Effect of Turkish classical music on prenatal anxiety and satisfaction: A randomized controlled trial in pregnant women with pre-eclampsia

https://doi.org/10.1016/j.ctim.2016.11.005Get rights and content

Highlights

  • Music Therapy had positive effect on Newcastle Satisfaction with Nursing Scale scores of pregnant women with pre-eclampsia.

  • Music Therapy had an increasing effect on fetal movement counts.

  • Music Therapy had a minimalizing effect on fetal heart rate.

  • Music Therapy had a lowering effect on blood pressure.

  • Music Therapy had no effect on anxiety in pregnant women with pre-eclampsia.

Abstract

Objectives

The present study aimed to evaluate the effect of music therapy on anxiety and satisfaction in pregnant women with preeclampsia.

Design, setting and subjects

A randomized controlled trial was performed on 70 pregnant women with pre-eclampsia hospitalized in the research and application hospital of Kahramanmaras Sütcü İmam University between December 2012 and February 2014. The subjects were allocated to experimental or control groups in a random manner (n = 35 each).

Interventions

Pregnant women in the experimental group were subject to a 30 min Turkish classical music therapy trial each day for a period of 7 days (5 days before and 2 days after labor) whereas those in the control group received routine care and also were assigned to 30 min of bed rest a day. The Personal Information Form, State-Trait Anxiety Inventory, and Newcastle Satisfaction with Nursing Scale were administered to participants. Data were analyzed using descriptive statistics, student t-test, and Mann-Whitney U test where appropriate.

Main outcome measures

Outcome measures were anxiety scale scores, satisfaction scale scores, vital signs, fetal movement and fetal heart rate.

Results

The differences between anxiety scores were not statistically significant (p > 0.05). On the other hand, Newcastle Satisfaction with Nursing Scale scores of the experiment group were higher than the control group (p < 0.01). Finally, when considering fetal movement counts, a significant increase was determined in the experiment group, whereas Music Therapy had a minimalizing effect on fetal heart rate and a lowering effect on blood pressure (p < 0.05).

Conclusion

It may be suggested that nurses and midwives can utilize music therapy in the care and follow-up of pregnant women with preeclampsia in obstetrics units.

Introduction

Music therapy is a type of treatment performed with a structured method by arranging the physiological and psychological effect of musical sounds and melodies.1 Scientific studies proved years ago that music affects spiritual and mental well-being, and the body, positively.2, 3 Music therapy is thus one of the methods that is as old as the history of medicine itself. There are many studies showing that music therapy is beneficial to the anxiety experienced by the ill and pregnant.4, 5, 6, 7, 8 Specifically, a type of music called Medical Resonance Therapy (MRT) is known to have various beneficial effects in high risk pregnancies and to reduce stress.9 In this context, music therapy, which is a cognitive behavioral therapy type with high effect on anxiety, can be used as a complementary and alternative treatment method.10

Pre-eclampsia, which is categorized as hypertension (≥140/90 mmHg) caused by pregnancy and can be seen alongside proteinuria after the 20th week of pregnancy classically,11 causes fear and anxiety in pregnant individuals regarding themselves or their babies, and presents as anxiety during pregnancy.12, 13 In addition to a subjective feeling of expectation and anxiety characterized by horror, worrying, or the feeling that a disaster is closing in,14 pre-eclampsia, if not treated throughout pregnancy, may cause negative outcomes such as babies with low birth weights (SGA), variational APGAR scores, fetal hemodynamics, movement disorders, increase in the risk of pre-eclampsia, early membrane rupturing, or caesarean sections.15

Pre-eclampsia and eclampsia, also known as toxemia, present as a pregnancy complication in 2.8% of pregnancies in developing countries and 0.4% of pregnancies in developed countries. According to the World Health Organization 2005 report (WHO), 12% of all direct mother deaths are caused by eclampsia and this cause comes third among the reasons for such deaths.16 In addition to this report, in a report published in 2010, 18% of direct mother deaths were stated to be caused by hypertension and the cause was stated to be ranked second among causes for such deaths.17 In Turkey, 18.4% of mother deaths are caused by oedema, proteinuria, and hypertensive disorders, and 13.7% are caused by eclampsia, with eclampsia coming second among reasons for such deaths.18

Music therapy is used today in many fields of medicine, especially in reducing anxiety caused by dental treatments, cardiac procedures, medical and surgical procedures, obstetrics, and oncology treatments, reducing stress, pain management, and reducing hypertension.5, 6, 7, 19, 20, 21, 22, 23, 24

On the other hand, the use of music therapy on pregnant individuals is limited and studies on high risk pregnant women are especially insufficient. In literature, music therapy was found to be used on normal physiological pregnancies, in pregnancies where transvaginal ultrasonography was performed, in pregnant woman at delivery, and in pregnant women to whom the Non Stress Test (NST) was applied in the reduction of anxiety.4, 8, 25, 26 Although among high risk pregnancies, studies on using the method on high risk pregnant women who were suggested bed rest and pregnant women with hypertension were present 7, 9 no studies on pregnant women with pre-eclampsia were found.

In literature, there are no studies investigating the effect of Classical Turkish Music presented before and after birth to pregnant women with pre-eclampsia on anxiety, physiological parameters, well-being of the fetus, and satisfaction. There are a limited number of research studies in our country regarding music therapy in the field of obstetrics,4, 8 and no clinical or experimental studies on the effect of music therapy on satisfaction and anxiety of pregnant women with pre-eclampsia were found in the literature. From this aspect, the current study is original.

It was thought that Classical Turkish Music would have a positive effect on pregnant women with pre-eclampsia.2, 3, 4, 5, 6, 7, 8, 9, 24, 25, 26 For this reason, the aim of this study is to investigate whether music therapy performed with classical Turkish music would have positive effects on the anxiety and physical symptoms of the mothers and the fetuses, as well as investigating the general satisfaction of the pregnant women with music therapy.

Section snippets

Study design

This was a parallel group, randomized controlled trial (RCT). The study was conducted with pregnant women who were present at the maternity unit of Kahramanmaras Sutcu Imam University Research and Application Hospital and were diagnosed with pre-eclampsia.

The hospital where the study was conducted was the only public hospital which offers third step medical services in the city, and all of the complicated cases such as pre-eclampsia were being forwarded to this hospital. In the 12 bed

Measurements

The following scales were used in the study.

Classical Turkish music presentation

The “Nihavend” and “Buselik” modes of Turkish music suggested by the Turkish Music Research and Promotion Group (TUMATA) that have relaxing properties were used by taking expert views. Participants in the study group listened to the mode of music they selected from between the Nihavend and Buselik modes regularly 30 min a day for seven days through an MP3 player and headphones whilst lying down.

The participants in the study group arranged the sound level of the music according to their desires,

Results

The participants in the study were found to have an average age of 30.64 ± 5.81, with most being elementary school graduates and unemployed (Table 1). The average number of pregnancies was found to be 3.16 ± 1.77, with 24.2% having their first pregnancy, the women giving an average of 2.26 ± 1.19 births, 9.4% having a history of stillbirth, and 49.1% having a history of miscarriage. The participants included in the study were found to give their births in an average of 36.20 ± 2.40 weeks (Table 2).

Discussion

With regard to the socio demographic characteristics and other obstetric characteristics, no statistically significant difference between the groups that could affect the results of the study was found.

As a result of our study, music therapy was not found to have a significant decreasing effect on anxiety in pregnant women with pre-eclampsia. This result is considered to have arisen from the facts that the participants in our sample were high risk, each of the situations such as pre-eclampsia

Conclusion

In conclusion, through the findings obtained by applying music therapy to pregnant women with pre-eclampsia, music therapy was found to increase satisfaction with nursing care in pregnant women, decrease blood pressure, the positive effect on fetal movement counts, and minimalizing effect on fetal heart rate. Although it seems not to have an effect on anxiety levels in our study, participants relaxed while listening to music. The participants’ pulse and respiratory rates were normal before the

Acknowledgment

The TUMATA Association was consulted in every step of this study from planning to application, and complete cooperation was received from the team working at the obstetrics clinic where the application was performed.

The present study is a dissertation completed in the Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Marmara University, İstanbul, Turkey.

This manuscript has been presented orally at the Complementary and Supportive Care Applications Congress, held in

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