BACKGROUND: Multiparous women of advanced maternal age are more susceptible to psychological stress. OBJECTIVE: This study examined the impact of mindfulness yoga on psychological well-being (anxiety and sleep quality) and pregnancy outcomes (Apgar scores and adverse perinatal events) in aging multiparous women. STUDY DESIGN: Participants meeting the criteria were randomly assigned to a control or a mindfulness yoga intervention group. The Chinese version of the Childbirth Attitudes Questionnaire, the Chinese version of the Pregnancy-Related Anxiety Questionnaire, and the Self-Rating Scale of Sleep were utilized to assess fear of childbirth, anxiety levels, and sleep quality, respectively. Maternal and neonatal outcomes, including vaginal delivery rates, labor analgesic use, duration of labor, postpartum bleeding volume, fetal anomaly rates, and Apgar scores, were analyzed. RESULTS: A total of 148 multiparous women of advanced maternal age participated in the study. No significant differences in baseline characteristics were observed between the two groups. Participants in the mindfulness yoga group exhibited significantly lower scores on the C-CAQ, PRAQ, and SRSS scales compared to those in the control group. Additionally, higher vaginal delivery rates, reduced analgesic use, and shorter durations across all three stages of labor were observed in the mindfulness yoga group, contributing to an overall reduction in total labor duration. Neonatal outcomes demonstrated notable differences, with higher Apgar scores and lower incidences of adverse perinatal events in the mindfulness yoga group. CONCLUSION: Engagement in mindfulness yoga during pregnancy may contribute to improved psychological well-being and enhanced pregnancy outcomes in older multiparous women.