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

Article (PDF Available)inJournal of Affective Disorders 156 · December 2013with231 Reads
DOI: 10.1016/j.jad.2013.12.027 · Source: PubMed
Abstract
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. 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. 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 24h, 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). 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. 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.
Research report
Effect of music therapy during vaginal delivery on postpartum pain
relief and mental health
Serap Simavli
a,b,
n
, Ikbal Kaygusuz
c
, Ilknur Gumus
c
, Betul Usluogulları
c
,
Melahat Yildirim
c
, Hasan Kafali
c
a
Department of Obstetrics and Gynecology, Pamukkale University School of Medicine, Denizli, Turkey
b
Laboratory of Reproductive Endocrinology, Brigham and Women
0
s Hospital, Harvard Medical School, Boston, MA 02115, USA
c
Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey
article info
Article history:
Received 5 October 2013
Received in revised form
16 December 2013
Accepted 16 December 2013
Available online 28 December 2013
Keywords:
Postpartum pain
Anxiety
Satisfaction
Music therapy
Pospartum depression
abstract
Background: Childbirth is an important experience in a woman
0
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 (n¼80) or
a control group (n¼81). 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 signicant at all time intervals (1, 4, 8, 16 and 24 h, po0.001). A
signicant difference was observed between the two groups in terms of satisfaction rate (po0.001) and
postpartum depression rate at postpartum day one and day eight (po0.05).
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.
Published by Elsevier B.V.
1. 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 rst 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
0
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
Contents lists available at ScienceDirect
journal homepage: www.elsevier.com/locate/jad
Journal of Affective Disorders
0165-0327/$- see front matter Published by Elsevier B.V.
http://dx.doi.org/10.1016/j.jad.2013.12.027
n
Corresponding at: Laboratory of Reproductive Endocrinology, Brigham and
Women
0
s Hospital, Harvard Medical School, Boston, MA 02115, USA.
Tel.: þ1 857 222 1836; fax: þ1 617 264 5275.
E-mail address: serapsimavli@yahoo.com (S. Simavli).
Journal of Affective Disorders 156 (2014) 194199
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 pharmacolo-
gical 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; Liu et al., 2010). Addi-
tionally, 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;
Zimmerman et al., 1989; Siedliecki 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 quantiable psychological benets. If music therapy
reduces antenatal depression rate, it may reduce postnatal depres-
sion, 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 signicantly less post-
partum pain than those in the control group.
2. Patients in the music group will have signicantly less anxiety
than those in the control group.
3. Patients in the music group will have signicantly high satis-
faction level with the childbirth experiance than those in the
control group.
4. Patients in the music group will have signicantly less post-
partum depression than those in the control group both in
postpartum day one and day eighty.
2. Methods
2.1. Study population
This randomised controlled trial was conducted between Sep-
tember 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 Good
Clinical Practice guidelines. Eligible patients were informed about
the study protocol and signed informed consent was obtained from
all patients before the randomisation.
Inclusion criteria were women between 18 and 35 years,
primiparous with a 3741 weeks of gestation and were singleton
pregnant with babies of cephalic presentation and normal birth-
weight, expected to have normal spontaneous delivery. Women
who had any of the followings were excluded; maternal hyper-
tensive disorders, diabetes mellitus, evidence of intrauterine
growth restriction, postdates, premature rupture of membranes
for longer than 20 h, multiple pregnancies, desired cesarian, rec-
eiving analgesic or antipsychotic medications, mothers with hear-
ing difculties, chronic pain problems, severe dysmenorrhea,
inability to understand visual annolog scale or EPDS, fetal death
in utero, known fetal anomaly. Data for age, height, weight,
gestational week, educational level, occupation, family class were
recorded on a data sheet.
2.2. Randomization
Randomization was completed using a computerized minimi-
zation program to assign participant women to either music group
or control group by our clinical secretary at 36 weeks of gestation.
Randomisation was stratied according to maternal age, gesta-
tional week, education and family class. In this way, external
variables were controlled and minimized of group differences.
Calculation of the required sample size was performed with
respect to postpartum depression rate. According to the literature,
a standard deviation of EPDS 3.7 was expected, and the analysis
was carried out with respect to detecting a difference of at least 1.5
(40%) for this parameter. With a power of 90% and
α
level of 0.05, a
sample size for each group of at least 64 patients was calculated as
being appropriate. Sixteen patients (25% of calculated sample size)
were also added to each group to replace possible missing data for
all potential causes.
2.3. Procedures
The primary researcher gave participants in the music therapy
group detailed descriptions of the music therapy protocol. Parti-
cipants were recommended to choose one of the following types
of music; soft, relaxing, regular rhythmic patterns and no extreme
changes in dynamics which was used and recommended in the
literature for anxiety-reducing. In order not to affect the results,
participants were not informed that this kind of music therapy
was used for anxiety-reducing. Six types of music were used as a
result of the participants desired; including classical music, light
music, popular music, Turkish art music, Turkish folk music and
Turkish sumusic. To take into consideration the wide variety of
music-listening habits, women were allowed to choose whether or
not to use headphones. The tempo of the music was selected to
mimic the human heart rate (6080 beats/min).
Anxiety and pain was recorded at 1, 4, 8, 16, 24 h in the
postpartum period. Satisfaction with childbirth was recorded also
at 212, and 24 h of the postpartum period. Procedure started
after 2 cm cervical dilatation. Data were collected within 024 h
after the delivery and postpartum day eight. During the labor, the
melodies previously selected by the pregnant women were played
all the time with a 20-min break for every two hours of music and
music was continued to the end of the third stage. All the
participants in the music group were asked to bring their favorite
tape recorder cassette or CD to the hospital on the day of labor.
A suitable substitution was provided for those patients in the
music group who forgot to bring a CD or cassette. The nurse placed
the cassette or CD in the player according to the procedure.
S. Simavli et al. / Journal of Affective Disorders 156 (2014) 194199 195
2.4. Outcome measures
Postpartum maternal health was measured using responses to
four self-reported measures: the VAS for anxiety (VAS-A), VAS for
pain (VAS-P), the VAS for satisfaction (VAS-S) and the EPDS for
postpartum depression. Data for depression were also collected
before the procedure to compare baseline antenatal depression
rates between groups.
Anxiety ratings; the rst outcome measure was anxiety level
during the 024 h of postpartum period. Anxiety level was
assessed using a 010 cm horizontal visual analog scala; 0¼having
no anxiety or the least possible anxiety, 10¼having severe anxiety
or the worst possible anxiety. Patients were asked by a blinded
member of the medical staff to marked their anxiety to eliminate
possible hesitancy to report anxiety scores. All patients were asked
to score their anxiety at 5 real-time points (1, 4, 8, 16 and 24 h).
Anxiety level was compared between the groups.
Pain score; the second outcome measure was pain intensity
during the rst 24 h of the postpartum period. Pain intensity was
assessed using a 010 cm VAS; 0 ¼having no pain or the least
possible, 10¼having severe pain or the worst possible. Patients
were asked by a blinded member of the medical staff to marked
their pain to eliminate possible hesitancy to report pain scores. All
patients were asked to score their pain at 5 real-time points (1, 4,
8, 16 and 24 h). Pain intensity was compared between the groups.
Satisfaction rate: The third outcome measure was satisfaction
with childbirth. Satisfaction rates were assessed also using a 0
10 cm VAS. All patients were educated about the VAS before
starting the study and were asked to marked for their satisfaction
level (0¼totally unsatised, 10¼totally satised) at 2, 12 and 24 h
postpartum.
Postpartum depression rate; The EPDS is one of the most
widely used self-report instruments to screen for depression in
the postnatal and antenatal periods. The 10-item EPDS was
developed to detect depressive symptoms in postpartum women
(Cox et al., 1987). The scale can be completed quickly and does not
require professional knowledge to score. Minimum and maximum
total scores ranged from 0 to 30. The scale has been validated for
use postnatally and during pregnancy and focuses on the cognitive
and affective features of depression. Although the scale cannot in
itself conrm a diagnosis of depression, score of Z10 suggests
minor depressive symptoms and Z13 suggests probable major
depression. The EPDS was found to have satisfactory sensitivity
and specicity, and was also sensitive to change in the severity of
depression over time (Cox et al., 1987). They were instructed about
the importance of describing their feelings in the previous seven
days and not only on the day they were completing the ques-
tionnaire. Depression rates were assessed at three time points: at
36 weeks of gestation, postpartum day one before being dis-
charged, and postpartum day eight with using EPDS.
2.5. Statistical analysis
Continuous variables were rst inspected for normality of
statistical distribution graphically and by ShapiroWilk test. Data
are presented as mean 7standard deviation (SD) or median with
interquartile range (IQRs), as appropriate. For descriptive statistics,
numbers and percentages were used for categorical variables.
Baseline characteristics and outcome measures of the two groups
were analyzed with Student
0
st-test or MannWhitney test for
continuous data and chi-square test for the comparison of cate-
gorical variables. For paired datas Friedman and Wilcoxon signed
ranks tests were used. All the comparisons were two-tailed.
pvalues r0.05 were considered statistically signicant. Statistical
analysis was performed with SPSS version 17.0 software (SPSS Inc.,
Chicago, IL).
3. Results
Women in the music therapy and control groups completed the
study, as shown in the ow 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
Eligible 161 women included
Music therapy group (n = 80)
( music therapy+ rutin care)
Excluded (n=9)
-Performed caesarean (n=4)
-Forget group assigment (n=2)
-Cervical dilatation>3 cm (n=3)
Analysed (n=71)
Control group (n=81)
(rutin care only)
Excluded (n=11)
-Performed caesarean (n=7)
-Forget group assigment (n=4)
Analysed (n=70)
Fig. 1. Flow diagram of subject progress through the phases of the trial.
S. Simavli et al. / Journal of Affective Disorders 156 (2014) 194199196
(n¼11), did not inform the researchers when they went to the
maternity unit for labor (n¼5) and had cervix dilation of more than
3cm (n¼4). Although 161 pregnant women were enrolled in the
groups, 141 participants were included in the nal analysis. Seventy-
onewomenwereinthemusictherapygroup,and70womenwerein
the control group.
The demographic characteristics of music therapy and control
groups were shown in Table 1. The music therapy and control
groups were found similar with respect to maternal age, BMI,
gestational age, family class, education level, employment situa-
tion and antenatal depression rate (p40.05). The type and
percentage of music chosen by women were classical music,
11.3% (n¼8); light music, 14% (n¼10); popular music, 18.3%
(n¼13); Turkish art music 21.2% (n¼15); Turkish folk music
15.5% (n¼11) and Turkish sumusic 19.7% (n¼14).
The music therapy group
0
s antenatal minor depression rate
(EPDSZ10) was 25.4% and control group
0
s was 30.0% (p¼0.54).
Groups
0
antenatal major depression rates (EPDSZ13) were 11.3%
and 12.9%, respectively (p¼0.77). Although antenatal depression
rate was not different, in the postpartum period there were
statistically signicant difference for minor and major depression
rate between music therapy and control group both in the
postpartum day one and day eight (po0.05) (Table 2). Not only
minor but also major postpartum depression rates were signi-
cantly lower in the music therapy group than in the control group
at both postnatal day one and day eight (all po0.05) (Table 2).
In the music therapy group, antenatal and postnatal depression
rates were different. At antenatal, postnatal day one and postnatal
day eight, minor depression rates were 25.4%, 15.5%, 12.7%, and
major depression rates was 11.3%, 5.6%, 5.6%, respectively. In the
music therapy group, while postnatal minor depression rate was
statistically signicantly lower than antenatal depression rate
(p¼0.03), there were no statistically signicant differences
between antenatal and postpartum periods for major depression
rate (p¼0.23). In the control group, minor depression rate was
30.0%, 31.4%, 35.7%, and major depression rate was 12.9%, 17.1%,
18.6% at antenatal, postpartum rst day and eight day, respec-
tively. Additionally, while not signicantly different, postnatal
minor and major depression rates were higher than antenatal
depression rates in the control group (p¼0.70, p¼0.54, resp-
ectively).
The music therapy group had a signicantly higher satisfaction
rate than the control group at postpartum second hour
(8.3270.78 versus 5.6770.91, po0.001). Likewise, a signicant
difference was observed between the two groups in terms of
satisfaction rate at postpartum 12 h and 24 h again (po0.01)
(Table 3).
Mothers in the music therapy group had a lower level of
postpartum pain intensity compared with those in the control
group and it was statistically signicant at all time intervals (1, 4, 8,
16 and 24 h, po0.001). In the music therapy group, anxiety level
was signicantly lower than the control group, again at all time
intervals (po0.001) (Table 3).
4. Discussion
Music, which in everyday life is used for pleasure and its mood-
changing effects can be used for therapeutic benet. Music therapy
is widely used in the treatment of mental health. In the present
Table 1
Demographic characteristics of groups.
Variables Music therapy group
(n¼71)
Control group
(n¼70)
p
Maternal age
(years)
24.1773.22 23.3973.88 0.19
n
BMI (kg/m
2
)27.2072.53 26.7872.38 0.32
n
Gravidity 1.00 (0.00) 1.00 (1.00) 0.01
nn
Gestational age
(days)
270.5275.39 271.9775.81 0.13
n
Education
Primary school 25 (35.2%) 30 (42.9%) 0.56
High school 21 (29.6%) 17 (24.3%)
University 25 (35.2%) 23 (32.8%)
Family class
Low 16 (22.5%) 16 (22.9%) 40.99
Middle 44 (62%) 43 (61.4%)
High 11 (15.5%) 11 (15.7%)
Employment
situation
Full time 15 (21.1%) 15 (21.4%) 0.78
Part time 13 (18.3%) 16 (22.9%)
House wife 43 (60.6%) 39 (55.7%)
Antenatal EPDS 8.0472.76 8.49 72.58 0.33
n
Data are means7standard deviation (SD) or median (IQR). Abrevations: BMI; body
mass index, EPDS; Edinburg Postpartum Depression Scale.
n
pValue represents the signicance level of the ttest.
nn
Value represents the signicance level of the Mann Whitney Utest.
Value represents the signicance level of the X
2
.
Table 2
Antenatal and postnatal Edinburgh Postnatal Depression Score.
Variables Music therapy group
(n¼71)
Control group
(n¼70)
p
Antenatal depression
Mean (SD) score 8.04 72.76 8.4972.58 0.33
n
EPDSZ10 18 (25.4%) 21 (30.0%) 0.54
EPDSZ13 8 (11.3%) 9 (12.9%) 0.77
Postnatal depression
day one
Mean (SD) score 7.3172.35 8.2772.76 0.03
n
EPDSZ10 11 (15.5%) 22 (31.4%) 0.03
EPDSZ13 4 (5.6%) 12 (17.1%) 0.03
Postnatal depression
day eight
Mean (SD) score 7.1472.13 8.5972.85 0.001
n
EPDSZ10 9 (12.7%) 25 (35.7%) 0.01
EPDSZ13 4 (5.6%) 13 (18.6%) 0.02
Data are means7standard deviation (SD). Abrevations: EPDS; Edinburg Postpar-
tum Depression Scale.
n
pValue represents the signicance level of the ttest.
Value represents the signicance level of the X
2
.
Table 3
Postpartum anxiety, pain and satisfaction score.
Variables Music therapy group (n¼71) Control group (n¼70) p
VAS-A (1 h) 3.3070.46 4.89 70.93 o0.001
n
VAS-A (4 h) 2.7470.38 4.24 70.77 o0.001
n
VAS-A (8 h) 2.2870.29 3.31 70.46 o0.001
n
VAS-A (16 h) 1.6570.31 2.75 70.38 o0.001
n
VAS-A (24 h) 0.8870.57 2.30 70.29 o0.001
n
VAS-P (1 h) 3.29 70.44 5.4270.93 o0.001
n
VAS-P (4 h) 3.10 70.38 4.5870.91 o0.001
n
VAS-P (8 h) 2.74 70.38 4.2270.76 o0.001
n
VAS-P (16 h) 2.33 70.31 3.3970.49 o0.001
n
VAS-P (24 h) 2.1770.23 3.30 70.46 o0.001
n
VAS-S (2 h) 8.3270.78 5.6770.91 o0.001
n
VAS-S (12 h) 8.7570.56 6.1270.95 o0.001
n
VAS-S (24 h) 9.6970.27 6.77 71.05 o0.001
n
Data are means7standard deviation (SD).
Abrevations: VAS-A; Visual Analog scala-Anxiety, VAS-P; Visual Analog scala-Pain,
VAS -S; Visual Analog scala-Satisfaction.
n
pValue represents the signicance level of the ttest.
S. Simavli et al. / Journal of Affective Disorders 156 (2014) 194199 197
study, we showed the benecial effect of music therapy rst on
postpartum anxiety and pain, second on satisfaction with child-
birth, and third on early postpartum depression rate. Music
therapy during labor decreased postpartum anxiety, pain and
postpartum depression rate and increased the satisfaction with
childbirth.
Music therapy is one of the relaxing techniques and the
benecial effects have been recognized for many years. The results
of clinical studies suggest that listening to music has a positive
effect on psychological and physiological conditions, and therefore
music therapy has been used as an anxiolytic in stress-related
interventions. (Ovayolu et al., 2006; Lee et al., 2002; Lee, 2010;
Angioli et al., 2013). In some studies, music therapy was found
helpful for postpartum mental health, but no one had yet tested
the use of music therapy during labor. In this study, we investi-
gated the effects of continuous music during all stage of labor with
an optimal sample size in a single-blinded randomized
controlled trial.
A meta-analysis of the effectiveness of music listening in
reducing depressive symptoms in adults conrmed the benets
of music listening in reducing depressive symptoms in the adult
population. As a result of this meta-analysis, it is suggested that all
types of music can be used as a listening material, depending on
the preferences of the listener. So, it is recommended that the
listeners are given choices over the kind of music which they listen
to Chan et al. (2011).
Lee (2010) investigated effects of music therapy on postpartum
blues and maternal attachment of puerperal women. After mea-
suring postpartum blues and maternal attachment, music therapy
was provided to the experimental group (30 puerperal women) for
40 min, once a day, and for 8 days. Then, postpartum blues and
maternal attachment for the experimental and control group were
measured again on the 8th day. He showed that music therapy has
positive inuences on decreasing postpartum blues and increasing
maternal attachment of puerperal women. In this study, they used
music in postpartum period, while we used music therapy
during labor.
Analgesic effects of music therapy have been reported pre-
viously on postoperative pain (Ebneshahidi and Mohseni, 2008;
Good et al., 2002; Sen et al., 2010). Auditory stimuli can affect
human response to stress, an uncomfortable environment, loss of
control, and fear of disgurement. This response can be attenuated
by the relaxing effects of music. It has been suggested that pain
and auditory pathways inhibit each other; thus the activation of
the auditory pathway can play a role in inhibiting the central
transmission of painful stimuli (Ebneshahidi and Mohseni, 2008;
Nilsson et al., 2005). Music therapy during the postoperative
period of caesarean section surgery has been shown to decrease
postoperative pain and analgesic requirement (Ebneshahidi and
Mohseni, 2008; Sen et al., 2010).
Boudou et al. (2007) investigated the relationship between
childbirth pain and mood disorders in 43 women at three days
postpartum. They showed a signicant positive correlation
between the pain scores and the maternity bluesquestionnaire
scores, and between pain scores and EPDS score at three days
postpartum. According to the results, they suggested that knowl-
edge of the risk factors, such as pain, could help to improve the
efciency of detection, and let professionals focus on the psycho-
logical impact of labor and especially on post-traumatic stress
disorders. Although our study differs from this study, we agreed
that psychological impact of labor is associated with post-
traumatic stress disorders.
Pain after vaginal delivery may result from episiotomy, perineal
laceration, or uterine involution. This is usually treated with oral
medications (Goodman et al., 2005). To our knowledge, this is rst
study to investigated the effect of music therapy during labor on
postpartum pain, anxiety, satisfaction and postpartum depression
rate. Some studies investigated the effect of music therapy during
labor on postoperative pain (Good et al., 2002; Ebneshahidi and
Mohseni, 2008; Sen et al., 2010), not postpartum pain and some
studies investigated the effect of music therapy during the post-
partum period on mental health (Lee, 2010), not during labor.
Although the application time or patient groups were different in
this study, our results are compatible with the literature. In the
music therapy group, postpartum pain was lower than the control
group and early postpartum depression rate was again lower
compared to the control group.
Childbirth is a stressful event, and maternal anxiety is known to
be associated with a less positive experience and lower satisfaction
with the birth (Waldenstrom et al., 1996). If anxiety could be
reduced, satisfaction may be improved. Our results support this
hypothesis. In the music therapy group, anxiety level decreased and
satisfaction increased. Most studies revealed that music increased
patients
0
satisfaction (Tanabe et al., 2001; Thorgaard et al., 2004;
Ovayolu et al., 2006). Our results are consistent with the literature.
The satisfaction score was higher in the music therapy group. The
use of music therapy in addition to standard care during labor had a
favorable effect on patients
0
satisfaction.
Siedliecki and Good (2006) investigated the effect of music
therapy on power, pain, depression and disability, comparing the
effects of researcher-provided music (standard music) with
subject-preferred music (patterning music) in patients with
chronic non-malignant pain. They showed that music therapy
groups had more power and less pain, depression and disability
than the control group, but there were no statistically signicant
differences between the two music interventions. Although our
study population different, our results were consistent with this
study, demonstrating that music therapy increased satisfaction
and decreased pain, anxiety and depression.
Limitations of this study were subjects could not be blinded to
group assignment, because of the type of intervention studied.
However, both the obstetrician and nurses who were involved in
data collection were blinded to the groups. Thus, the observer bias
would be eliminated in this study. We investigated only self-
selected music effect. We did not compare music types. In
addition, we only measured the effect of music therapy on early
postpartum (day eight) depression rate. Effect of music therapy on
late postpartum depression rate should be carried out with further
larger study in the future.
To conclude listening to music during labor has a positive impact
on postpartum maternal well-being. Music therapy was an effective
method for reducing and relieving postpartum pain and anxiety,
improving satisfaction with childbirth and reducing early postpartum
depression rate compared with the control group and can be clinically
recommendedasanalternative,safe,andeasymethodwithno
known side effect for postpartum pain relief and mental health.
Role of funding source
None.
Conict of interest
None.
Acknowledgements
None.
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    • "The gait of Pushing Hand Taiji stipulates rhythmic movements, animating the interaction between the practitioners and their partners from which both parties improve social skills. Moreover, practising Taiji with music (Qiu, 2000) may enrich the use of music therapy, which is also a prominent treatment for mental illnesses (Gardstrom, Bartkowski, Willenbrink, & Diestelkamp, 2013; Gold et al., 2013; Simavli et al., 2014; Solli, Rolvsjord, & Marit, 2013). These exercises offer more choices for versatile service providers and recipients. "
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