Many childbirth educators include background music within our classes – maybe we have energizing music playing as people arrive or over break, maybe we use relaxing music during relaxation techniques, maybe we use it as one of the tools during an ice exercise. Or we vaguely mention that you could have a birth playlist prepared. But I think it tends to be a background thing. How often do you explicitly talk about music in pregnancy, labor and postpartum and what the benefits are?
It turns out there is actually some good research into music in the perinatal period.
Music During Pregnancy
Several studies have shown that listening to music during a non-stress test reduces the parent’s anxiety and improves the results of the NST. (RCT by Catalgol, RCT by Oh, RCT by Soylu, trial by Dolker and RCT by Garcia-Gonzalez et al). With clearly proven benefits, and no risks, this seems like an easy thing to suggest. And while all these studies were in the context on an NST, one might be able to guess that listening to music during other stressful procedures or any time during pregnancy might also help reduce anxiety and improve baby’s responsiveness. Again, with no harm, is it worth sharing this idea?
One quasi-experiment found that when women in their third trimester listened to relaxing music with a tempo of 60 beats per minute for just 15 minutes, their anxiety level was significantly reduced. There were additional studies that looked at parents participating in music therapy sessions in their home and/or prenatal music classes. (cited in McCaffrey, et al)
Music During Labor
- Dance and music combined and music alone both reduced pain and fear during active labor. (RCT by Gonenc and Dikemen)
- Listening to music during labor led to lower levels of pain and anxiety, improved fetal heart rate and less postpartum analgesia. (RCT by Simavali, et al.)
- Listening to music reduced pain and anxiety during latent phase, but no difference during active labor. (RCT by Liu et al)
- Listening to music during labor reduced pain levels during active labor and at one hour postpartum, and decreased anxiety in active labor, second stage and one hour PP. (RCT by Buglione, et al)
- In a systematic review and meta-analysis by Santavinez-Acosta, (they use the term “music therapy” but I believe the included studies were all listening to music) they found: less pain during latent and active labor, less post-cesarean pain, less anxiety during labor and in the first 24 hours, less pain meds after cesarean.
- Another systematic review by Chen (note, there may be some overlap in the studies reviewed by this and the prior listing) showed lower anxiety, less depressive symptoms, lower pain and better blood pressure.
- An integrative review by McCaffrey, et al, showed 15 out of 20 studies showed statistically significant decrease in pain, and four showed a decrease. 8 of 11 studies showed statistically significant decreases in anxiety. Music also promoted relaxation and decreased stress. Two studies showed faster labor progress.
Reasons posited for why listening to music reduces pain:
- When music enters the ear, it stimulates the hypothalamus to produce dopamine and reduces cortisol. Causes the pituitary gland to release endorphins which decreases pain.
- Gate control theory of pain – non-painful stimuli (music) close the nerve “gates” so less of the painful stimuli reach the brain. (Distraction.)
- Positive memories may be associated with the music.
None of the studies showed any adverse effects or unfavorable outcomes.
Music and Cesarean:
Listening to music before surgery led to increased positive emotions, decreased negative emotions and lower blood pressure (RCT by Kushnir, et al). Listening to music during surgery reduces stress and anxiety (based both on subjective evaluation by the parent and objective parameters like saliva cortisol levels, heart rate and blood pressure). Stress levels continued to be lower two hours after the surgery. (RCT by Handan, et al; RCT by Hepp, et al; systematic review by Weingarten, et al; Cochrane review) When people listened to music after the surgery, they reported less pain and used less morphine. (RCT by Ebneshahidi and Mohseni)
Availability and Caregiver Preferences
In a survey of midwives and OB’s in Germany, 97% had the means to play music during vaginal birth, but just 38% of those did routinely. 47% had the ability to play music during a cesarean, but of those, only 15% typically did. 66% would recommend music during vaginal birth, and 38% during a cesarean. Most professionals felt music was helpful for team communication and patient communication, was relaxing to them and did not report that music distracted the medical team.
It may be worth educating parents that their caregivers might not think to suggest that they use music during labor or might not offer to play music during a cesarean, but that the parents can play music, or ask for it to be played in the OR, and generally that would be supported.
Types of Music
All of the above research is based on simply listening to music. The study protocols ranged a bit on whether the participant listened to music on headphones or in the room, and on the type of music played. Some used instrumental recordings only, some used songs with vocals. In some cases, there was standard music played for all, in some the participants were able to choose amongst a few standardized selections, perhaps in different genres to appeal to different tastes. Some used music associated with cultural traditions or “relaxing” music with no major changes in dynamics. In other cases, the person in labor chose the music.
I have always encouraged parents to think about having two kinds of playlists – one that motivates them to get up and moving which can be helpful when you’re getting tired but know that movement and positioning is helpful and one that relaxes them and make them feel safe and comforted.
Where to Cover
Here are ideas for where to include this info in a prenatal class:
- When talking about stress reduction in pregnancy, touch on the benefits of music for reducing anxiety and improving baby’s heart rate.
- When talking about exercise, talk about creating a get-up-and-get-moving playlist that you can use for exercise during pregnancy and then use in labor if desired.
- When teaching relaxation exercises, talk about creating a soothing playlist to use during pregnancy to calm you and build positive associations, then use it again in labor.
- When talking about what to pack for the hospital, remind them to prepare their playlist.
- When talking about getting settled into the hospital or birth center after triage, remind them to turn on their music to create the environment they will best labor in.
- When I teach the 3R’s of Labor Coping (Relaxation, Rhythm and Ritual) I always say “if you turn on music and the person in labor relaxes, then keep it on! If you turn it on and she tenses, turn it off for that contraction, then between contractions, try to figure out if all music is bad, or just that particular music (or volume or whatever), then correct it.
- When teaching how to have the “best possible cesarean” if it comes to that, include asking for music to be played.
Photo credit: from https://www.beautyandgroomingtips.com/2013/04/6-confidence-tricks-for-pregnancy-blues-days.html, marked in google search as free to share and use