Since ancient times, music is believed to have healing powers and has been used as a form of therapy. Singing song to the babies is known across different cultures and societies all across the world from time immemorial. Many renowned music composers including Mozart, Brahms and Schubert, composed memorable lullabies.
Many researchers in recent times have recommended daily listening to music during pregnancy as an effective way of relaxation during pregnancy.
How does music help in alleviating health symptoms?
The exact mechanism of how music helps therapeutically is unknown.
The following may be possibilities:
Music is known to reduce stress symptoms and anxiety by reducing the catecholamine and stress hormone levels. This, in turn, improves general health and wellbeing.
The use of music to help in pain control is called ‘music-induced analgesia’ (MIA) or ‘audio-analgesia’.
Music may help improving pain symptoms in the following ways:
1. Increase endorphin secretion. Endorphins reduce pain and create a sense of wellbeing in the brain.
2. The distraction of mind and a ‘sense of control’ to do something for pain relief at any time during the pain.
3. Better tolerance and coping with pain due to less anxiety and increased relaxation.
4. A direct or indirect inhibitory effect on the Descending Pain Modulatory System (DPMS). This is situated at the brain stem and thought to be responsible for controlling pain perception.
Why music therapy could be a unique approach?
Music therapy during pregnancy could have the following advantages:
Treatment of insomnia and mental health conditions (such as anxiety and depression) with medicine during pregnancy is always challenging.
This is due to limited data and possible risk of harm of these medications to the fetus.
As a result, many pregnant women are extremely concerned about taking antidepressants and other medications.
Music therapy has advantages for being cheap, socially accepted and an enjoyable non-pharmacological option of treatment.
Several individual interventions (such as cognitive-behavioural and interpersonal psychotherapy and hypnotherapy), or group interventions (such as parenthood-based antenatal education) during the third trimester have been shown to reduce postnatal depression.
Attending in-person or group appointments could be challenging towards the end of pregnancy due to increased tiredness, pain and discomfort.
It could be even more difficult if the pregnant woman is working or have other commitments.
Music therapy could be a cheap, effective, home-based suitable alternative solution for the pregnant woman. She can listen and enjoy the music at the comfort of her home.
What are the musical interventions?
Musical interventions are of two broad types: Music Medicine and Music Therapy.
Music medicine involves passive listening of (usually pre-recorded) music.
Music therapy, on the other hand, involves assessment, treatment and evaluation by a therapist who uses either pre-recorded or live music.
The American National Association for Music Therapy (1997) defined music therapy as the use of music to improve physical and psychological health and wellbeing.
Listening to music (either therapist-guided intervention or a routine day-to-day listening) has been shown to reduce stress, anxiety and depression and promote wellbeing.
How music therapy can be beneficial during pregnancy?
Many benefits of music therapy to treat various physical and mental health conditions during pregnancy have emerged in recent years. However, more research is required to establish standardised robust therapy protocols for the perinatal period. This would describe a recommended type of music, time and duration of therapy.
Music has been shown to help pregnant women in the following ways:
Studies have shown that music therapy can improve sleep quality.
2. Stress and anxiety during pregnancy
Music therapy can be beneficial in improving prenatal anxiety.
3. Preeclampsia treatment
Music can help in lowering blood pressure in pregnant women with pregnancy-induced hypertension/ preeclampsia. Therefore, can be a useful adjunct to the conventional preeclampsia treatment.
4. Stress and anxiety during labour
Research suggests the benefits of music interventions are effective in reducing anxiety during labour.
5. Prenatal depression
Music can help in reducing depression during pregnancy along with stress and anxiety.
6. Labour pain
It can help in reducing pain during labour.
7. Planned Caesarean Section
Studies have shown that listening to music prior to the Caesarean section can provide better coping skills to deal with the stress and anxiety before the surgical procedure.
There is some evidence to suggest that music may increase birth satisfaction and experience of planned caesarean section performed under regional anaesthesia (spinal or epidural).
8. Prevention of PND
Addressing good mental wellbeing is vital during pregnancy (especially during the third trimester) to prevent low mood and mental health problems after the childbirth.
Studies have indicated that listening to music in the third trimester of pregnancy can reduce the risk of postnatal depression (PND).
What type of music is beneficial to the fetus?
The physiological and psychological response of listening to music depends on its type and rhythm.
For example, heart rate and blood pressure can increase while listening to fast-paced music.
Whereas, calming, relaxing and slow-paced music can lower both the heart rate and blood pressure.
Researchers suggest that perhaps regular and low-rhythm music (lullabies) are most suitable for the fetus and newborn babies.
How long one should listen to music for stress reduction?
More research is required to confirm the effective duration of listening to music.
Studies have shown that listening to music as little as 30 minutes can reduce stress hormone level.
Another scientific paper found that listening to recorded music for 20 minutes daily for 12 weeks reduced anxiety and depression symptoms during pregnancy.
How does fetus respond to music?
The fetus starts responding to music by the changes in the fetal heart and movement within 30 weeks of gestation.
As the pregnancy advances, the hearing perception matures and the fetus responds to even low-level musical stimulation.
Fetal heart rate increases on mother listening to fast music and decreases in response to slow and relaxing musical piece.
Scientists have discovered that the anatomical structure of the ear is developed by 20 weeks of gestation.
Although fetus has been shown to respond to external sound as early as 16 weeks, the hearing system becomes fully functional later (between 25-29 weeks).
During this time, neurological connections between the brain (‘auditory cortex’) and the cochlear system of the middle ear (‘receptor organ’) becomes complete.
The third trimester is very important for future hearing abilities of the child.
From 28 weeks of gestation (and until delivery), the hair cells of the cochlea (a key element of the hearing system) and its delicate neuronal connections with the brain undergoes fine-tuning. This is thought to continue for the first few months after birth.
The process of fine-tuning of the cochlea and neurons functions well when the fetus is exposed to simple melody music, the voice of the mother and family and common environmental sounds. The sound level should be less than 50dB (This roughly relates to the sound levels of normal conversation).
Exposure to the loud noise of over 80 dB (such as machinery or loud music system) can interfere with this process and can also damage the hair cells. This may cause hearing impairment of the child.
Studies have indicated that the fetus also has the ability to remember the sounds and music heard in the mother’s womb. They can recognise the tune after birth. A fetus can remember them from a few days to until 4 weeks.
Researchers think that this memory of the sounds (‘auditory learning’) starts developing from 27 weeks of pregnancy.
Moreover, a newborn perhaps can distinguish between the different external sounds they have heard in the womb.
They can recognise mother’s voice (over a stranger’s voice) and mother’s native language (over a foreign language).
Are reading and singing to the fetus beneficial?
The sound heard by the fetus is muffled by the amniotic fluid, placenta, uterine muscles and body tissues of the mother. Also, there are a plethora of noises the fetus is exposed to in the mother’s womb. Examples include the sounds of the mother’s heartbeat and movements of the lungs, bowel and joints.
Still, it is quite clear enough for them to recognise distinctly mother’s voice or the music. Therefore, the hearing system significantly matures with the growth of the fetus.
However, perhaps the mother’s voice is heard better and clearer by the fetus. It is likely to be less attenuated and muffled than external noise and sounds.
Newborn babies seem to identify and recognise novel rhymes read out by their mothers every day in the third trimester.
The fetus responds to the sounds better when the frequencies are lower than 500 Hz. As the sound frequency of a human female voice is around 225 Hz, the mother’s voice is a very useful stimulant for the fetus.
Talking or singing to the fetus can lay the foundation of good parent-infant attachment.
Some studies indicated that a mother’s voice can be important for speech and language development of the child. (1)
Research also has indicated that the gentle touch of the mother across the abdomen during pregnancy can also influence fetal behaviour and movement and help in the better attachment.
Talking, reading and singing to the fetus by the mother during pregnancy can help in developing better bonding and attachment, good hearing functions and possible speech and language development in the forthcoming years.
Is any technical music device beneficial?
Studies have recommended that technical devices such as pregnancy music belts have no beneficial effect.
Rather, simple singing by the mother during the pregnancy seems to be a more reasonable approach to improve parent-infant bonding.
No headphone or sound device should be applied directly to the abdomen during pregnancy. This can result in damage to the fetal hearing system (hair cells in the cochlea) and hearing loss.
Is exposure to loud noise harmful during pregnancy?
Scientists advise that exposure to intense low-frequency noise (>60 dB) should be avoided during pregnancy (especially after 20 weeks).
Can music make my baby smarter and more intelligent?
Following the publication of an article at the renowned Nature journal in 1993, many people believed that 10 minutes listening to Mozart sonata for two pianos (K448) can result in better reasoning skills, IQ and academic achievements.
This was called the Mozart effect.
This followed a popular theory of extending this concept to pregnant women with an idea of having more ‘intelligent’ babies.
There is no robust scientific data to support such claim and the so-called Mozart effect exists.
Research on animals has shown that it does not increase growth factors (such as neurotrophin) required for brain development.
Key points to remember
1. Exposure of the fetus to music during pregnancy can be beneficial.
2. Loud noise (>80dB) should be avoided during pregnancy, especially recurrent and long exposures. This can result in hearing loss.
3. Talking, singing and reading aloud to the baby (by the mother, partner and family member) during pregnancy (especially during the third trimester) can improve bonding and attachment, ensure good hearing, and speech and language development.
4. There is no scientific evidence to suggest that music therapy/ specific compositions during pregnancy makes the baby more intelligent.
5. Headphones/music device/ loudspeakers should NOT be placed directly on the abdomen during pregnancy.
6. No robust scientific evidence to support the use of pregnancy music belts or other similar commercial devices.
7. Music such as regular, slow and soft rhythm (such as ‘lullabies’ and classical music) are thought to be most suitable for the fetus.
Research on music therapy during pregnancy is still at early stages. More robust scientific data is required before offering music therapy in clinical practice and should not replace existing medical care for pain or mental health conditions.