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Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 51407

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Dr. Łucja Bieleninik

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Guest Editor

1. Faculty of Social Sciences, Institute of Psychology, University of Gdańsk, Gdansk, Poland
2. GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
Interests: clinical psychology; mental health; psychosocial intervention; music therapy; mother-infant bonding
Special Issues, Collections and Topics in MDPI journals

Dr. Mark Ettenberger

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Guest Editor

(1) University Hospital Fundación Santa Fe de Bogotá, Colombia
(2) SONO – Centro de Musicoterapia, Colombia
Interests: music therapy; intensive care unit; preterm infants; bonding and attachment; family-centered care; neurodevelopment

Special Issue Information

Dear Colleagues,

Auditory experiences play an extraordinary role during the perinatal period and can positively or negatively impact maternal mental health and infant development. Thus, music, voices and sounds can both avert or nurture human life and relationships. From the potentially noxious auditory landscape of the neonatal intensive care unit to the ability for music to foster bonding between parents and their baby, research on music, voices and sounds has a decade-long trajectory during the perinatal period. This Special Issue will focus on auditory experiences during the perinatal period, including pregnancy, labor and post-natal care, inclusive of the hospitalization in the neonatal intensive care unit. Theoretical articles, perspective articles, research studies and reviews are welcomed, covering the impacts of music, voices and sounds on maternal mental health, attachment and bonding, or on infant development. The underlying mechanisms, the development or clarifications of concepts and theories, systematic reviews of the literature, detailed descriptions of innovative clinical practices and the results from experimental studies will be at the center of this Special Issue. Authors from a wide range of professional backgrounds are invited to participate.

Dr. Łucja Bieleninik
Dr. Mark Ettenberger
Guest Editors

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Keywords

music therapy
auditory stimulation
maternal voice
perinatal period
pregnancy
preterm infants
labor
Neonatal Intensive Care Unit (NICU)

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Published Papers (11 papers)

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17 pages, 2481 KiB

Open AccessArticle

A Survey of Neonatal Nurses Perspectives on Voice Use and Auditory Needs with Premature Infants in the NICU

by Amy R. Smith, Deanna Hanson-Abromeit, Ashley Heaton and Brenda Salley

Int. J. Environ. Res. Public Health 2021, 18(16), 8471; https://doi.org/10.3390/ijerph18168471 - 11 Aug 2021

Cited by 5 | Viewed by 3677

Abstract

Background: Exposure to the voice and language during the critical period of auditory development associated with the third trimester is thought to be an essential building block for language. Differences in the auditory experience associated with early life in the NICU may increase the risk of language delays for premature infants. NICU nurses are fundamental in the care of premature infants; how they use their voices may be important in understanding auditory experiences in the NICU. This study examined voice use behaviors of NICU nurses in the United States and their current knowledge of early auditory development. Method: An opt-in, online questionnaire. Results: Nurses reported using their voice more as the age of infants approached term gestation and speaking to infants was the most common type of voice use. Both infant and nurse factors influenced reported voice use decisions in the NICU. Nurses did not believe the NICU auditory environment to be sufficient to meet early auditory needs of premature infants but did believe that premature infants are exposed to adequate voice sounds. Conclusions: A gap in knowledge regarding the importance of early exposure to voice sounds may be a barrier to nurses using their voices to support early auditory development. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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10 pages, 1075 KiB

Open AccessArticle

Music Therapy Is Effective during Sleep in Preterm Infants

by Susann Kobus, Marlis Diezel, Monia Vanessa Dewan, Britta Huening, Anne-Kathrin Dathe, Ursula Felderhoff-Mueser and Nora Bruns

Int. J. Environ. Res. Public Health 2021, 18(16), 8245; https://doi.org/10.3390/ijerph18168245 - 4 Aug 2021

Cited by 21 | Viewed by 6215

Abstract

Recent research found evidence supporting music therapy for preterm infants to stabilize vital signs and possibly promote neurodevelopment. Even though preterm infants spend a considerable amount of time sleeping, the effectiveness of music therapy during sleep has not been studied. The aim of this study was to investigate the effect of music therapy on preterm infants’ vital signs with respect to the state of wakefulness. The first 20 consecutive infants born with <32 weeks’ gestational age (GA) from the intervention group of an ongoing randomized controlled trial received live music therapy twice a week until hospital discharge. The heart rate, respiratory rate, oxygen saturation, and state of wakefulness were recorded before and after therapy. We observed significantly lower heart and respiratory rates and higher oxygen saturation after live music therapy sessions in general (mean differences −4.9 beats per min; −7.0 breaths per min and +1.5%, respectively). When music therapy was applied during sleep, respiratory rates significantly lowered by 8.8 breaths per min and oxygen saturation increased by 1.6%, whereas in the awake state the vital parameters did not significantly change (heart rate −5.2 beats per min; respiratory rate +0.6 breaths per min and oxygen saturation +1.0%). Music therapy stabilized the respiratory rates and oxygen saturations in sleeping preterm infants. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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11 pages, 793 KiB

Open AccessArticle

Parental Attitudes toward Consent for Music Intervention Studies in Preterm Infants: A Cross-Sectional Study

by Sofia Bauer, Shulamit Epstein, Łucja Bieleninik, Dana Yakobson, Cochavit Elefant and Shmuel Arnon

Int. J. Environ. Res. Public Health 2021, 18(15), 7989; https://doi.org/10.3390/ijerph18157989 - 28 Jul 2021

Cited by 2 | Viewed by 2217

Abstract

(1) Background: This study investigated parents’ motives for enrolling preterm infants into music therapy intervention studies during Neonatal Intensive Care hospitalization. (2) Methods: We surveyed Israeli parents of preterm infants after they consented or refused to participate in such studies. The pre-piloted questionnaires evaluated attitudes toward research and music therapy intervention studies. The study included 116 (57%) parents who agreed to participate in music therapy studies and 87 (43%) who declined. (3) Results: Infants of those who agreed to participate were younger (17 ± 2.3 vs. 28 ± 4.7 days old, p = 0.03) and sicker (Clinical Risk Index for Babies score 6.1 ± 2.7 vs. 3.68 ± 4.1, p = 0.04). More single-parent families declined to participate (p = 0.05). Parents agreed to participate because they thought the study might help their child, would improve future care of preterm infants and increase medical knowledge (all p < 0.05). In addition, they perceived music as beneficial for brain development, thought it might improve bonding, and routinely listened to music daily. (4) Conclusions: When recruiting parents and preterm infants for music therapy intervention studies, one should highlight potential contributions to the child’s health, future children’s health and medical knowledge. Stressing music as a potential tool for brain development and augmenting bonding is important. The best time to recruit is when improvements are still anticipated. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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13 pages, 1291 KiB

Open AccessArticle

Maternal Anxiety, Infant Stress, and the Role of Live-Performed Music Therapy during NICU Stay in The Netherlands

by Karianne E. Kraft, Artur C. Jaschke, Anne-Greet Ravensbergen, Annet Feenstra-Weelink, Maud E. L. van Goor, Marlou L. A. de Kroon, Sijmen A. Reijneveld, Arend F. Bos and Nienke H. van Dokkum

Int. J. Environ. Res. Public Health 2021, 18(13), 7077; https://doi.org/10.3390/ijerph18137077 - 2 Jul 2021

Cited by 15 | Viewed by 5305

Abstract

Having an infant in the neonatal intensive care unit (NICU) elicits maternal anxiety, which may hamper parent−child bonding. We performed a prospective cohort study to describe anxiety in mothers of infants born before 30 weeks of gestation during NICU stay in The Netherlands, and investigated the influence of infant stress and gestational age. Second, we performed a randomized-controlled live-performed music therapy trial (LPMT trial) to investigate whether music therapy applied to the infant alleviated maternal anxiety. The relation between infant stress, gestational age, and maternal anxiety was measured in 45 mother−infant dyads, using the Neonatal Infant Stressor Scale and the State-Trait Anxiety Inventory (STAI). The effect of LPMT on anxiety was assessed in 21 mothers whose infants were assigned to either LPMT (n = 12) or waitlist (n = 9). Mothers completed the STAI before and after this period. Maternal anxiety decreased over time in all mothers, and was strongly related with infant stress (r = 0.706, p < 0.001), but not with gestational age. Anxiety scores decreased by 12% after LMPT, and increased by 1% after a waitlist period (p = 0.30). Our results indicate that LPMT in the weeks after birth may accelerate the reduction of maternal anxiety. Further research should focus on the effects on mother−child bonding. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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20 pages, 3100 KiB

Open AccessArticle

Music Is Life—Follow-Up Qualitative Study on Parental Experiences of Creative Music Therapy in the Neonatal Period

by Friederike Barbara Haslbeck, Lars Schmidli, Hans Ulrich Bucher and Dirk Bassler

Int. J. Environ. Res. Public Health 2021, 18(12), 6678; https://doi.org/10.3390/ijerph18126678 - 21 Jun 2021

Cited by 11 | Viewed by 5456

Abstract

Developmental problems in extremely preterm (EP) infants and the associated longitudinal burden for their families are major health issues worldwide. Approaches to social-emotional support such as family-integrating Creative Music Therapy (CMT) are warranted. We aimed: (1) to explore parental perspectives on the use of CMT with EP infants in the neonatal hospitalization period and (2) to examine the possible longitudinal influence of CMT. A qualitative design was used to examine the perspective of six families from various backgrounds. Semi-structured interviews were carried out when the infants reached school age. We used an inductive–deductive thematic analysis to identify three main themes, each with three sub-themes: (1) the positive impact of CMT on the infants, the parents, and bonding; (2) the attitude toward CMT, from being open-minded to recommending it as complementary therapy; and (3) the experience of overall healthy infant development despite unique developmental delay issues. The findings elucidate the positive and formative impact of CMT on both infants and parents in the stressful NICU setting and beyond. CMT may empower positive transformation in the parents through individualized early nurturing musical interactions, capacity building, and positive reinforcement. Further research may help to identify and implement potentially modifiable factors for improving health care in this vulnerable group through early family-integrating, resource-based approaches such as CMT. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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12 pages, 1225 KiB

Open AccessArticle

Combining Kangaroo Care and Live-Performed Music Therapy: Effects on Physiological Stability and Neurological Functioning in Extremely and Very Preterm Infants

by Loïs C. Span, Nienke H. van Dokkum, Anne-Greet Ravensbergen, Arend F. Bos and Artur C. Jaschke

Int. J. Environ. Res. Public Health 2021, 18(12), 6580; https://doi.org/10.3390/ijerph18126580 - 18 Jun 2021

Cited by 10 | Viewed by 3587

Abstract

Interventions such as kangaroo care (KC) and live-performed music therapy (LPMT), are increasingly used to facilitate stress reduction in neonates. This study aims to investigate the effect of combining the two on physiological responses and neurological functioning in very preterm infants. Infants received six sessions of LPMT. KC was added to one LPMT session. Physiological responses included heart rate, respiratory rate and oxygen saturation. We videotaped infants for 30 min before and after two sessions to assess general movements (GMs). We included 17 infants, gestational age median 26.0 weeks (IQR 25.6–30.6 weeks), of whom six were males. Combined interventions showed a decrease in heart rate from mean 164 bpm before to 157 bpm during therapy, p = 0.001. Oxygen saturation levels increased during combination therapy from median 91.4% to 94.5%, p = 0.044. We found no effects of LPMT or combined interventions on GMs. Infants with a postnatal age (PNA) <7 days generally seem to display less optimal GMs after therapy compared with infants with a PNA >7 days. In conclusion, combining interventions is equally beneficial for physiological stability and neurological functioning as LPMT alone. Future studies should focus on the effects of this combination on parent-infant bonding. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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8 pages, 329 KiB

Open AccessArticle

The Effect of a Voice-Centered Psycho-Educational Program on Maternal Self-Efficacy: A Feasibility Study

by Helen Shoemark, Marie Dahlstrøm, Oscar Bedford and Lauren Stewart

Int. J. Environ. Res. Public Health 2021, 18(5), 2537; https://doi.org/10.3390/ijerph18052537 - 4 Mar 2021

Cited by 12 | Viewed by 3148

Abstract

This study examined the effect of a brief psycho-educational program, Time Together, on maternal self-efficacy, mother-infant bonding, and mood/anxiety for community-based mothers. This program centered on maternal voice, timing of interplay, and recognition of infant cues. A convergent parallel mixed-methods design included quantitative measures: the Karitane Parenting Confidence Scale, the Mother-Infant Bonding Scale, Edinburgh Postnatal Depression Scale and State & Trait Anxiety Inventory, and a sequential qualitative analysis to elaborate on the quantitative findings. Significant changes on the Karitane Parenting Confidence Scale were found. Qualitative analysis of the participant interviews and reflective diaries from the two weeks following the psycho-educational program confirmed that participation enhanced mothers’ ability to understand their infant, to soothe their infant when distressed, to play and to establish an effective bedtime routine. This feasibility study indicated that this is a promising approach to improve early mother-infant interaction and maternal self-efficacy. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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12 pages, 352 KiB

Open AccessPerspective

Potential Psychological and Biological Mechanisms Underlying the Effectiveness of Neonatal Music Therapy during Kangaroo Mother Care for Preterm Infants and Their Parents

by Łucja Bieleninik, Mark Ettenberger, Shulamit Epstein, Cochavit Elefant and Shmuel Arnon

Int. J. Environ. Res. Public Health 2021, 18(16), 8557; https://doi.org/10.3390/ijerph18168557 - 13 Aug 2021

Cited by 10 | Viewed by 4205

Abstract

Neonatal music therapy (MT) has become more accessible worldwide. Previous research suggests multiple benefits of MT for preterm infants and their caregivers; however, far too little attention has been paid to understanding the mechanisms of change in previous Neonatal Intensive Care Unit (NICU)-MT research so far. This perspective article describes potential mechanisms of MT interventions exposed during kangaroo mother care on the preterm infant’s response (behavioral and physiological outcomes) and the mother-infant relationship. The paper focuses on the hypothalamic–pituitary–adrenal axis’ role in stabilization of behavioral state, the autonomic nervous system’s role in stabilization of physiologic state, as well as co-regulation as a potential mechanism for the developing of the parent-infant relationship. Mechanisms play a pivotal role in understanding variables related to the therapy course and well as in generating new knowledge regarding treatment susceptibility and optimizing resources. Understanding of the mechanisms of how interventions may lead to specific outcomes plays an important role in addressing the issue of improvement of currently available approaches of MT used in the NICU. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

13 pages, 811 KiB

Open AccessCase Report

Music Therapy with Neonatal Intensive Care Unit-Discharged Mother-Infant Dyads: Developing a Method for Nurturing Communicative Parental Efficacy (CoPE with Music)

by Galit Calderon-Noy and Avi Gilboa

Int. J. Environ. Res. Public Health 2021, 18(16), 8553; https://doi.org/10.3390/ijerph18168553 - 13 Aug 2021

Cited by 4 | Viewed by 3086

Abstract

While much advancement has been documented in the practice of music therapy in the neonatal intensive care unit (NICU) environment, there is currently a shortage of music therapy-based methods for NICU-discharged dyads. Back in their homes, mothers might feel alone, lacking guidance, and possibly losing their parental efficacy and their ability to communicate with their baby. In this article, we present a method for nurturing the communicative parental efficacy (CoPE) that was successfully practiced with several NICU-discharged dyads. In eight weekly sessions, the music therapist improvises with the dyad and focuses on (1) containing the mother’s emotions; (2) modeling musical interactions with the baby; and (3) practicing these musical interactions with the mother, enabling her to gain communicative parental efficacy. The basic ideas of CoPE are outlined, and a short case study is then described, to demonstrate how it is used. Finally, suggestions for future directions for the development of CoPE are provided. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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17 pages, 393 KiB

Open AccessPerspective

The Effect of Musical Stimulation and Mother’s Voice on the Early Development of Musical Abilities: A Neuropsychological Perspective

by Ilona Poćwierz-Marciniak and Michał Harciarek

Int. J. Environ. Res. Public Health 2021, 18(16), 8467; https://doi.org/10.3390/ijerph18168467 - 11 Aug 2021

Cited by 11 | Viewed by 4325

Abstract

An infant’s early contact with music affects its future development in a broad sense, including the development of musical aptitude. Contact with the mother’s voice, both prenatally and after birth, is also extremely important for creating an emotional bond between the infant and the mother. This article discusses the role that auditory experience—both typically musical and that associated with the mother’s voice—plays in fetal, neonatal, and infant development, particularly in terms of musical aptitude. Attempts have also been made to elucidate the neuropsychological mechanisms underlying the positive effects that appropriate musical stimulation can have on a child’s development. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

10 pages, 334 KiB

Open AccessPerspective

Defining Attachment and Bonding: Overlaps, Differences and Implications for Music Therapy Clinical Practice and Research in the Neonatal Intensive Care Unit (NICU)

by Mark Ettenberger, Łucja Bieleninik, Shulamit Epstein and Cochavit Elefant

Int. J. Environ. Res. Public Health 2021, 18(4), 1733; https://doi.org/10.3390/ijerph18041733 - 10 Feb 2021

Cited by 26 | Viewed by 8373

Abstract

Preterm birth and the subsequent hospitalization in the Neonatal Intensive Care Unit (NICU) is a challenging life event for parents and babies. Stress, anxiety, and depressive symptoms, limitations in holding or touching the baby, and medical complications during the NICU stay can negatively affect parental mental health. This can threaten the developing parent-infant relationship and might adversely impact child development. Music therapy in the NICU is an internationally growing field of clinical practice and research and is increasingly applied to promote relationship building between parents and babies. The two most commonly used concepts describing the early parent-infant relationship are ‘attachment’ and ‘bonding’. While frequently used interchangeably in the literature, they are actually not the same and describe distinctive processes of the early relationship formation. Thus, it is important to discuss the overlaps and differences between attachment and bonding and the implications for music therapy clinical practice and research. Whereas providing examples and possible scenarios for music therapists working on either bonding or attachment, the distinction between both concepts is relevant for many health care professionals concerned with early parenting interventions in the NICU. This will hopefully lead to a more precise use of theory, and ultimately, to a more informed clinical practice and research. Full article

(This article belongs to the Special Issue Auditory Experience, Music and Voice across the Perinatal Period: Innovations in Theory, Research and Clinical practice)

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