Music Therapy With Antepartum Patients
By Elise Scullin, MusicWorx Intern
Disclaimer: I will be using the terms “antepartum patients” (pre-birth) and “pregnant individuals” to describe the patient population. While all of the antepartum patients I have worked with personally have been female identifying, not all people who experience pregnancy identify that way. My goal is to make this an inclusive resource for anyone looking to learn more about this population and potential goal & intervention areas, therefore I wanted to give some background on my verbiage and wording.
The antepartum period is a time that can be filled with excitement, anticipation, and usually a great deal of anxiety, discomfort, and stress. The period of pregnancy is different for all those experiencing it, both physically and emotionally. Physically, the body is transforming itself to simultaneously support a developing fetus and prepare for labor; as a human experience, people are getting ready to bring a child into the world who will fundamentally change their daily lives.
A study published by van Willenswaard, et al. in 2017 found that 84% of pregnant individuals surveyed reported feeling stress or anxiety during their pregnancy. A 2018 study from Garcia, et al. reported a strong relationship between maternal well being and fetal welfare. In any pregnancy, stress and anxiety management is important for the wellbeing of the parent as well as the baby.
Clinical research frequently shows that music therapy is an excellent tool for stress and anxiety management overall, and the limited research on antepartum applications has shown benefits for pregnant patients (Garcia, et al, 2018; Corey, et. al 2019; Kafall, et. al, 2011). In my music therapy career thus far, I have had the opportunity to work with three individual antepartum patients, each with specialized diagnoses and facing unique challenges. I have compiled a list of interventions that I have used with these patients and have found them to be beneficial for the patient’s goals, as well as fun and a chance to get creative. As a reminder, while these interventions may in turn have an effect on the fetus through the effects on the parent, the interventions listed here address the physical and emotional wellbeing of the antepartum individual.
Sessions with antepartum people can be uncommon in hospital settings outside of maternity wards. A high risk pregnancy often requires frequent monitoring of both the fetus and pregnant individual, and is usually coupled with a prescription of bedrest or limited activity. In the time I have had to work with antepartum patients in this setting, I have always found these visits to allow me to really expand on my intervention creativity! Naturally, any of these interventions can be translated to other populations and settings.
Playlist creation is a fun way to give expectant parents something tangible to do for themselves or for their baby, and is also something they can walk away with after sessions have ended. I always look for ways to help restore a sense of autonomy and control that can be missing during a long-term hospital stay, and playlist creation is a very hands-on way to provide more opportunities to accomplish this.
Creating a playlist in preparation for the baby’s arrival to follow the energy flow of caretaking arcs.
- Here is one example that a past professor gave me: Creating a playlist for chestfeeding at night/when the parent is tired. When played in order, the playlist ideally follows a flow that increases stimulation to help the individual to wake up, maintain stimulation to stay awake, and decrease the stimulation to help with returning to sleep or rest. Always check in with the patient to make sure this is something beneficial to them, as not all individuals chestfeed. If they do plan to chestfeed, including other caregivers of the child can maximize the effectiveness of the overall feeding and pumping routine.
- Following the MT technique of the iso-principle, creating a playlist that plays at a decreasing energy or stimulation level can be a useful tool for helping to soothe a baby. Being wary to not overstimulate the baby, matching a song to the energy level of the child and allowing the songs to slowly decrease in energy level/stimulation can help to prompt the child to follow suit and create a soothing atmosphere. When creating a playlist of this nature that will directly impact the stimulation levels of the baby, be mindful about the music you are selecting; air on the side of caution and lean towards music that is diatonic, has simpler rhythms, melodies, and harmonies, and typically no more than 1-2 instruments in addition to voice (i.e. voice, guitar, & piano).
- For more information on avoiding and treating overstimulation, check out this resource: Healthline
- “Nap Time” playlists of special lullabies or soothing music. An additional emotional benefit of this intervention is that it can also serve as an item of sentimentality for the pregnant individual to remember their time during pregnancy and the times when their child is young and utilizing this playlist.
- Playlists can be short, about 10-15 songs, or longer if desired, and are a tangible and personalized outcome for the patient to walk away with.
Family Support/Social Support
- Spotify (both free and premium versions) has an innovative feature that allows you to make collaborative playlists. With one of the patients I worked with, we were able to make a collaborative playlist between her and her family so that her children at home were able to share music with her.
- On the Spotify app, create a playlist. Select the icon with the three dots, and select “collaborative playlist”. From there, you can share the playlist via text message, email, or shareable link and send to friends and family members. The playlist will show who added what song, and is a way for patients to stay connected with friends and family when they may be separated.
- While Apple Music does not yet have a feature of this nature, here is a link to collaborative playlist making on YouTube.
Themed Playlists for Support
- One of the most basic forms of playlist making is creating a playlist surrounding a theme. Themed playlists great long-term projects, especially as a patient may be challenged to think of multiple songs that fit a theme off the top of their head. This project is a unique opportunity to utilize therapeutic processings skills and ask prompting questions about music that draws support, and even open up a conversation to help further emotionally support a patient. Examples:
- Hope – here is an example playlist
- A creative twist to this type of playlist creation is to have the first letter of each song spell out the theme of a playlist. For example, if the playlist is for “gratitude”, the playlist songs in order could be “God Only Knows” by the Beach Boys, “Rainbow” by Kacey Musgraves”, and so on to spell out “gratitude”.
- This type of playlist can also be a gift that a patient works on for someone special, with each song spelling out their name. I have attached an example playlist for the word “Support”
Writing a lullaby with an expectant parent or parents can be a great tool for parent-baby bonding, emotional expression, and creative expression. Lullabies typically use simpler melodic lines, as well as simpler messages and lyrics. Providing the parent with options of cyclical chord progressions is an easy way to get started.
Lullabies can be useful tools for helping the parent(s) to express what they are feeling or thinking. Writing lyrics through a verbal processing approach can generate incredibly meaningful words for the song, and can also help the parent(s) to feel supported during this time. Asking probing questions often helps lyrics to fall into place. Examples of questions that I have found helpful to ask are:
- What do you want to tell your baby?
- What words describe how you feel about being a parent/being pregnant/etc?
- What lessons have you learned during your pregnancy that you would like to teach your child?
Story songs are great for teaching lessons, creative expression, and conveying emotion. Here I have listed three examples of story songs to write with expectant parents:
- Story of the Pregnancy: This example allows the parent to process this period of their life and retell it through their unique lens.
- Bedtime Story: Writing a story song that the parent can sing to their child at bedtime can be a nice opportunity for lighthearted creative expression (writing a “silly” story), as well as for giving the parent(s) something to look forward to when the baby is born.
- Lesson: When asking the parent(s) about what they have learned during this period, putting that lesson into a short story song can be a validating experience. It is an opportunity to remind them what they have learned and affirming their emotions related to what they are going through. Lessons can include themes of:
- Importance of Family
Stress Relief & Family Bonding
Especially for parents with other children at home, I found songwriting using a “MadLibs”-style template to be a source of mood elevation, as well as a way to include other family members. Using familiar tunes like popular radio or Disney songs can be accessible tools to teach patients to use when they are one on one with their families and wanting to do something lighthearted and fun.
Heart Beat Recordings
During an ultrasound, or other similar procedures, medical professionals may use Dopplers to listen to the sound of the baby’s heartbeat in utero. Using a standard microphone attachment, heartbeats are recorded from the sound of the Doppler directly into your production software. Heart beat recordings can be an incredibly meaningful addition to a songwriting project.
Drumming – The benefits of drumming on the mind and body are extensive, but a unique aspect of drumming with antepartum patients is a concept called vibro-tactile stimulation. Vibro-tactile stimulation is the act of sending stimulating vibrational frequencies to the baby in utero. This has shown benefits of decreasing heart rate, which can be helpful in soothing an in utero child. The benefits have been tested multiple times, with similar outcomes.
MUSIC AND CREATIVE ARTS
Mandalas: Mandalas are holistic centering tools that aim to bring focus to the mind. Using a previously created template or a blank canvas, mandalas are a combination of music centered mindfulness and art creation. When using these, I recommend to play music or soundscapes in the background and allow the mind to wander where it likes; using music with previous associations runs the risk of interrupting the creative flow of the activity. This activity can help with creative and emotional expression.
Chain Links: Creating a paper chain a la kindergarten is a fun activity to do with expectant parents. You can create a chain a day or a chain per week with an intention, a goal, or a song that represents the feelings and needs of the patient.
This patient population, though less common in the music therapy world, is a rewarding population to work with. Pregnancy has many highs and lows, and having the opportunity to support someone through that time using music can teach us a lot about ourselves as music therapists and stretch us to try new things.
Corey, K., Fallek, R., & Benattar, M. (2019). Bedside Music Therapy for Women during Antepartum andPostpartum Hospitalization. MCN. The American Journal of Maternal Child Nursing, 44(5), 277–283
García González, J., Ventura Miranda, M. I., Requena Mullor, M., Parron Carreño, T., & Alarcón Rodriguez, R. (2018). Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial. Journal of Maternal-Fetal & Neonatal Medicine, 31(8), 1058–1065.
Kafalİ, H., Derbent, A., Keskİn, E., Sİmavlİ, S., & Gözdemİr, E. (2011). Effect of maternal anxiety and music on fetal movements and fetal heart rate patterns. Journal of Maternal-Fetal & Neonatal Medicine, 24(3), 461–464.
van Willenswaard, K. C., Lynn, F., McNeill, J., McQueen, K., Dennis, C.-L., Lobel, M., & Alderdice, F. (2017). Music interventions to reduce stress and anxiety in pregnancy: a systematic review and meta-analysis. BMC Psychiatry, 17, 1–9.