Elsevier

Midwifery

Volume 83, April 2020, 102627
Midwifery

The role and outcomes of music listening for women in childbirth: An integrative review

https://doi.org/10.1016/j.midw.2020.102627Get rights and content

Abstract

Aim

To synthesise primary research on the role and use of music listening for women in childbirth.

Methods

Whittemore and Knafl's (2005) five-stage integrative review method was utilized to complete a systematic search of the literature. Studies were included if they were (a) peer-reviewed, (b) written in the English language, (c) published between 1 January 1979 and 5 April 2019 and (d) described the use of music listening during labour and birth. Studies were appraised for quality and methodological rigor using standardised assessment tools including the Critical Appraisal Skills Programmes (CASP) checklist for the qualitative studies and the Joanna Briggs Institute Critical Appraisal Tool for the quasi-experimental studies and randomised control trials. Data extrapolation, methodological quality assessment and Thematic Content Analysis (Braun and Clarke, 2006) were carried out.

Findings

A total of 931 articles were retrieved and 24 papers were included in the review (12 randomized controlled trials, 9 quasi-experimental and 3 qualitative). The quality of the studies was moderately good overall. Two overarching themes emerged including ‘outcomes of using music in childbirth’ and, ‘music application during childbirth’. Within ‘outcomes of using music in childbirth’ four subthemes are described: ‘pain’, ‘anxiety’, ‘psychological supports’ and ‘progression of labour’. Within ‘music application during childbirth’ four themes are presented: ‘timing of the music application’, ‘type of music’, ‘birth preparation using music’ and ‘mode of music listening’.

Conclusion and implications for practice

The findings indicate that music listening has a significant role to play for women in childbirth. This non-pharmacological intervention can reduce pain and anxiety while offering a multifaceted form of psychological support to alleviate stress and promote an increased sense of control in women during labour. However, further awareness is needed around the idiosyncratic nature of the music listening experience.

Introduction

Childbirth is an event of great psychological, social and emotional significance in a woman's life. It is a time of marked transition and new beginnings when psychological support of the woman is paramount. There is increased understanding that a positive birth experience can support better outcomes for a mother and her baby, while a traumatic birth experience can lead to higher incidents of post-partum depression and anxiety (Leeds and Hargreaves, 2008). Women's perceptions of factors that promote a positive birth experience have been identified (Lavender et al., 1999). These include having a sense of control (Meyer, 2013), being provided with adequate information and support (Nieuwenhuijze and Low, 2013), and taking an active role in decision making during the birthing process (Sigurðardóttir et al., 2019). These factors align with a woman-centred approach to childbirth, where the wishes, perspectives and needs of the woman are fundamental (Petit-Steeghs et al., 2019). Indeed the concept of woman-centred care is now central to the design and delivery of modern maternity care services internationally (Leap, 2009).

Women's choice to use non-pharmacological interventions during childbirth is commonplace (Smith et al., 2012). The impetus to do so can stem from a wish to: reduce the need for analgesics that may have harmful effects on mother and infant (Jones et al., 2012); use personalized coping-strategies (Spiby et al., 2003) and; realise a sense of self-determination in the birthing process (Bowman et al., 2018). In their crucial role of safely navigating women through the childbirth experience, midwives are key in imparting informed knowledge about the safe use of possible non-pharmacological interventions (Hall et al., 2013). This knowledge can be used to inform the design of a woman's birth plan, a document that articulates one's individual preferences for their birthing experience to those that are caring for them (Welsh and Symon, 2014).

Music listening can be described as a non-pharmacological or complementary intervention that has gained increased interest in the healthcare literature (Biley, 2000). Such interest is possibly due to parallel developments in the disciplines of music therapy, music psychology but also music and medicine, which have collectively served to highlight the role of music as a health promoting resource (MacDonald et al., 2012). The act of listening to audio-recorded music is recognised as a non-invasive intervention that can be utilized by patients to promote health and well-being due to its distractive nature and its positive effects on physiological responses (McCaffrey and Locsin, 2002).

Initial scoping of the midwifery literature suggests that over the past two decades, music listening has been increasingly utilized by women during childbirth, particularly for the purposes of pain reduction (Hollins Martin, 2014). Rationale for same is commonly premised on Melzack and Wall's gate control theory of pain Melzack and Wall (1996) which asserts that non-painful sensory input can close the nerve "gates" to painful input into the central nervous system. Music listening is also suggested to stimulate the pituitary gland to release endorphins for decreasing pain while also altering pain perception through affect and cognition (Boso et al., 2006). Such investigation into the relationship between music listening and pain reduction is undoubtedly important in terms of enhancing women's experience of childbirth. Yet, it is equally important to cast a wider net across the published literature to consider additional roles and outcomes that music listening might offer women during labour and birth.

The first music listening and childbirth study was published almost forty years ago (Clark et al., 1981), and since then no comprehensive review of the literature has been carried out to consider how music listening has been utilized and evaluated in childbirth. Such a review is warranted in order to inform women, in partnership with their midwives, to make informed choices about their birth preferences using the best available evidence. This study addresses this need by presenting an integrative review of the role and outcomes of music listening for women during childbirth.

Section snippets

Methods

This study examined the reported role and outcomes of music listening as used by women in childbirth. An initial scoping review of the literature indicated a range of related studies across diverse methodological design and philosophical approach. The inherent complexity or combination of such diverse studies informed the choice to employ Whittemore & Knafl's (2005) integrative review framework. This five-stage integrative review method is specifically designed to accommodate diverse data

Narrative synthesis

As recommended by Patton (2002), the extracted data was reduced into categories and sub-categories of themes. This process followed the steps of Thematic Content Analysis (Braun and Clarke, 2006) which resulted in two overarching themes. The first ‘outcomes of using music in childbirth’ contained four subthemes related to ‘pain’, ‘anxiety’, ‘psychological supports’ and ‘progression of labour’. The second overcharging theme ‘music application during childbirth’ had four subthemes including

Outcomes of using music-listening in childbirth

Findings revealed that multiple outcomes have been reported about women's use of music-listening during childbirth that can be considered in relation to pain, anxiety, psychological supports and progression of labour.

Timing of music application

Variance existed across all studies in terms of the timing and duration of the music listening application during childbirth. Participants were exposed to music listening during the latent phase of labour (n = 2), the active phase of labour (n = 11) and the second stage of labour only (n = 1). Three studies described using music during both the latent and active phases of labour, while four music therapy studies featured music throughout both stages of labour. The duration of music listening

Discussion

This integrative review of 24 papers explored the role and outcomes of music listening for women during childbirth. Two overarching themes emerged that described the outcomes of music listening and the variance in its application during childbirth. Findings indicated that pain reduction was the most commonly investigated factor among music listening studies in childbirth. This is unsurprising given that pain and pain relief are much considered aspects of the childbirth experience, particularly

Implications for practice and research

The findings from this integrative review highlight a number of implications for both midwifery practice and research related to music listening in childbirth. Music listening can be a helpful intervention for women during childbirth, particularly for pain and anxiety reduction but also in terms of promoting relaxation, offering a more positive view of childbirth and promoting an increased sense of control. This highlights a need to educate clinicians about the role of music listening as a

Strengths and weaknesses of the review

The methodology employed in this review enabled the authors to explore in detail the role and outcomes of music listening for women in childbirth. A strength of this study is its interdisciplinary nature that drew on expertise from the fields of music therapy, midwifery alongside that from library and information science. This collaboration ensured a systematic search and extensive use of studies that have considered music listening in its broadest context in childbirth. These studies originate

Conclusion

The findings of this integrative review conclude that music listening has a significant role to play for women in childbirth. This non-pharmacological intervention can reduce pain and anxiety while offering a multifaceted form of psychological support to alleviate stress and promote an increased sense of control in women during labour. In utilizing music listening in this context, there is also an opportunity to determine the soundtrack to which one's baby is born; and so contributing to a

Ethical approval

Not applicable.

Funding sources

Not applicable.

Declaration of Competing Interest

Not applicable.

Acknowledgments

Not applicable.

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