly better prenatal relationship with their babies, 
being able to better recognize their babies' needs after birth, enjoying 
breastfeeding and cuddling their babies, and talking to their babies more after 
birth (Bellieni et al., 2007; Eckstrom and Nissen, 2006). 
Becoming a parent adds new roles and responsibilities to an individual's 
life. While most people see parenthood as a meaningful part of life, some 
experience parenthood as a stressful and difficult period (Martincs, 2019). 
Mindfulness teaches individuals to regulate their emotions during the parenting 
process, to accept the roles and responsibilities of parenting with a non-
judgmental attitude, and to use mechanisms to cope with the stress of parenting 
(Corthorn & Milicic, 2016), and it also allows the individual to show 
compassion to themselves and their child (Duncan, Coatsworth, Greenberg, 
2009). Pregnancy is seen as a period of psychological and emotional 
preparation for parenthood (Van Vreeswijk, Broersen, Schurink, 2014). 
Prenatal attachment, which begins during this period, affects the formation of 
parents' attachment and attachment styles in the postpartum period (Hicks et 
al., 2018; Fernandes et al., 2022; Gioia et al., 2023; Howland et al., 2020). 
Children of mothers who reported quality attachment during pregnancy and up 
to 12 months after birth had an easier temperament (Davies et al., 2021; Capelli 
et al., 2023) are reported to be less angry and more cooperative (McDonal et 
al., 2022), and not socially shy children (Le Bas et al., 2022). 
MBCP training may be potentially effective in improving parent-child 
attachment for pregnant women and their partners (Duncan and Bardacke, 
2010; Veringa et al., 2014; Duncan and Shaddix, 2015; Lonnberg, 2018; 
Teskereci et al., 2021; Sansone et al., 2024). MBCP training may facilitate 
healthy parent-child attachment by promoting present-focused, non-
judgmental mindfulness and compassion, allowing parents to accept 
challenging pregnancy-related symptoms or life experiences without judgment 
and attributing them to the unborn child (Duncan and Shaddix, 2015). Studies 

 
49 
have suggested that participation in a prenatal MBCP program may help 
pregnant women develop a positive and meaningful relationship with their 
babies (Beattie et al., 2017; Körükcü and Kukulu, 2017; Kantrowitz-Gordon et 
al., 2018). Additionally, two qualitative studies (Duncan and Bardacke, 2010; 
Lonnberg et al., 2018) and a study protocol (Veringa et al., 2016) suggested 
evaluating the effects of MBCP training on maternal attachment. A qualitative 
study reported that participation in an antenatal MBCP program may contribute 
to women's acceptance of maternal emotions as an effective strategy to cope 
with stressful situations (Roy Malis et al., 2017) and significant improvements 
in maternal sensitivity were observed (Potharst et al., 2017). 
Negative repetitive thoughts due to high levels of anxiety and fear can 
negatively affect parents' feelings towards the fetus. (Schmidt, 2017; Özcan et 
al., 2019 ; Özdemir et al., 2020 ; O'Dea et al., 2023; Jacka et al. 2013, Liu et al. 
2022b). Parent-infant bonding begins during pregnancy ( de Waal et al., 2024; 
Le Bas, 2021; Tichelman et al., 2019) and that maternal awareness developed 
through education during pregnancy can promote more positive feelings 
towards the fetus and promote prenatal and postnatal mother-infant bonding. 
Evidence is provided that ( de Waal et al., 2024; McDonald et al., 2022; Brassel 
et al., 2020; Gheibi et al., 2020; Shreffler et al., 2019; Golmakani et al., 2021 ; 
Öztürk and Erci, 2016 ). At the same time, families with high levels of parent-
infant attachment reported fewer social and emotional problems in their 
children in later periods ( de Waal et al., 2024) . The level of mindfulness that 
developed during pregnancy has been associated with better maternal mental 
health (Hulsbosch et al., 2022) and better attachment quality in the 3-18 months 
after birth (McDonald et al., 2022; Brassel et al., 2020). In the study by Fındık 
et al. (2025), it was observed that MBCP significantly increased prenatal 
attachment compared to routine prenatal education. In the literature, many 
sources emphasize that birth and parent-focused awareness programs can 
support maternal-fetal attachment (Duncan and Bardacke, 2010; Duncan and 
Shaddix, 2015; Lönnberg et al., 2018; Veringa et al., 2016). However , apart 
from the study by Fındık et al. (2025), only one study was found examining the 
claim regarding the effect of MBCP on attachment. This study, similar to the 

 
50 
study by Fındık et al. (2025), showed that maternal-fetal attachment increased 
significantly after the intervention in women who participated in the MBCP 
program compared to women who received routine prenatal care (Gheibi et al., 
2020). MBCP appears to have a positive effect on maternal-fetal attachment. 
However, more evidence is needed on this subject. 
As parents experience birth differently, it is important to consider 
fathers’ experiences (Belanger-Lévesque et al., 2017). Fathers have been 
increasingly present at the birth of their babies since 1990 (Draper, 1997; 
Johansson et al., 2012a; Plantin, 2007). Being present at birth has been 
associated with more emotionally connected, mature fatherhood and has been 
described as beneficial to the health of fathers, their partners and their children 
(Johansson et al., 2012a; Plantin, 2007). Fathers play a key role in pregnancy 
and birth, and this role can strengthen the couple’s relationship and facilitate 
bonding with the baby (Zhang et al., 2020; Calister, 1995; Johansson et al., 
2012a). Fathers’ involvement in children’s lives is associated with a variety of 
outcomes, including improved cognitive function and mental health (Allport 
BS 2018). First-time fathers appear to need more information about the birth 
process, including a tour of the delivery room, compared to those who have 
had children before (Eggermont et al., 2017). First-time fathers experience a 
variety of emotions, including anxiety, due to the unknown they will 
experience (Labrague et al., 2013). 
Mindfulness interventions can be offered to parents to strengthen the 
parent-infant bond and improve infant outcomes after birth ( de Waal et al., 
2024). Therefore, learning about coping with stress and other challenging 
emotions from pregnancy onwards, receiving education, and receiving support 
during and after birth are important in supporting the parenting experience ( 
Öztürk & Aydın, 2018 ). These mindfulness practices can continue as a life 
skill in parenting and may benefit parental emotion regulation and the parent-
infant relationship (Duncan & Bardacke, 2010). 
2.5.4. MBCP Training and Postpartum Adjustment 
The postpartum period is an important developmental transition period in 
which physical, social and emotional changes occur in the family. During this process, 

 
51 
the mother and father need to prepare and adapt to new roles and responsibilities due 
to the addition of a new member to the family. In the postpartum (PP) period, the father 
and mother need to adapt to the physiological and psychological changes they 
experience, the role of motherhood, accept their baby and gain the necessary 
knowledge and skills to care for themselves and their baby when they go home. During 
this period, it is important to determine the needs of the mother and the baby and to 
provide care, education and consultancy services in line with these needs (Taşkın, 
book; Vural and Akan, 1995). In the postpartum period, women try to cope with 
postpartum discomfort and changes in body image, and get used to the fact that the 
pregnancy has ended. This period is also the period of transitioning to a family with 
children and adapting to being a mother (London et al., 2003). In the postpartum 
period, women experience the process of attachment to the role of motherhood, which 
is a developmental and interactive process. During this process, the new mother learns 
motherhood behaviors and accepts her identity as a mother (Mercer, 2006). Lederman 
and Lederman (2009) determined that the woman's preparation for the role affects 
postpartum adjustment and satisfaction with the role of motherhood. In a different 
study, it was found that women with high prenatal adjustment also have high 
postpartum adjustment. Women with high adjustment are more prepared for birth, 
have more control in their birth experiences, have better spousal relationships, and 
their husbands are more likely to participate in baby care. The study also found that 
women who took on the role of motherhood better during pregnancy had higher self-
confidence in coping with maternal duties in the postpartum period, higher satisfaction 
with life, and higher satisfaction with the role of motherhood (Kiehl & White, 2003). 
Similarly, Shin, Joo-Park, and Kim (2006) found that mothers who had a stronger bond 
with their babies during pregnancy had an easier time accepting their maternal identity 
in the postpartum period. 
Pregnancy, birth, and motherhood are challenging processes that 
require adaptive responses to maintain the mother's mental health, establish a 
relationship with the baby, and adapt to a new role (McLeish and Redshaw, 
2017). According to Mercer (2004), maternal role adaptation is characterized 
by "an event in which the mother bonds with the baby and feels harmony, self-
confidence, competence, pleasure, and satisfaction from performing tasks 

 
52 
related to child care and the establishment of a maternal identity." The first year 
after birth is the most challenging period in the process of adapting to the 
maternal role, especially for new mothers (Slomian et al., 2017), and it is during 
this period that a woman begins to connect the maternal role to her personality 
(Asadi et al., 2021). 
The maternal role is influenced by many factors, including variables 
related to the mother, child, and social environment. The mother's problems in 
balancing her roles as a wife, mother, and employee are related to a general 
sense of inadequacy, and role conflict is the most important predictor of 
maternal role acquisition in this context (Ahmadpour et al., 2022). Given the 
close relationship between a child's physical and psychological health and the 
mother's health, improving the mother's mental health can play an effective role 
in protecting the health of the family and society (Frosch et al., 2021). Mothers 
who cannot adapt appropriately to their roles will have reduced maternal 
function, especially in terms of their attachment to the child, and thus increase 
the risk of exposing the child to developmental delays (Khandan et al., 2018). 
Since infant development is sensitive to the quality of mother-infant 
interaction, infancy (0-12 months) is a good time for healthcare providers to 
assess and improve maternal role adaptation (Rayce et al., 2017). The 
implementation of interactive and reciprocal interventions by health care 
professionals is one of the most important ways to promote maternal role 
acquisition (WHO, 2020). 
Parent education programs have been shown to have positive effects on 
the development of secure attachment, the development of reflective 
functioning of parents in infancy and childhood, and the psychosocial well-
being and empowerment of parents in terms of the co-parenting relationship 
(Izett et al., 2021). Some studies have provided evidence for the effect of using 
methods such as self-efficacy and self-confidence-enhancing strategies on 
improving maternal role adaptation (Azmoude et al., 2014 , Fasanghari et al., 
2019 ). 
It is widely accepted that adapting to any new role, including the 
transition to parenthood, is often accompanied by stress, and this stress can lead 

 
53 
to certain difficulties in adapting to new roles ( Izett et al., 2021 ; Kim, 2021 ). 
Previous studies have reported that trainings such as MBCP have beneficial 
effects in reducing anxiety and stress and supporting psychological well-being 
in mothers during pregnancy, childbirth, and the postpartum period in clinical 
settings ( Shi and MacBeth, 2017 ). In addition to supporting maternal mental 
health, increasing mindfulness can improve social and psychological 
development and facilitate adaptation. Increased mindfulness has been found 
to increase self-confidence and self-esteem in breastfeeding mothers ( Perez-
Blasco et al., 2013 ), improve mothers' mental health, and have a positive effect 
on reducing problems related to mother-infant adaptation ( Potharst et al., 2017 
). In another study on MBCP training, a significantly higher increase in the 
awareness scores of the mothers in the intervention group during the follow-up 
period was observed, indicating that the application of MBCP training had a 
positive effect to support this process (Sajadian et al., 2022). 
Mindfulness is also associated with improved parental satisfaction with 
their new roles as parents ( Duncan & Bardacke, 2010). Increased conscious 
awareness leads to a better parent-child relationship (Orue et al., 2020). 
Mindfulness practices can support the adjustment process in the postpartum 
period and adaptation to new parenting roles. These practices help parents cope 
with the challenges they face after birth and allow them to easily adapt to 
increased responsibilities (Dimidjian et al., 2016). 
2.6. WOMEN'S HEALTH NURSING AND CONSCIOUS AWARENESS 
Mindfulness is a new concept emerging in the health care and research 
communities that has shown significant value for holistic health promotion, but 
is relatively underdeveloped in nursing. The concept of mindfulness has similar 
theoretical perspectives to holistic nursing practice and needs conceptual 
clarification for further development in the discipline. The concept of 
mindfulness encompasses a complex set of interconnected attributes: It is a 
transformative process in which a person increasingly experiences awareness, 
acceptance, and mindfulness. Mindfulness can support improved physical, 
emotional, psychosocial, and spiritual well-being and can help translate holistic 
health promotion from theory to practice. Integrating mindfulness into 

 
54 
education and practice can enhance therapeutic nursing skills and support the 
transition from a purely theoretical form of knowledge acquisition to a more 
concrete and holistic knowledge . Through access to education, nurses can gain 
personal experience of being mindful and applying mindfulness, and thus have 
the tools to promote holistic health practice in a variety of clinical settings and 
healthcare communities. As an emerging concept in nursing, mindfulness has 
great potential to support practitioners and, by extension, the healthcare 
communities they serve. However, rigorous methodological research designs 
are needed to ground this concept in nursing practice. There are important gaps 
and directions that nursing can explore to contribute to the science of 
mindfulness (White, 2014). 
It is known that conscious awareness interventions provide 
improvements in the emotional and social well-being of healthcare 
professionals and increase the quality of healthcare (Conversano et al., 2020; 
Kriakous et al., 2021), and it is noteworthy that they are also being 
implemented in the field of women's health (Aghamohammadi et al., 2022; 
Kuo et al., 2022; Van der Meulen et al., 2023). 
The use of mindfulness-based interventions is increasing day by day 
and its clinical benefits are proven by studies. In the light of current data, high-
level evidence-based studies have been found that show that mindfulness-based 
interventions are an effective method that women can use to combat stressors 
in every period of their lives. In the light of these studies, it can be said that the 
method can be used in women not only to reduce stress but also as an effective 
method with physiological benefits. It is recommended to increase basic-level 
mindfulness training for nurses, to include mindfulness-based interventions in 
care, to develop intervention programs for problems specific to women's life 
periods by providing the necessary collaborations, and to evaluate their results 
(Bilgiç and Can Gürkan, 2021). 
In order to better understand these effects of MBCP, multicenter, larger 
sample and repetitive studies on the subject are recommended to establish the 
evidence base. In addition, studies are recommended to evaluate maternal 

 
55 
mood and mother-infant bonding in the postpartum period and their impact on 
child development. A large number of factors that may affect this area can be 
included in future studies. For example, studies that evaluate the impact of 
paternal mood and couple relationships on maternal mental health, mother-
infant bonding, and even child development and health economic assessments 
will contribute to a more comprehensive understanding of the subject. 
Nieminen and colleagues (2017) compared the healthcare use and costs 
of 43 women with severe fear of childbirth with those of 107 women with 
severe fear of miscarriage. They found that, on average, women with severe 
fear of childbirth used more healthcare resources and had higher societal costs. 
More specifically, postpartum costs, including longer delivery room stays and 
sick leave costs, were higher, suggesting that societal costs could be reduced if 
severe fear of childbirth could be effectively managed. 
Women's health nurses fulfill their role of education and counseling by 
being with the pregnant women and their partners during the pre-pregnancy, 
pregnancy and post-pregnancy processes and reflecting the most up-to-date 
evidence in their care (Erickson et al., 2017). 
Birth is a physiological event, but it is also related to managing pain, 
happiness, and expectations regarding birth. This can sometimes lead to 
women being alone during the process (Dereje et al., 2023). At this point, 
women need care services that allow them to share their feelings and express 
their expectations (Wigert et al., 2020). Negative birth experiences should be 
addressed by increasing women's awareness, identifying negative experiences 
in prenatal care, and providing the necessary prenatal care (Massae et al., 
2021). 
in maternal and infant health, take action with evidence-based practices 
to reduce fear of childbirth, encourage natural birth, and improve negative pre-
pregnancy, pregnancy, and post-pregnancy outcomes caused by fear (Souto et 
al., 2022). Considering the increasing rates of elective cesarean sections in 
developed countries, interventions for fear of childbirth have become more 
important. The negative effects of cesarean section on both maternal and infant 

 
56 
health and the damage it causes to the health system due to increased costs are 
clear (Weaver et al., 2012). For all these reasons, the inclusion of awareness-
based interventions such as MBCP in childbirth preparation class education 
programs not only aims to reduce the increasing cesarean section rates, but also 
aims to provide awareness that women and their partners can benefit from not 
only during pregnancy, birth, and parenthood, but throughout their lives. 
 
 
 
 
 
 
 
 
 
 
 
3. MATERIALS AND METHODS 
3.1. Research Design 
In this research The experimental design of the quantitative research 
method was used. Quantitative research is a research that involves the process 
of observing and measuring numerical values objectively and systematically in 
order to obtain information about the current situation and facts, and the 
measurements can be repeated (Burns and Grove, 1993). Quantitative research 
focuses on the relationships and differences between variables, makes 
predictions about the future and has the aim of generalization (Başol, 2008). In 

 
57 
quantitative research based on the positivism approach, hypotheses are clearly 
determined and tested (Fraenkel and Wallen, 2006). 
Since the study examined the effects of awareness-based parenting and 
childbirth preparation training given in the childbirth preparation class on 
maternal-paternal attachment, birth parameters and postpartum sleep of a 
sample group that had the power to represent the universe, an experimental 
design with a pre-test and post-test control group was used in this study 
(Büyüköztürk, 2007). 
3.2. Universe and Sample of the Research 
The universe of the study consisted of pregnant women who applied to 
the Pregnancy School and Pregnancy Polyclinic of Kayseri City Education and 
Research Hospital between June 1 and September 1, 2023. The number of 
pregnant women who attended the Pregnancy School in these three months was 
approximately 130, and the number of pregnant women who applied to the 
Pregnancy Polyclinic was 900. In determining the number of pregnant women 
to be included in the sample of the study, in the study of Duncan and Bardacke 
(2010), the mean difference of pre and post Mindfulness values (0.30) was 
taken as basis, and 95% confidence (1-α), 95% test power (1-β) and d=1.111 
effect size were calculated with the Gpower program and as a result of the 
paired samples t test, it was found that a total of 13 couples should be included 
in the study (Figure 1). It was anticipated that there may be data losses in the 
study and at least 15% more couples should be included. Therefore, 26 couples 
will be included in the study. In the study, couples were assigned to two groups 
using a web-based randomization program ( https://www.randomizer.org ) 
according to the following randomization list (Figure 2). The first 13 
assignments in the randomization list constitute the intervention group 
participants, and the last 13 assignments constitute the control group 
participants. The sample group consists of 26 couples who were selected 
between June 1 and September 1, 2024 , met the inclusion criteria, and accepted 

 
58 
the study . The trainings were provided between September 2024 and 
November 2024. 
Figure 1. Number of samples calculated with G*Power program 
 
 
 
 
 
 
 
 
 
 
 
 

 
59 
Figure 2. Randomization list of groups 
 
3.3. Location and Characteristics of the Research 
The study was conducted in the Pregnancy School and Pregnancy 
Polyclinic of Kayseri City Education and Research Hospital. There is one 
pregnancy school and 10 pregnancy polyclinics in Kayseri City Hospital. The 
pregnancy polyclinics and pregnancy school provide service in the Gynecology 
and Obstetrics building. The polyclinics are on the ground floor of the 
Gynecology and Obstetrics building, and the pregnancy school provides 
service on the third floor. There is a doctor and a secretary in each pregnancy 
polyclinic. Each pregnancy polyclinic provides service to an average of 60 
pregnant women per day. Two midwives provide training in rotation in the 
pregnancy school. Pregnant women who are 24 weeks pregnant and over can 
attend the pregnancy school. Training is provided at different hours for 
pregnant women who are hospitalized and pregnant women who come from 
outside. Training is provided in the morning for pregnant women who are 
hospitalized, and in the afternoon for pregnant women who come from outside. 
Training lasts 1 week, 5 days a week and 3 hours per day for a group. 
Kayseri City Training and Research Hospital Pregnant School Education Plan: 
Monday: Education is given about introductions and expectations, the 
pregnancy process, the physiology of pregnancy, the formation of pregnancy, 
fetal development, physiological and psychological changes that occur during 
pregnancy, daily life during pregnancy and individual preparations during 
pregnancy, followed by practical breathing exercise training. 
Tuesday: Education is given about perception of birth, normal labor, signs of 
birth, massage methods, breathing exercises, skin-to-skin contact and safe 
birth, followed by practical breathing exercise training. 
Wednesday: Training is given on the postpartum period, breast milk and 
breastfeeding techniques, newborn care, family planning methods, followed by 
practical breathing exercise training. 

 
60 
Thursday: Affirmations, focusing on positive birth, subconscious work, and 
sleep meditation are done. 
Friday: Pregnancy Pilates is done. Pregnant women who have received at least 
three sessions of training at the pregnancy school can participate in the pilates 
practice. 
Those with risky pregnancies and those with systematic and chronic diseases 
cannot participate in pregnancy pilates. 
3.4. Variables of the Research 
Independent Variables: Sociodemographic characteristics (age, education 
level, occupation, economic status, etc.), pregnancy-related characteristics 
(gestational week, birth method preference, etc.) 
Dependent Variables: Maternal-paternal bonding, birth parameters and 
postpartum adjustment scores 
Intervention variable: Mindfulness-Based Parenting and Childbirth Preparation 
Education 
3.5. Inclusion and Exclusion Criteria for the Study 
Research Inclusion Criteria 
 Those who are in the 18-35 age group, 
 First pregnancy, 
 In the 24-28th week of pregnancy, 
 Those accepted to the Pregnancy School training during the research 
period, 
 At least literate education level and 
 People without communication barriers were included in the study. 
Exclusion Criteria from the Study 
 Those with psychiatric disorders, 
 Pregnant women with pregnancy-related risk factors that may lead to 
premature birth, 

 
61 
 Pregnant women with chronic diseases that could lead to a risk of 
premature birth were not included in the study. 
3.6. Data Collection Tools 
In the prenatal period ; Parent Introduction Form, Conscious Awareness Scale 
(Özyeşil et al., 2011), Prenatal Attachment Scale (Türkmen Çevik & Kurnaz, 
2018), Prenatal Father Attachment Scale (Benli & Aksoy Derya, 2019), 
Fathers' Fear of Childbirth Scale (Calpbinici et al., 2023) and Wijma Childbirth 
Expectation/Experience Scale A Version (Körükcü et al., 2009) were used. 
In the postpartum period ; Wijma Birth Expectation/Experience Scale Version 
B (Körükcü et al., 2014), Postpartum Self-Assessment Scale (Taşçı & Mete, 
2010), Father-Infant Attachment Scale (Güleç & Kavlak, 2013) and Maternal 
Attachment Scale (Kavlak & Şirin, 2009) were used. 
3.6.1. Parental Identification Form (ETF) 
The ETF, created by the researcher, is a data collection tool consisting 
of 16 questions to examine the obstetric history, pregnancy and birth 
preferences and sociodemographic characteristics of pregnant women and the 
sociodemographic characteristics of fathers (Appendix-1). 
3.6.2. Conscious Awareness Scale (CAS) 
The English version of the “Mindful Attention Awareness Scale 
(MAAS)” was developed by Brown and Ryan (2003) and its Turkish 
adaptation was made by Özyeşil et al. (2011). The aim of the scale is to evaluate 
individual differences in individuals' states of being conscious in their daily 
experiences, the frequency of being conscious, and the awareness and attention 
in the current moment. Mindful awareness includes current experiences and 
measures the tendency to be aware of these experiences (Özyeşil et al., 2011). 
It has a 6-point Likert scale (“1=almost always”, “2=most of the time”, 
“3=sometimes”, “4=rarely”, “5=fairly rarely”, “6=almost never”). The scale 
consists of 15 items. There is no reverse item in the scale. The lowest score that 
can be obtained from the scale is 15, and the highest score is 90. A high score 

 
62 
indicates a high level of conscious awareness. The Cronbach Alpha internal 
consistency coefficient of the scale is 0.80 (Özyeşil et al., 2011) (Appendix-2). 
3.6.3. Prenatal Attachment Scale (PAS) 
PBÖ, a scale designed by Türkmen Çevik and Kurnaz (2018) to 
measure the level of attachment of pregnant women to their unborn babies, 
consists of 33 items. The scale items are graded in threes and each item is 
answered as I definitely agree (3), I partially agree (2), I definitely disagree (1). 
There is no reverse statement in the scale. The lowest score that can be obtained 
from the scale is 33, and the highest score is 99. A high score obtained from 
the scale indicates a high level of prenatal attachment. The scores that can be 
obtained from the curiosity and excitement factor vary between 13-39; from 
the acceptance and enthusiasm factor between 9-27 and from the hope factor 
between 11-33. The total internal consistency coefficient of the scale was 
calculated as 0.94 and it was determined that the scale is a reliable and valid 
tool for measuring the level of attachment of pregnant women to their babies 
(Appendix-3). 
3.6.4. Prenatal Father Attachment Scale (PPA) 
The scale, developed by John Condon (1993) and adapted into Turkish 
by Benli and Aksoy Derya (2019), consists of 16 Likert-type items. While each 
item of the scale focuses on measuring the father's feelings, attitudes, 
behaviors, and thoughts towards the developing fetus in the womb, most items 
are based on the fathers' experiences in the last two weeks. The scale has two 
factors: "quality of attachment", which measures the father's emotional 
experience while thinking about the baby in the womb, and "time spent on 
attachment", which expresses the intensity of preoccupation with the fetus. 
Items 1, 3, 5, 6, 7, 8, 12, 13, and 15 on the scale are reverse scored. Items six 
and 13 are added to the total score of the scale. Each item of the scale is scored 
as 1 = absence of feelings toward the fetus; 5 = very strong feelings toward the 
fetus. The score that can be obtained from the scale is between 16-80; The score 
that can be obtained from the quality of attachment sub-dimension is 8-40; The 
score that can be obtained from the time spent on attachment sub-dimension is 

 
63 
6-30. An increasing score indicates a higher degree of attachment. Cronbach's 
α in the total of the DÖBBÖ is 0.82. The same scale was later studied by Güleç 
Şatır and Kavlak (2021) under the name "Paternal Antenatal Attachment Scale" 
(Appendix-4). 
3.6.5. Fathers' Fear of Childbirth Scale (FDFS) 
The scale was developed by Ghaffari et al. (2021) to determine the 
levels of fear of childbirth in expectant fathers during pregnancy. The scale 
consists of two sub-dimensions: the birth process (12 items) and hospital fear 
(5 items), which affect fathers' fear of childbirth. It is a 5-point Likert-type scale 
and the items are answered as strongly disagree (1), disagree (2), undecided 
(3), agree (4), and strongly agree (5). The score that can be obtained from the 
scale varies between 17 and 85. Scores of 17–35, 36–54, and > 55 indicate low, 
moderate, and high fear of childbirth, respectively. Higher scores indicate a 
higher level of fear related to childbirth (Ghaffari et al., 2021). The Cronbach 
alpha coefficient of the scale was calculated as 0.84. The validity and reliability 
of the scale in Turkish was performed by Calpbinici et al. (2023). The content 
validity index of the scale was found to be 0.96. Cronbach alpha reliability 
coefficient for the entire scale is 0.93 (Appendix-5). 
 
 
3.6.6. Wijma Birth Expectation/Experience Scale Version A (WBDÖ-A) 
This scale was developed by Wijma et al. (1998). The aim of the scale 
is to evaluate the fear of childbirth experienced by women during pregnancy. 
The validity and reliability study of its Turkish was conducted by Korukcu et 
al. (2009). The scale consists of 33 items. The responses on the scale are 
numbered from 0 to 5 and are of a six-point Likert type. Zero represents 
“completely” and 5 represents “not at all”. The minimum score on the scale is 
0, while the maximum score is 165. A high total score indicates a high level of 
fear. The negatively loaded questions on the scale (2, 3, 6, 7, 8, 11, 12, 15, 19, 
20, 24, 25, 27, 31) are calculated by reversing them in order to ensure 

 
64 
consistency in measurement. A score below 37 indicates mild fear of childbirth, 
between 38-65 indicates moderate fear of childbirth, between 66-84 indicates 
severe fear of childbirth, and 85 and above indicates clinical fear of childbirth. 
In the study by Körükcü et al. (2009), the Cronbach's alpha value of the WD 
EQ Scale A version was found to be 0.89 (Appendix-6). 
3.6.7. Wijma Birth Expectation/Experience Scale Version B (WBDBS-B) 
The current scale was developed by Klaas and Barbro Wijma (1998) to 
measure the fear of childbirth experienced by women. The scale is administered 
to women in their rooms after they give birth. This six-point Likert-type scale 
consists of 32 items (Wijma et al., 1998). The answers are numbered from 0 to 
5, with 0 representing “completely” and 5 representing “not at all”. The 
minimum score of the scale is 0, and the maximum score is 160. While the 
answers to some questions of the scale are calculated according to the number 
they correspond to, questions numbered “2, 3, 6, 7, 10, 11, 14, 18, 19, 23, 24, 
26 and 30” are calculated by turning them in the opposite direction. The 
calculated W-DEQ-B score is ≤37 and indicates a low level, 38-65 indicates a 
moderate level, 66-84 indicates a severe level, and ≥85 and above indicates a 
level of fear of childbirth that requires clinical treatment (Wijma et al., 1998). 
The scale was adapted to Turkish and its validity and reliability study was 
conducted by Körükcü et al. in 2014, and the Cronbach alpha value was found 
to be 0.88 (Körükcü et al., 2014) (Appendix-7). 
3.6.8. Postpartum Self-Evaluation Scale (PSS) 
The Cronbach's alpha value of the scale, whose validity and reliability 
study was conducted by Taşçı and Mete (2010), was determined as 0.84. It is a 
4-point Likert-type scale with 82 items developed by Lederman and 
Weingarten in 1981 to evaluate the adjustment of women to motherhood in the 
postpartum period. The scale has 7 sub-dimensions that evaluate the 
postpartum adjustment of mothers. 39 of the items in the scale are reverse-
biased. The numbers of the reverse-biased items in the scale are as follows; 1, 
2, 4, 6, 9, 10, 14, 15,16, 22, 29, 30, 32, 33, 36, 38, 40, 41, 42, 43, 44, 46, 47, 
49, 51, 53, 54, 59, 61, 62, 67, 69, 71, 73, 77, 78, 79, 81, 82. The scale is 

 
65 
measured with a 4-point assessment. Postpartum adjustment is evaluated based 
on the results of scores ranging from “1” to “4” (4: “Describes very much”, 3: 
“Partially describes”, 2: “Describes a little”, 1: “Does not describe at all”). A 
minimum of 82 and a maximum of 328 points can be obtained for the entire 
scale. Low scores indicate high postpartum adjustment (Appendix-8). 
3.6.9. Father-Infant Attachment Scale (FBA) 
It was developed by Condon et al. (2008) to measure the postpartum 
father-infant bond. The validity and reliability of the Turkish version was done 
by Güleç and Kavlak (2013). Each item of the scale is scored between one and 
five points. 12 items in the scale (4, 5, 7, 8, 9, 10, 11, 12, 13,14, 15,16) are 
reverse-coded. High scores obtained from the scale indicate high bonding. The 
original scale consists of three sub-dimensions and 19 items. The Turkish 
version of the scale includes three sub-dimensions (patience-tolerance, 
pleasure in interaction, love-pride) and 18 items (item 16 was removed) 
(Appendix-9). 
3.10. Maternal Attachment Scale (MAS) 
MBI was developed by Mary and Muller (1994) to measure maternal 
love and attachment. In the study in which Kavlak and Şirin (2009) tested the 
validity and reliability of the scale in Turkish society, the Cronbach's alpha 
reliability coefficient of the scale was found to be 0.77 for mothers with 1-
month-old babies and 0.82 for mothers with 4-month-old babies. It was 
determined that it can be used safely for mothers with babies in the 1st and 4th 
months after birth. The scale is a 4-point Likert-type scale consisting of 26 
items. Each item includes direct expressions and is calculated as always (a) = 
4 points, often (b) = 3 points, sometimes (c) = 2 points and never (d) = 1 point. 
The lowest score to be obtained from the scale varies between 26 and the 
highest score varies between 104. A high score indicates a high level of 
maternal attachment (Appendix-10). 
3.7. Analysis of Data 

 
66 
The data obtained from this study were analyzed with SPSS for 
Windows 25.00 (Statistical Package for Social Sciences) statistical package 
program. Descriptive statistics were given as number of units (n), percentage 
(%), mean ± standard deviation (x ̄ ±ss), minimum value (min), maximum 
value (max) . Skewness and kurtosis values and mode median and median 
values were evaluated within the framework of normality test. When the 
skewness and kurtosis values of the relevant variables were examined, it was 
found that all values were within the accepted limits ( ± 2) and the variables 
were normally distributed, so parametric tests were used in the analyses. For 
numerical variables, comparisons of groups according to time were made with 
the Paired Samples t (dependent groups) test in repeated measurements and 
comparisons between groups were made with the Independent-Samples t 
(Independent groups) test. Mixed Design Anova test was used to help 
determine statistically significant differences by taking into account both 
within-group factors and between-group factors. In this way, both the 
differences between the groups and the changes over time were evaluated in 
the same analysis. The chi-square test was applied to evaluate the compatibility 
between birth expectation and the actual birth type. In all comparisons, p<0.05 
was accepted as the significance level of statistical tests (Pallant, 2020). 
 
 
3.8 Ethical Aspects of the Research 
Erciyes University Faculty of Health Sciences Academic Board 
decision was received (09.10.2023, 2023/50, Decision number: 71) (Appendix 
11). Institutional permission was received from Kayseri City Training and 
Research Hospital Education Planning Board (24.11.2023, Number: 
76397871) (Appendix-12). Ethics committee permission was received from 
Kayseri City Training and Research Hospital Clinical Research Ethics 
Committee (31.10.2023, Decision no: 938) (Appendix-13). Pregnant women 
who volunteer to participate in the research during the data collection phase 
will be asked to read and sign the Informed Consent Form (Appendix-14). 

 
67 
The researcher has a certificate of participation in the eight-week 
"Mindfulness-Based Stress Reduction (MBSR) Program" organized by Gazi 
University Faculty of Nursing , a certificate of "Conscious Awareness 
(Mindfulness) Training" organized by Başkent University, a certificate of 
"Birth Coach-Doula Trainer Training", "Breastfeeding Consultant", "Baby 
Care", "Pregnancy Yoga", "Fit Breathing Coaching" and "Stress Management" 
organized by the Turkish Education Foundation, and a certificate of 
participation in the 2nd International 4th National Childbirth Preparation 
Education Congress "Mindfulness-Based Childbirth Preparation Education" 
(Appendix-). 
3.9. Implementation of the Research 
Kayseri City Hospital Pregnancy School and Pregnancy Polyclinic June 
1-September 1, 2024  26 pairs of parents who applied between and met the 
inclusion criteria were assigned to groups according to the randomization list. 
Awareness-Based Parenting and Childbirth Preparation Education was given 
as a group education during the hours when the pregnancy school did not 
provide education and on Sundays of each week. No intervention was made to 
the parents who formed the control group other than the childbirth preparation 
education conducted by Kayseri City Education and Research Hospital. The 
flow diagram (Figure 3.1) is given below. 
 
 
 
Figure 3.2: CONSORT 2025 Flow Diagram ( https://www.consort-
spirit.org/ ) 

 
68 
 
3.9.1. Control Group Application Steps 
No additional application was made to the control group except for the 
1-week birth preparation training at the Kayseri City Education and Research 
Hospital Pregnancy School. In the first session, written consent was obtained 
from the parents who met the inclusion criteria and agreed to participate in the 
study, and the surveys were filled out by the researcher in the first hour of the 
training. In this session, the pregnant woman and her partner were introduced 
and the ETF was filled in to learn their socio-demographic information. BFÖ, 
PBÖ, DÖBBÖ, BDKÖ, WBDÖ-A were applied. Then, the pregnancy school's 
own training was given by the trainer at the pregnancy school for 1 week. 

 
69 
After the 1-week birth preparation training was completed, BFÖ, PBÖ, 
DÖBÖ, BDKO, WBDÖ-A were applied. On the first postpartum day, WBDÖ-
B was applied to determine the birth experiences of the mothers. 
In the 4th month postpartum, mothers were contacted via phone and the 
PCAS was administered to assess mother-infant adjustment and the MBI was 
administered to assess mother-infant attachment; and fathers were contacted in 
the 6th month postpartum and the BBBÖ was administered to assess father-
infant attachment. 
3.9.2. Intervention Group Implementation Steps 
In addition to the 1-week birth preparation training at the Pregnancy 
School of Kayseri City Education and Research Hospital, the intervention 
group received Mindfulness-Based Parenting and Birth Preparation Training. 
This training aimed to teach participants how to monitor their thoughts and 
emotional states, how to deepen their sensory awareness of their bodies, how 
to be more careful about how their minds work, and how to deepen their 
sensory self-awareness, so that they would be more sensitive during the birth 
and parenting processes. A total of 9 separate sessions were implemented. 
Mindfulness-Based Parenting and Birth Preparation Training was implemented 
in 1 session per week for 9 weeks, with the duration of each session varying 
according to the parents' compliance and needs in the program, with each 
session lasting an average of 150 minutes. The practices were taught by the 
researcher during the training, and the sections related to the practice were 
marked and shown in the training booklet and read once in class. Homework 
assignments, audio recordings containing guiding conscious awareness 
practices, and the Mindfulness-Based Parenting and Birth Preparation Training 
Booklet, which was created by the facilitator and included the training protocol, 
were distributed for each session. Only one session (session 5) was a make-up 
session via the Zoom Workplace application for parents who could not attend 
face-to-face training due to weather conditions. Throughout the course, parents 
were asked to practice meditation at home with guided meditation audio 
recordings for 30-45 minutes a day, 6 days a week. 

 
70 
 1 (150 minutes) 
The first session was held on Sunday of the first week. In the first hour of 
this session, the researcher filled out the questionnaires. The pregnant woman 
and her partner were introduced and ETF was filled out in order to learn their 
socio-demographic information. BFÖ, PBÖ, DÖBBÖ, BDKÖ, WDBÖ-A were 
applied. Then, the trainings started and in the first session, the definition of 
awareness was made, the purpose and content of Awareness-Based Parenting 
and Birth Preparation Training was explained, talking about when she first 
learned about pregnancy, what she did and felt after learning, Breath 
Awareness Meditation, Being with the Baby Practice, Raisin Meditation 
applications were included. 
 Session 2 (150 minutes) 
The second session was held on Sunday of the second week. The second 
session focused on understanding labor, pain, fear and hormones from a mind-
body perspective. In this session, Body Scan Practice, Breath Awareness 
Practice, Being with the Baby Practice and Birth Yoga Practices were done. 
Questioning the turning points in her life and role models related to parenting 
and awareness-based eating behavior were discussed. Formal and informal 
practical homework assignments were evaluated. 
 Session 3 (150 min) 
The 3rd session was held on Sunday of the third week. In this session, 
practices for coping with pain were discussed. In this session, the Body Scan 
Practice was applied. It was discussed how to do daily activities such as 
brushing teeth, driving, taking a shower, shaving, washing dishes, and cooking 
with awareness. Breath Awareness Meditation and Being with the Baby 
Practice were performed. The Pleasant Events Calendar was explained and 
homework was given to the couples. The formal and informal homework given 
in the previous week was evaluated. It was discussed what kind of mother one 
dreams of being, and fears and anxieties about the future were discussed. The 
formal and informal homework was evaluated. 

 
71 
 Session 4 (150 min) 
The 4th session was held on Sunday of the fourth week. In this session, the 
role of the spouse/partner in birth, pain management and awareness practices 
were discussed. Birth Yoga Practices and Body Scan Practice were applied. 
Breathing Awareness Practice, Three-Minute Breathing Break Practice and 
Being with the Baby Practice were applied. Formal Pain Practice was applied 
with ice. Formal and informal homework assignments were evaluated. 
Homework was given by explaining the Unpleasant Events Calendar. Baby 
care training was emphasized. Baby Care Training: Umbilical cord care, baby 
bath and skin care, nail care, excretion, diaper use and diaper rash, thrush, body 
temperature assessment and dressing, vaccination, baby care rehearsal with a 
baby model were performed. 
 5  ( 150 min) 
On Sunday of the fifth week, the 5th session could not be held face-to-face 
due to weather conditions and was held online via Zoom Workplace. In the 
fifth session, the needs of the newborn and the new parent and secure 
attachment issues were discussed. Birth Yoga Practices, Body Scan Practice, 
Breath Awareness Practice, Being with the Baby and Formal Pain Practice 
were applied. Mindful Pooping Practice was discussed. Formal and informal 
homework assignments were evaluated. After the practices, the expectant 
mother was given training on how to care for herself during the postpartum 
period. This training included early mobilization, lochia follow-up, perineal 
care, care if an episiotomy was applied, breast care and problems, information 
on milk expression and storage conditions, information on the wound healing 
process and facilitating factors if a cesarean section was given, nutrition, sleep 
and rest, Kegel exercises and postpartum exercises, transition time to sexual 
activity and contraception, emotional preparation for the process and 
information on support systems. 
 6  (150 minutes ) 

 
72 
The 6th session was held on Sunday of the sixth week. Birth Yoga 
Practices, thirty-minute Sitting Meditation and Body Scan Meditation were 
applied. Formal Pain Practice was performed. Fear and Happiness Research 
Practice was performed. Walking Meditation and Speaking and Listening 
Research were applied. Formal and informal homework assignments were 
evaluated. In this session, the choice of birth method, preparation of the birth 
bag, signs of the beginning of labor and ways to facilitate birth were discussed. 
A One-Day Mindfulness Practice (retreat) assignment was given between 
Weeks 6 and 7. 
 7  (15 0 minutes) 
The 7th session was held on Sunday of the seventh week. Sitting 
Meditation, Preference-Free Awareness, Body Scan, Birth Yoga Practices, 
Compassion Meditation and Speaking and Listening Research on Family Roots 
were applied. Mindful breastfeeding and breastfeeding education were 
discussed. Breastfeeding Education: The structure of breast tissue, the 
importance of breastfeeding, how breastfeeding is performed, placing the baby 
on the breast, breastfeeding positions, evaluation of breastfeeding, starting 
complementary foods, breast care, possible problems related to the nipple, 
burping the baby after breastfeeding, breastfeeding rehearsal with a baby model 
were conducted. Formal and informal homework assignments were evaluated. 
 8  (15 0 minutes) 
8th  
week . Compassion Meditation was applied. How much time do 
you spend looking at your mobile phone, texting or sharing on social media? 
How might this be related to your stress? The practice of spending one day of 
the week as a “technology-free day” was explained by searching for answers 
to the questions. Formal and informal homework assignments were evaluated. 
 9  (180 minutes ) 
Sunday of the ninth week . The practices that the group found most useful 
were re-implemented. The section titled “Endings and Beginnings: The Last 
Lesson” was read and discussed. The partners were asked to share with each 

 
73 
other what was rising from within them. They were given homework to 
continue to apply formal pain practices at certain intervals until they gave birth. 
They were encouraged to approach routine activities with awareness and 
continue to develop their awareness at every moment of their daily lives. They 
were encouraged to practice Being with the Baby, Compassion Meditation, and 
Three-Minute Breathing Breaks. 
On the day the 9th session was completed, BFÖ, PBÖ, DÖBBÖ, BDKÖ, 
WBDÖ-A were applied. 
On the first postpartum day, mothers were contacted by phone and the 
WBDBS-B Version was administered to determine their birth experiences. 
In the 4th month postpartum, mothers were contacted via phone and the 
PCAS was administered to assess mother-infant adjustment and the MBI was 
administered to assess mother-infant attachment; and fathers were contacted in 
the 6th month postpartum and the BBBÖ was administered to assess father-
infant attachment. 
 
 
 
 
 
 
 
 
 
 
 
Ebeveynlere araştırmanın amacı açıklanıp, yazılı onam alınması 
Müdahale ve kontrol grubuna eğitimler verilmeden önce ETF, BFÖ, PBÖ, DÖBBÖ, BDKÖ, WDBDÖ-A 
uygulanması 
Müdahale grubu  
Kontrol grubu 
Ebeveynlerin 1 haftalık Kayseri Şehir Eğitim ve 
Araştırma Hastanesi Gebe Okulunda doğuma 
hazırlık eğitimine katılmalarının sağlanması  
ve ardından 
9 haftalık Farkındalık Temelli Ebeveynlik ve 
Doğuma Hazırlık Eğitimine katılımları sağlanması 
 
Ebeveynlerin 1 haftalık Kayseri Şehir Eğitim 
ve Araştırma Hastanesi Gebe Okulunda 
doğuma hazırlık eğitimine katılımlarının 
sağlanması 
Randomizasyon yöntemi ile atamaların yapılması 

 
74 
 
 
 
 
 
 
 
 
 
 
 
Figure 3.3. Research workflow diagram 
3.10. Awareness-Based Parenting and Birth Preparation Education 
Booklet 
The “Mindfulness-Based Parenting and Birth Preparation Education 
Booklet” (Appendix-15), which was created by the researcher by scanning the 
relevant literature (Atalay, 2018; Bardacke, 2012; Vreeswijk, 2019), was sent 
to the participants in printed form and the audio recordings to be listened to 
during meditation (Appendix-16) were sent to the participants via WhatsApp 
application. Before the booklet was used, it was presented to the opinion of an 
academician who is an expert in the field of Obstetrics-Women's Health and 
Diseases Nursing and an academician who is an expert in the field of 
educational sciences, and the booklet was finalized in line with the suggestions 
received. 
3.11. Limitations of the Research 
Eğitimler tamamlandıktan sonra; BFÖ, PBÖ, DÖBBÖ, BDKÖ, WDBDÖ-A uygulanması 

 
75 
that the research results are limited to the research group and 
generalizations cannot be made, the data collection tools were filled out based 
on self-reporting, single blinding was possible in the study, and the sample size 
was kept small due to the scope of the training. 
. 
. 
. 
. 
. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
76 
4. FINDINGS 
Awareness-Based Parenting and Childbirth Preparation Education Given to Couples 
This study, which was conducted to determine the effects of maternal-paternal 
bonding, birth parameters and postpartum sleep, was completed with a total of 24 
couples (48 people) (24 intervention-24 control) and the findings are given below. 
The distributions of demographic variables included in the study are given in Table 
4.1. 
Table 4.1. Distributions of demographic variables 
  
Category 
n (%) 
Mother's Education Status 
 
 
 
Primary education 
1 (4.2%) 
 
Secondary 
Education 
11 (45.8%) 
 
Bachelor's degree 
and above 
12 (50.0%) 
Father's Education Status 
  
  
 
Secondary 
Education 
15 (62.5%) 
  
Bachelor's degree 
and above 
9 (37.5%) 
Mother's Profession 
 
 
 
Housewife 
16 (66.7%) 
 
Officer 
4 (16.7%) 
 
Private sector 
4 (16.7%) 
Father's Profession 
  
  
 
Private sector 
17 (70.8%) 
  
Officer 
7 (29.2%) 
Mother's Economic Status 
 
 
 
My income is more 
than my expenses 
6 (25.0%) 
 
My income is equal 
to my expenses 
13 (54.2%) 
 
My income is less 
than my expenses 
5 (20.8%) 
Father's Economic Status 
  
  
 
My income is more 
than my expenses 
7 (29.2%) 
 
My income is equal 
to my expenses 
12 (50.0%) 
  
My income is less 
than my expenses 
5 (20.8%) 
Planned Pregnancy? 
 
 

 
77 
 
Yes 
20 (83.3%) 
 
No 
4 (16.7%) 
Is He Getting Any Other 
Education? 
  
  
  
No 
24 (100.0%) 
Mother Pre-Pregnancy Sports 
 
 
 
Yes 
4 (16.7%) 
 
No 
20 (83.3%) 
Mother Pre-Pregnancy Sports 
Type 
  
  
 
Walk 
1 (25.0%) 
  
Pilates 
3 (75.0%) 
Father Pre-Pregnancy Sports 
 
 
 
Yes 
2 (8.3%) 
 
No 
22 (91.7%) 
Father Pre-Pregnancy Sports 
Type 
  
  
 
Walk 
1 (50.0%) 
  
Football 
1 (50.0%) 
Mother Pregnancy Sports 
 
 
 
Yes 
4 (16.7%) 
 
No 
20 (83.3%) 
Mother Pregnancy Order Sport 
Type 
  
  
 
Walk 
2 (50.0%) 
  
Pilates 
2 (50.0%) 
Father Pregnancy Order Sports 
 
 
 
Yes 
1 (4.2%) 
 
No 
23 (95.8%) 
Father Pregnancy Order Sport 
Type 
  
  
  
Football 
1 (100.0%) 
Mother Hobby 
 
 
 
Yes 
2 (8.3%) 
 
No 
22 (91.7%) 
Mother Hobby Type 
  
  
  
Reading books 
2 (100.0%) 
Dad Hobby 
 
 
 
No 
24 (100.0%) 
Mom, Don't Take Time for 
Yourself 
  
  
 
Yes 
7 (29.2%) 
 
No 
8 (33.3%) 
  
Partially 
9 (37.5%) 
Dad, Don't Take Time for 
Yourself 
 
 
 
Yes 
7 (29.2%) 
 
No 
13 (54.2%) 

 
78 
 
Partially 
4 (16.7%) 
Mother Chronic Disease 
  
  
  
No 
24 (100.0%) 
Maternal Medication Use 
 
 
 
No 
24 (100.0%) 
Discomfort During Pregnancy 
  
  
  
No 
24 (100.0%) 
Father Chronic Disease 
 
 
 
No 
24 (100.0%) 
Father Drug Use 
  
  
  
No 
24 (100.0%) 
 
A total of 24 individuals participated in the study. 50% of the mothers had a bachelor's 
degree or higher, 45.8% had a secondary education, and 4.2% had a primary education. 
62.5% of the fathers had a secondary education, and 37.5% had a bachelor's degree or 
higher. 66.7% of the mothers were housewives, 16.7% were civil servants, and 16.7% 
worked in the private sector. 70.8% of the fathers were private sector employees, and 
29.2% were civil servants. 
Regarding the economic status of the mothers, 54.2% stated that their income was 
equal to their expenses, 25.0% stated that their income was more than their expenses, 
and 20.8% stated that their income was less than their expenses. Regarding the 
economic status of the fathers, 50.0% stated that their income was equal to their 
expenses, 29.2% stated that it was more, and 20.8% stated that it was less. 83.3% of 
the pregnancies were planned. All participants (100.0%) reported that no one else was 
receiving education at home. 
16.7% of mothers reported that they did sports before pregnancy, 75.0% of these sports 
were pilates and 25.0% were walking. In the father group, 8.3% reported that they did 
sports before pregnancy, and these sports were walking and football at equal rates 
(50.0%). 16.7% of mothers reported that they did sports during pregnancy, 50.0% of 
these activities were walking and 50.0% were pilates. Only 4.2% of fathers did sports 
during pregnancy, and this person was involved in football. 
Only 8.3% of mothers reported having a hobby, and this hobby was reading books. In 
the father group, no participant reported having a hobby. 29.2% of mothers reported 
spending time with their children, 33.3% did not spend time, and 37.5% partially spent 
time. For fathers, these rates were 29.2% yes, 54.2% no, and 16.7% partially, 

 
79 
respectively. All mothers and fathers (100.0%) reported that they did not have a 
chronic disease and did not use medication. In addition, none of the mothers reported 
experiencing any discomfort during pregnancy. 
 
 
 
 
 
In the evaluation of the normal distribution of the variables in the study, 
kurtosis and skewness values were examined. The analysis results are given in 
Table 4.2. 
 
Table 4.2. Descriptive statistics of variables 
Variables 
Avg. 
SD 
Distortion Kurtosis 
Pre-Test - Conscious Awareness Scale (CAS) – Mother 
3.71 
0.99 -0.756 
0.075 
Post-Test - Conscious Awareness Scale (CAS) – Mother 
4.00 
1.40 -0.660 
-0.388 
Pre-Test - Conscious Awareness Scale (CAS) – Father 
4.24 
0.81 -0.317 
-1.358 
Post-Test - Conscious Awareness Scale (CAS) – Father 
4.57 
1.02 -0.812 
-0.991 
Pre-Test - Prenatal Attachment Inventory (PAI) 
2.78 
0.27 -2.154 
3,803 
Post-Test - Prenatal Attachment Inventory (PAI) 
2.82 
0.32 -2.489 
5,420 
Pre-Test – PBO – Curiosity and Excitement 
2.71 
0.28 -1.219 
0.810 
Final Test – PBO – Curiosity and Excitement 
2.81 
0.36 -2,564 
6,141 
Pre-Test – PBO – Acceptance and Enthusiasm 
2.83 
0.27 -2.239 
4,180 
Post-Test – PBO – Acceptance and Enthusiasm 
2.83 
0.28 -2.153 
3,843 
Pre-Test – PBO – Hope 
2.82 
0.31 -2.217 
3,939 
Final Test – PBO – Hope 
2.81 
0.32 -2.222 
4,284 
Pre-Test – Prenatal Paternal Attachment Scale (PPAS) 
4.06 
0.45 -0.325 
0.168 
Post-Test – Prenatal Paternal Attachment Scale (PPAS) 
4.43 
0.46 -1.225 
0.764 
Pre-Test – DOBBO – Quality of Attachment 
4.49 
0.43 -0.981 
0.732 
Final Test – DOBBO – Quality of Attachment 
4.81 
0.25 -2.118 
5,156 
Pre-Test – DOBBO – Taking Time to Connect 
3.62 
0.58 0.095 
-0.771 
Final Test – DOBBO – Taking Time to Connect 
4.05 
0.69 -1.029 
-0.015 
Pre-Test – Fathers’ Fear of Childbirth Scale (FFS) 
3.29 
1.04 -0.199 
-0.801 
Post-Test – Fathers’ Fear of Childbirth Scale (FBS) 
2.62 
1.03 0.844 
0.130 
Pre-Test – BDKO – Fear of Childbirth 
3.41 
1.08 -0.136 
-0.883 
Post-Test – BDKO – Fear of Childbirth 
2.83 
1.07 0.492 
-0.431 
Pre-Test – BDKO - Hospital Fear 
3.01 
1.18 -0.042 
-0.949 
Post-Test – BDKO - Hospital Fear 
2.12 
1.10 1,354 
1,303 
Pre-Test – Wijma Childbirth Expectation/Experience Scale – A 
(WDBDÖ-A) 
1.75 
1.13 1,338 
0.915 

 
80 
Post-Test – Wijma Childbirth Expectation/Experience Scale – A 
(WDBDÖ-A) 
1.01 
0.75 1,051 
0.474 
Wijma Birth Expectation/Experience Scale – B (WDBDÖ-B) 
2.44 
1.06 0.733 
-0.672 
Postpartum Self-Evaluation Scale (PSS) 
3.53 
0.50 -0.890 
-0.856 
PKDÖ - Quality of Relationship Between Spouses 
3.58 
0.55 -0.979 
-0.638 
PKDÖ - Partners' Perspective on Participation in Baby Care 
3.64 
0.55 -1.087 
-0.635 
PKDÖ - Satisfaction with Birth Experience 
3.38 
0.62 -0.583 
-1.258 
PKDÖ - Contentment with the Continuity of Life 
3.32 
0.73 -0.594 
-1.353 
PKDÖ - Relying on Strength to Cope with Motherhood Duties 
3.53 
0.48 -0.895 
-0.374 
PKDÖ - Satisfaction with Motherhood and Newborn Care 
3.61 
0.38 -1.114 
0.960 
PKDÖ - Support for Motherhood from Family and Friends 
3.59 
0.59 -0.955 
-0.974 
Father-Infant Attachment Scale (FBA) 
4.08 
0.65 -1.123 
0.283 
BBBÖ - Patience-Tolerance 
3.90 
0.55 -1.017 
-0.079 
BBBÖ - Pleasure in Interaction 
4.05 
0.82 -0.940 
0.051 
BBBÖ - Love-Pride 
4.51 
0.61 -1.319 
0.972 
Maternal Attachment Scale (MAS) 
3.74 
0.42 -1.218 
-0.343 
 
When the skewness and kurtosis values of the relevant variables are examined, it is 
seen that all values are within the accepted limits and the variables are distributed close 
to the normal distribution. This supports the use of parametric tests in the analysis. In 
particular, the skewness and kurtosis values remaining in the range of ±2 reveal that 
the data do not show a statistically significant deviation. Therefore, the variables meet 
the normal distribution assumption. 
 
Conscious Awareness – Mother 
The effect of the mindfulness-based parenting and birth preparation training 
given to couples on the mean scores of mothers from the Conscious Awareness Scale 
was evaluated with Mixed Measures ANOVA. The analysis results and post-hoc results 
are given in Table 4.3. 
Table 4.3. Variance analysis and post-hoc results regarding the mean scores of mothers 
on the Conscious Awareness Scale 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
p 
Before Application 
4.02 ± 0.81 
3.40 ± 1.08 
1.59 
.126 
After Application 
4.77 ± 0.71 
3.22 ± 1.51 
3.21 
.004 
Test Statistics b 
t 
= 
4.23  
p < .001 
t 
= 
1.00  
p = .327 
 
 
 
 
 
 
 
Test Statistics c 
F 
p 
η 2 g 
 

 
81 
Group 
6.66 
.017 
.22 
 
Time 
5.21 
.032 
.02 
 
Group x Time 
13.69 
.001 
.05 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
The differences in the mean scores of the mothers in the intervention and 
control groups on the mindfulness scale before and after the application were evaluated 
with mixed Measures ANOVA. As a result of the analysis, it was determined that the 
scores obtained differed statistically significantly according to the groups of the 
participants, F (1, 22) = 6.66, p = .017, η 2 g = .22. It was also determined that there 
was a statistically significant difference according to time, F (1, 22) = 5.21, p = .032, 
η 2 g = .02. In addition, a significant interaction was observed between group and time, 
F (1, 22) = 13.69, p = .001, η 2 g = .05. 
In the comparisons made after the interaction, a significant difference was 
found between the pre- and post-intervention scores in the experimental group ( t (22) 
= 4.23, p < .001), but this difference was not significant in the control group ( t (22) = 
1.00, p = .327). In the comparisons made between the groups between the times, there 
was no significant difference between the experimental and control groups before the 
intervention ( t (22) = 1.59, p = .126), but after the intervention, the mothers in the 
experimental group had significantly higher scores ( t (22) = 3.21, p = .004). The 
results of the analyses are given in Figure 4.1. 
 
Figure 4.1. Pre-Test and Post-Test Changes in Experimental and Control Groups 
– Conscious Awareness 

 
82 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Conscious Awareness – Father 
The effect of the mindfulness-based parenting and birth preparation training 
given to couples on the mean scores of fathers on the Conscious Awareness Scale was 
evaluated with Mixed Measures ANOVA. The analysis results and post-hoc results are 
given in Table 4.4. 
 
Table 4.4. Variance analysis and post-hoc results regarding the mean scores of fathers 
on the Conscious Awareness Scale 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
p 
Before Application 
4.57 ± 0.72 
3.91 ± 0.85 
2.14 
.044 
After Application 
5.19 ± 0.69 
3.96 ± 0.90 
3.69 
.001 
Test Statistics b 
t 
= 
4.85  
p < .001 
t 
= 
0.35  
p = .732 
 
 
 
 
 
 
 
Test Statistics c 
F 
P 
η 2 g 
 
Group 
9.42 
.006 
.28 
 
Time 
13.51 
.001 
.05 
 
Group x Time 
10.14 
.004 
.04 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
The differences in the average scores of fathers in the experimental and control 
groups from the conscious awareness scale before and after the application were 
evaluated with ANOVA for mixed Measurements. As a result of the analysis, it was 
determined that the scores obtained differed statistically significantly according to the 
groups of the participants, F (1, 22) = 6.66, p = .017, η 2 g = .22. It was also determined 
that there was a statistically significant difference according to time, F (1, 22) = 5.21, 
p = .032, η 2 g = .02. In addition, a significant interaction was observed between group 
and time, F (1, 22) = 13.69, p = .001, η 2 g = .05. 
In the comparisons made after the interaction, a significant difference was 
found between the pre- and post-intervention scores in the experimental group ( t (22) 

 
83 
= 4.23, p < .001), but this difference was not significant in the control group ( t (22) = 
1.00, p = .327). In the comparisons made between the groups between the times, there 
was no significant difference between the experimental and control groups before the 
intervention ( t (22) = 1.59, p = .126), but after the intervention, the fathers in the 
experimental group received significantly higher scores ( t (22) = 3.21, p = .004). The 
results of the analyses are given in Figure 4.2. 
 
Figure 4.2. Pre-Test and Post-Test Changes in Experimental and Control Groups 
– Conscious Awareness 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Prenatal Bonding 
The effect of mindfulness-based parenting and birth preparation education 
given to couples on mother-infant attachment during the prenatal period was evaluated. 
The effect of the education on the mean scores of the Prenatal Attachment Inventory 
(PAI) was evaluated with Mixed Measures ANOVA. The analysis results and post-hoc 
results are given in Table 4.5. 
 
Table 4.5. Variance analysis and post-hoc results regarding mean scores of the Prenatal 
Attachment Scale 
Experiment 
Control 
Test Statistics a 

 
84 
Variable 
𝑿̅±ss 
𝑿̅±ss 
t 
p 
Before Application 
2.85 ± 0.08 
2.72 ± 0.08 
1.17 
.254 
After Application 
2.96 ± 0.08 
2.67 ± 0.08 
2.41 
.025 
Test Statistics b 
t 
= 
4.24  
p < .001 
t 
= 
1.64  
p = .116 
 
 
 
 
 
 
 
Test Statistics c 
F 
P 
η 2 g 
 
Group 
3.36 
.080 
.13 
 
Time 
3.38 
.079 
.00 
 
Group x Time 
17.26 
.000 
.02 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The effects of mindfulness-based parenting and birth preparation education 
given to couples on mother-infant attachment during the prenatal period were 
evaluated with Mixed Measures ANOVA. According to the analysis results, it was seen 
that there was no statistically significant difference between the groups, F (1, 22) = 
3.36, p = .080, η 2 g = .13. There was no significant difference in terms of time effect, 
F (1, 22) = 3.38, p = .079, η 2 g = .00. However, the group and time interaction was 
found to be statistically significant, F (1, 22) = 17.26, p < .001, η 2 g = .02. 
Comparisons made after the interaction showed that there was a significant 
difference between the scores before and after the application in the experimental 
group ( t (22) = 4.24, p < .001). This difference was not significant in the control group 
( t (22) = 1.64, p = .116). In the comparisons between the groups across times, no 
significant difference was found between the experimental and control groups before 
the application ( t (22) = 1.17, p = .254), but it was seen that the participants in the 
experimental group had significantly higher scores after the application ( t (22) = 2.41, 
p = .025). 
 

 
85 
  
Figure 4.3. Pre-Test and Post-Test Changes in Experimental and Control Groups 
– Prenatal Attachment 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Prenatal Bonding – Curiosity and Excitement 
The effect of mindfulness-based parenting and birth preparation education 
given to couples on mother-infant attachment during the prenatal period was evaluated. 
The effect of the education on the mean scores of the Prenatal Attachment Inventory 
(PAI) curiosity and excitement sub-dimension was evaluated with Mixed Measures 
ANOVA. The analysis results and post-hoc results are given in Table X. 
Table 4.5.1 Variance analysis and post-hoc results of the mean scores of the curiosity 
and excitement sub-dimension of the Prenatal Attachment Scale 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
p 
Before Application 
2.76 ± 0.08 
2.67 ± 0.08 
0.72 
.480 
After Application 
2.96 ± 0.10 
2.67 ± 0.10 
2.03 
.056 
Test Statistics b 
t 
= 
3.73  
p < .001 
t 
= 
0.00  
p = 1.000 
 
 
 
 
 
 
 
Test Statistics c 
F 
P 
η 2 g 
 
Group 
2.23 
.150 
.08 
 
Time 
6.94 
.015 
.03 
 

 
86 
Group x Time 
6.94 
.015 
.03 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The differences in the scores of the mothers in the experimental and control 
groups from the Prenatal Attachment Questionnaire – Curiosity and Excitement sub-
dimension before and after the application were evaluated using mixed measures 
ANOVA. As a result of the analysis, it was determined that the scores differed 
significantly according to time, F (1, 22) = 6.94, p = .015, η ²g = .03. A significant 
interaction was also found between group and time, F (1, 22) = 6.94, p = .015, η ²g = 
.03. However, no significant difference was observed between the groups in general, 
F (1, 22) = 2.23, p = .150, η ²g = .08. 
In the comparisons made after the interaction, a significant difference was 
found between the pre- and post-intervention scores in the experimental group ( t (22) 
= 3.73, p = .001), but this difference was not significant in the control group ( t (22) = 
0.00, p = 1.000). In the comparisons made between the groups between the times, no 
significant difference was found between the experimental and control groups before 
the application ( t (22) = 0.72, p = .480); after the application, the difference reached 
borderline significance ( t (22) = 2.03, p = .055). 
  
Figure 4.5. Pre-Test and Post-Test Changes in Experimental and Control Groups 
– Prenatal Attachment Curiosity and Excitement 

 
87 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
Prenatal Attachment – Acceptance and Enthusiasm 
The effect of mindfulness-based parenting and birth preparation education 
given to couples on mother-infant attachment during the prenatal period was evaluated. 
The effect of the education on the acceptance and enthusiasm sub-dimension mean 
scores of the Prenatal Attachment Inventory (PAI) was evaluated with Mixed Measures 
ANOVA. The analysis results and post-hoc results are given in Table X. 
Table 4.5.2. Variance analysis and post-hoc results of the mean scores of the 
acceptance and enthusiasm sub-dimensions of the Prenatal Attachment Scale 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
p 
Before Application 
2.93 ± 0.08 
2.74 ± 0.08 
1.72 
.099 
After Application 
2.98 ± 0.07 
2.68 ± 0.07 
3.22 
.004 
Test Statistics b 
t 
= 
2.35  
p = .028 
t 
= 
2.75  
p = .012 
 
 
 
 
 
 
 
Test Statistics c 
F 
P 
η 2 g 
 
Group 
6.02 
.023 
.21 
 
Time 
0.08 
.784 
.00 
 
Group x Time 
13.00 
.002 
.02 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The scores of the participants in the experimental and control groups from the 
acceptance and enthusiasm sub-dimensions of PBÖ before and after the application 
were analyzed using mixed measures ANOVA. As a result of the analysis, a significant 
difference was observed between the groups, F (1, 22) = 6.02, p = .023, η ²₉ = .21. The 
effect of the time variable was not significant, F (1, 22) = 0.08, p = .784, η ²₉ = .00. 
However, a significant interaction was found between group and time, F (1, 22) = 
13.00, p = .002, η ²₉ = .02. 
In the comparisons made after the interaction, a significant increase was 
observed between the pre- and post-application scores in the experimental group ( t 
(22) = 2.35, p = .028), while a significant decrease was observed in the control group 

 
88 
( t (22) = 2.75, p = .012). In the comparisons between the groups across time periods, 
the difference between the experimental and control groups before the application was 
not significant ( t (22) = 1.72, p = .099), but a significant difference was found in favor 
of the experimental group after the application ( t (22) = 3.22, p = .004). 
 
  
Figure 1Pre-Test and Post-Test Changes in Experimental and Control Groups – 
Prenatal Attachment, Acceptance and Enthusiasm 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
Prenatal Bonding – Hope 
The effect of mindfulness-based parenting and birth preparation education 
given to couples on mother-infant attachment during the prenatal period was evaluated. 
The effect of the education on the mean scores of the hope sub-dimension of the 
Prenatal Attachment Inventory (PAI) was evaluated with Mixed Measures ANOVA. 
The analysis results and post-hoc results are given in Table X. 
Table 4.5.3. Variance analysis and post-hoc results of the mean scores of the hope sub-
dimension of the Prenatal Attachment Scale 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
p 
Before Application 
2.89 ± 0.09 
2.75 ± 0.09 
1.09 
.286 
After Application 
2.94 ± 0.09 
2.67 ± 0.09 
2.20 
.038 

 
89 
Test Statistics b 
t 
= 
1.42  
p = .170 
t 
= 
2.03  
p = .055 
 
 
 
 
 
 
 
Test Statistics c 
F 
P 
η 2 g 
 
Group 
2.81 
.108 
.11 
 
Time 
0.19 
.671 
.00 
 
Group x Time 
5.94 
.023 
.01 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The effect of education on the mean scores of the hopes and plans subscale of 
the Prenatal Attachment Inventory (PAI) was analyzed using mixed measures 
ANOVA. As a result of the analysis, a significant interaction between group and time 
was found, F (1, 22) = 5.94, p = .023, η ²g = .01. Although the main effect of group 
was not significant, F (1, 22) = 2.81, p = .108, η ²g = .11; the main effect of time was 
also not significant, F (1, 22) = 0.19, p = .671, η ²g = .00. 
In the comparisons made regarding the interaction, no significant difference 
was observed between the scores before and after the application in the experimental 
group ( t (22) = 1.42, p = .170). Similarly, no significant difference was found in the 
control group ( t (22) = 2.03, p = .055). In the comparisons between the groups, no 
significant difference was observed between the experimental and control groups 
before the application ( t (22) = 1.09, p = .286); however, after the application, the 
participants in the experimental group received significantly higher scores than the 
control group ( t (22) = 2.20, p = .038). 
 

 
90 
  
Figure 2Pretest and Posttest Changes in Experimental and Control Groups – 
Prenatal Attachment Hope 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Prenatal Paternal Attachment 
The effect of mindfulness-based parenting and birth preparation education 
given to couples on father attachment during the prenatal process was evaluated. The 
effect of the education on the mean scores of the Prenatal Father Attachment Scale 
(PPA) was evaluated with Mixed Measures ANOVA. The analysis results and post-hoc 
results are given in Table 4.5. 
Table 4.6. Variance analysis and post-hoc results of the mean scores of the Prenatal 
Father Attachment Scale 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
p 
Before Application 
4.17 ± 0.13 
3.95 ± 0.13 
1.21 
.240 
After Application 
4.75 ± 0.10 
4.11 ± 0.10 
4.72 
.000 
Test Statistics b 
t 
= 
8.11  
p < .001 
t 
= 
2.32  
p = .030 
 
 
 
 
 
 
 
Test Statistics c 
F 
p 
η 2 g 
 
Group 
7.98 
.010 
.25 
 
Time 
54.41 
.000 
.20 
 

 
91 
Group x Time 
16.79 
.000 
.07 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The effect of education on the mean scores of the Prenatal Father Attachment 
Inventory (PPAI) was analyzed using mixed measures ANOVA. According to the 
analysis results, the main effect of group was significant, F (1, 22) = 7.98, p = .010, η 
²g = .25. Similarly, the main effect of time was also significant, F (1, 22) = 54.41, p < 
.001, η ²g = .20. In addition, a significant interaction was found between group and 
time, F (1, 22) = 16.79, p < .001, η ²g = .07. 
In the comparisons made after the interaction, a significant difference was 
observed between the scores before and after the application in the experimental group 
( t = 8.11, p < .001). A statistically significant difference was also found in the control 
group ( t = 2.32, p = .030). In the comparisons made between the groups between the 
times, no significant difference was found between the experimental and control 
groups before the application ( t = 1.21, p = .240), but the experimental group received 
significantly higher scores after the application ( t = 4.72, p < .001). 
 
 
  
Figure 3Pre-Test and Post-Test Changes in Experimental and Control Groups – 
Prenatal Paternal Attachment 

 
92 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
Prenatal Paternal Attachment – The Nature of Attachment 
The effect of mindfulness-based parenting and birth preparation education 
given to couples on father attachment during the prenatal process was evaluated. The 
effect of the education on the mean scores of the Prenatal Father Attachment Scale 
(PAAS) attachment quality sub-dimension was evaluated with Mixed Measures 
ANOVA. The analysis results and post-hoc results are given in Table X. 
Table 4.6.1. Variance analysis and post-hoc results of the mean scores of the Prenatal 
Paternal Attachment Scale, quality of attachment sub-dimension. 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
P 
Before Application 
4.62 ± 0.12 
4.36 ± 0.12 
1.52 
.142 
After Application 
4.95 ± 0.06 
4.68 ± 0.06 
3.07 
.006 
Test Statistics b 
t 
= 
3.87  
p < .001 
t 
= 
3.74  
p = .001 
 
 
 
 
 
 
 
Test Statistics c 
F 
p 
η 2 g 
 
Group 
4.70 
.041 
.15 
 
Time 
28.93 
< .001 
.20 
 
Group x Time 
0.01 
.931 
.00 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The effects of mindfulness-based parenting and childbirth preparation 
education given to couples on the quality of father-infant attachment in the prenatal 
process were evaluated using Mixed Measures ANOVA. As a result of the analysis, it 
was determined that the scores obtained differed statistically significantly according 
to the groups, F (1, 22) = 4.70, p = .041, η ²g = .15. The time effect was also found to 
be significant, F (1, 22) = 28.93, p < .001, η ²g = .20. However, no significant 
interaction was found between group and time, F (1, 22) = 0.01, p = .931, η ²g = .00. 
In the comparisons made after the interaction, a significant difference was 
found between the pre- and post-intervention scores in the experimental group ( t = 
3.87, p = .001), and a similar significant increase was seen in the control group ( t = 

 
93 
3.74 , p = .001). In the comparisons made between the groups between the times, no 
significant difference was found between the groups before the intervention ( t = 1.52, 
p = .142), but after the intervention, the fathers in the experimental group received 
significantly higher scores ( t = 3.07, p = .006). 
  
Figure 4Pre-Test and Post-Test Changes in Experimental and Control Groups – 
Prenatal Father Attachment Quality 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
Prenatal Paternal Bonding – Making Time for Bonding 
The effect of mindfulness-based parenting and birth preparation education 
given to couples on father attachment during the prenatal process was evaluated. The 
effect of the education on the time allocation sub-dimension scores of the Prenatal 
Father Attachment Scale (PAAS) was evaluated with Mixed Measures ANOVA. The 
analysis results and post-hoc results are given in Table X. 
Table 4.6.2. Variance analysis and post-hoc results of the mean scores of the Prenatal 
Paternal Attachment Scale, time allocation for attachment sub-dimension. 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
P 
Before Application 
3.71 ± 0.17 
3.53 ± 0.17 
1.21 
.463 
After Application 
4.55 ± 0.14 
3.55 ± 0.14 
5.12 
<.001 
Test Statistics b 
t 
= 
7.33,  
p < .001 
t 
= 
0.18,  
p = .858 
 
 

 
94 
 
 
 
 
 
Test Statistics c 
F 
p 
η 2 g 
 
Group 
8.55 
.008 
.25 
 
Time 
28.20 
.000 
.15 
 
Group x Time 
25.55 
.000 
.14 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The effects of mindfulness-based parenting and birth preparation education 
given to couples on the time spent on attachment sub-dimension of father-infant 
attachment during the prenatal process were evaluated using mixed measures ANOVA. 
As a result of the analysis, a statistically significant difference was found between the 
groups, F (1, 22) = 8.55, p = .008, η ²g = .25. A significant difference was also observed 
according to the time variable, F (1, 22) = 28.20, p < .001, η ²g = .15. In addition, a 
significant interaction was found between the group and time variables, F (1, 22) = 
25.55, p < .001, η ²g = .14. 
In the comparisons made after the interaction, it was determined that there was 
a significant difference between the scores before and after the application in the 
experimental group ( t = 7.33, p < .001). In contrast, this difference was not significant 
in the control group ( t = 0.18, p = .858). In the comparisons between the groups, no 
significant difference was found before the application ( t = 0.75, p = .463), but after 
the application, the experimental group received significantly higher scores than the 
control group ( t = 5.12, p < .001). 
 
 

 
95 
  
Figure 5Pre-Test and Post-Test Changes in Experimental and Control Groups – 
Prenatal Father Attachment Time Allocating for Attachment 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Fathers' Fear of Childbirth Scale 
 
Fathers' Fear of Childbirth - Hospital 
The effect of mindfulness-based parenting and childbirth preparation education 
given to couples on fathers' fear of childbirth during the prenatal period was evaluated. 
The effect of the education on the mean scores of the hospital fear sub-dimension of 
the Fathers' Fear of Childbirth Scale (FBS) was evaluated with Mixed Measures 
ANOVA. The analysis results and post-hoc results are given in Table X. 
Table 4.7.1 Variance analysis and post-hoc results of the mean scores of the hospital 
fear sub-dimension of the Fear of Childbirth Scale for Fathers (FBS) 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
P 
Before Application 
3.25 ± 0.34 
2.77 ± 0.34 
1.00 
.329 
After Application 
1.70 ± 0.30 
2.53 ± 0.30 
1.98 
.061 
Test Statistics b 
t 
= 
5.43  
p < .001 
t 
= 
0.82  
p = .423 
 
 
 
 
 
 
 
Test Statistics c 
F 
P 
η 2 g 
 

 
96 
Group 
0.19 
.671 
.01 
 
Time 
19.51 
< .001 
.15 
 
Group x Time 
10.64 
.004 
.09 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
of mindfulness-based parenting and childbirth preparation education given to 
couples on the fear of hospital sub-dimension of fathers' fear of childbirth were 
evaluated using mixed measures ANOVA. No significant difference was found 
between the groups, F (1, 22) = 0.19, p = .671, η ²g = .01. The time effect was found 
to be significant, F (1, 22) = 19.51, p < .001, η ²g = .15. In addition, a significant 
interaction was found between group and time variables, F (1, 22) = 10.64, p = .004, 
η ²g = .09. 
In the comparisons made after the interaction, a significant difference was 
found between the scores before and after the application in the experimental group ( 
t = 5.43, p < .001). This difference was not significant in the control group ( t = 0.82, 
p = .423). In the comparisons between the groups, no significant difference was found 
before the application ( t = 1.00, p = .329); after the application, although the scores of 
the experimental group were not statistically significant compared to the control group, 
they showed a tendency close to significance ( t = 1.98, p = .061). 
 
 
 

 
97 
  
Figure 6Pre-Test and Post-Test Changes in Experimental and Control Groups – 
Fathers’ Fear of Childbirth – Fear of Hospital 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Fathers' Fear of Childbirth – The Birth Process 
The effect of mindfulness-based parenting and childbirth preparation education 
given to couples on fathers' fear of childbirth during the prenatal period was evaluated. 
The effect of the education on the mean scores of the sub-dimension of the Fear of 
Childbirth Scale for Fathers (FBDSI) was evaluated with Mixed Measures ANOVA. 
The analysis results and post-hoc results are given in Table X. 
Table 4.7.2. Variance analysis and post-hoc results of the mean scores of the Fear of 
Childbirth Scale for Fathers (FBS) in the sub-dimension of fear of childbirth process 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
P 
Before Application 
3.26 ± 0.32 
3.56 ± 0.32 
0.68 
.502 
After Application 
2.32 ± 0.28 
3.33 ± 0.28 
2.59 
.017 
Test Statistics b 
t 
= 
5.26  
p < .001 
t 
= 
1.29  
p = .212 
 
 
 
 
 
 
 
Test Statistics c 
F 
p 
η 2 g 
 
Group 
2.70 
.114 
.10 
 
Time 
21.44 
< .001 
.08 
 

 
98 
Group x Time 
7.90 
.010 
.03 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The effects of mindfulness-based parenting and childbirth preparation 
education given to couples during the prenatal period on fathers' fear of the birth 
process were evaluated using mixed measures ANOVA. As a result of the analysis, no 
significant difference was observed between the groups, F (1, 22) = 2.70, p = .114, η²g 
= .10. A significant difference was found according to the time variable, F (1, 22) = 
21.44, p < .001, η²g = .08. In addition, the group and time interaction was found to be 
significant, F (1, 22) = 7.90, p = .010, η²g = .03. 
In the comparisons made after the interaction, it was determined that there was 
a significant difference between the scores before and after the application in the 
experimental group ( t = 5.26, p < .001). This difference was not significant in the 
control group ( t = 1.29, p = .212). In the comparisons between the groups, no 
significant difference was found before the application ( t = 0.68, p = .502), but after 
the application, the scores of the experimental group were significantly lower than 
those of the control group ( t = 2.59, p = .017). 
 
 
Figure 7Pre-Test and Post-Test Changes in Experimental and Control Groups – 
Fathers’ Fear of Childbirth – Fear of the Birth Process 

 
99 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Mothers' Fear of Childbirth 
The effect of mindfulness-based parenting and childbirth preparation education 
given to couples on the fear of childbirth in mothers before birth was evaluated. The 
effect on the mean scores of Wijma Childbirth Expectation/Experience Scale Version 
A (WBSES-A) was evaluated with Mixed Measures ANOVA. The analysis results and 
post-hoc results are given in Table X. 
Table 
4.8. 
Variance 
analysis 
and 
post-hoc 
results 
of 
Wijma 
Birth 
Expectation/Experience Scale Version A (WBDBS-A) mean scores 
Variable 
Experiment 
Control 
Test Statistics a 
𝑿̅±ss 
𝑿̅±ss 
t 
P 
Before Application 
1.65 ± 0.33 
1.85 ± 0.33 
0.43 
.674 
After Application 
0.55 ± 0.17 
1.48 ± 0.17 
3.86 
.001 
Test Statistics b 
t = 5.60 
p < .001 
t = 1.91 
p = .069 
 
 
 
 
 
 
 
Test Statistics c 
F 
P 
η 2 g 
 
Group 
2.68 
.116 
.09 
 
Time 
28.20 
< .001 
.15 
 
Group x Time 
6.79 
.016 
.04 
 
a: t Test for Independent Samples, b: t Test for Repeated Measures, c: ANOVA for 
Mixed Measures 
 
The effects of mindfulness-based parenting and childbirth preparation 
education given to couples on the levels of expectations and fears about childbirth 
during the prenatal period were evaluated using the Wijma Childbirth 
Expectation/Experience Scale Version A (WBSES-A). The effect of the application 
was analyzed with ANOVA for mixed measures. 
According to the analysis results, no significant difference was observed 
between the groups, F (1, 22) = 2.68, p = .116, η ²g = .09. However, a significant 
difference was found according to the time variable, F (1, 22) = 28.20, p < .001, η ²g 

 
100
= .15. In addition, a significant interaction was found between the group and time 
variables, F (1, 22) = 6.79, p = .016, η ²g = .04. 
In the comparisons made after the interaction, it was determined that there was 
a significant difference between the pre- and post-application scores in the 
experimental group ( t = 5.60, p < .001). This difference was not significant in the 
control group ( t = 1.91, p = .069). In the comparisons between the groups, no 
significant difference was found between the pre-application scores ( t = 0.43, p = 
.674), and a significant difference was observed in favor of the experimental group 
after the application ( t = 3.86, p = .001). 
 
 
Figure 8Pre-Test and Post-Test Changes in Experimental and Control Groups – 
Fathers’ Fear of Childbirth – Fear of the Birth Process 
Note. Gray dots represent individual scores on pretest and posttest, and gray 
lines represent change. Box plots show the median for each group and the distribution 
of the data. Black dots represent group means, and error bars represent standard errors. 
 
Birth Mode Expectations – By Groups 
The agreement between birth expectation and actual birth type was evaluated 
separately in the experimental and control groups. In the experimental group (n = 12), 
a high level of agreement was observed between birth type expectation and actual 
birth. 10 (83.3%) of the participants gave birth in accordance with their birth 
expectations. 8 of them expected a vaginal birth and gave birth vaginally, and 2 

 
101
expected a cesarean birth and gave birth by cesarean. The remaining 2 participants did 
not have an expected birth type. 
In the control group (n = 12), 8 participants (66.7%) gave birth in accordance 
with their birth expectations, while the birth method did not match the expectations of 
4 participants. Although there was a difference between these compliance rates, 
according to the Chi-square test results, this difference was not found to be statistically 
significant, χ ²(1, N = 24) = 0.22, p = .637. 
As a result, a higher concordance between the expectation of the type of birth 
and the actual birth was observed in the experimental group that received awareness-
based childbirth preparation training, but this difference was not statistically 
significant. 
When the type of birth was examined, 66.7% (n=16) of all participants had 
vaginal birth and 33.3% (n=8) had cesarean section. While 75% of the participants in 
the intervention group had vaginal (n=9) and 25% had cesarean section (n=3), 58.3% 
of the participants in the control group had vaginal (n=7) and 41.7%  
had 
cesarean section (n=5). According to the chi-square test results, the vaginal birth rate 
was higher in the experimental group, but this difference was not found to be 
statistically significant, χ ²(1, N = 24) = 0.75, p=.386. 
Differentiation of Postpartum Factors According to Groups 
In the section related to the postpartum period, various psychometric scales were used 
to evaluate the postpartum processes of the participants. These scales are: Wijma Birth 
Expectation/Experience Scale – B (WBSES-B), Postpartum Self-Assessment Scale 
(PSS), Maternal Attachment Scale (MAS) and Father Infant Attachment Scale 
(FBAS). In order to examine the differences between the experimental and control 
groups on all or sub-dimensions of the scales, t-test for independent samples was 
applied. The analysis results are given in Table XX. 
 
Table 4.9 Comparison of the Scores of the Experimental and Control Groups on the 
Postpartum Period Scales (T-Test Results for Independent Samples) 

 
102
 
Experiment 
Control 
 
 
Variable 
𝑿̅ ± ss 
𝑿̅ ± ss 
t 
p 
Wijma Birth Expectation/Experience Scale – B 
(WDBDÖ-B) 
1.94 ± 0.42 
2.93 ± 1.28 
-2.54 0.024 
Postpartum Self-Evaluation Scale (PSS) 
3.70 ± 0.41 
3.36 ± 0.53 
1.75 
0.094 
PKDÖ - Quality of Relationship Between 
Spouses 
3.74 ± 0.49 
3.42 ± 0.58 
1.45 
0.162 
PKDÖ - Partners' Perspective on Participation in 
Baby Care 
3.77 ± 0.47 
3.51 ± 0.62 
1.18 
0.250 
PKDÖ - Satisfaction with Birth Experience 
3.65 ± 0.44 
3.10 ± 0.67 
2.38 
0.028 
PKDÖ - Contentment with the Continuity of 
Life 
3.50 ± 0.65 
3.14 ± 0.78 
1.22 
0.235 
PKDÖ - Relying on Strength to Cope with 
Motherhood Duties 
3.71 ± 0.37 
3.35 ± 0.52 
1.93 
0.068 
PKDÖ - Satisfaction with Motherhood and 
Newborn Care 
3.72 ± 0.29 
3.49 ± 0.44 
1.57 
0.134 
PKDÖ - Support for Motherhood from Family 
and Friends 
3.76 ± 0.50 
3.42 ± 0.65 
1.44 
0.164 
Father-Infant Attachment Scale (FBA) 
4.24 ± 0.50 
3.92 ± 0.75 
1.23 
0.234 
BBBÖ - Patience-Tolerance 
4.01 ± 0.49 
3.78 ± 0.61 
1.01 
0.323 
BBBÖ - Pleasure in Interaction 
4.23 ± 0.66 
3.87 ± 0.96 
1.06 
0.300 
BBBÖ - Love-Pride 
4.73 ± 0.34 
4.29 ± 0.74 
1.85 
0.084 
Maternal Attachment Scale (MAS) 
3.95 ± 0.11 
3.53 ± 0.52 
2.71 
0.019 
VAS Pain Scale 
5.42 ± 1.73 
6.58 ± 1.78 
-1.63 0.118 
According to the analysis results, the Wijma Birth Expectation/Experience 
Scale – B (WBSES-B) scores were found to be significantly lower in the experimental 
group, indicating that the experimental group had less fear of childbirth ( t = -2.54, p 
= .024). 
Similarly, it was found that the experimental group was more satisfied with the 
birth experience (PCAS - Satisfaction with Birth Experience sub-dimension; t = 2.38, 
p = .028). In addition, maternal attachment levels were found to be significantly higher 
in the experimental group (MBS; t = 2.71, p = .019). 
No significant difference was found between the experimental and control 
groups in other scales and sub-dimensions ( p > .05). However, results close to 
significance were observed in some variables such as relying on power in coping with 
maternal duties ( t = 1.93, p = .068) and love-pride sub-dimension ( t = 1.85, p = .084). 
 

 
103
 
 
 
 
 
 
 
5.DISCUSSION 
This research is about the effects of mindfulness-based parenting and birth 
preparation education given to couples. maternal-paternal bonding, birth 
parameters and postpartum sleep effects were determined. The findings 
obtained The effects on birth expectation/experience, delivery method, parent-
infant bonding and postpartum adjustment are discussed under the headings. 
The effect of Mindfulness-Based Parenting and Childbirth Preparation 
Education on birth expectation/experience (awareness, fear, pain); 
Awareness 
the mothers in the intervention and control groups before and after the 
application from the BFÖ differed statistically significantly according to the 
groups of the participants (p = .017). It was also found that there was a 
statistically significant difference according to time (p = .032). In addition, a 
significant interaction was observed between group and time (p = .001). (Table 
). 
the fathers in the intervention and control groups before and after the 
application from the BFÖ differed statistically significantly according to the 
groups of the participants (p = .006). It was also found that there was a 
statistically significant difference according to time (p = .001). In addition, a 
significant interaction was observed between group and time (p = .004) (Table 
). 

 
104
These findings show that Mindfulness-Based Parenting and Childbirth 
Preparation Education was effective in increasing the level of conscious 
awareness of pregnant women and their partners in the intervention group. The 
increase in the mean conscious awareness scores after the intervention may 
indicate that it strengthened the capacity of pregnant women and their partners 
to stay in the moment, to be aware of their inner experiences, and to feel self-
compassion towards themselves. 
These findings confirm our hypothesis that "Mindfulness-based parenting 
and childbirth preparation education has an effect on parents' conscious 
awareness levels."  
on the subject were examined, it was found that mindfulness-based 
interventions applied to women during the perinatal period increased the levels 
of mindfulness (Duncan, 2017; Pan et al., 2019; Byrne et al., 2014; Pan et al., 
2019; Rasmusson, 2022; Beattie et al., 2017; Byrne et al., 2014; Yang et al. 
2019, Fernandes et al. 2022, Hulsbosch et al. 2023). Pan et al. (2019), Duncan 
and Bardacke (2010) and Duncan et al. (2017) found that the mindfulness 
levels of women increased significantly as a result of the MBCP training they 
conducted. Pan et al. (2019a), Zarenejad et al. (2020), Lönnberg et al. 2021, 
Veringa-Skiba et al. 2022b, Zhang et al. The study by 2023b, Warriner et al., 
2018 and Guo et al. (2020) also supports the increased level of awareness. 
Recently, health professionals have been trying to attract fathers' attention and 
increase their awareness of childbirth and parenting preparation training 
(Ferguson et al., 2013). Studies have found that childbirth and parenting 
preparation training increases spousal support during pregnancy and 
postpartum periods and that spouses' participation in the process increases after 
the training. Fathers' participation in prenatal training prepares fathers for the 
experiences that will be experienced during pregnancy and childbirth, raises 
their awareness and improves their supportive roles (Ferguson, Davis, and 
Browne 2013). A study found a significant difference in the mean awareness 
scores of fathers who received MBCP training before and after the training 
(Sian Warriner, 2018). These results show that although the application method 

 
105
and duration of MBCP training differ in the studies, it has a positive effect on 
conscious awareness and explains that our results are parallel to the literature. 
Fear  
In this study, the mean scores of WBDDS-A used to assess the fear of childbirth 
in the prenatal period were investigated. According to the analysis results, a 
significant difference was found between the intervention and control groups 
according to the time variable (p < .001). In addition, a significant interaction 
was found between the group and time variables (p = .016). In the comparisons 
made after the interaction, a significant difference was determined between the 
pre- and post-education scores in the intervention group (p < .001). This 
difference was not significant in the control group (p = .069). In the 
comparisons between the groups, a significant difference was observed in favor 
of the experimental group after the application (p = .001). (Table). According 
to the analysis results regarding the mean WBDDS-B scores used to measure 
the level of fear experienced by mothers regarding birth during and after labor, 
a significant difference was found between the intervention and control groups 
( 0.024). (table ).  
According to the BDKS used to evaluate the effect of mindfulness-based 
parenting and birth preparation education given to couples on fathers' fear of 
birth in the prenatal period ……….. (Table ). 
These findings show that Mindfulness-Based Parenting and Childbirth 
Preparation Education was effective in reducing the level of fear related to 
childbirth in the pregnant women and their partners in the intervention group. 
These findings confirm our hypothesis that “Mindfulness-based parenting 
and childbirth preparation education has an effect on fear of childbirth in 
parents.” 
In support of our findings, Çankaya and Şimşek (2020) found that primiparous 
pregnant women who received prenatal education had lower levels of fear of 
childbirth compared to women in the control group, both before and after birth, 
and prenatal education was found to be effective in reducing fear of childbirth. 

 
106
Veringa et al. (2016) and Van der Meulen et al. (2023), (Pour-Edalati et al. 
(2018) , Rasmusson (2022), Kavas (2024, thesis), Abdolalipour et al., 2023, 
Ertuğrul, 2016; Kuo et al., 2022, Li et al., 2022, Alaçam (2024, thesis) findings 
also support our hypothesis. In the light of these findings, it is possible to say 
that those who participated in mindfulness-based birth and parenting education 
had more positive experiences during pregnancy, birth and the postpartum 
process compared to classical education. At the same time, since false beliefs 
and information originating from myths were replaced by correct and positive 
information about birth, this situation may have been effective in reducing fear. 
When the research results in the literature are examined, it is seen that these 
programs can be a potentially useful resource that can improve birth outcomes 
by being integrated into the prenatal education curriculum, considering that 
mindfulness-based interventions reduce the level of fear of birth . 
In a study conducted by Byrne et al. (2014), fear of childbirth increased in both 
groups after mindfulness training; however, the increase was greater in the 
control group. Considering that the effectiveness of the training was not at the 
desired level and there was no decrease in fear of childbirth scores, this 
suggests that women may not have spent enough time on homework. In a 
qualitative study conducted by Fisher et al. (2012), it was stated that 
mindfulness practice was most useful during childbirth and early parenthood 
and that its applicability during pregnancy was limited. This result shows that 
home practices should be emphasized in future studies of mindfulness training 
given to pregnant women and that women should be encouraged to participate 
in the practice by determining the obstacles to this. 
Parallel to these findings, a qualitative study found that prenatal education 
reduced anxiety and fear in some women and increased it in others (Serçekuş 
and Mete, 2010). In addition, as women enter the last trimester of pregnancy, 
the thought of labor makes the pregnant woman anxious (Khanjari et al., 2017). 
These data may indicate that there is an increase in the level of fear due to the 
fact that pregnant women are in the last trimester, the unknowns about birth, 
and the approaching birth. Another study conducted for two weeks and in a 
total of four sessions found that the mean WDEQ-A scores were higher in the 

 
107
intervention group (Akın, 2023, thesis). In the mentioned study, the limited 
duration of the education and the limited number of sessions due to the 
COVID-19 pandemic may have hindered the effectiveness of the education. In 
the same study, it was found that the mean WDEQ-B scores after birth were 
not statistically significant in the intervention and control groups. These data 
also make us think that keeping the number of sessions and duration of training 
short, giving only homework, and not monitoring the actual time spent on 
homework in a controlled manner may reduce the effectiveness of the training. 
Pain 
In this study, although it was determined that the mean scores of the mothers 
in the intervention and control groups from the VAS pain scale before and after 
the application did not differ statistically significantly according to the groups 
of participants (p = 0.118), the mean score of the control group (6.58 ±1.78) is 
higher than the mean score of the intervention group (5.42±1.73). Although it 
did not create a significant difference, the findings are clinically significant 
(Table ). 
These findings confirm our hypothesis that “Mindfulness-based parenting 
and childbirth preparation education has no effect on pain.” 
MBCP training provides access to deep internal resources to cope with pain 
(Mindfulbirthing, 2025). In studies based on mindfulness, pain intensity was 
found to be lower in intervention groups compared to control groups (Ahmadi 
and Bagheri, 2017; McLachlan et al. (2015); Oskoui et al., 2023 ; Van der 
Meulen et al., 2023 ; Guo and Lei, 2022 ; Ertuğrul, 2016; Gür, 2020; Li et al., 
2021 ; Pan et al., 2020). It was concluded that there was a trend towards a 
decrease in the use of opioid analgesia during labor in a birth preparation 
education based on mindfulness (Duncan et al., 2017). This suggests that the 
group that received the education was better able to cope with labor pain. In a 
study examining mind-body interventions, it was concluded that mindfulness-
based practices were effective in relieving the severity of labor pain but did not 
reduce the use of epidural analgesia (Wang et al., 2024). There are a limited 
number of studies in the literature evaluating the effects of mindfulness-based 

 
108
practices on labor pain outcomes. and since the evidence in these studies is 
inconsistent, further randomized controlled trials are needed. 
The reason for our result, which is not parallel with the literature , may 
be due to the fact that we did not perform a mindfulness intervention during 
labor. Providing mindfulness-based counseling in the delivery room by an 
experienced researcher with a certificate in mindfulness skills may increase the 
effectiveness of the intervention. Accordingly, women can better manage labor 
pain by using mindfulness skills and their active participation in the labor 
process can create an enjoyable birth experience for them. These interventions 
may serve as complementary or alternative methods for labor pain management 
in clinical practice. 
The effect of Awareness-Based Parenting and Childbirth Preparation 
Education on the mode of birth; 
In this study, the concordance between birth expectation and actual birth type 
was evaluated separately in the experimental and control groups. In the 
experimental group (n = 12), a high level of concordance was observed 
between birth type expectation and actual birth. 10 (83.3%) of the participants 
gave birth in accordance with their birth expectations. 8 of them expected a 
vaginal birth and gave birth vaginally, and 2 expected a cesarean section and 
gave birth by cesarean. The remaining 2 participants' birth type did not match 
their expectations. In the control group (n = 12), 8 participants (66.7%) gave 
birth in accordance with their birth expectations, while 4 participants' birth type 
did not match their expectations. Although there was a difference between 
these concordance rates, this difference was not found to be statistically 
significant according to the Chi-square test results (p = .637). As a result, a 
higher concordance was observed between birth type expectation and actual 
birth in the experimental group that received awareness-based birth preparation 
training, but this difference was not statistically significant but clinically 
significant. 

 
109
In addition, although the vaginal birth rate appeared to be higher in the 
intervention group, no significant difference was found between the groups 
(p=.386). (Table). However, these findings are clinically significant. 
These findings confirm our hypothesis that “ Mindfulness-based parenting 
and childbirth preparation education has no effect on the type of birth that 
occurs.”  
When the literature is examined, there are studies reporting that childbirth 
preparation training can affect women's preference for delivery method and 
increase vaginal delivery (Mete et al., 2017; Serçekuş and Başkale, 2016;  
Esencan et al., 2018 ; Delaram and Aein 2012; Bergström, Kıeler, and 
Waldenström 2009; Okumuş et al. 2002; Stoll and Hall 2012). In a systematic 
review including 17 studies, it was found that childbirth preparation training 
increased the rate of vaginal delivery (Buran et al. 2020).  
Contrary to these results , some studies have found that the cesarean section 
rates were similar between the intervention group and the control group 
(Ferguson et al., 2013). In a study conducted in Austria in which 100 
nulliparous women participated, the women received structured education. As 
a result of the study, no difference was found between the two groups in terms 
of delivery method (Phipps et al., 2009). Another study found that the rate of 
birth with intervention was higher in those who attended a childbirth 
preparation class (Ferguson et al., 2013). 
When the women in our study were evaluated in terms of birth type, it was 
determined that 25% of the women in the intervention group and 41.7% of the 
women in the control group had a cesarean section. 33.3% of all participants 
had a cesarean section. According to the TNSA report, 52% of all births in 
Türkiye are cesarean sections (TNSA, 2018). The data we obtained as a result 
of the study are below the average in Turkey and show that this situation is 
effective in reducing cesarean section rates regardless of classical education or 
mindfulness-based education. There is limited data in the literature on 
mindfulness-based interventions on birth type in pregnant women. In one 
study, the vaginal birth rate in pregnant women who received mindfulness 

 
110
training was 65%, while vaginal birth was 40% in pregnant women who did 
not receive mindfulness training (Akın, 2023). This finding is striking. In the 
study by Veringa et al. (2022), it was found that the rate of elective cesarean 
section was lower in pregnant women who received mindfulness-based 
parenting and birth preparation training compared to pregnant women who 
received standard care. It is stated in the literature that psychoeducation-based 
prenatal education programs contribute to a positive birth experience and 
significantly affect the preference for vaginal birth (Rouhe et al., 2015; Taheri 
et al., 2014; Toohil et al., 2017; Sezen and Ünsalver, 2019; Bayrı Bingöl et al., 
2022; Çankaya and Şimşek, 2020; MacKinnon et al., 2021). The literature 
findings are consistent with the findings of this study. Mindfulness-based 
education given before birth allows women to trust their own birth skills, and 
this can be offered as an effective intervention to prevent non-emergency 
obstetric interventions and elective cesarean section by reducing the fear of 
birth. Since high cesarean section rates are an important problem that 
negatively affects maternal and infant health and increases health expenditures 
and costs, awareness-based interventions can provide positive outcomes for the 
country's economy by reducing the economic burden of cesarean section. 
The Effect of Mindfulness-Based Parenting and Childbirth Preparation 
Education on Parent-Infant Attachment 
The prenatal attachment level of mothers was measured with the PBİ. 
Comparisons between groups showed that there was a significant difference 
between the PBİ scores before and after the intervention in the intervention 
group ( p < .001). This difference was not significant in the control group ( p = 
.116). Comparisons between groups between times showed that the participants 
in the intervention group had significantly higher scores after the intervention 
( p = .025). (Table ). 
The prenatal attachment level of fathers was measured with the ESRS. A 
significant difference was observed between the pre- and post-intervention 
scores in the intervention group (p < .001). A statistically significant difference 
was also found in the control group (p = .030). In the comparisons made 

 
111
between the groups between the times, the intervention group scored 
significantly higher after the application (p < .001). (Table ). 
These findings confirm our hypothesis that “Mindfulness-based parenting 
and childbirth preparation education has an effect on prenatal maternal and 
paternal attachment.” 
Postpartum attachment levels of mothers were measured with the MBI and 
maternal attachment levels were found to be significantly higher in the 
intervention group (p = .019). Postpartum attachment levels of fathers were 
measured with the BBBI and no significant difference was found between the 
intervention and control groups in terms of postpartum paternal attachment 
levels (p = .234). 
These findings; “ Mindfulness-based parenting and birth preparation 
education has an impact on postpartum maternal It confirms our hypothesis 
that “Mindfulness-based parenting and childbirth preparation education has no 
effect on postpartum paternal attachment.” and also confirms our hypothesis 
that “Mindfulness-based parenting and childbirth preparation education has 
no effect on postpartum paternal attachment.” 
When the literature is examined, Serçekuş and Başkale (2016) found that 
prenatal education had no effect on postnatal attachment to mother and father. 
In Akın (2023)'s thesis study, the total MBI score average between the 
intervention and control groups was not found to be statistically significant. 
The lack of significant maternal attachment suggests that parents do not 
continue conscious awareness practices after birth, and that their roles and 
responsibilities increase in the postnatal period and that they may have 
difficulty in allocating time for formal and informal practices, which negatively 
affects the effectiveness and sustainability of the education. 
On the other hand, there are also study results showing that education is 
effective in prenatal attachment in primiparous pregnant women (Abasi et al., 
2013; Akbarzadeh et al., 2017; Nasari et al., 2021; Sağıroğlu, 2025; Sajadian 
et al., 2022; Ibıcı Akca et al., 2023). It has been stated that pregnant women 

 
112
who participated in mindfulness-based education experienced better 
connection with their newborn babies compared to the control group (Beattie 
et al., 2017). In the study of Duncan and Shaddix (2015), it was concluded that 
mindfulness-based birth and parenting education can facilitate healthy parent-
child attachment by supporting being in the moment, non-judgmental 
awareness and compassion. In studies that provided conscious awareness-
based birth preparation training and examined postpartum maternal attachment 
levels, attachment levels in the intervention group were found to be 
significantly higher compared to the control group (Körükcü and Kukulu, 
2017; Gheibi et al., 2020). These results show that conscious awareness-based 
interventions have positive effects on prenatal and postpartum attachment 
processes. 
In the systematic review and meta-analysis study conducted by Dhillon, 
Sparkes, and Duarte (2017), it was shown that mindfulness practices during 
pregnancy contribute to the mother's development of a greater understanding 
of herself and her environment, which in turn increases both mother-infant 
bonding and the mother's positive feelings about herself. 
The limited number of studies on the effects of mindfulness interventions on 
attachment keeps the data in the existing literature limited. This situation has 
revealed the need for new research that will comprehensively address the 
effects of mindfulness-based interventions on attachment. 
The Effect of Mindfulness-Based Parenting and Childbirth Preparation 
Education on Postpartum Sleep –pkdö Scale 
Postpartum adjustment levels of mothers were measured with PBDS and it was 
found that the intervention control group was more satisfied with the birth 
experience (PBDS - Satisfaction with Birth Experience sub-dimension; t = 
2.38, p = .028). However, no significant difference was found between the 
intervention and control group PBDS total scores (p = 0.094) (Table ). 
These findings confirm our hypothesis that “Mindfulness-based parenting 
and childbirth preparation education has no effect on postpartum sleep.” 

 
113
Parallel to our findings; in the studies conducted on the effect of education on 
postpartum sleep, Serçekuş (2010), Arcamone (2005) and Bergström et al. 
(2009) found that there was no significant difference in women's postpartum 
adaptation scores compared to the control group. This result can be interpreted 
as the fact that the women in the group receiving classical education also 
received education about the postpartum process and therefore did not create a 
significant difference. Nichols (1995) found that education did not affect the 
sense of competence for motherhood and did not make the transition to 
motherhood easier. Different studies have also found that education has no 
effect on women's parenting skills (Fabian et al., 2005; Lumney and Brown, 
1993; Willford, 1998). Barclay et al. (1997) emphasized in their qualitative 
study that some of the women who received education thought that the 
education was useful in preparing for birth but useless in preparing for 
parenthood. Deave et al. (2008) and Ho and Holroyd (2002) found that women 
thought that the education they received was insufficient to prepare them for 
motherhood. Although the content of the education given in the antenatal 
period included topics related to postpartum adaptation, women may not be 
able to focus sufficiently on postpartum issues because their attention is 
directed to the upcoming birth. Another reason may be that the postpartum self-
assessment scale was applied after the fourth week postpartum in the study. 
Because discomfort, fatigue, and breastfeeding problems experienced in the 
postpartum period are often more intense in the first weeks (London et al., 
2003). The resolution of most of these problems after the fourth week may have 
closed the difference between the groups that received the training and the 
control group. For these reasons, the application of the postpartum self-
assessment scale in the first weeks postpartum may provide a more accurate 
interpretation of the results. In addition, the increase in the expectations of 
some women after the training and the failure of some women to meet their 
expectations may be the reason why the satisfaction score with the birth 
experience was not much higher in the intervention group compared to the 
control group. 

 
114
In contrast to these results, Schachman and colleagues (2004) found that a new 
education program developed for adaptation to the role of motherhood had a 
positive effect on postpartum adaptation compared to the standard education 
program. When the mean scores of the PBAS and subscales were evaluated in 
terms of education groups in similar studies, it was determined that the 
adaptation rates of mothers who received childbirth preparation education were 
better and the difference was significant in all groups (Doğan Merih et al., 
2017; Başar and Arıöz, 2017). This finding can be explained by the 
effectiveness of the education given in the childbirth preparation class. Similar 
studies have also found that women who received education had a high 
adaptation to their role as mothers (Lumney and Brown, 1993; Lu et al., 2003; 
Mete et al., 2017); it was concluded that mothers' social support networks 
increased in education classes, they continued their communication with each 
other in the postpartum period, and they facilitated the adaptation process by 
supporting each other (Deave et al., 2008; Fabian et al., 2005). Studies 
examining the effectiveness of 8-week mindfulness-based training in first-time 
mothers have shown that the intervention supports postpartum adaptation 
(p<0.05) (Ocak Aktürk, 2023; Sajadian et al., 2022). In a study with results 
contrary to our findings, it was determined that the difference between the 
mean scores of mothers in the intervention and control groups in all sub-
dimensions of the scale (except satisfaction with the birth experience) was 
statistically significant (Demir and Taşpınar, 2022). 
When we look at the literature findings parallel to the significance in our 
satisfaction with birth experience sub-dimension, it has been concluded that 
awareness-based trainings increase the psychological and spiritual well-being 
of women and their partners and improve the birth experience (Shorey and Ng, 
2020). Fisher and colleagues (2012) stated in their qualitative study that women 
who received antenatal training felt strong during birth, did not lose control 
even when unplanned situations occurred, and were satisfied with the birth 
experience (Fisher, 2012; Quine et al., 1993). According to the results of a 
study, when the fear-tension-pain cycle is intervened, the fear and pain chain 
is broken, the birth duration is shortened, and the satisfaction with the birth 

 
115
experience is positively affected (p<0.05) (Ertuğrul, 2016-thesis). These results 
may show us that antenatal training helps the woman maintain control 
throughout the birth and positively affects her satisfaction with the birth 
experience. 
 
 
 
 
 
 
 
6. SUGGESTIONS 
 
 
 
 
 
 
 
 
 
 
 
 

 
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