Running head: MUSIC THERAPY IN LABOR 1

Music Therapy in Labor vs. No Music Therapy

Nicole Mercedes

University of South Florida

No Music Therapy vs. Music Therapy in Labor 2

Abstract

Clinical Problem: The clinical problem is pain management in the population of primiparous

women, ages 18-39 years, at full-term.

Objective: To determine if music therapy has any effect on decreasing labor pain in primiparous

women, ages 18-39 years, at full term as opposed to no music therapy in labor pain management.

PubMed, Science Direct, the Wiley Online Library, and Karger were used to find randomized

control trials exploring the question of music therapy in labor pain management. The American

Music Therapy Association website was used to find clinical guidelines for music therapy. Key

terms used in these search engines included: music therapy and labor pain, music and labor, as

well music and anxiety.

Results: The research showed that music therapy did have an effect on decreasing pain levels in

women during labor. The literature indicated that music therapy only had significant pain

decreasing effects on certain stages of labor, not all.

Conclusion: The research showed that music does indeed have an effect on decreasing pain, and

anxiety along with other symptoms of labor. There are some discrepancies between the different

studies that shows the need for added research to truly say that music therapy should be used

over other methods of pain management in women during labor.

No Music Therapy vs. Music Therapy in Labor 3

No Music Therapy vs. Music Therapy in Labor

Alternatives to conventional management of pain, anxiety, and post partum depression

have been popular topics surrounding labor and birth plans (Smith et al., 2006). This leads to the

following questions: could the interest in complementary or alternative methods of dealing with

labor pain and anxiety have come about because of the side effects associated with conventional

pharmacological interventions? What measures are considered conventional or routine care?

The literature reviewed did not address much in regards to these questions about the side effects

of conventional interventions in labor care or what routine labor care is considered. But, the

literature did give some insight to following question; in women ages 18-39 years old, at 37-41

weeks of gestation how does music therapy compared with no music therapy & routine labor

care affect pain and anxiety during labor?

Literature Search

The three randomized controlled trials contained within this paper were accessed

primarily through PubMed. PubMed then led to outside domains such as Science Direct, the

Wiley Online Library, and Karger. Key terms searched in PubMed included: music therapy and

labor pain, music and labor, as well music.

Literature Review

In women ages 18-39 at 37-41 weeks of gestation, how does routine labor care compared

with music therapy affect pain and anxiety during labor? Three randomized control trials were

gathered and assessed to answer this question. In the first trial conducted by Liu et al. (2010), a

sample of sixty primiparous women of ages ranging from 18 to 39 was used. The aim of this

study was to investigate whether music therapy, opposed to routine labor care, could have effect
No Music Therapy vs. Music Therapy in Labor 4

on decreasing pain & anxiety levels in women giving birth vaginally. The format of the study

was a randomized control trial, with the women randomly divided into two groups. Half were in

the group receiving the music (experimental), while the other half received routine labor care

(control). Before being qualified for the study the women had to meet the following parameters:

be full term, have normal singleton fetus, have no intentions of using pharmacological

interventions, & have planned for vaginal delivery. Pain and anxiety were measured using a

visual analogue scale (VAS), where the women rated their pain and anxiety on a scale of 1-10,

with 10 being the worse pain or anxiety. Pain was also measured using a nurse rated- present

behavioral intensity (PBI) scale. This measures the physiological changes associated with pain

such as respirations and therefore is objective. Another objective pain measurement used was

finger temperature. Finally, there was an open ended questionnaire 24-hours post labor survey

conducted. The results of this study showed that during the latent phase of labor, the women in

the experimental group had lower levels of pain and anxiety but that during the active phase

there wasnt a significant difference. Weaknesses in this study include lack of cohesiveness in

music genre among the experimental group, lack of ability to assess music preference prior to the

study and pre-selected music genres. Additional weaknesses were lack of double blind method

when assessing PBI, and the researchers failure to define routine labor care. The open ended

questionnaire being 24 hours post labor was also a weak point. Within that time frame, the

women could loose memory of the pain or anxiety they went through at the time of labor. The

strengths of the trial include the randomization format, as well as the use of two objective and

two subjective measurements for pain and anxiety during labor.

Dehcheshmeh and Rafiei (2015) conducted a randomized control trial. This study had

two different experimental groups receiving either haiku ice point massage (Group B) or music
No Music Therapy vs. Music Therapy in Labor 5

therapy (Group A) and, a control group receiving routine labor care (Group C). The sample in

this study consisted of ninety-primiparous women, ages ranging from 17-38 years old, at 38-40

weeks along in pregnancy. Like the previous study, in order to participate the women had to be

full term, without any health conditions, and planning to give birth vaginally. Pain in this study

was measured using only the VAS at the beginning of the active phase of labor and then before

and after the respective interventions. The women in the music intervention group were allowed

to pick between sound wave and piano music, and they listened to the music at intervals of thirty

minutes. The women in the haiku ice point massage group received the intervention at intervals

of twenty-minutes. The results showed that at the beginning of the active phase the pain scores

for groups A, B, and C were similar. After the interventions the scores decreased for groups A &

B compared to group C. Group A also showed more decrease in pain than group B but it was not

statistically significant. The strengths include the measurements of pain at different stages of

labor, equal distribution and similar demographics among the three groups observed, and that the

supervisor of the maternity ward who divided the women into groups was blinded. The greatest

weakness with this study was use of only one measurement for pain, the VAS. Adding to the

weak spots, the time lengths of the interventions varied and one of the researchers conducting the

study was also the one doing the haiku ice point massage for that particular group. This presents

potential bias or conflict of interest. Finally, the researchers in this study also failed to define

what they considered routine labor care.

Simavli et al. (2014) also conducted a randomized controlled trial study to look at the

effects of music on labor pain, anxiety levels, maternal hemodynamics, neonatal parameters, and

post-partum analgesic requirements. The sample in this study consisted of one-hundred and fifty-

six primiparous women, between ages 18-36 years old, at 37 weeks of gestation or above. The
No Music Therapy vs. Music Therapy in Labor 6

women were divided into two groups, n= 77 as the music group and n=79 as the control group

receiving only routine labor care. Parameters for participant participation included: being 37

weeks gestation or above, having no health issues, and having singleton fetus. Pain and anxiety

levels were measured using the VAS. Maternal systolic blood pressure/ diastolic blood pressure

(SBP/DBP) along with HR were taken before the start of labor as well as during the latent, active

and second stages of labor. Fetal parameters were measured prior to interventions and during the

latent and active phase of labor using a non stress test. The study found that the group with the

music therapy intervention had lower levels of anxiety and pain compared to the control group

during all the stages of labor (p< 0.001). There were multiple strengths in this study. For one, the

study had computer generated randomization, which lends itself to the randomized control trial

format. Any information on the calming effects of music was withheld from the participants,

which prevented any bias. The women, in both groups, were not allowed to see their previous

VAS scores to eliminate potential for future bias. Data recorded was monitored offline by one of

the authors who had no idea of the womens group or maternal pain and anxiety scores. The final

strength was the large sample. One of the weaknesses in this study was that the experimental

music group had five different categories of music genres to choose from, so there wasnt

continuity across the board in the experimental group. This study also did not define what was

done as part of routine care.

The clinical guidelines for music therapy are provided by the American music therapy

association (AMTA)and mostly relate to the steps before, during, and after music therapy is

administered (American Music Therapy, 2013). Music therapy use, according to the guidelines,

is supported in ten areas with one of these being the medical setting. Within the areas used,

music therapy is utilized when it can help to improve or prevent a clients condition cognitively,
No Music Therapy vs. Music Therapy in Labor 7

psychologically, socially, etc. The guidelines then outline the need of a music therapy cultural

assessment that include demographic information, religion & spirituality, social interactions,

family background, etc. With this information gathered the music therapy is adjusted for the

specific patient and their needs. All three of the studies looked at, did not go into much detail or

tailor the music to the womens needs based on pre-assessment like the guidelines mention here.

Anyways, the guidelines go more in depth on the steps necessary for getting a patient access to

music therapy such as referral, the steps in documentation, observance during the therapy, and

discontinuation.

Synthesis

The study conducted by Liu et al. (2010) showed that during the latent phase (at 2-4 cm

dilation) of labor, music therapy had a positive effect in regards to decreasing pain, but during

the active phase, the study showed that music didnt have much of an effect. Dehcheshmeh &

Rafiei (2015) found that among the two interventions administered in his experimental groups,

music had the greatest effect on reducing pain. And, Simavli et al. (2014) similar to the previous

two studies, found that music had a positive effect on decreasing pain during all stages of labor.

Although all of the studies found that music had a positive effect on decreasing pain and

anxiety in first time mothers, more research is needed. Two of the studies above had

considerably small samples at sixty total in the study conducted by Liu et al. (2010), and ninety

in the study conducted by Dehcheshmeh & Rafiei (2015). Such small samples dont translate

well enough to be implanted with larger populations. Each of the studies also focused on

different stages of labor and the pain associated with those subsets, instead of all the stages.

Another topic that also needs further clarification, and is brought up in all three studies, is the

guidelines for what is categorized as routine labor care. Neither of the studies addressed this or
No Music Therapy vs. Music Therapy in Labor 8

outlined parameters for what they considered routine. Another issue, mentioned in the clinical

guideline section, was the lack of pre-music therapy assessment in all of the studies.

Furthermore, all of the studies were conducted on women in countries outside of the United

States, one in Taiwan and two in Turkey, therefore theres a possibility the results may not

translate as well in the United States due to cultural differences. There is limited research in the

United states addressing the possibility of music therapy as an alternative to labor pain

management option.

Clinical Recommendations

With the results of the research being considered, adding music to the labor experience of

first time mothers could be potentially beneficial. All of these studies showed that music therapy

had some positive effects, even if only miniscule. Used in conjunction with a soothing, low lit

environment, music therapy could be therapeutic in regards to pain management and decreasing

anxiety levels. Though the research doesnt give enough information to rely solely on music

therapy as a form of pain management in labor, it can be beneficial in conjunction with other

methods currently used. Theres also potential that if music therapy is used costs, and hospital

stay lengths can both decrease, but none of the studies made mention of this.
No Music Therapy vs. Music Therapy in Labor 9

Bibliography

American Music Therapy Association. (2013, November). Retrieved March 29, 2016, from

http://www.musictherapy.org/about/standards/

Dehcheshmeh, F. S., & Rafiei, H. (2015). Complementary and alternative therapies to relieve

labor pain: A comparative study between music therapy and Hoku point ice massage.

Complementary Therapies in Clinical Practice, 21(4), 229-232. doi:

10.1016/j.ctcp.2015.09.002

Liu, Y.-H., Chang, M.-Y. and Chen, C.-H. (2010), Effects of music therapy on labor pain and

anxiety in Taiwanese first-time mothers. Journal of Clinical Nursing, 19: 10651072.

doi: 10.1111/j.1365-2702.2009.03028.x

Simavli, S., Gumus, I., Kaygusuz, I., Yildirim, M., Usluogullari, B., & Kafali, H. (2014). Effect

of music on labor pain relief, anxiety level and postpartum analgesic requirement: A

randomized controlled clinical trial. Gynecologic and Obstetric Investigation Gynecol

Obstet Invest, 78(4), 244-250. doi: 10.1159/000365085

Smith, C., Collins, C., Cyna, A., & Crowther, C. (2006). Complementary and alternative

therapies for pain management in labour. Protocols Cochrane Database of Systematic

Reviews. doi: 10.1002/14651858.cd003521