Sunday, 8 July 2018

Music, Pain and Labour

I came across the video of Ed Sheeran and Andrea Bocelli singing 'Perfect Symphony' - if you haven't experienced this visual and auditory delight, take five minutes and watch it now.  I bet you'll be glad you did :)


I found myself enraptured with the video, the sounds and the sights gave me goosebumps. Time stood still.  I hit play again and again - I then shared it on Twitter and Facebook asking if anyone else was loving this video as much as I did. As I listened to this song, I felt happy and my whole body felt warm and tingly, especially when Andrea's voice soared.

We know that music moves our body, soul and spirit - I've been at music events and couldn't sit still, I had to dance. Women often dance in labour, finding the movement and the music helpful. A midwife friend, Dr Robyn Thompson, a rock and roll aficionado and Elvis fan, told me that in her homebirth practice she found women loved to dance - swing and bop in labour. 

Even doctors get into the act! Dancing doc Fernando Guedes da Cunha in Brazil dances with labouring women to funky music!  Camila, the woman in the video, asked for the music and they choreographed the moves together. Looks like they are having lots of fun! Pain takes a hike when we are having fun, laughing and generally enjoying what we are doing. Camila thanked her doctor for making her birth experience so memorable.


 Music started making its way into the Australian labour wards, along with women's partners, in the 70's and early 80's.  Couples were encouraged to make their music compilations and bring their tapes and tape players with them.  The idea behind it was to make the environment more homelike and comfortable. Along with more benign choices, we had birds whistling, Enya, whales sounding and sometimes heavy metal as our background ambience while women laboured.  In the early 80's, as Brereton announced the 'beds to west' policy and the building of Westmead Hospital, I  had the immense pleasure of working in the Crown Street Women's Hospital Birth Centre before it was closed, as part of the 'beds to the west' move, and the building made into apartments. The birth centre was established in 1976 and was the first public hospital birth centre in Australia. Crown Street had wonderful management, both medical and midwifery, an unusual combination. It was an amazing hospital for many reasons, including the way the women who flooded in to Sydney from war torn Vietnam were cared for - but that's another story for another time.

The birth centre was downstairs from the labour ward and had three birth rooms.  When the birth centre was empty, I worked in the labour ward under the watchful and supportive eye of one of the grand old labour ward managers, Sister Pat Sparrow.

I came to work on a morning shift and the three birth rooms were full.  In one room, the couple were Hare Krishna followers. The prospective father had a guitar and, as he played, the couple were chanting Om Namah Shivaya (“I bow to the inner Self”).   In that room I was required to be quiet and not disturb the couple. In the next room were a talkative pair - country and western was their choice and it was Johnny Cash up loud! In the third room were self-identified hippies - they had whale songs playing and brought their own bean bags. Each couple had decorative items from home in their birth rooms, items such as photos, wall hangings, blankets, floor coverings, cushions etc that reflected their belief systems and music choices.  As I went from room to room, taking observations, observing progress, encouraging water intake, suggesting the woman went to the toilet etc, I stood at each  doorway, taking three deep breaths because I had to change my 'state' to enter each room, as each couple needed completely different behaviour from me, along with my midwifery care.  Each woman  coped well with labour and birthed well, their attentive partners fully involved in the birth of their babies.

Over the last few decades, birth centres and labour wards (now called delivery suites - a term I find obnoxious - birth centre is much more appropriate, but birth centre implies the woman has agency, so isn't popular with the power brokers), have CD and IPod players; tapes have given way to CD's and digital music, but women still collate the music of their choice for their labour and birth. Interestingly, sometimes the music/sounds they've thought they wanted, they don't want in labour. They choose something else or sometimes silence. One woman, after several hours of bird calls as her background music yelled out 'turn those f'king BIRDS OFF!' I turned them off happily - they'd started to wear me down too.  Other women sing.  One particularly memorable experience was a woman singing 'Everything's alright' from the musical, Jesus Christ Superstar.  Her volume increased as the contraction peaked.


She sounded a lot like the woman in this 1970 version of the song from the musical. She birthed beautifully (of course!).

Did the music make a difference?

Midwives have long observed the difference music and other sensory cues have on women's ability to labour and birth well. The evidence is increasing that an enviroment that feels safe is crucial to a woman's ability to relax and enable her physiology to function well. Music is part of that environment and according to a recent systematic review of  the literature, 'Music is an effective intervention for the management of pain'. Good to see evidence validating the art and science of midwifery knowledge and practice.

Reference

Martin-Saavedra, J. S., et al. (2018). "Music is an effective intervention for the management of pain: An umbrella review." Complementary Therapies in Clinical Practice 32: 103-114.