Elsevier

Journal of Affective Disorders

Volume 156, 1 March 2014, Pages 194-199
Journal of Affective Disorders

Research report
Effect of music therapy during vaginal delivery on postpartum pain relief and mental health

https://doi.org/10.1016/j.jad.2013.12.027Get rights and content

Abstract

Background

Childbirth is an important experience in a woman's life, and unfavorable birth experiences have been shown to negatively impact postpartum maternal health. Aim of this study was to evaluate the effects of music therapy on postpartum pain, anxiety level, satisfaction and early pospartum depression rate.

Methods

Totally 161 primiparous women were recruited and randomized either music group (n=80) or a control group (n=81). Women in the music group listened to self-selected music during labor. Postpartum pain intensity, anxiety level and satisfaction rate were measured using the visual analog scale (VAS), postpartum depression rate was assessed with Edinburg Postpartum Depression Scale (EPDS) at postpartum day one and day eight.

Results

Mothers in the music therapy group had a lower level of postpartum pain and anxiety than the control group and it was statistically significant at all time intervals (1, 4, 8, 16 and 24 h, p<0.001). A significant difference was observed between the two groups in terms of satisfaction rate (p<0.001) and postpartum depression rate at postpartum day one and day eight (p<0.05).

Limitations

We only measured the effect of music therapy on early postpartum depression rate. Effect of music on late postpartum depression rate should be investigated in future.

Conclusions

Using music therapy during labor decreased postpartum anxiety and pain, increased the satisfaction with childbirth and reduced early postpartum depression rate. Music therapy can be clinically recommended as an alternative, safe, easy and enjoyable nonpharmacological method for postpartum well-being.

Introduction

Women are more exposed to psychiatric illness during the postnatal period. The rate of psychiatric admission is increased postnatally, mostly because of the raised risk of psychosis and depressive illnesses in the first three month after labor (Kendell et al., 1976). Many women experience considerable stress when confronted with the physiological and psychological changes which occur during pregnancy and childbirth (Matas, 1997, Turner et al., 2004). Childbirth is an important experience in a woman's life, and the grade of this experience has short and long terms effects. Unfavorable birth experiences have been shown to negatively impact postpartum psychiatric symptoms, sexual functioning, expectations about future births and connection between mother and infant (Goodman et al., 2004). Women experience increasing pain and anxiety during childbirth as labour progresses especially for primiparas which can negatively affect both mothers and neonates. Unrelieved severe labor pain may have a detrimental effect on both the mother and the infant (Phumdoung and Good, 2003).

Boudou et al. (2007) investigated the association between the intensity of childbirth pain and the intensity of postpartum blues. They showed that intensity of the childbirth pain is associated with mood disorders in the immediate postpartum. Several explanations they suggested: First, maternity blues could be a reaction to stress caused by childbirth pain. Furthermore, pain can be felt as a failure for women who prepared themselves for a painless labor. Actually, the prepared childbirth training pretends to give women the ability to overcome pain through physical and mental training. Thus, because their responsibility in coping with the labor is heavy and might make them feel guilty if they fail, pain may be at the origin of a great disappointment. They concluded that a strong association was found between the intensity of labor pain and mood disorders in early postpartum period. Additionally, the intensity of postpartum blues is the best predictor of postnatal depression. Labor pain could result in the loss of emotional control leading to mood disorders (Phumdoung and Good, 2003). In this point we hypothesized that if pain-related labor can be decreased, postpartum depression can be decreased, too.

Music therapy has been accepted as a safe, cheap and effective non-pharmacological anxiolytic agent due to its effect on the perception of anxiety and pain, reducing the regular pharmacological sedative doses (Ovayolu et al., 2006). Music therapy has also been shown to improve physical signs, decrease stress hormone and stabilise vital signs (Hoffman, 1997, Lıu et al., 2010). Additionally, previous studies have found music therapy to be effective in decreasing pain, anxiety and anajgesic consumption related to postoperative, procedural, chronic and cancer pain (Sen et al., 2010, Lopez-Cepero Andrada et al., 2004, Menegazzi et al., 1991, Zımmerman et al., 1989, Siedlieckı and Good, 2006).

Chang et al. (2008) examined the effects of music therapy on stress, anxiety and depression in 236 pregnant Taiwanese women. The music therapy group received two weeks of relaxing music (four types) intervention. The control group received only general prenatal care. Participants in the experimental group were given the prerecorded CD and asked to listen to at least one disc (30 min) a day for two weeks at any time during the day. They showed that two weeks of music therapy during pregnancy provides quantifiable psychological benefits. If music therapy reduces antenatal depression rate, it may reduce postnatal depression, too. The effect of music therapy on postpartum pain, anxiety, depression, and satisfaction during vaginal delivery has not yet been investigated.

In the present study, we aimed to evaluate the effects of music therapy during vaginal delivery on postpartum anxiety, pain, satisfaction with childbirth and postpartum depression rate in primiparous women.

The following hypotheses were tested in the postpartum period:

  • 1.

    Patients in the music group will have significantly less postpartum pain than those in the control group.

  • 2.

    Patients in the music group will have significantly less anxiety than those in the control group.

  • 3.

    Patients in the music group will have significantly high satisfaction level with the childbirth experiance than those in the control group.

  • 4.

    Patients in the music group will have significantly less postpartum depression than those in the control group both in postpartum day one and day eighty.

Section snippets

Study population

This randomised controlled trial was conducted between September 2011 and September 2012. Overall, 161 primiparous women who are at 36 weeks of gestational age, coming to Obstetry and Gynecology Department for their antenatal care, were asked to participate in a trial which investigates the effect of music therapy on postpartum maternal health. The study was approved by the Turgut Ozal University Human Ethical Committee and complied with the Helsinki Declaration including current revisions and

Results

Women in the music therapy and control groups completed the study, as shown in the flow diagram of randomization presented as Fig. 1. Twenty women dropped out because of one of the following reasons: Received unplanned caesarean section for prolonged labour (n=11), did not inform the researchers when they went to the maternity unit for labor (n=5) and had cervix dilation of more than 3 cm (n=4). Although 161 pregnant women were enrolled in the groups, 141 participants were included in the final

Discussion

Music, which in everyday life is used for pleasure and its mood-changing effects can be used for therapeutic benefit. Music therapy is widely used in the treatment of mental health. In the present study, we showed the beneficial effect of music therapy first on postpartum anxiety and pain, second on satisfaction with childbirth, and third on early postpartum depression rate. Music therapy during labor decreased postpartum anxiety, pain and postpartum depression rate and increased the

Role of funding source

None.

Conflict of interest

None.

Acknowledgements

None.

References (27)

  • M.Y. Chang et al.

    Effects of music therapy on psychological health of women during pregnancy

    J. Clin. Nurs.

    (2008)
  • J.L. Cox et al.

    Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

    Br. J. Psychiatry

    (1987)
  • A. Ebneshahidi et al.

    The effect of patient-selected music on early postoperative pain, anxiety, and hemodynamic profile in cesarean section surgery

    J. Altern. Complement. Med.

    (2008)
  • Cited by (69)

    • Effect of audio-visual therapy on pain and anxiety in labor: A randomized controlled trial

      2023, European Journal of Obstetrics and Gynecology and Reproductive Biology: X
    View all citing articles on Scopus
    View full text