Music in Perinatal Care

There are multiple different theories about where music evolved from, why we have music in our lives. One of them suggests that music may have evolved to try and help mother-infant communication and this argues that music developed out of something called motherese. Motherese is a way of speaking to babies that we often adopt automatically that involves high melodic arches, calm patterns, slightly singsong qualities to it. The argument is that motherese is easier for babies to understand and therefore helps with communication.

Certainly we see that babies can actually perceive sounds as early as around 19-20 weeks during pregnancy and babies have been shown to respond to sounds that they’ve heard during birth. And we also see that mothers communicate very well with babies using singing and music, for example, singing to babies compared to speaking to babies leads to stronger visual attention from the baby, less movements and longer periods of attention. We also found that the mothers themselves feel more emotionally close to their babies when they’ve been singing with them, not speaking to them.

In terms of whether there were kind of wider benefits of that this is something that’s been researched quite a bit over the last few years. What’s been shown is that for babies themselves if a baby is born prematurely, for example, then singing and music in neonatal intensive care can be a real value. For example, it can help the babies to stop moving around so much so they’re wasting fewer calories, it’s keeping them calmer, it can also help it to feed better which again helps with this calorific intake and weight gain and this can also build up to them being able to leave hospitals sooner. If a baby is born healthily we also found that over time singing and music actually help with their language development, so because music is cognitively easier to process and language is kept in these simple melodic phrases then it can actually help with the development of the brain architecture that then naturally goes on develop into speech.

For mothers as well we also find benefits: for example, listening to music during pregnancy is associated with lower levels of stress and anxiety and also lower levels of depression in mothers and there are even suggestions these benefits can last over into the perinatal periods, into the postnatal periods. We also found that mothers who listen to music, for example during the birth process actually need lower levels of pain medication and in some studies have been found to have shorter labor. But post birth is where I think it gets really interesting because we’re actually starting to see data that are suggesting that listening to music could help the stress and mental health of new mothers.

I’ve been involved in this with some of my colleagues over the last few years where we’ve particularly been looking at postnatal depression. Postnatal depression is a very difficult condition to treat. It effects probably around 13% of mothers in the UK each year, but some suggest that it could be as high as 30%. It’s very difficult to tell because many mothers don’t contact any health professionals when they’re feeling the symptoms. In fact many mothers don’t even realize that what they’re experiencing is any different from the normal tiredness and difficulties and challenges as well as the wonders of having a new baby. But what’s particularly difficult about treating postnatal depression is that though many mothers don’t take medication as they’re breastfeeding, and many mothers also don’t have the time to attend counseling or psychological therapies. They can even feel worried about the stigma of going to these if they’re concerned that it submits in some way that they’re not coping as well as they should be or could be as a mother.

Because of this there has been interest over the last few years about whether community-based psychosocial programs could actually help new mothers and their mental health. One of the ones that I worked on was looking specifically at singing programs for new mothers. Building on the research I mentioned before about the potential anthropological evolutionary basis of singing there’s a theoretical argument for why singing might help but also singing provides the opportunity for mothers to meet other people in their communities who might be having the same kind of mental health challenges and therefore find a support group as well. In one of the studies I worked on we ran a randomized control trial for mothers who had postnatal depression and they were randomized either into 10-week programs of usual care, ten weeks of usual care with weekly social groups with other mothers who also had postnatal depression or 10-week programs of social groups with singing involved. What we found was whilst postnatal depression does gradually get better at the time we found that the mothers who are in the singing group recovered about a month earlier than the mothers in either of the other two groups.

This is really promising because it’s important in postnatal depression to try and help mothers to recover earlier because we find that the longer a mother has symptoms the more likely these symptoms are actually going to turn into longer term depression. About 25% of mothers actually go on to experience symptoms for over a year. But with the singing classes we were particularly intrigued about why was it the singing group but not the social? Because the social groups on their own didn’t really have any faster improvement compared to usual care.

So we ran some follow-up studies to look at this as well. We ran a qualitative study where he compared the responses from mothers who’ve been in the social group with mothers in the singing group. Some of the groups reported similar mechanisms, so they said they enjoyed being part of a group with other mothers, having a regular structure in their weeks. But in fact what we found was for the singing group there are particular mechanisms the were reported more than for the social group: for example, mothers in the singing group particularly spoke about the benefits they felt the singing and bonding them with their baby and we actually followed up on this and did a laboratory study to try and understand this a bit more. What we did is we actually worked with mothers to take part in a singing session and a social session and we randomized the order of these and we looked at what happened. Some mothers perceived closeness with their babies when they were singing with them compared to when they were playing or chatting with them and we found that they reported being much closer after the singing session. But the mothers also had greater reductions in stress hormone, levels of cortisol during the singing session compared to the social session and stress is very much linked in when perceived closeness. We found there was an association between this reduction in cortisol and increase in mother-infant bonding. So this certainly could be one of the mechanisms by which to have 10-week singing programs can be helping postnatal depression.

We also found other mechanisms. Some of the mothers particularly spoke about the emotional expression they got from singing. This was a benefit for them because it gave them an outlet for what they might be feeling during the weeks. They also spoke about the immersive nature of the music, the fact it was a very mindful activity that gave them space away from their stresses and worries. They also spoke about music being a tool, something they could actually use back at home with their babies to help them to sleep or feed or stop crying and this was making them feel more confident and able as mothers. So it was actually translating back into their broader experiences in motherhood.

We also did another follow-up study on this and found that the mothers who are engaged in singing programs start to engage more in music in other aspects of their daily lives as well. It suggests it’s not just about one or two hours a week of singing but it’s about how this stimulates other musical activities.

Because of these really promising results from this study we’ve now been working to deliver this program to more mothers who’ve got postnatal depression in partnership with an organization called ‘Breathe’. We’ve been working in South London particularly with mothers who are from more deprived areas or might be facing additional challenges. We’ve been finding that again these programs are helping to reduce the symptoms of the perinatal depression.

So as we move forward there’re kind of big opportunities and questions. Could we actually be offering this as something very simple for mothers all across the country? Many music groups exist in communities already. Could we be referring these mothers into these programs to try and help with their mental health? Could we even be using this as a preventative thing, encouraging mothers very early on after birth to start engaging in musical activities for their bonding with their babies, for their own mental health and their babies development as well?

Also from a research perspective we’re interested in what are the other benefits that music might be having. What about for fathers, for example, their own mental health needs during their period of fatherhood, the early period of fatherhood are often unmet as well. So this gives us a really nice opportunity to provide a service that actually fills current gaps in terms of what’s provided for new mothers. It also provides this joint-up approach between what’s offered from terms of health and social care and also what’s being offered by arts and community sectors as well. Overall what this hopefully suggests is that music could be something we could be promoting amongst new mothers to try and improve their experiences in motherhood.