Effects of maternal singing during kangaroo care on maternal anxiety, wellbeing, and mother-infant relationship after preterm birth: a mixed methods study

ABSTRACT

Introduction

Preterm birth may disturb the typical development of the mother–infant relationship, when physical separation and emotional distress in the neonatal intensive care unit may increase maternal anxiety and create challenges for early interaction. This cluster-randomized controlled trial examined the effects of maternal singing during kangaroo care on mothers’ anxiety, wellbeing, and the early mother–infant relationship after preterm birth.

Method

In the singing intervention group, a certified music therapist guided the mothers (n = 24) to sing or hum during daily kangaroo care during 33–40 gestational weeks (GW). In the control group, the mothers (n = 12) conducted daily kangaroo care without specific encouragement to sing. Using a convergent mixed methods design, the quantitative outcomes included the State-Trait Anxiety Inventory (STAI) at 35 GW and 40 GW to assess the change in maternal-state anxiety levels and parent diaries to examine intervention length. Post-intervention, the singing intervention mothers completed a self-report questionnaire consisting of quantitative and qualitative questions about their singing experiences.

Results

The mothers in the singing intervention group showed a statistically significant decrease in STAI anxiety levels compared to the control group mothers. According to the self-report questionnaire results, maternal singing relaxed both mothers and infants and supported their relationship by promoting emotional closeness and creating early interaction moments.

Discussion

Maternal singing can be used during neonatal hospitalization to support maternal wellbeing and early mother–infant relationship after preterm birth. However, mothers may need information, support, and privacy for singing.

KEYWORDS:

• Early interaction
• emotional connection
• maternal anxiety
• maternal singing
• preterm birth
• preterm infant

Acknowledgments

The authors thank the families for their participation in this study and the nursing staff in Jorvi and Kätilöopisto neonatal wards for their collaboration during the data collection. We are grateful to Prof. Vineta Fellman for her valuable advices and support, and for initiating the study. We also thank Dr. Friederike Haslbeck for her comments on the early draft of this manuscript, and Dr. Elsa Campbell for the English translation of the self-report questionnaire.

Disclosure statement

The authors report no conflicts of interest.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This project has received funding from Alfred Kordelin Foundation (KK), Signe and Ane Gyllenberg Foundation (V. Fellman), Medicinska Understödsföreningen Liv och Hälsa (V. Fellman), and Finnish Cultural Foundation (MH).

Notes on contributors

Kaisamari Kostilainen

Kaisamari Kostilainen, M.A., Music Therapist, is currently finishing her Ph.D. studies at the Cognitive Brain Research Unit, Faculty of Medicine, University of Helsinki, Finland. She examines the effects of parental singing on preterm infants’ auditory processing and language development, maternal wellbeing, and early relationship. She is specially trained in NICU music therapy and works in implementing neonatal music therapy in the hospital setting in the Helsinki metropolitan area.

Kaija Mikkola

Kaija Mikkola, MD, Ph.D., is a neonatologist working at the Department of Pediatrics and Neonatology at Children’s Hospital, Helsinki University Hospital, Finland. Her interests include the neurodevelopmental outcome of preterm infants and postnatal interventions on that.

Jaakko Erkkilä

Jaakko Erkkilä is a Professor of Music Therapy at the University of Jyväskylä, Finland. In addition to his responsibilities in music therapy master’s and clinical trainings, he is known for his research, such as the effect of improvisational music therapy for depression and anxiety as well as for developing theory and treatment models in the context of psychiatric music therapy.

Minna Huotilainen

Minna Huotilainen is a Professor of Educational Sciences at the University of Helsinki, Finland. She is best known for her work in studying auditory brain responses in infants and fetuses and showing the benefits of musical training for children and adolescents as well as for her studies on the neuroscience of work.