The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials

Abstract

Introduction

The abundant functions of music and its effects on human’s mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention.

Objective

This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women.

Method

A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study.

Result

The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations.

Conclusion

Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.

Keywords:

• Music therapy
• pregnancy
• pain
• anxiety
• fetuses

Introduction

In 2021, the average fertility of the world’s population stood at 2.3 births per woman over a lifetime. Although global fertility is projected to decline further to 2. I births per woman by 2050, the incrcasing trend of world population will be driven by the momentum of past growth, even that governments have taken actions to reduce fertility to slow the pace of growth [1]. Pregnancy is a complex journey that begins with conception and ends with delivery. It entails various physical and psychological changes in a mother’s body, leading to not only physical discomfort but also emotional and psychological challenges.

Labor pain is the most intense pain experienced for most women in their life [2]. It is reported that 60% of primiparas experienced severe labor pains [3]. Unrelieved labor pain influences the mother’s clinical characteristics, including her cardiac output, blood pressure, respiratory rate, oxygen consumption and catecholamine levels. Unlike other types of pain, labor pain cannot be predicted and controlled, and it intensifies following labor progresses [4]. Labor pain is not only regulated by physiological factors such as intensity of uterine contraction, but also involves psychological factors. Increased levels of stress and anxiety can negatively generate the enhanced perception of pain and the use of postoperative analgesics [5]. Women’s experience of pain in the process of childbirth varies widely. How to effectively relieve maternal pain in childbirth and improve the rate of vaginal delivery as much as possible is one of the key focuses of current obstetric project.

The stages of pregnancy themselves can cause stress for pregnant women. Psychological changes occur early at first trimester of pregnancy, and several factors can aggravate anxiety experienced by pregnant, such as awareness and knowledge of physical changes during pregnancy, previous pregnancy history, and the age of the mothers. A link has been shown that there is connection between the mental health of the mother during pregnancy and the health of the fetuses [6].

The abundant functions of music and its effects on human’s mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention. The World Health Organization guideline " Care in normal birth: a practical guide" [7] mentioned that music is presented as a choice of noninvasive and non-pharmacological intervention options for pain management during delivery. In the field of obstetrics, in particular, it is advisable to include musical intervention as an additional treatment option. In addition to its maternal benefits, music therapy can have positive effects on basal fetal heart rate and accelerations. A review supported conclusion above, and also caught the wide public’s eyes [8]. Positive reports about music therapy have increased the interest of many obstetricians and neonatologists in this particular branch. This study aimed to investigate the benefits of music therapy on prenatal, delivery and postpartum of pregnant women through bibliometric analysis of the effects of music therapy application in obstetrics over the past ten years.

Method

Search strategy

Two professionals participated in the study. One is a music therapist and the other is an obstetrician attending. The research adopted the "PICO" framework, which concludes the population (pregnant women and fetuses), Intervention (music therapy conducted before, during and after delivery), comparison, and outcome. The peak question of this research is studing the benefits of music therapy on pregnant women and fetuses by bibliometric analysis of published papers over ten years. Search electronic publications from CINAHL, Web of science, PubMed/Medline and CNKI database using title and text word combinations. It is divided between January 2013 and December 2022 for articles published in English and Chinese. We used descriptors in Medical Subject Headings (MeSH) and thesaurus in English and Chinese (music, labor, anxiety, and pain). Descriptors were combined using the Boolean operators "AND" and "OR". The protocol of this systematic review was carried out following the recommendations of PRISMA 2020.

The recruited trials for this review were compliant with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. Selection and evaluation of articles is conducted through by two authors. Based on the inclusion and exclusion criteria, a preliminary recognition of the title of the manuscript was performed at first. Then, the abstract is evaluated. Finally, the full texts of selected articles were reviewed and analyzed.

Inclusion and exclusion criteria

We included randomized controlled trials which investigate the application of music therapy before and during pregnancy. The studies on the intervention of music played to fetus through the mother’s abdomen were also included. All types of music and music therapy strategies are qualified. These pregnant women were randomly assigned to either music group (intervention group) or control group. Exclusion criteria: Observational and non-randomized control trials were excluded.

Selection and data collection process

Research search and selection was accomplished by the EndNote software (version 9.0). Two researchers screened and evaluated the titles, abstracts, and full text for eligibility independently. The parsed data was filled the pre-designed data form for data extraction. If there was a disagreement during the review process, the discussion will be renewed until both reviewers agree to review the manuscript.

Data evaluation and extraction

Data extracted from the articles include: author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments and result. Articles are listed in chronological order according to the year of publication. Relevant data was extrapolated and presented in narrative summary template (Table 1).

Table 1. Summary of included trials.

Author, year	Location	Sample size	Intervention phase	Type of music	Music therapy strategy	Measuring instruments	Result
S.E. Hosseini, etc. 2013	Iran	30	Not mentioned	BaraneEshgh (Love Rain) composed by Manouchehr Cheshmazar	30 min in each hour for a two-hour period during labor	Numerical Pain Rating Scale Visual Analogue Scales (VAS), and Verbal Pain Rating Scale	decreased feeling visual, verbal and numeric pain one hour after intervention of music-therapy
Serap Simavli, etc. 2013	Turkey	156	Primiparous women at 37–41 weeks of gestation	classical music, Turkish art music, Turkish folk music, Turkish classical music and popular music	all the time with a20- min break for every hour during the latent phase and the first 2 h and changed to be more rhythmic during the late active phase (after the first 2 h) and the second stage of labor	VAS	lower level of pain, anxiety and vital signs and higher fetal movements, basal fetal heart rate (BFHR) and accelerations
Serap Simavli, etc. 2013	Turkey	161	Primiparous women at 37–42 weeks of gestation	classical music, light music, popular music, Turkish art music, Turkish folk music and Turkish sufi music	all the time with a 20-min break for every two hours during labor	VAS and Edinburg Postpartum Depression Scale	lower level of postpartum pain and anxiety, so did postpartum depression rate at postpartum day one and day eight
Yu-Hsiang Liu, etc. 2015	China	121	18–34 weeks of gestation	Symphonic music and other western classical music or Chinese children’s rhymes and songs performed primarily by the glass armonica/Crystal Music.	30 min per day at bedtime for two weeks	Pittsburgh Sleep Quality Index, Perceived Stress Scale, and State- Anxiety Inventory(STAI)	significant improvement in sleep quality, stress, and anxiety in the Music Listening group
J. García González, etc. 2017	Spain	409	at and above 36 weeks of gestation	"Musical Journey through Pregnancy" by Gabriel F. Federico	40 min, at 65–70 dB, three times a week at the same time of day	STAI	reduced anxiety in full-term pregnant women, and improved the delivery process by reducing the length of the first stage of labor
J. García González, etc. 2017	Spain	409	at and above 37 weeks of gestation	"Musical Journey through Pregnancy" by Gabriel F. Federico	41 min, at 65–70 dB, three times a week at the same time of day	Electronic monitor, fetal monitoring cardiotocograph, scales and tape measure and an analytical blood test.	The fetal heart rate (FHR) and BFHR increased with more reactive and greater chest circumference. systolic blood pressure (SBP), diastolic (DBP)and maternal heart rate(MHR)decreased at the end of the NST
Sule Gokyildiz Surucu, etc. 2017	Turkey	50	37–41 weeks of gestation	Not mentioned	Acemasiran mode with earplugs for 3 h (20 min of listening with 10-minute breaks).	VAS, STAI and Post-Delivery Evaluation Form	Painwas less and state anxiety average scores became lower.
J. Garcıa Gonzalez, etc. 2018	Spain	409	36 weeks of gestation	“Musical Journey through Pregnancy” by Gabriel F. Federico	40 min per session for 14 sessions, three times a week and at the same time of day.	STAI	reduced state-trait anxiety in pregnant women during the third trimester, and improved the delivery process
Philip Hepp, etc. 2018	Germany	304	Not mentioned	15 tracks at tempo of 60–80 bpm were each assigned to one of the 4 different genres of music.	started when the participant entered the operating theater	VAS, STAI and salivary cortisol and alpha-amylase level	the effect of reduing anxiety and stress soothing on the wake patient during cesarean
HaticeErkunDolker, etc. 2019	Turkey	100	32–41 weeks of gestation	Turkish classical music, Turkish folk music or classical music	when NST was taken	STAI and fetal monitoring cardiotocograph	increase fetal acceleration numbers and reactive NST rates and reduce mean anxiety score
Annarita Buglione, etc. 2020	Italy	30	37–42 + 0 weeks of gestation	select music based on personal preference	whole labor process	VAS	lower pain scores and anxiety level of active phase of labor and 1 h postpartum was were presented
Şeyma Çatalgöl, etc. 2021	Turkey	100	36–38 weeks of gestation	12 Classical Turkish Music	when NST was taken	STAI,	reduce anxiety level and increase acceleration, mean number of fetal movements and reactivity
Perković, R, etc. 2021	Austria	198	14–33 + 6 weeks of gestation	Not mentioned	daily in the evening before bedtime, lasting 15 min	VAS and Symptom Checklist − 90	lower pain scores and weak performance in the dimensions of interpersonal sensitivity, hostility, phobic anxiety, and paranoid ideations
Yasemin Sanlı, etc. 2022	Turkey	70	Not mentioned	musical pieces composed in Uşşak mode	30 min every other day (Mondays, Wednesdays and Fridays) for two weeks before going to sleep	Prenatal comfort scale and Pittsburgh Sleep Quality Index–1 week	better subjective sleep quality, sleep latency and general sleep quality in the second week of the intervention
Eti Salafas, etc. 2022	Indonesia	30	Not mentioned	relaxation music with a beat of 60 bit/minute	15 min	Hamilton Rating Scale for Anxiety	The average anxiety score dropped to 4.47 from 9.53, although it was still in the mild anxiety category
Huimin Guo, etc. 2022	China	440	Not mentioned	select music based on personal preference	comfortable meditation or hypnotic music in the early stage of the first stage of labor, intense rhythmic music in the middle and late stages of the first stag, parent-child music in the second and third stages	Perception of Labor Pain Questionnaire (PLPQ) and Perineal Pain Score	Better results of pain score, postpartum hemorrhage, and perineum condition. But a longer duration of the first stage and total stage of labor due to less medical intervention
Susann Kobus, etc. 2023	Germany	33	<32 weeks gestational age	singing at low volume or played soft sounds of the instrument sansula	The first session was performed during the second week of life and from then on was provided twice per week until discharge	Allgemeine Depressions Skalalang, Center for Epidemiologic Studies Depression Scale and Impact of Event Scale revised questionnaire	Mothers whose infants received music therapy showed stronger declines of depressive and stress symptoms

Result

Study selection

Figure 1 provides a flow chart of the search and selection process. Based on search strategy, 240 publish original articles in journals between January 2013 and December 2022 were involved. In the title analysis, 40 studies were considered relevant and read in full, after 117 studies were selected and their abstracts were read. Then, 18 studies were excluded because they did not meet eligibility criteria and 5 references were excluded due to lack of full text. Finally, 17 articles were included in the analysis

Figure 1. Flow diagram.

Study characteristics

The features and results of the individual studies are presented in Table 1. These studies were published between 2013 and 2023 and a total of 2,232 primiparas were included in the study. The details can be found in Table 1. Among the studies, there are six literatures from Turkey, one from Iran, two from China, three from Spain, one from Italy, one from Indonesia, two from Germany and one from Australia. As for mothers, Three tools, Chinese Perception of Labor Pain Questionnaire, Numerical Pain Rating Scale Visual Analogue Scales and Verbal Pain Rating Scale, were used to prove that music therapy can significantly reduce the degree of pain during childbirth through 7 papers proved. Twelve literatures supported music therapy lead to the reduction of anxiety stress, based on the score of State- Anxiety Inventory, after the non-stress test, during delivery and after preterm delivery. Two literatures proved that after two-week music listening interventions sleep-disturbed pregnant women obtain the better sleep quality. In all stages of labor, maternal systolic blood pressure was significantly lower in the music group.

With regard to fetus, four literatures suggested that it can effectively make influence on basal fetal heart rate and accelerations. The number of accelerations in the music group was significantly higher than in the control group during the latent phase and basal fetal heart rate rose at latent and active phase.

Discussion

The main objective of this review was to investigate the benefits of music therapy on prenatal, delivery, and postpartum experiences of pregnant women. The main finding of this study was music therapy can make active influence on relieving the delivery pain and anxiety, improving the sleep quality and increase the reactivity of intrauterine fetuses.

Labor pain is a common and subjective experience that is part of the childbirth process. Although pain is divinable, regular pain that exceeds a woman’s capacity can adverse physical and psychological effects on the mother and fetus. Labor analgesia is generally divided into non-drug analgesia and drug analgesia methods. The latter mainly refer to the intraspinal block analgesia anesthesia, which may prolong the second stage of labor and lead to increased dose of oxytocin, as well as anesthesia risk of trauma, puncture. An increasing number of literatures support the application of non-pharmaceutical methods to manage pain during Labor, because they could benefit mothers and children, including reducing the need for obstetric intervention, midwifery or cesarean section [9].

The music therapy aims to achieving the distraction of maternal attention, increase of the sense of self control and reduction of the sense of pain. Medical staffs offer whole-course medical guidance with the auditory stimulation via music. The theory of auditory sense considers that in the cerebral cortex, if one nerve center excites, it suppresses other nerve centers around it. Both auditory and pain centers are located at the temporal lobe of the brain. Thus, when the maternal auditory center is stimulated by music, the surrounding pain centers are restrained [10]. Furthermore, puerpera will secrete endorphins after receiving the stimulation of music, and endorphins owns strong analgesic effect, therefore the puerpera who accept music analgesic experience subdued labor pain [11].

After the introduction of music intervention for analgesia, maternal muscle tension is significantly improved, which relaxes maternal tension, satisfies maternal physical and mental needs to the maximum extent, and increases the sense of security and comfort during childbirth [12]. In one study [13], after music intervention, maternal pain score decreased significantly. This result is consistent with previous studies [12,14,15]. During the incubation period, music can promote maternal relaxation and reduce the discomfort and pain [16,17]. This is also supported by the findings of a meta-analysis of the effects of relaxation techniques on the management of labor pain of the pregnant and newborn health [18]. At the active phase, music therapy can continuously alleviate pain and pressure, help pregnant women to relax themselves, and promote uterine contraction activity in the later period even physical exertion, so as to obtain more satisfaction during and after labor [19]. Phumdongbelieved that more than three hours of music intervention could adequately achieve analgesic effects [20].

Up to 25% of pregnant women report the experience of symptoms of anxiety during pregnancy [21]. Pregnant women are particularly vulnerable to stress during pregnancy, delivery and the postpartum period [22]. Anxiety levels were lower in the first and second trimesters than in the third. When classified by anxiety level, 47.2% of pregnant women had moderate or severe anxiety [23]. Primiparas experience increased anxiety during pregnancy and delivery, which negatively affects both mother and newborn [24]. It may be a risk factor for the development of mental health changes in pregnant women, such as increased rates of postpartum depression [25] and so as for decreased birth length of the newborn [26]. The anxiety of pregnant women must be overcome; otherwise it can adversely affect subsequent pregnancy and childbirth. The increasing trend of anxiety perplexes the pregnant. The concern about the health of the fetus increases their psychological pressure and the fear for labor pain can lead to lost in emotions and affects labor progress [27]. Postpartum anxiety is also associated with reduced rates and safety of child breastfeeding [28].

Music can be used as a practical non-pharmaceutical method for managing stress and anxiety during pregnancy, delivery and the postpartum period [29,30]. The application of music during delivery process has specific benefits for depression, anxiety and postpartum satisfaction, which are associated with loss of delivery confidence, excessive physical exertion and weak uterine contraction [3,30–32]. According to the gate theory, nerve center acts as a "gate", a gate which can adjust the pain consciousness, before the injurious stimulus reaches the cerebral cortex. When music instead of the pain draw the attention, the nerve center is occupied by the stimulus of music and the pain will be attenuated [14]. Therefore, if a puerpera focuses on the melody and rhythm of music, the melodious music can coordinate her psychological and physiological activities, eliminate mental tension, and reduce negative emotions and pain perception. Simavli’s study showed that systolic blood pressure rate decreased after music intervention significantly [16]. This was a strong evidence that the pregnant dropped into the physical relaxation. It enhances her pain tolerance and contributes to eliminating the abnormal contractions which lead to prolongation or stagnation of stages of labor caused by psychological factors, so that she can actively cooperate with medical staff to shorten labor time, improve the safety and rate of vaginal delivery.

Researchers found that the pregnant listening to music during non-stress test presented positive information of lower trait anxiety [33,34]. A meta-analysis [32] of five studies involving 392 primiparas found that application of music was associated with remission in pain and anxiety compared with control group. Another research pointed that the anxiety index of pregnant women was significantly decreased after music intervention during pregnancy, and the average level of β-endorphin was significantly increased [23]. The maternal laboratory examination showed that the levels of renin, epinephrine, norepinephrine and angiotensin II in the music observation group were significantly lower than those in the control group during the second stage of labor [35]. There is also a literature to support the rewarding influence of music on reducing anxiety and stress during cesarean section, both in subjective and objective dimensions [36]. It is suggested that application of therapeutic music can be an effective method to relieve trait anxiety during pregnancy.

Pregnant women may also experience sleep disturbances due to physical, psychological or social changes. Sleep quality decreased significantly in women closer to 11 to 12 weeks of pregnancy, second only to postpartum mothers in the first three month [37]. Factors affecting sleep quality in the second and third trimesters may include mood swings caused by fluctuating hormone secretion, symptoms potentially manifested as stress, anxiety, and/or depression, and other physical discomfort caused by increased fetal size (e.g. frequent urination, fetal movement). This phenomenon increases from the first to the third trimester of pregnancy [38]. In addition, fatigue during pregnancy was directly correlated with sleep quality, sleep disorders and daytime sleep dysfunction. The higher the fatigue score, the lower the sleep quality, which is linked to poor pregnancy outcomes [39]. Actively listening to music for at least 30 min per day music significantly reduced stress and anxiety in pregnant women and improved sleep quality, which proves music therapy as an enjoyable, noninvasive treatment that is capable of creating an environment that promotes the health of pregnant women [40]. A study [41] focused on 88 pregnant women with poor sleep quality showed that listening to music every day had a positive effect on them. After four weeks, the pregnant woman in music group showed significant improvements in all components of the Pittsburgh sleep quality index, as well as in the total sleep quality index. Another study [11] showed that participating pregnant women who began listening to music during the second week of the intervention had better subjective sleep quality, sleep latency and general sleep quality than the control group and participants in the control group had more severe daytime dysfunction.

Studies have demonstrated the connection between mother and fetus during pregnancy [42]. When a pregnant woman is stressed and anxious, the adrenal glands secrete epinephrine and catecholamine in response to the situation. These hormones are transmitted to the fetus through the placental barrier, establishing a physiological state associated with the mother’s state of stress or anxiety. Playing music to a fetus can positively improve the bond between mother and child [43]. The introduction of ultrasound technology into obstetrics has given us the opportunity to perform noninvasive examinations of human fetuses and facilitate the study of the effects of various maternal psychological conditions on fetuses. Significant changes in fetal cardiac status, fetal heart rate acceleration and increased fetal electrocardiogram reactivity were observed during musical stimulation. The incidence of fetal unresponsiveness increased after musical stimulation was reduced. Newborns respond positively or calm down when they listen to the music their mothers ever listened during pregnancy [31,44]. Through the results of visual analogue scale and maternal antenatal attachment scale [45], it was confirmed that the perceived closeness between pregnant women and their babies increased over time. The higher scores may have been caused by an increase in fetal feedback during the last trimester.

Mothers of premature babies have a higher risk of anxiety, depression and post-traumatic stress disorder than mothers of term newborns. Unanticipated maternal roles and the emergence of premature babies are the most vital stressors for mothers [46]. They suffer from a broken bond with their babies due to prolonged stay in the intensive care unit. Early skin-to-skin contact between infants and parents, impeded by impede medical instability of the preterm infants, mechanical ventilation, and indwelling catheters, reduces maternal stress and improves parents’ self-efficacy in caring for infants [46]. Music therapy can improve maternal symptoms of depression and anxiety by promoting the physiological stability of premature infants and potentially improving their neurodevelopmental outcomes [46–48]. Music enhances the ability of mothers to interact with their infants and promotes synchronization, which may be protective factors for infant development, maternal health, and the mother-child relationship [49]. It strengthens calming cycle theory regarding emotional relationships between mothers and children, providing opportunities for positive intervention when problems arise.

The choice of music is influenced by several aspects and needs to be adjusted according to individual differences. Music appreciation habits and style orientation are determined by cultural education, age, region and other factors. The relaxation music of 60 beat/minute helps to relax and control anxiety because the 60 beats/min is the rhythm of brain nerve vibration, which can stimulate the brain nerve oscillations [30,40,50]. This rhythm enhances the release of beta-endorphins, which block nerve cells from releasing pain signals. The pregnant become calmer and happier.

When pregnant women choose music in the early stages of pregnancy, they should preferentially consider the music with a steady rhythm and slow melody, so as to relieve tension. For the second and third trimester, rhythmical elements can be appropriately added into the music, aiming to motivate the growth and development of fetal motor nerve. In the process of song selection, music needs to avoid wide frequency symphonies and high frequency compositions, which can cause brain fatigue. High frequency stimulation can affect the basement membrane of the cochlea, which is not conducive to fetal education. Before delivery, the pregnant choose the music basing on their interest which product a positive impact in return. Mothers can use these songs to practice relaxation, breathing or self-hypnosis ahead to bring themselves into a relaxed or hypnotic state during delivery. During childbirth, specific music can be selected to help the puerpera to improve her mood, increase self-control, and personalize the birth event [9,51]. If the puerpera does not have designated music, sharp heavy music can be avoided as far as possible, and some soothing music can be recommended, such as classical music, piano music and light music. For the tools used to play music, the small player is commendatory, such as headphones and small Bluetooth speakers. At the same time, the volume of the music should be regulated according to the maternal needs of comfort. In the studies of Simavli [16] the midwives changed the type of music (more rhythmic) and the volume at the active stage and the second stage of labor. It successfully helped the maternal to exert correctly and accelerate the progress of labor.

Limitation

The duration and opportunity of music therapy intervention varies in different studies. Liu chose to play music for 30 min at the time of 2–4 cm and 5–7 cm dilation of the cervix uteri respectively [40]. The results showed that in the incubation period (2–4 cm), the pain of the music therapy group was significantly reduced compared with the conventional care group, while in the active period (5–7 cm), there was no significant difference. At the same time, Liu consisted that the realization of the research purpose would affect the score of the research subjects, namely the Hawthorne effect [40]. Although music therapy has been applied in obstetric practice, the intervention time is not the same and there is a lack of uniform standards, which may lead to a bias in the repeatability of the research. Attention should be paid to avoid Hawthorne effect.

The operational staffs of music therapy include both specialized music therapists and midwives. In the study of Simavli [16] music implementers were midwives in the delivery room. In most clinical hospitals, nursing staff assume this role, which makes the work of nursing staff complicated. Compared to primipara, multiparous women’s duration of labor and pain is shorter, and the anxiety caused by the process pregnancy and concern about fetus is less. There was bias in pain assessment and anxiety assessment. The type of music used can also influence these variables, whether it was used with headphones/at the ambient level. Untrained midwives in different levels of expertise may skew the evaluation of the effectiveness of music therapy. Nursing staff undertake additional tasks and roles. If the capacity of nursing staff is inadequate, it may make the treatment effect difficult to reach the expected. So more professional training for nursing staff is needed, so as to promote music therapy to play a greater role.

Conclusion

The perception of stress, anxiety and pain during pregnancy and delivery can negatively impact pregnant women and newborns. Music therapy can be used as an effective auxiliary means for physiological and psychological problems. It is suggested to popularize the application of music therapy. On one hand, music therapy related education for pregnant women should be strengthened aiming at improving understanding of significance and implementation method of music therapy; On the other hand, relevant management departments should intensify the training of midwives’ music therapy skills, and formulate specialized operational guidelines and norms. We consider that music therapy is worthy to be popularized in obstetrical clinical practice in order to make delivery as enjoyable as possible for expectant mothers. The specific mechanism of music therapy on the fetus still needs to be further explored.

Data availability statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.