During the last twenty-five years, researchers and clinicians have begun to explore the use of music with obstetrical patients. In keeping with the everchanging health care needs of a diverse and growing population, a demand has arisen for new choices and alternatives in childbearing. The application of music therapy in obstetrics, both during pregnancy and at the time of labour and delivery, has answered, in part, a demand for techniques which would help to create a more pleasurable, more relaxed childbirth experience.
Research has shown that those women participating in a music therapy assisted childbirth programme experience significantly more positive perceptions of their childbirth experience than those not participating in such a programme (Clark, McCorkle, & Williams, 1981; Hanser, Larson, & O’Connell, 1983). Further, women perceive greater support from significant others and report lower levels of anxiety, pain and discomfort during childbirth. Music therapy patients noted increased benefits of Lamaze techniques when accompanied by appropriate music and report spending significantly more time in home practice sessions of these techniques.
Numerous life stressors during pregnancy, such as concerns for the baby, self, medical care, childbirth, and finances, can contribute to elevated levels of anxiety. This anxiety can be further intensified by hospitalization for high-risk complications. It has been suggested that high anxiety or psychological stress in the mother can result in a higher number of fetal abnormalities and maternal obstetrical complications. Winslow (1986) describes a highly effective music therapy treatment for such anxiety that resulted in significant decreases in levels of anxiety and an increased sense of control.
Music can also play an important role in neonatal care. Owens (1979) speculates on the role music therapy can play in teaching new parents the necessity of stimulation and how to use music as a way to stimulate and to soothe. Standley (1991) discusses the important use of music in the pacification/stimulation of the premature infant. She suggests that music in the neonatal intensive care unit can mask the aversive sound levels there, thereby facilitating homeostasis which increases the infant’s neurological development.
The applications of music therapy in childbirth and neonatal care are varied, and continued research and practice in the field will continue to find more. The literature base as it stands, however, unquestionably supports the potential of obstetrical music therapy to make a significant contribution to both maternal and neonatal health and well-being.
In childbirth and neonatal care, music therapy can:
Act as an attention-focusing stimulus.
It has been suggested that attention focusing cannot only increase pain tolerance, but may totally eliminate pain sensation. It is perhaps preferable to distraction techniques because of the active, purposeful mental involvement of the patient (Clark, et al 1981). The potential of music for becoming an effective attention-focusing stimulus is great, for it is difficult to ignore and, appropriately chosen, pleasurable to hear. Mothers in a study by Hanser et al. (1983), found, not only that music “took their minds off pain,” but also that many used the musicto focus attention more than, or instead of, Lamaze-practiced visual focal point techniques.
Be a distraction stimulus to divert attention from pain
Music can also be used to great effect to direct attention away from pain. While the subjective experience of pain is not, reduced, sound stimulation can effectively distract the patient and provide a cognitive strategy for pain control and suppression of pain responses. Important in considering music as a distraction or – attention-focusing – stimulus is the degree of intrusiveness of the musical selections (Clark et al. 1981). Intrusiveness refers to the qualities of music which allow it to penetrate the listener’s awareness and hold his or her attention, or which allows it to distract the listener from other stimuli (pain). The “intrusive” qualities of rhythm, tempo, dynamics, timbre, and so on become significant when therapists are selecting particular music for distraction or attention-focusing purposes.
Act as a conditioned stimulus for relaxation
Relaxation during childbirth can be crucial in insuring adequate oxygenation of vital areas and in minimizing both physical and psychological fatigue. Most relaxation training exercises use a trigger stimulus for the learned relaxation response, and music has been shown to have excellent potential as a conditioned stimulus for relaxation (McKinney, 1990). Various studies have demonstrated the effectiveness of background music in inducing relaxation under stress, and Hanser et al. (1983) report on the extremely relaxing effect of music on women experiencing labour. In this study, an individualized music therapy programme was developed for each participant, including music selections based on the mother’s preferences and on observations of the pace or tempo of her breathing, as well as training in progressive relaxation with the music serving as stimulus. Over 70% of participants felt that the music aided relaxation and an overwhelming 100% displayed fewer pain responses during labour while music was playing than when it was not.
Decrease tension and anxiety
The anxiety and tension levels of women both prior to and during childbirth, can have a significant impact on the pregnancy and the labour outcome. If this is a first or perhaps high-risk pregnancy concerns over the baby and oneself, and facing the unknowns of the childbirth experience can greatly increase levels of anxiety and tension in the mother. McKinney (1990) cites numerous studies where the use of music therapy successfully decreased anxiety levels and reduced negative expectations. Music used with progressive relaxation techniques has been effective in relieving mental and physical tension (Winslow, 1986), and guided imagery and music techniques have aided in alleviating fears, especially for first-time mothers (Clark et al. 1981). Both individual and group music therapy sessions, can provide patients with important opportunities to express their anxiety and begin to cope effectively with these feelings.
Be used as a structural aid to breathing
Music, especially when used in conjunction with such practiced breathing technique as in Lamaze, can be an extremely effective cue fo correct breathing. When chosen carefully and individually, appropriately paced music can be used to time rapid breathing during contractions. Music can reinforce and support the breathing patterns and rhythms learned in childbirth classes. The breathing becomes an almost natural physical response to the rhythm and tempo of the music.
Provide a stimulus for pleasure response
Throughout the available literature, it appears universal that music is a welcome addition to the labour and delivery process and that positive perceptions of the childbirth experience greatly increase with the presence of music and obstetrical music therapy techniques (McKinney, 1990). Certain elements in music seem consistently to stimulate generalized meanings and feelings. Consequently, music can be chosen not only for its effectiveness in inducing relaxation or cuing correct breathing, but also for its unique ability to evoke a positive emotional state.
Both stimulate and pacify newborns
Music, with its components of sound and rhythm, can play an important role in neonatal care. Music has the potential to arouse the lethargic or withdrawn infant, and it can effectively calm crying, anxious babies and act as a natural sleep-inducer (Standley, 1991). Music therapy can also play an important role in educating parents about the importance of stimulation and how to use music effectively to both stimulate and soothe their newborn (Owens, 1979). Finally, music plays a significant role because it influences almost all activities in a positive way.