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THE USE OF MUSIC BY WOMEN DURING CHILDBIRTH

Lucy Newmark Sammons, RNC, NP, MS

ABSTRACT
The purposes of this study were to determine factors affecting the use of music by
women during childbirth and to compare the frequency of actual music use during
childbirth by women who heard music during prenatal labor rehearsal vs those who
did not hear music in rehearsal. Fifty-four women attending Lamaze childbirth classes
were randomly assigned to music-rehearsal or nonmusic-rehearsal groups. After de-
livery, all subjects completed questionnaires about music use and subjective responses
to music. Eleven factors involved in determination of actual music use were identified.
No significant differences in music use by rehearsal group assignment were found.
Results demonstrate that music provides an adjunct to childbirth that is .highly de-
sirable for some women, while unappealing or inconvenient for others. Suggestions
for utilization of findings by maternity care providers are presented.

Music is one of the elements included ing childbearing and to determine and the dental office.6 The purported
in Harriet Palmer's description of an whether labor rehearsal with musical mechanism for enhanced dental pa-
ideal labor/birth environment. I Music a c c o m p a n i m e n t increases subse- tient comfort is R. Melzack's gate
is also an important component in quent intrapartum use of music. control theory, by which impulses
several commercially available tapes triggered by musical stimuli will over-
and records for relaxing during child- ride pain signals carried by smaller
BACKGROUND
birth preparation, 2 for exercising pre- nerve fibers. He has demonstrated in
natally and postnatally, and for en- The therapeutic uses of music are the the laboratory that auditory stimula-
hancing parenting and breastfeeding. subject of a growing body of litera- tion, in the form of stereophonic
Although the potential for music to ture. Music therapy has established music and white noise (sound con-
e n h a n c e both psychological and value in programs for the mentally sisting of all frequencies), coupled
physical health has been recorded retarded, the physically handi- with a strong suggestion that pain will
since the time of the ancient Greeks? capped, children and adults with be abolished, provide an effective
little systematically obtained infor- emotional disturbances and behavior pain control strategy. 7
mation about the subjective re- disorders, and geriatric clients. 4 In Only a limited number of reports
sponses of contemporary women to these areas of application, the have attempted to relate the pre-
the use of music for childbearing is uplifting effects of music arise from ceding findings and recommenda-
available. Such information is poten- music's ability to promote interper- tions, which are based on work with
tially useful to health care providers sonal relationships, facilitate achieve- the ill, the institutionalized, or individ-
and educators concerned with as- ment of self-esteem, and to energize uals in laboratory settings, to healthy
sisting pregnant women in obtaining and bring order through rhythm. women in labor. Richard Stevens re-
a satisfying childbirth experience. To The use of music in health care ferred to music in his description of
fill this gap, an investigation was settings where music may decrease psychological strategies for manage-
undertaken to determine factors the client's discomfort and hence ment of pain in prepared child-
affecting the actual use of music dur- potentiate or reduce the n e e d for birth. 8,9 He considered music, which
anesthetics is gaining increasing he classified as a "distraction" type
support. Music is advocated as of cognitive control utilizing inter-
Address correspondence to Lucy Newmark
Sammons, 2608 Campeche Court, San an adjunct to routine anesthetic ference, to be of comparative-
Ramon, CA 94583. procedures in the operating room S ly low effectiveness for pain man-

266 Journal of Nurse-Midwifery • Vol. 29, No. 4, July/August 1984


0091-2182/84/$03.00 Copyright © 1984 by the American College of Nurse-Midwives
agement in laboratory studies. METHODS riod. Thirty of the women were as-
Livingston I° heartily endorses the signed to the control (non-music)
The aims of the study were twofold:
use of music for pregnant women. group and twenty-four women were
to identify factors affecting the use of
She recommends that the character- assigned to the experimental (music)
music by women during childbirth
istics of the music be tailored to the group by random designation of nine
and to determine whether musical
type of activity it accompanies. For consecutive class series.
accompaniment to labor rehearsal
example, attention should be paid to Demographic characteristics of the
during prenatal educational classes
rhythm for conditioning exercises; women did not differ significantly by
affected actual use of music intrapar-
tempo, pitch, and intensity for per- group assignment (Table 1). Ninety-
tally. Survey methods were used to
sonal selections in labor and delivery; six percent of the women were white,
obtain data for the process of factor
and harmony and soothing qualities married, with husbands acting as
identification. A quasiexperimental
for vaginal or cesarean birth. How- coach; 82% were between 20 and
approach using a posttest-only con-
ever, no data are provided that in- 30 years old; 76% were preparing for
trol group design 12 was used to as-
dicate the actual reactions and atti- the birth of their first child; 48%
sess the effect of rehearsal with music
tudes of childbearing women to- planned to deliver in a private hos-
on intrapartal music use.
wards the use of music. Such pital delivery room, 20% in a private
subjective responses would be valu- hospital Birth Center, and 32% in a
able for assisting pregnant women in Sample
Health Maintenance Organization or
determining the appropriateness of A convenience sample of 54 women military facility. None of the hospital
music for their particular experience. who attended Lamaze childbirth maternity tours encouraged use of
A study from the University of preparation classes led by the inves- music at the time this information
Kansas compared women who par- tigator completed questionnaires on was gathered. All women anticipated
ticipated in six individual third- their feelings about the use of music vaginal delivery. Eighty-five percent
trimester music therapy training ses- for childbirth. The study sample rep- actually delivered vaginally, the re-
sions to women without music resents 90% of all consecutive class mainder giving birth by cesarean de-
therapy training. 11 The 13 experi- registrants during the induction pe- livery after an interval of labor.
mental group members reported
feeling more support from significant
TABLE 1
others, less perceived anxiety and
Characteristics of total sample and groups
discomfort during birth, shorter per-
ceived length of labor, and greater Total Non-music group Music group
helpfulness of Lamaze than their Variable n = 54 (%) n = 30 (%) n -- 24 (%)
seven control group counterparts, Race
when questioned postpartally. Be- White 52(96.3) 29 (96.7) 23(95.8)
cause the experimental group also Asian 2 (3.7) I (3.3) I (4.2)
were attended in labor by their music Marital status
therapist, the applicability of these Married 53(98. I) 30(100) 23(95.8)
Single I (1.9) 0 (0) 1 (4.2)
findings to women not receiving in- Coach
tense individualized therapy is not Husband 52(96.3) 30(100) 22(91.7)
clear. The need for an empirically Other 2 (3.7) 0 (0) 2 (8.3)
based report on why women choose Agea
to incorporate music into their Under 20 years 1 (1.8) 0 (0) I (4.2)
20-25 years 21(38.9) 14 (46.7) 7(29.2)
birthing experience and factors 26-30 years 23(42.6) 14 (46.7) 9(37.5)
guiding their musical selections led to Over 30 years 9(16.7) 2 (6.7) 7(29.2)
this investigation. Parity
0 41(75.9) 25 (83.3) 16(66.7)
I 9(16.7) 3 (10.0) 6(25.0)
2 4 (7.4) 2 (6.7) 2 (8.3)
Intended setting~
Private hospital Del Rm 26(48.1) 15 (50.0) 11(45.8)
Lucy S a m m o n s is an A S P O Certified Private hospital ABC 11(20.4) 6 (20.0) 5(20.8)
Childbirth Educator and an O B / G Y N Military hospital/HMO 17(31.5) 9 (30.0) 8(33.3)
Nurse Practitioner. Concurrently, she is Delivery
a D N S c candidate at the University of
Vaginal 46(85.2) 25 (83.3) 21(87.5)
Cesarean 8(14.8) 5 (16.7) 3(12.5)
California at San Francisco.
a Percentages do not sum to 100 due to rounding.

Journal of Nurse-Midwifery Vol. 29, No. 4, July/August 1984 267


Measures Factors Affecting Actual Use of music. One aspect is the institutional
Music During Childbirth nature of the birth setting. One
Postpartum questionnaires using
woman commented, "Besides its
forced-choice responses and open- Of the 54 women, a total of eight
[soothing] effect, it [music] de-
ended questions were administered actually used music during labor and/
creased the sterile environment and
to all subjects. Questionnaire items or delivery, while an additional eight
seems to normalize the situation."
asked if music during labor was ac- planned to use music but did not.
Another aspect subject to alteration
tually used, and if so, what were the The selections used ranged from
is the unfamiliarity of the setting. This
selections, the motivations for music rock music to Mozart. Responses
is illustrated by the selections of
in general and for specific selections, from all subjects are incorporated in
ethnic music by a young German
the effect of the music, and the the listing of factors to illustrate that
couple temporarily relocated to this
equipment used. Additional ques- a factor perceived as an advantage
country, because they were "think-
tions asked women who did not ac- of music use by one woman may be
ing of h o m e . " Music can further
tually use music if they had planned perceived as disadvantageous to a
create a very personalized atmo-
to do so, and what had affected that different individual.
sphere by the use of a selection with
decision. All subjects were asked
significance to the woman or couple.
their plans for music use if they were
Prior Experience with Music in This use is exemplified by music se-
to experience another labor.
Labor Rehearsal lections from a couple's wedding cer-
emony and selections with lyrics con-
Labor rehearsal with musical accom- cerning love and children. Other re-
Procedures paniment during prenatal class had sponses about the atmosphere
The subjects attended Lamaze child- some effect on the subsequent use of referred to the warm emotional tone
birth preparation classes consistent music intrapartally. Members of both created by music or the pleasant
with American Society for Psycho- the music and non-music groups ac- mood obtained from the entertain-
prophylaxis in Obstetrics (ASPO) tually used or intended to use music ment value of music.
standards. The non-music group re- during labor and delivery (see Table
ceived standard class content, which 2). Although there was a tendency
towards more use of music by music Potential to Increase Relaxation
included information that use of
group members than non-music Many of the actual music users did
music during labor was an option.
The music group received similar in- group members, when the sum of report that the primary effect of the
struction with the addition of expo- both those actually and intending to music was to aid relaxation. One
use music is considered (42% vs woman commented, "If my mind is
sure to taped music during one active
rehearsal of all breathing patterns. 20%), this trend did not reach statis- relaxed, my body is more easy to
tical significance. control and relax."
Musical selections used in class con-
sisted of portions of the following:
" C o m e Saturday Morning" by Potential to Establish Personal Response to Music
Mystic Moods Orchestra, "Lara's Desired Atmosphere
Theme" by Ferrante and Teicher, Although this factor is difficult to
and "The Impossible Dream" by Establishment of a favorable mood completely separate from other fac-
Ferrante and Teicher. All are orches- was a prominent reason for the de- tors affecting use of music for child-
tral arrangements without vocaliza- sire to use music for childbirth. Sev- birth, women indicated that the
tion. Postpartum questionnaires eral aspects of the atmosphere meaning of music and their reaction
were distributed at reunions and by seemed amenable to influence by to it influenced their decision re-
mail 2 - 1 2 months after delivery.
TABLE 2
Actual and intended music use by group
FINDINGS Non-music group Music group Total
Behaoior n = 3 0 (%) n = 24 (%) n = 54 (%)
Questionnaire data were summa-
rized by use of descriptive statistics Intended/Actuallyused 3 (10%) 5 (21%) 8 (15%)
and coding of open-ended re- Intended/Not Used 3 (10%) 5 (21%) 8 (15%)
Sum
sponses. Chi-square analysis was
used to examine differences between Actual and Intended Use 6 (20%) 10 (42%) 16 (30%)
No use/No intent 24 (80%) 14 (58%) 38 (70%)
control and experimental group out-
comes. X2 = 2.05, dr(l), P = 0.1519 for sum vs no intent comparison.

268 Journal of Nurse-Midwifery • Vol. 29, No. 4, July/August 1984


garding music use. For five women, Equipment Availability woman's efforts as she participated
the major reason not to use music in preoperative preparations. Several
Those who actually used music for
was that the idea definitely did not women commented that music
labor and delivery made use of a va-
appeal to them. Another woman, a seemed more appropriate to them
riety of equipment. Four played
musician, described her love for for early labor.
music on a record player or radio at
music, which she did use during
home. Four listened to radio, cas-
birthing.
sette recorder, 8-track prerecorded Projected Subsequent
tape, or piped-in music at the hos- Use of Music
Value of Music as a Distraction pital. The lack of available equip-
ment, equipment failure or poor On the postpartum questionnaire to
The ability of music to serve as a dis- all subjects, most (61%) of the
radio reception, frustrated several
traction was perceived as both ben- women responded that they would
women in their attempts to use music
eficial and detrimental. Some actual consider using music if they were to
within the hospital.
music users did find music effective have another delivery. Among the
as a distraction from pain. On the actual music users, the feelings about
other hand, several women chose Perceived Institutional Support future music use were unanimously
not to use music because they did in favor (see Table 3). However, an
Although no one reported that they
not want to be distracted from their impressive 30% of the total sample
used music due to encouragement of
relaxation and breathing patterns. responded negatively, while the re-
the hospital staff, one couple did not
carry out their desire to use music maining 9% gave neutral or no re-
Potential Reinforcement to due to perceived staff attitudes. They sponse.
Rhythm of Breathing/Labor commented that they were afraid the
hospital staff would not approve.
Several women who had not used DISCUSSION
music commented on the potential
While caution must be taken in gen-
for music to help with the beat, Need for Prior Planning
eralizing the findings of this explor-
rhythm, and pace of their controlled
A common problem among couples atory study based on a small, ho-
breathing through the phases of
who intended to use music but did mogeneous, convenience sample,
labor. The only comment from a
not was that they found labor started the responses clearly indicate that
music user who had thought the
before they were organized. Couples music provides an adjunct to child-
rhythm might help with breathing
who created their own tapes of pre- birth that is highly desirable for some
was her surprise in noting afterwards
recorded selections of particular ap- women. Empirical support is pro-
that it had not assisted with breathing
peal found it necessary to prepare vided for propositions previously
patterns.
well in advance of labor. based on theoretical notions that
music in prepared childbirth may
Recognition of Music Use as function by means of attention fo-
Characteristics of Labor
Birthing Option cusing, distraction, stimulus for plea-
and Delivery
sure response, and as a stimulus for
The predominant (79%) reason
The course of labor and delivery in- relaxation. 11 It is also important to
given for not using music by those
fluenced the use of music in ways note, however, that some women
who did not intend to do so was
that had not been anticipated. For have a definite preference not to use
that they did not think about it as
three women who intended to use music for childbirth. These individual
an option for childbirth. This is a star-
music, labor simply went too fast. preferences should be acknowledged
tling figure, considering that music
Preparations for an emergency ce- and respected.
was mentioned at several points
sarean delivery dominated another The failure to demonstrate a sip-
throughout class content for both
groups. Music was mentioned as a
means of increasing relaxation, and TABLE 3
music was referred to again when the Projected subsequent use of music by current usage groups
possibility of taking a cassette player
A c t u a l user Non-user Total
for recording the birth was discussed. P r o j e c t e d use n = 8 (%) n = 4 6 (%) n = 54 (%)
Furthermore, 42% of all music re-
hearsal group subjects, who actually Use music 8 (100%) 25 (54%) 33 (61%)
practiced with music, stated they did Not use music 0 (00%) 16 (35%) 16 (30%)
No response/neutral 0 (00%) 5 (11%) 5 (9%)
not think about using music.

Journal of Nurse-Midwifery Vol. 29, No. 4, July/August 1984 269


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270 Journal of Nurse-Midwifery • Voi. 29, No. 4, July/August 1984

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