Sinaga M, Tanjung M, Siringoringo E. Effect of Yoga Exercises on Preventing Postpartum Blues in Postpartum Mothers. Health Educ Health Promot 2025; 13 (2) :249-256 URL: http://hehp.modares.ac.ir/article-4-78999-en.html
1- Department of Midwifery, Medan Sehati College of Health Sciences, Medan, Indonesia 2- Department of Midwifery, Sakinah Husada Tanjungbalai College of Health Sciences, Tanjungbalai, Indonesia
* Corresponding Author Address: Jl. Pembangunan No. 130 C, East Helvetia Village, Medan Helvetia District, Medan City, Indonesia. Postal Code: 20124 (meiyanasinaga87@gmail.com)
Introduction The puerperium is a very important and challenging period for a mother after childbirth. During this time, the mother’s body and mind undergo major changes that require physical and emotional adaptation. Drastic hormonal changes after childbirth can affect a mother’s emotional balance, often leading to feelings of anxiety, stress, and unstable mood swings. In addition to hormonal changes, social and psychological factors also play an important role in the well-being of postpartum mothers [1]. Support from partners, family, and the surrounding environment can greatly affect a mother’s emotional state. A lack of social support is often associated with an increased risk of postpartum blues. Additionally, cultural pressures and societal expectations of the perfect mother can also add to the mental burden for new mothers. This condition often makes mothers feel overwhelmed and less confident in caring for their children. One psychological problem that is quite common during the postpartum period is postpartum blues, which is a mood disorder that generally appears within a few days to weeks after giving birth. This condition is characterized by symptoms such as excessive anxiety, irritability, frequent crying for no apparent reason, fatigue, and a lack of confidence in fulfilling the role of mother. Postpartum blues can be experienced by around 50-80% of postpartum mothers, and although it is temporary, this condition requires special attention. If left untreated, postpartum blues can develop into more serious postpartum depression and impact the mother’s quality of life and emotional relationship with the baby [2]. The impact of postpartum blues is not only limited to the mother but can also affect the development of the child [3]. Mothers who experience postpartum blues tend to have difficulty giving their full attention to their babies, which can impact the quality of the emotional bond between mother and child. In addition, this condition can also cause disturbances in sleep and feeding patterns in infants due to a lack of positive stimulation from the mother. Therefore, the prevention and management of postpartum blues are very important aspects of ensuring the well-being of both mother and baby [4]. Given its considerable impact on maternal well-being and child development, effective prevention efforts are needed to address postpartum blues. One method that can be applied is a physical and psychological approach, such as yoga exercises. Yoga has been shown to help stabilize emotions, reduce stress, and improve the physical well-being of postpartum mothers [5]. Thus, the application of yoga as one of the strategies to prevent postpartum blues is expected to help mothers cope better with the postpartum period, allowing them to fulfill their roles as mothers with more confidence and comfort [4]. Based on data released by the World Health Organization (WHO), around 20% of cases of postpartum blues that are not treated properly develop into postpartum depression [6]. This condition is more common in developing countries, including Indonesia, where a lack of social support and limited knowledge about mental health problems are often causal factors [7]. Riskesdas data for 2023 shows that the prevalence of postpartum depression in Indonesia reached 11.5%, with main risk factors including physical fatigue after giving birth, social pressure, and a lack of support from family or partners [8]. These factors may affect mothers’ ability to adapt to their new roles and negatively impact their mental health. Therefore, it is important for society, especially families and health workers, to find solutions that can prevent or mitigate the problem of postpartum blues, one of which is using yoga exercises as an intervention that can be easily and affordably implemented [9]. Yoga is a physical method that combines various body movements, breathing techniques, and meditation to create a balance between body and mind [10]. This yoga practice is believed to reduce stress, improve sleep quality, increase body flexibility, and strengthen the relationship between mother and baby. According to Gerbarg & Brown, yoga positively lowers cortisol levels, a hormone associated with stress and anxiety [11]. Yoga can also help overcome physical problems that postpartum mothers often face, such as back pain, fatigue, or muscle tension [12]. In terms of mental health, yoga can reduce anxiety and improve maternal emotional well-being [13]. Munns et al. also found that mothers who regularly practiced yoga during the postpartum period reported experiencing a significant reduction in symptoms of depression and anxiety. Therefore, yoga exercises are considered an effective alternative to help postpartum mothers prevent or reduce the symptoms of postpartum blues, as well as to support their physical and mental recovery after giving birth [14]. Research on the relationship between yoga and the mental health of postpartum mothers has been conducted by several previous researchers. Satyapriya et al. in India found that postpartum mothers who participate in a yoga program for six weeks experience a significant reduction in postpartum blues symptoms compared to mothers who did not participate in the yoga program [15]. Similar research by Chuntharapat et al. in Thailand also showed that yoga can reduce anxiety and improve the quality of life of mothers after giving birth [16]. The results of this research indicate that yoga is not only beneficial for physical health but can also support the mental well-being of mothers. However, although these studies show positive results, most were conducted in health centers or with the guidance of yoga instructors, thus paying less attention to affordability and convenience for postpartum mothers who live in areas with limited access to health facilities. This research differs from previous studies, particularly in its approach, which integrates family health media as a tool to facilitate the implementation of yoga at home. In most previous studies, yoga was implemented with the assistance of a direct instructor or in a health center. Meanwhile, this research tested the application of yoga through family health media, such as video tutorials or digital applications that can be accessed by postpartum mothers independently at home. This approach is expected to increase the accessibility of yoga for postpartum mothers who may not have the time or resources to attend scheduled yoga classes. Through family health media, it is hoped that mothers can carry out yoga exercises regularly at home, thereby increasing the likelihood of success in preventing or reducing symptoms of postpartum blues. Even though many studies have discussed the benefits of yoga for postpartum mothers, there is still a gap in the implementation of yoga that can be widely accessed by postpartum mothers at home. Some previous studies were limited to interventions carried out in health centers or with the assistance of professional yoga instructors. This makes it difficult for postpartum mothers who do not have access to these facilities to obtain the same benefits. Additionally, more affordable and practical approaches, such as digital media, have not been widely explored. This gap is the main reason this research was conducted to determine how effective the application of yoga exercises through family health media is in preventing postpartum blues in postpartum mothers. With this approach, it is hoped that mothers can practice yoga easily at home, which will suit their circumstances and needs. The main purpose of this study was to analyze the effect of applying yoga exercises on preventing postpartum blues in postpartum mothers using family health media as a means of intervention. In addition, this study aimed to contribute to the development of an effective and practical family-based intervention model. Through this research, a system was developed that increased mothers’ awareness of the importance of maintaining mental and physical health during the postpartum period and helped them overcome the symptoms of postpartum blues. Thus, the results of this study can serve as a basis for the development of health policies that are more inclusive and pay greater attention to the welfare of postpartum mothers in Indonesia. Instrument and Methods Type of research This research was quantitative with a cross-sectional method, in which, the main goal was to examine a specific population or sample using a structured research instrument. This approach is relevant for evaluating the effect of implementing yoga exercises on preventing postpartum blues because it provides an overview of the relationship between yoga exercise as a health intervention and postpartum blues conditions in postpartum mothers at a single point in time. Research setting The research was carried out at the Alisah Clinic. This health facility is a strategic location because it has a relevant target population; postpartum mothers registered as patients. The selection of this location was based on considerations of accessibility, data availability, and support from the clinic to ensure the smooth running of the research. The research was done from June to July 2024, with activity stages designed systematically. Sample The sampling technique employed was total population sampling, which included all postpartum mothers registered at Alisah Clinic, totaling 80 individuals. Since this study utilized a single intervention group, all participants received treatment in the form of postpartum yoga exercises combined with family health media. This single-group approach enabled researchers to assess changes before and after the intervention within the same group, without making comparisons to a control group. Data collection The data collection was carried out through two main types of data sources, including primary and secondary data. Primary data were obtained directly from respondents through questionnaires and interviews. A questionnaire was designed with 18 statements for each research parameter, using an ordinal scale to measure postpartum mothers’ perceptions and experiences regarding the effect of yoga exercises on preventing postpartum blues. In addition, interviews were conducted directly to explore more in-depth information, such as emotional experiences, levels of family support, and the benefits of yoga exercises according to the respondents’ views. This approach aimed to obtain accurate and comprehensive data and to complement the results of the questionnaire.The validity of the questionnaire was assessed through content validity, which involved seeking opinions from experts (expert judgment), such as supervisors or health practitioners experienced in the fields of postpartum maternal health and postpartum psychology. Each item in the questionnaire was reviewed to ensure that the statements accurately reflect the aspects to be measured, such as the perception of yoga benefits, postpartum blues symptoms, and family support. Meanwhile, secondary data were obtained from patient medical records at the Alisah Clinic. Medical records provided objective data regarding the postpartum mother’s health condition, birth history, and risk factors relevant to postpartum blues. This information helped ensure the validity of the research data and provided a broader context for the analysis. By using a combination of primary and secondary data, it is hoped that this research will provide a comprehensive picture of the effect of yoga exercises in preventing postpartum blues and support more valid and reliable conclusions. Data analysis Data analysis was conducted using SmartPLS software version 4, which is an application based on Partial Least Squares Structural Equation Modeling (PLS-SEM). Findings Most respondents were young mothers, with the majority in the 17-25 age group, followed by those in the 26-35 age group. In terms of education, the respondents predominantly had a diploma or Junior high school background, although a significant portion had lower levels of education, including junior high, elementary, and high school/vocational school (Table 1). Table 1. Demographic characteristics of the subjectsobtained from primary data, 2024 Reliability of the research parameters The reliability and construct validity tests indicated that several constructs measured showed varying levels of reliability and validity. The construct “frequency of application of yoga exercises” demonstrated low reliability, with Cronbach’s alpha and composite reliability values below the acceptable threshold, suggesting that this construct may not be reliable for measuring its intended variable. Similarly, “family health media quality” also showed moderate reliability, with an average variance extracted (AVE) slightly below the ideal value, indicating room for improvement. On the other hand, “yoga practice duration” and “level of family support” exhibited better reliability, with acceptable composite reliability and AVE values, supporting their validity as strong indicators in the model. Importantly, the construct “the effect of applying yoga exercises in preventing postpartum blues” exhibited perfect reliability and construct validity, with all indicators at the maximum value, indicating that this construct is highly reliable and valid for measuring the effect of yoga exercises on preventing postpartum blues. These findings highlight that while some constructs require refinement, the research successfully supports the intended goal of examining how yoga exercises can effectively prevent postpartum blues, particularly with the strong performance of the “effect of yoga” construct. This reinforces the research’s focus on the importance of yoga interventions in improving postpartum mental health, aligning with the goal of developing effective family-based health interventions (Table 2). Table 2. Composite reliability and Cronbach’s alpha results
The application of yoga practice had a highly significant effect on preventing postpartum blues in postpartum mothers. The research model used demonstrated excellent predictive ability, with the independent variables explaining most of the variation in the incidence of postpartum blues. The high adjusted R-squared value indicated that the model remained robust even when adjusted for the number of predictors used. This confirms the importance of integrating yoga exercises into postpartum women’s health programs to reduce the risk of postpartum blues (Figure 1).
Figure 1. Regression results on the effect of applying yoga exercises on preventing postpartum blues. Independent and dependent parameterswere assessed using the bootstrapping method in SE Mpls to determine the validity and reliability of the research data. This test used T-statistics and p-values, which were later presented as a t-table, to identify valid research data for T-statistic values greater than 1.96 and p-values less than 0.05 (Table 3). Table 3. Bootstrapping method results All independent parameters significantly influenced the application of yoga exercises in preventing postpartum blues among postpartum mothers. Each parameter showed significant results (high T-statisticsand p=0.0001). Among the parameters, “yoga practice duration” demonstrated the strongest influence with the highest original sample value, followed by “regularity of yoga practice,” which also showed a substantial effect. Additionally, “frequency of application of yoga exercises,” “family health media quality,” and “level of family support” all contributed significantly to the overall outcome, with each showing positive relationships with the prevention of postpartum blues. These findings directly align with the research’s goal of evaluating the effectiveness of yoga exercises, particularly through family-based health interventions, in reducing the risk of postpartum blues. Discussion This study aimed to analyze the effect of yoga exercises on preventing postpartum blues in postpartum mothers using family health media as an intervention. The frequency of implementing yoga exercises significantly influenced the parameters analyzed, supporting the importance of consistency in this activity. The results are in line with previous research showing that physical activity carried out regularly, such as yoga, has a significant positive impact on both physical and mental health. Smith et al. revealed that regular yoga contributes to increased body flexibility, reduced stress, and improved sleep quality and concentration [17]. This is in line with our results, where the frequency of applying yoga exercises positively affected physical condition and general well-being. Additionally, Rafika emphasized that the frequency of yoga activities is directly related to the benefits obtained [18]. The more often a person engages in yoga, the greater the positive impact felt in managing stress and improving mental health. These findings support that more frequent application of yoga may provide greater benefits in enhancing quality of life. Thus, our results strengthen previous findings, which show that consistency in practicing yoga exercises significantly improves physical and mental well-being. The frequency of application of “Family Health Media Quality” significantly influenced the analyzed parameters, with results indicating a positive relationship between the quality of media used in the family health context and its impact on health knowledge and behavior. Previous research has confirmed the importance of the quality of health media in influencing health-related decision-making, especially within families.<