Feasibility and preliminary effects of the use of music and movement during childbirth
Jacobs, Nicole, author
LaGasse, Blythe, advisor
Davis, William, committee member
Nett, Terry, committee member
In 1965, the rate of cesarean birth was 4.5% (Taffel et al. 1987). Presently, the World Health Organization recommends a rate of 15% (WHO, 2009) and yet the current cesarean rate in the United States is double this recommendation, closing in at 32.8% (Hamilton & Martin, 2011). The Lamaze International Education Council addressed the growing cesarean rate in 2004 by publishing an article in the Journal of Perinatal Education which outlined six care practices to promote normal birth. The second care practice, freedom of movement throughout labor, holds promising application for neurologic music therapy. Numerous studies have found ambulation during labor to be effective in increasing oxytocin levels, advancing labor progression, decreasing length of labor, and improving birth outcome. Previous research on music therapy-assisted childbirth has focused exclusively on the use of music listening to decrease pain and anxiety. However, the effect of using music to support ambulation through motor entrainment with laboring mothers has not been studied. In addition, the effects of music in stimulating the release of oxytocin has documented beneficial effects on several patient populations but its use during parturition has not been studied. Pitocin, a synthetic form of oxytocin, is routinely given to induce and augment labor. However, some mothers decline this intervention as it can have unpleasant side effects and disrupts physiologic birth. Likewise, its use can be contraindicated for some mothers such as those with a history of prior cesarean section. As a result, there is a need to identify nonpharmacological interventions which appeal to laboring mothers and medical staff, support normal labor progression, and improve outcome. The purpose of this pilot study was to identify initial evidence regarding the effect music-facilitated movement has in supporting ambulation during labor, determine the feasibility of recruiting participants from area obstetrical clinics, evaluate prenatal training and labor support procedures, assess participant preferences and hospital staff support of the intervention during labor, and analyze the effect on labor progression and outcome. A single-system design was used for this investigation. One mother responded to the advertisements, met criteria for the study, and participated in three prenatal training sessions. Upon the start of active labor, the participant contacted the investigator, who provided nearly two hours of support while laboring at home. At the time of labor support, the participant served as her own control and an ABAB design was used to assess the effects of music-facilitated ambulation. A FitBit Flex pedometer was worn by the participant to compare ambulation activity between conditions. Data on the participant’s use of the intervention and effect on labor progression, as measured by contraction frequency, was collected during that time. Following the birth, data were collected from the online pedometer software, medical records, and through a post-partum interview to determine perceived benefits, preferences regarding use of the strategies and support of the music therapist, implementation of the intervention at the hospital, receptiveness of hospital staff, duration of labor, and birth outcome (vaginal, assisted vaginal, or cesarean section). Visual inspection of the raw movement data failed to identify any effect of the intervention on physiological measures. In addition, there were numerous possible alternative explanations that may have influenced the movement data including passage of time and natural labor progression as well as use of other nonpharmacological interventions. Outcomes related to feasibility suggest this intervention was perceived positively by both the mother and the healthcare providers. Implications, limitations, and recommendations for future investigations are presented.
Includes bibliographical references.
Includes bibliographical references.