The Effects of Mother Baby Yoga and Baby Massage on Attachment,Weight,and Sleep: A Randomized Crossover Study

Abstract

Background: Limited research exists on the combined effects of mother–baby yoga and massage on infant health, prompting this investigation. This study was conducted to investigate the effects of mother–baby yoga and massage on mother–infant attachment, sleep, and weight. Method: A randomized, crossover study was conducted in the postpartum ward of a hospital between January and November 2023 with 36 mothers and their infants, 18 in each group, who were in the postpartum period. One group received mother–baby yoga for the first 4 weeks and massage for the second 4 weeks (Group 1), and the other group received massage for the first 4 weeks and mother–baby yoga for the second 4 weeks (Group 2). Results: The groups were homogeneous in sociodemographic and obstetric evaluation before the intervention. There was no statistical difference between the groups in terms of attachment before the intervention and at the end of the first 4-week intervention, but there was a statistical difference at the end of the second intervention. There was no significant difference between the babies in Group 1 and Group 2 in terms of the frequency of nighttime awakenings, nighttime, and all-day sleep duration in the pre-intervention, first and second 4-week follow-ups. There was a statistically significant difference in the body weights of the infants at the first and second 4-week follow-ups. Conclusion: In the study, it was observed that both interventions positively affected mother–infant attachment, sleep, and weight in the intragroup evaluation independently of each other.

Keywords

mother–baby yoga massage attachment sleep weight

Key Messages

Mother–baby yoga and massage positively affect mother–infant attachment.

Both yoga and massage improve the infant's sleep patterns and quality.

Massage and yoga contribute to the infant's weight gain.

Yoga is more effective in enhancing infant attachment in the early postpartum period, while massage has a greater effect on weight gain in the following months.

Future studies should consider cortisol measurements to evaluate the infant's stress levels.

Studies evaluating the effects of online baby care training and postpartum counseling on mothers’ self-confidence and baby health are limited.

Our results showed that online education and postpartum counseling had a positive impact on mothers’ self-confidence and baby health.

In cases where face-to-face education opportunities are interrupted, education and postpartum counseling can be provided to mothers online.

Introduction

Parent–infant attachment, breastfeeding, and sleep are important components for the maintenance of health and healthy growth and development indicators in healthy newborns. (WHO, 2022; Yılmaz et al., 2023). For this, babies need integrated and quality care and parental communication (Toksöz, 2023; WHO, 2022). This shows that the baby's health can only be optimized with multidimensional care, not just hygienic care (WHO, 2022).

While baby massage is a part of care in some countries, in Turkey and similar countries, it is still thought to harm the baby, and therefore, it has not been integrated into care (Yılmaz et al., 2023). Studies have reported that massage care is effective in increasing the well-being of the mother, increasing the mother's attachment to her baby, maintaining the breastfeeding process successfully, accelerating the healing process if the baby has a health problem, and regulating the baby's sleep pattern (Noorbaya et al., 2020; Saputro et al., 2021; Ventura et al., 2023; Yılmaz et al., 2023). As a result, massage practice, which is very important for maintaining the baby's body contact and strengthening the feeling of being safe, also supports the mother's attachment behavior. Although not part of traditional yoga practice, studies have shown that in recent years, mothers have included their babies in yoga classes and see it as an educational, social, and exercise opportunity and a way to bond with their babies (Boybay Koyuncu & Yayan, 2022). In mother–baby yoga, the combination of various touches, strokes, grasps, and movements applied to babies by their mothers provides multisensory stimulation for babies. Positive sensory and movement experiences that infants are exposed to in a safe and familiar environment help them cope with possible future environmental stressors and help them regulate physiologically (Bilmez et al., 2020). Although there are studies examining the effect of baby massage on various variables in the literature, studies on the effectiveness of mother–baby massage are quite limited. There is no study examining the effectiveness of two nonpharmacologic interventions in a crossover design in terms of infant health. This study was conducted to examine the effects of mother–baby yoga and massage on mother–baby attachment, infant sleep, and weight. Hypotheses of the study are as follows:

H1: Mother–baby bonding is higher in the group that received mother–baby yoga for the first 4 weeks and massage for the second 4 weeks (Group 1) compared to the group that received massage for the first 4 weeks and mother–baby yoga for the second 4 weeks (Group 2).

H2: Infants in Group 1 had longer sleep duration and less frequent awakenings compared to infants in Group 2.

H3: Infants in Group 1 gain more weight compared to infants in Group 2.

H4: Mothers in Group 2 have higher mother–infant attachment compared to mothers in Group 1.

H5: Infants in Group 2 have longer sleep duration and less frequent awakenings compared to infants in Group 1.

H6: Infants in Group 2 gain more weight compared to infants in Group 1.

Materials and Methods

The randomized, crossover study was conducted in the postpartum ward of a hospital between January and November 2023. The study consisted of an 8-week follow-up and intervention period.

Study Population

No sample calculation method was used for the study. The sample of the study consisted of mothers and their infants who met the sample selection criteria on the dates when the research data were obtained.

Inclusion Criteria

In the first week postpartum, healthy, singleton, term (37–40 GW), normal birth weight of the baby (2500–4000 g), literate mothers were included in the study.

Exclusion Criteria

Mothers with communication problems, physical disability or presence of any chronic disease (hypertension, diabetes mellitus, etc.), psychological disease (major depression, psychosis, etc.), pregnancy through assisted reproductive techniques, diagnosis of sleep disorder, and therefore treatment for their baby were excluded from the study.

Exclusion Criteria

Mothers whose practices were not performed according to the schedule, whose infant/mother was diagnosed with infection, chronic disease, etc. during the research process, and who incompletely completed the data collection forms were excluded from the study. A total of 36 mothers and their babies, 18 in each group, were included in the study. The study was completed with a total of 28 mothers and their infants, 14 in each group. Post hoc analysis after the data collection process showed that the sampling power was 95% and the sample was adequate.

Randomization and Blinding

Participants were included in the study until the minimum number determined for the sample (1:1) was reached. During the study, 63 mothers were interviewed. Ten mothers refused to participate in the study. Seventeen mothers and their infants were excluded from the study because they did not meet the sample selection criteria. The remaining 36 mothers and their infants were included in the sample. Randomization of the groups was performed by an investigator who was not present in the study using the Random Allocation Software program (1.0). The mothers and infants included in the study were assigned to two groups: Experimental Group 1: (A) and Experimental Group 2: (B). Which letter to start with which intervention was determined by lottery at the beginning of the study. During the research process, there were some participants who did not participate in all the interventions (n = 4) and some who were lost due to infectious diseases in the baby (n = 4). As a result, the study was completed with a total of 28 mothers and their babies, 14 in Group (A) and 14 in Group (B). The enrollment, assignment, follow-up, and analysis steps of the study were demonstrated using CONSORT 2018 (Updated Guidelines for Reporting Randomized Parallel Group Studies) (Grant et al., 2018) (Figure 1).

The mother–baby yoga and massage intervention and follow-up were conducted by the researcher (RT) who was not blinded to the interventions. Randomization was performed by another academic who was not an investigator in the study. To avoid bias, the researcher (RT) who conducted the intervention did not participate in any step of the pretest, posttest, and statistical evaluation process. Group information was not shared with the statistical expert who performed the analysis.

Measurement

In the study, measurements were obtained through a data collection form consisting of 18 questions (12 questions to evaluate the sociodemographic characteristics of mothers and infants and six questions to evaluate the characteristics of the infant), which was developed by the researchers by reviewing the literature (Ağapınar Şahin & Bekar, 2023; Del-Ponte et al., 2020).

The Mother–Infant Attachment Scale developed by Taylor et al. was used to measure mother–infant attachment. The Turkish validity and reliability study of the scale was conducted by Karakulak et al. (2016). The Mother–Infant Bonding Scale (MIBS) is designed to be administered from the first-day after birth and allows the mother to express her feelings toward her baby with a single word. This scale, which can be easily and quickly administered by the mother or father alone, shows the relationship between the established bond and the mother's early mood. The MIBS is a 4-point Likert scale consisting of 8 items. The responses consisting of four options are scored between 0 and 3, with a minimum score of 0 and a maximum score of 24. In the evaluation, Items 1, 4, and 6 are positive expressions of emotion and are scored as 0, 1, 2, and 3, while Items 2, 3, 5, 7, and 8 are negative expressions of emotion and are scored as 3, 2, 1, and 0. The internal consistency reliability (Cronbach alpha) of the scale was reported to be 0.68. In this study, 0.71 was found.

Sleep characteristics of the infants were assessed using a sleep diary form created by the researchers. The form included questions about the time of starting the bedtime routine, the time of going to bed, the number of nighttime awakenings, the duration of staying awake at night, the longest sleep time spent without waking up at night, the total sleep time at night, the number of daytime naps, and the total sleep time during the day (Ağapınar Şahin & Bekar, 2023; Del-Ponte et al., 2020; Hanifarizani et al., 2020; Mrljak et al., 2022). The mothers were asked to write in this diary to be recorded for one day during the first and last week of the implementation process.

Intervention

Thirty-six mothers and their infants who met the sample selection criteria were included in the study in the first week after delivery. Mothers were randomized into two groups in a 1:1 ratio. Data Collection Form, Mother–Infant Attachment Scale, and Sleep Diary were applied to all mothers. For the sleep diary, mothers were asked to note the time their babies were asleep and awake with a stopwatch one day before the intervention. One group of mothers practiced mother–baby yoga and the other group practiced baby massage.

The mothers in the mother–baby yoga group were given a 10-min training on mother–baby yoga before the practice and then practiced one session together. The mothers were asked to choose the most suitable time of the day for themselves and the baby, to feed the baby at least 45 min before the yoga, and to practice in a calm and dim environment, listening to music or white noise of their choice. Approximately one yoga session lasted 20 min. Mother and baby practiced mother–baby yoga three times a week for 4 weeks. The content of mother–baby yoga consisted of mood regulation: abdominal/belly breathing, warm touch from the heart, chair pose, scoop hug, bukka bukka, vortexing, fertile falls one hand two hands, tiny stretches, here and now awareness, and dolphin pose.

In the baby massage practice, mothers were trained on baby massage and watched a mother massage her baby once. The baby massage video prepared by the researchers was shared with the mothers. Mothers were informed about the importance of the same characteristics of the application room for each application. The baby massage application was performed 90 min after feeding, and each application was performed at the same time. Mothers were asked to massage their babies for 15 min three times a week for 1 month. The massage application content included 1 min face, 2 min chest, 4 min arm, 2 min abdomen, 4 min leg, and 2 min back massage (Mrljak et al., 2022; Virgian & Setiawati, 2021). A researcher called all mothers once a week for counseling and follow-up of the process.

At the end of 4 weeks, measurement tools were applied to all mothers and the groups were switched and massage was applied to the group practicing yoga and yoga intervention was applied to the group practicing massage as at the beginning of the study. At the end of 4 weeks, mother–infant attachment and infant sleep diary assessments were taken in all mothers.

Statistical Methods

The data of the study were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 26.0 program. Descriptive statistics were used to evaluate the study data. The difference between categorical variables was evaluated by chi-square test. Shapiro–Wilks test and Q–Q graphs were used to evaluate the conformity of dependent variables to normal distribution. Mann–Whitney U was used to analyze categorical variables that did not show normal distribution. Repeated measures analysis of variance was used to analyze repeated measures. Bonferroni was applied in post hoc analysis to determine at which time the difference occurred. In the analysis of the results, p < .05 was considered significant.

Ethical Considerations

In this study, scientific and universal ethical principles were followed. Ethical approval was obtained before the data collection process (Date: March 22, 2023; approval number: KAEK-234). Informed consent was obtained from the mothers regarding participation in the study. The study was registered in ClinicTrials.gov with the ID NCT05489861.

Results

The study was completed with 28 mothers and their infants. No statistically significant difference was found between the sociodemographic and obstetric characteristics of the mothers and infants who participated in the study (p > .05; Table 1).

Table 1.

Comparison of Sociodemographic and Obstetric Characteristics of Groups (N = 28).

Variable	Group 1 (n = 14)		Group 2 (n = 14)		Test Value	p
Variable	Mean ± SD	(Min–Max)	Mean ± SD	(Min–Max)	Test Value	p
Mother age	29.42 ± 3.25	24.00–36.00	29.78 ± 2.63	25.00–34.00	90.000^a	.711
Baby age (day)	4.28 ± 1.22	2.00–7.00	4.35 ± 1.21	2.00–6.00	93.000^a	.813
Baby's birth weight (gr)	3032.85 ± 263.70	2.500–3.345	2617.71 ± 256.47	2.500–3.200	85.000^a	.457
Baby's birth size (cm)	49.61 ± 1.00	47.00–51.00	49.71 ± 0.82	47.00–50.00	97.000^a	.949
Baby's birth head circumference (cm)	34.57 ± 1.34	32.00–37.00	34.28 ± 0.91	33.00–36.00	83.000^a	.474

	n	%	n	%
Mother education status
High school	1	7.1	3	21.4	1.167^b	.280
University and above	13	92.9	11	78.6	1.167^b	.280
Father education status
High school	2	14.3	1	7.1	0.373^b	.541
University and above	12	85.7	13	92.9	0.373^b	.541
Mother working status
Working	9	64.3	11	78.6	0.700^b	.403
Not working	5	35.7	3	21.4	0.700^b	.403
Revenue status
Middle	12	85.7	12	85.7	3.259^c	.233
High	2	14.3	2	14.3	3.259^c	.233
Pregnancy planning status
Planned	11	78.6	11	78.6	0.000^b	1.000
Not planned	3	21.4	3	21.4	0.000^b	1.000
Birth type
Caesarean	12	85.7	11	78.6	0.243^b	.622
Vaginal birth	2	14.3	3	21.4	0.243^b	.622
Sex of the baby
Girl	4	28.6	7	50.00	1.348^b	.246
Boy	10	71.4	7	50.00	1.348^b	.246

Note. Group 1: first 4 weeks mother–baby yoga; second 4 weeks massage. Group 2: First 4 weeks massage; second 4 weeks mother–baby yoga.

Mann–Whitney U test.

Chi-square.

Fisher's exact.

The MIBS total mean score of the group (Group 1), which received mother–baby yoga for the first 4 weeks and massage for the second 4 weeks, and the group (Group 2), which received massage for the first 4 weeks and mother–baby yoga for the second 4 weeks, did not differ statistically between the groups before the intervention and at the end of the first 4-week intervention, but there was a statistical difference at the end of the second intervention. The mean MIBS scores of Group 1 and Group 2 were statistically different before the intervention, at the end of the first 4-week intervention and at the end of the second 4-week intervention according to the analysis of variance in repeated measures (p < .05; Table 2).

Table 2.

Comparison of the Mother–Infant Attachment Scale Total Score Average of the Groups (N = 28).

MIBS × total score	Group 1 (n = 14)		Group 2 (n = 14)		Test value	p
MIBS × total score	Mean ± SD	(Min–Max)	Mean ± SD	(Min–Max)	Test value	p
Pre-intervention (a)	19.42 ± 2.70	13.00–23.00	20.57 ± 2.37	15.00–24.00	72.000^a	.222
4 weeks (b)	20.00 ± 2.11	15.00–23.00	21.14 ± 1.95	17.00–24.00	66.500^a	.150
8 weeks (c)	20.64 ± 2.02	16.00–23.00	22.14 ± 1.35	20.00–24.00	55.000^a	.049
Test	6.015^b		5.858^b
p	.007		.017
Bonferroni	c > a		c > a

Note. MIBS: Mother–Infant Bonding Scale; SD: standard deviation. Group 1: First 4 weeks mother–baby yoga; second 4 weeks massage. Group 2: First 4 weeks massage; second 4 weeks mother–baby yoga.

Mann–Whitney U test.

Analysis of variance in repeated measurements.

p<0.05 significance of bold values.

The sleep characteristics of the infants in Group 1 and Group 2 are summarized in Table 3. No significant difference was found between the babies in Group 1 and Group 2 in terms of the frequency of nighttime awakenings, nighttime, and total daytime sleep duration before the intervention and at the first and second 4-week follow-ups (p > .05). In terms of total daytime sleep duration, no significant difference was found before the intervention (p > .05), but a significant difference was found in the first and second 4-week follow-ups (p < .05). According to the results of repeated measures analysis of variance in the in-group evaluation of sleep characteristics, it was determined that there was a significant difference between the pre-intervention, first and second 4-week follow-ups in the frequency of nighttime awakenings, daytime, nighttime, and all-day total sleep duration of the infants in Group 1. In Group 2, there was a significant difference between the pre-intervention, first and second 4-week follow-ups in the frequency of night waking, daytime sleep frequency, daytime, nighttime, and all-day total sleep duration (p < .05; Table 3).

Table 3.

Comparison of Sleep Characteristics of Babies in Groups (N = 28).

Sleep features	Group 1 (n = 14)		Group 2 (n = 14)		Test Value	p
Sleep features	Mean ± SD	(Min–Max)	Mean ± SD	(Min–Max)	Test Value	p
Frequency of waking up at night (19:00–08:00)
Pre-intervention (a)	4.57 ± 1.50	3.00–7.00	4.14 ± 1.09	2.00–6.00	85.000^a	.521
4 weeks (b)	3.21 ± 0.69	2.00–4.00	3.00 ± 0.55	2.00–4.00	80.000^a	.342
8 weeks (c)	2.07 ± 0.26	2.00–3.00	2.71 ± 0.72	2.00–4.00	82.000^a	.423
Test	35.319^b		11.116^b
P	.000		.002
Bonferroni	a > c		a > c
Frequency of daytime sleeping (08:00–19:00)
Pre-intervention (a)	4.21 ± 1.36	2.00–6.00	4.00 ± 1.03	3.00–6.00	86.5000^a	.603
4 weeks (b)	3.92 ± 1.14	2.00–6.00	2.71 ± 0.61	2.00–4.00	38.000^a	.003
8 weeks (c)	3.64 ± 0.74	3.00–5.00	3.57 ± 0.75	3.00–5.00	92.000^a	.804
Test	3.108^b		12.789^b
P	.082		.001
Bonferroni	—		a > b
Total daytime sleep time (hour) (08:00–19:00)
Pre-intervention (a)	2.42 ± 0.85	1.00–4.00	2.50 ± 0.51	2.00–3.00	87.500^a	.635
4 weeks (b)	4.05 ± 1.01	3.00–7.00	3.50 ± 0.85	2.00–5.00	45.500^a	.014
8 weeks (c)	4.85 ± 0.53	4.00–6.00	4.07 ± 0.73	3.00–5.00	42.500^a	.009
Test	29.088^b		21.126^b
P	.000		.000
Bonferroni	c > a		c > b > a
Total sleep time at night (19:00–08:00)
Pre-intervention (a)	6.85 ± 1.29	5.00–9.00	6.85 ± 1.56	5.00–10.00	93.000^a	0.814
4 weeks (b)	7.85 ± 1.16	6.00–9.00	7.71 ± 1.32	5.00–10.00	91.000^a	0.736
8 weeks (c)	8.35 ± 1.00	7.00–11.00	8.71 ± 1.06	7.00–11.00	78.500	0.338
Test	6.960^b		8.972^b
P	.010		.004
Bonferroni	c > a
Total sleep time in a day (08:00–08:00)
Pre-intervention (a)	11.38 ± 1.72	11.00–15.00	10.35 ± 1.59	8.00–13.00	90.000^a	0.705
4 weeks (b)	12.35 ± 1.69	10.00–15.00	11.21 ± 1.76	8.00–15.00	62.500^a	0.096
8 weeks (c)	13.21 ± 1.18	12.00–16.00	12.78 ± 1.18	11.00–15.00	79.000^a	0.364
Test	35.201^b		19.081^b
P	.000		.000
Bonferroni	c > a		c > a

Note. SD^¥: standard deviation. Group 1: First 4 weeks mother–baby yoga; Second 4 weeks massage. Group 2: First 4 weeks massage; second 4 weeks mother–baby yoga.

Mann–Whitney U test.

Analysis of variance in repeated measurements.

p<0.05 significance of bold values.

The weights of the babies in Group 1 and Group 2 are summarized in Table 4. There was no significant difference between the body weights of the babies in Group 1 and Group 2 before birth and intervention (p > .05). There was a statistically significant difference between them in terms of body weights at the first and second 4-week follow-ups (p < .05). According to the results of repeated measures analysis of variance in the intragroup evaluation of the weights of the babies, there was a significant difference between Group 1 and Group birth, pre-intervention, first and second 4-week follow-ups (p < .05; Table 4).

Table 4.

Comparison of the Weights of the Babies in the Groups (N = 28).

Weight (gr)	Group 1 (n = 14)		Group 2 (n = 14)		Test Value	p
Weight (gr)	Mean ± SD	(Min–Max)	Mean ± SD	(Min–Max)	Test Value	p
Baby's birth weight (a)	3032.85 ± 263.70	2500–3345	2617.71 ± 256.47	2500–3200	85.000^a	.457
Pre-intervention (b)	2970.35 ± 254.75	2425–3280	2538.57 ± 264.50	2375–3120	56.000^a	.234
4 weeks (c)	3907.85 ± 364.14	3280–4445	3461.78 ± 294.47	3195–4200	33.500^a	.002
8 weeks (d)	4784.00 ± 401.03	4045–5400	4145.21 ± 409.63	3395–4980	26.500^a	.001
Test	263.295^a		402.411^a
P	.000		.000
Bonferroni	d > c > a > b		d > c > a > b

Note. SD: standard deviation. Group 1: First 4 weeks mother–baby yoga; second 4 weeks massage. Group 2: First 4 weeks massage; second 4 weeks mother–baby yoga.

Mann–Whitney U test.

Analysis of variance in repeated measurements.

p<0.05 significance of bold values.

Discussion

This study was conducted to examine the effects of mother–baby yoga and massage on mother–baby attachment, sleep, and weight of the baby. In the study, it was seen that both interventions positively affected mother–infant attachment, sleep, and weight in the in-group evaluation independently of each other. As a protocol, while massage was effective in the first 4 weeks and then mother–baby yoga was effective in infant attachment, yoga was more effective in the first 4 weeks and massage was more effective in the following period in terms of weight and daytime sleep.

The basic sense of trust between mother and baby in the early stages of life supports the psychosocial development of the baby. Touch, which is an effective method in providing and improving the interaction between the baby and the mother, positively affects attachment. Baby massage is one of the easiest and most natural ways to improve mother–infant bonding (Yılmaz et al., 2023). Yoga is reported to have positive effects on both mothers and babies in the postpartum period (Ağapınar Şahin & Bekar, 2023). In this study, it was observed that mother–infant attachment increased in both groups at 4- and 8-week follow-up. Among the groups, it was determined that mother–infant attachment was higher in the group that received massage first and then yoga. In a study, laughter yoga was reported to have a positive effect on prenatal mother–infant attachment (Ağapınar Şahin & Bekar, 2023). In a study examining the effectiveness of massage in preterm infants, it was reported that there was no effect on attachment in infants who received massage compared to the control group (Hwu et al., 2023). In a study conducted in a group with Down syndrome, it was reported that baby massage positively affected attachment (Pinero-Pinto et al., 2023). It was found that daytime sleepiness of the infants in the mother–baby yoga and massage group increased compared to the other group. While there are results regarding mother yoga in the literature, it was reported that mother–baby yoga positively affected mother–baby attachment in a limited study in which mother–baby yoga was included (Arasappa et al., 2023; Boybay Koyuncu & Yayan, 2022; Cameron et al., 2018). In these studies, studies on healthy mothers and newborns were limited and studied in special groups. The literature on baby massage is similar, but it is not possible to draw definite conclusions about the results of studies on mother–baby yoga due to the limited literature. This study will be a reference for future studies on mother–baby yoga.

It is stated that it strengthens mother–infant communication and mother–infant attachment with features such as positive touch, movement together, and mutual interaction; the sensory stimulation provided by yoga poses for infants supports the neuromuscular development of infants, increases body awareness, supports digestion, and contributes to improved sleep quality (Bilmez et al., 2020). In this study, it was observed that the interventions applied in both groups increased the sleep duration of the babies and decreased the frequency of awakening. It was determined that the daytime sleep duration of the group that received yoga first and then massage increased compared to the other group. In a study, parent-led baby massage was evaluated with sleep electroencephalogram (EEG) and it was reported that sleep spindle spectral power was higher in the intervention group in main and subgroup analyses, and the intervention group showed larger EEG magnitudes and lower interhemispheric coherence in subgroup analyses (Ventura et al., 2023). Another study similarly reported that massage increased sleep duration in infants (Saputro et al., 2021). In a systematic review, positive results of baby massage were reported in various variables that affect infant health (Yılmaz et al., 2023). Findings regarding the results of baby massage on sleep are contradictory in the literature. There is a need for meta-analysis studies that examine the effectiveness of massage on infant sleep and provide evidence. Since there is no literature on the effects of mother–baby yoga on infant sleep, no conclusion could be reached, and it is thought that it will be a reference for future studies.

In this study, it was observed that the weights of the babies in both groups increased and the group that received massage first and then mother–baby yoga gained more weight compared to the other group. In a study examining the effectiveness of massage in preterm infants, it was reported that weight gain was higher in infants who received massage (Hwu et al., 2023). A systematic review reported that massage has a positive effect on weight in infants (Yılmaz et al., 2023). Similarly, studies have reported that massage has a positive effect on weight gain in term and preterm infants (AÇAR et al., 2022; Erçelik, 2022; Hwu et al., 2023; Sarıkamış Kale, 2019). Similar to the results of this study, the results of the literature report that massage increases infant weight positively. However, no difference was found in the effect of mother–baby yoga on weight gain in infants.

Limitations and Strengths

While the limitations of the study are that it was conducted with a group, mothers with certain sociodemographic characteristics were included, and sleep was evaluated only in terms of duration, the superiority of the study is that it is the first study in this field with a crossover model, randomized controlled and single blind design. Since there are limited studies on the effectiveness of mother–baby yoga in the literature, this study will be a reference for future studies on mother–baby yoga.

Conclusion

In the study, it was observed that both interventions positively affected mother–infant attachment, sleep, and weight in the in-group evaluation independently of each other. As a protocol, while massage for the first 4 weeks and mother–baby yoga afterwards were effective in terms of infant attachment, yoga for the first 4 weeks and massage in the following period were found to be more effective in terms of weight and daytime sleep. Although there was no significant superiority between the two interventions, it is suggested that mother–baby yoga in the early postpartum period and baby massage protocol starting 1 month later should be considered as a part of infant care. This study focused on primary outcomes and is a study. In a randomized controlled type of study with a larger sample, cortisol results and findings evaluating stress will be presented as secondary outcomes. There are no meta-analysis studies in the literature on the effectiveness of mother–baby yoga and baby massage on infant health. It is recommended to conduct more randomized controlled trials for the effectiveness of interventions and meta-analysis studies to generate evidence.

Footnotes

Author Contributions

Fatma Şule Bilgiç: conceptualization, software, validation, formal analysis, investigation, data curation, writing‒original draft, writing‒review and editing, visualization, supervision, and project administration. Ruken Tunç: software, validation, investigation, resources, data curation, writing‒review and editing, and visualization. Keziban Amanak: investigation, resources, data curation, and writing‒review and editing.

Data Availability

Data can be shared upon request from the corresponding author. The study was registered in ClinicTrials.gov with the ID NCT05489861.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

Akdeniz University Faculty of Medicine Clinical Research Ethics Committee (Date: March 22, 2023; approval number: KAEK-234).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Fatma Şule Bilgiç

Notes on contributors

Fatma Şule Bilgiç, PhD, is an Assistant Professor in the Department of Midwifery at Çanakkale Onsekiz Mart University, Faculty of Health Sciences. She completed her PhD at Istanbul University-Cerrahpaşa. Her research focuses on infant care, postpartum practices, baby massage, and yoga-based complementary approaches to maternal and newborn health. She has contributed to the field with randomized controlled trials and systematic reviews, particularly in midwifery and nursing education. She has authored over 60 publications and has received approximately 130 citations (h-index ≈ 6).

Ruken Tunç graduated from the midwifery department of Kocaeli University's School of Health Sciences in 2017. That same year, she began her master's degree in the Midwifery Department at the Health Sciences Institute of Health Sciences University. While simultaneously practicing clinical midwifery, she began her doctoral studies in 2023. She continues her work in the areas of breastfeeding, infant massage, pregnancy, and childbirth.

Keziban Amanak, PhD, is an Associate Professor in the Department of Midwifery at Aydın Adnan Menderes University, Faculty of Health Sciences. She holds a PhD in Obstetrics and Gynecology Nursing. Her research focuses on maternal health, pregnancy related anxiety, cultural competence, and simulation-based education in midwifery. She has conducted various studies in the field of women's health and midwifery and has published extensively in national and international peer-reviewed journals. She also serves as a reviewer for several academic journals and actively contributes to scientific research and education.

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