Music in perinatal care and education

Her arms rested over the edge of the birthing tub, her laboring body buoyant in the water. Breathing through a contraction, her eyebrows furrowed slightly. Warm, dim light hummed throughout the room. A midwife, an assistant, her partner, and I floated through the suite offering her encouragement and support as she worked to bring her baby earthside. 

Photo by Rebekah Vos on Unsplash

Another wave of intensity swelled throughout her body. The “rhythmic sound of blood coursing through the uterine artery” was her baby’s surround sound. Simultaneously, the escalation of energetic strings on her playlist interrupted her concentration. She laughed. Something about the sound of this music struck her as funny, and she asked her husband to please advance the playlist. I sometimes think back to this little moment as evidence of how powerful music can be.

Then as her labor progressed, she produced her own music, a sound deep within that reverberated through the room, the vibrations of an ancient song.  

Elena Mannes, author of The Power of Music, has shown that “music stimulates more parts of the brain than any other human function.” 

Music can be used as a relatively low-cost, low-intervention tool in perinatal care. Though its use may seem innocuous, as with any tool, it should be used intentionally.  

 

Early on 

Photo by Greta Hoffman

Mannes points out that the “human relationship to sound starts early… The fetus begins to develop an auditory system between seventeen and nineteen weeks. Already, we are in a world of sound, of breath and heartbeat, of rhythm and vibration.”

She also highlights Dr. Sheila Woodward’s work which looked at the transmission of music into the human uterus and the human fetus and newborn response to music and found that a “fetus responds to a music stimulus from at least the 32nd week of gestation; and that the neonate alters the normal sucking pattern to activate longer periods of a music stimulus which has been repeatedly presented during the intrauterine stage and shorter periods of a novel music stimulus.”

Healthy Children Project’s Karin Cadwell shares a fond memory:  “I learned to play the guitar when pregnant with one kid. I wouldn’t exactly call what I was doing ‘music’ but it was probably rhythmic against my belly. She was only a few days old and I was mixing bread with a dough hook in my mixer and she was pushing her legs up and down exactly to the beat!” 

What’s more, the authors of Prenatal Music Exposure Induces Long-Term Neural Effects conclude that “prenatal exposure to music can have long-term plastic effects on the developing brain and enhance neural responsiveness to the sounds used in the prenatal training…Furthermore, we found that these plastic changes are long lasting, as the effect of prenatal exposure persists for at least four months without any additional stimulation.”

The authors declare some practical implications:  “… since the prenatal auditory environment modulates the neural responsiveness of fetuses, it seems plausible that the adverse prenatal sound environment may also have long-lasting detrimental effects. 

Such environments may be, for example, noisy workplaces and, in case of preterm infants, neonatal intensive care units. 

Furthermore, as prenatal exposure still affected the [event-related potentials (ERPs)] responses months after birth, additional fetal exposure to structured sound environments might be beneficial for supporting the auditory processing of, for example, infants at risk for dyslexia in whom basic auditory processing was shown to be impaired.”

 

Language learning 

Photo by Mălina Sîrbu

A more recent study looked at the language learning implications of prenatal music exposure. Sonia Arenillas-Alcón, et al conclude that their “findings support the idea that daily musical exposure during the last trimester of pregnancy is associated with enhanced encoding of low-frequency sound components, such as those typical of the fundamental frequency of human speech, that relate to pitch perception.” 

Matthew J. Traxler writes about prosodic (the rhythm and intonation of language)  features of language learning in Introduction to Psycholinguistics: Understanding Language Science. “Infants … appear to be endowed with perceptual and representational skills that enable them to tell the difference between different speech sounds from the moment they are born (or at most, within the first 24-48 hours),” Traxler writes. 

 

Music in therapy 

There’s compelling evidence that shows the importance of music as a therapeutic tool, like during labor and in other environments like the NICU.

Photo by Raul Angel on Unsplash

Marissa Rivera Bolaños recounts her experience with the didgeridoo during labor on the Womb Revolution blog: “…It resonates through your body as a non-touch massage…. During the birth, I just remember the sound was very grounding…. My husband played it directly into my belly while I circled my hips and sang my birth song. I felt like the vibrations were helping soften every cell of my body.” 

Andrea M. Cevasco , PhD, MT-BC, NICU-MT quotes a mother in The Effects of Mothers’ Singing on Full-term and Preterm Infants and Maternal Emotional Responses who said that knowing her infant listened to her singing helped her to cope with the baby’s stay in the NICU.

Jayamala AK, et al notes that their study results “suggest that music therapy has a positive effect in reducing stress in mothers of hospitalized premature neonates thereby increasing the amount of expressed breast milk. A relative increase in the amount of breast milk expressed is a boon to the premature baby for its growth and development as it requires additional nutrition. Music therapy being a non invasive method; can easily be used clinically as a method to increase breast milk secretion.” 

And the results of Caine’s work suggest that “music stimulation may have significantly reduced initial weight loss, increased daily average weight, increased formula and caloric intake, significantly reduced length of the NBICU and total hospital stays, and significantly reduced the daily group mean of stress behaviors for the experimental group.”

MUSIC AND HEALTH CARE: A Paper Commissioned by the Musical Connections Program of Carnegie Hall’s Weill Music Institute by Lea Wolf, MSW and Dr. Thomas Wolf details how music enjoyed by patients can reduce staff stress too.  (p .13)  

Annie Jameson plays alchemy crystal singing bowls which produce resonance and help people de-stress, release anxiety and relax deeply, she says. Her music can be used alongside most therapies to induce tranquility, she adds. 

“Because the brain of each individual patient has absorbed musical building blocks of his or her local sonic environment in infancy and developed expectations and preferences based on this experience, choosing appropriate musical selections is an important challenge,” Wolf and Wolf write. 

This is particularly evident in the anecdote I share up top as I sat alongside my laboring friend. The same sounds conjured comedy in her brain, whereas I was unaffected. 

The authors go on to offer a strategy for music choice in health care. 

Music in perinatal education and normalization 

Song can serve as a way to share stories and lessons and influence popular culture. 

If you’ve completed the Lactation Counselor Training Course (LCTC), you’ll be familiar with the jaunty  When you counsel tune which serves as a reminder to honor the mother as the expert of her baby(ies) and the agent of her decision-making. It  goes to the tune of Frère Jacques:

When you counsel
When you counsel 
Never judge 
Never judge 
Praise mother and baby 
Praise mother and baby 
Don’t command 
Do suggest 

If you’ve never heard T’Amentanefer Lumukanda Camara (TaNefer)’s viral “Teach Me How to Breastfeed” video, you’ll want to drop everything else to acquaint yourself. 

Equally entertaining is Sparrow Folk’s Ruin Your Day song, commentary on breastfeeding in public. 

On our Weird Findings installation, we shared a beautiful video from the Pokot community in Kenya which uses song to deliver a PSA about infant feeding. 

Finally, we prefer this version of Dua Lipa’s original: I’m Lac-a-tating.

Creative solutions for facilitating traditional Navajo birth

It was a whopping 102 degrees during the day with plummeting temperatures at night in Shiprock, New Mexico on the sacred land of Navajo Nation. The soon-to-be new parents’ camp was set up completely off grid with no running water or electricity.

Indigenous Doula, student homebirth midwife, and New Mexico Doula Association birth equity co-chair Natasha Bowman and her colleague Indigenous Doula and the Executive Director for The Navajo Breastfeeding Coalition Amanda Singer, CLC got to chatting about how they could best serve their client who desired a traditional Navajo birth under these conditions.

Considering their own well-being and the safety of their clients, Bowman and Singer initially joked about hauling Bowman and her fiancé LaDarrell Skeet’s fifth wheel out onto the land. But Skeet helped make it a reality.

The team was able to set up a mobile birthing suite for the new family and their care team complete with air conditioning, clean water and a bathroom. What’s more, the certified professional midwife attending the birth brought along her small trailer too.

“When we do births on the Navajo reservation, we have to think outside of the box,” Bowman explains.

Bowman, who has always been interested in labor and delivery, realized while working with the University of New Mexico’s Birth Companion Program, the lack of Indigenous birth workers. During one training, in a roomful of 40 participants, three were Indigenous.

“I was shocked,” Bowman says. “There has to be a change. There has to be more Indigenous birth workers.”

Later, Bowman attended another training with the Changing Woman Initiative, where she first met Singer. Since then, they’ve been realizing their vision of more Indigenous doulas and birth workers.

Bowman and her partners are continually learning the traditional Navajo ways of birthing and bringing those rituals to their clients.

“Some [clients] are for it, and some are against it because they have always been told they should be birthing in a hospital,” Bowman begins.

She goes on to explain that some of her clients have been scolded and ridiculed by pediatricians, other health care providers and even family and friends for planning a home birth despite the evidence confirming that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.

Bowman describes some of the elements of traditional birth which include integrating song, herbal remedies, teas and tinctures, and traditional dress in sash belts and moccasins.

“We believe in the exchange of energy and thoughts,” Bowman continues. “Good intentions, pure thoughts, and lots of prayers.”

It is customary for birth workers to tie a bandana over their heads as well as a Sani scarf, sash belt, or rebozo with an arrowhead tucked inside around the waist to protect the reproductive system.

“It is to protect us from the powerful energy the laboring parent is releasing,” Bowman explains. “It is like armor for us.”

Bowman and Singer and their partners are confronting the health realities in their community through other collaborations too. Their funding partners are The Kellogg Foundation, The Brindle Foundation and United HealthCare. Partnering organizations include Indigenous Women Rising, New Mexico Doula Association, Bidii Baby Foods and Saad K’idilyé, a grassroots organization dedicated to providing traditional teachings to the urban Diné communities around Albuquerque, New Mexico.

Last summer, the Saad K’idilyé Diné Language Nest (SKDLN) opened as a  central urban hub where Saad K’idilyé meets with families, babies, caretakers, and its community.

“A language nest is a community site-based language program for children from birth to three years old where they are immersed in their Native (heritage) language,” as described on their website. “SKDLN is a safe, home-like environment for young children to interact with Diné Bizaad speakers, often elders, through meaningful activities.”

Bowman was able to witness the interactions.
“It was amazing!” she exclaims.

Eventually, Bowman says that she and her colleagues would like to create their own Indigenous Doula training with teachings specific to Navajo birth culture.
In the meantime, they’re celebrating National Breastfeeding Month with Indigenous Milk Medicine Week: From the Stars to a Sustainable Future during the week of August 8 to 14. The breastfeeding coalition will reveal a Navajo translation breastfeeding art piece during this celebration.

And while the fifth wheel doula mobile has stirred up great interest within the community on social media, for the time being, there won’t be an expansion of this service. Bowman and Skeet’s fifth wheel remains on the move though, helping keep the birth team comfortable. Follow its tracks by following the Navajo Breastfeeding Coalition on Facebook.