The role and outcomes of music listening for women in childbirth: An integrative review
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.
References (57)
- et al.
Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women
Midwifery
(2015) - et al.
Women's motivation, perception and experience of complementary and alternative medicine in pregnancy: A meta-synthesis
Midwifery
(2018) - et al.
Complementary and alternative therapies to relieve labor pain: A comparative study between music therapy and Hoku point ice massage
Complement. Ther. Clin. Pract.
(2015) - et al.
The effect of music on pain and anxiety of women during labour on first time pregnancy: A study from Turkey
Complement. Ther. Clin. Pract.
(2018) - et al.
Navigating a safe path together: A theory of midwives’ responses to the use of complementary and alternative medicine
Midwifery
(2013) Pain and women's satisfaction with the experience of childbirth: a systematic review
Am. J. Obstet. Gynecol.
(2002)A narrative literature review of the therapeutic effects of music upon childbearing women and neonates
Complement. Ther. Clin. Pract.
(2014)- et al.
Massage or music for pain relief in labour: a pilot randomised placebo controlled trial
Eur. J. Pain
(2008) - et al.
The effect of education given to primigravida women on fear of childbirth
Appl. Nurs. Res.
(2016) Music listening to facilitate relaxation and promote wellness: integrated aspects of our neurophysiological responses to music
Arts Psychother
(2007)
A prospective study of women's views of factors contributing to a positive birth experience
Midwifery
Pain mechanisms: A new theory
Pain Forum
Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review
Midwifery
Client-centred maternity care from women's perspectives: need for responsiveness
Midwifery
Music reduces sensation and distress of labor pain
Pain Manag. Nurs.
Processing birth experiences: A content analysis of women's preferences
Midwifery
Effect of music therapy during vaginal delivery on postpartum pain relief and mental health
J. Affect. Disord.
Women׳s experiences of coping with pain during childbirth: a critical review of qualitative research
Midwifery
Unique and proforma birth plans: a qualitative exploration of midwives׳ experiences
Midwifery
The effects on patient well-being of music listening as a nursing intervention: a review of the literature
J. Clin. Nurs.
Neurophysiology and neurobiology of the musical experience
Funct. Neurol.
Using thematic analysis in psychology
Qual. Res. Psychol.
Music therapy in childbirth: Research in practice
Music Ther. Perspect.
Using music during childbirth. birth issues perinat
Care
Music therapy-assisted labor and delivery
J. Music Ther.
Toward a better understanding of the relation between music preference, listening behavior, and personality
Psychol. Music
English Oxford Living Dictionaries
The Music Therapy-Assisted Childbirth program: a study evaluation
Pre- Peri-natal Psychol. J.
Cited by (16)
Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review
2023, American Journal of Obstetrics and GynecologyThe role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials
2024, Journal of Psychosomatic Obstetrics and GynecologyThe effects of music therapy on labor pain, childbirth experience, and self-esteem during epidural labor analgesia in primiparas: a non-randomized experimental study
2023, Korean Journal of Women Health NursingNocturnal selective pressures on the evolution of human musicality as a missing piece of the adaptationist puzzle
2023, Frontiers in Psychology