Research reportEffect of music therapy during vaginal delivery on postpartum pain relief and mental health
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.
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