MUSIC THERAPY AND PREGNANCY - Article by Gabriel Federico and Giselle Whitwell
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APPPAH VIII C o n f e r e n c e , S a n F r a n cisco , USA , 1999
MUSIC THERAPY AND PREGNANCY
Article by Gabriel Federico and Giselle Whitwell
Introduction.
Music Therapy is a relatively young field utero, and these will stimulate its neural axis.
that was organized during the 1950’s in the Music will also enhance active movement of
United States of America. It belongs to the its limbs thus improving oxygen intake via a
behavioral sciences and therefore is based general increase of the exchange of fluids.
on a scientific approach. Its primary goal is to These movements also produce a relaxed
help clients use the expressive experiences condition in the future mother, which
of music to improve or enhance their level of enables further connection to her physical
physical, psychological and socio-emotional sensations produced by the baby. Music works
functioning. Most frequently, a music as an inter-active neurotransmitter affecting
therapist works within an interdisciplinary the cellular system and the hypophysis of
team. It is our hope that this will also be the fetus. This sets a track of a variety of
realized within the birthing scenario of sensations that will be recorded by the fetus
the future, so that the music therapist and remind him of the pleasant experiences
will interact directly with the obstetrician, he lived while in utero.
the nurse, the midwife, the neonatologist
and the anesthesiologist. Currently there
are some cases in which a music therapist Psychoprophylactic Music Therapy
is working with an obstetrician. Music
therapy is thus beginning to emerge as The work with pregnant women
another discipline that offers assistance to can be termed psychoprophylactic music
pregnant women. therapy. This term involves two specific
aspects of treatment, the pleasure and the
In general, we have found that music therapeutic areas. It is very important to bear
therapy treatment during pregnancy guides in mind the difference that exists between
future parents, and mothers in particular, these two areas because during treatment
to connect and bond with their babies in our activities and aims will be different.
a different way. This bond is conscious and For example, a mother who will have to
strengthened by using the effect of music undergo a cesarean operation because she
engaged with therapeutical activities within has been diagnosed with a placenta previa
a group context. This kind of treatment should not receive the same treatment as
improves the quality of pregnancy, labor, a future mother who has no foreseeable
and birth because it lowers the mother’s complications, or another mother who is
level of anxiety as well as neonatal stress. going to have a premature baby because
It also eases pain during labor contractions of an over-weight or high blood pressure
and birth. From the therapeutical point of problem. For this reason, we divide future
view, the future mother becomes much more mothers into three groups according to
involved in the three fundamental areas of commonly shared characteristics.
her pregnancy: physical, psychological and
emotional states. The baby will be drawn The criteria placing her in a particular
to the melodies that will be remembered in group depends on the information received
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during an individual interview or sometimes the need to stay in bed and the need of
on medical advice. After the interview, we medicine in order to continue the pregnancy.
make a personal file where we gather all In many cases, the treatment is carried out at
the information regarding her pregnancy the patient’s home or in a hospital because
including personal data. Details include the they should not move.
week of her present pregnancy, expected
date of birth, prescribed medication, any Special Pregnancies
special circumstances that require special
care, as well as previous pregnancies. Special pregnancy groups consist of
Additional information may include over-weight women, women who have
whether this pregnancy was produced as a hearing problems, multiple pregnancies,
result of a fertilization treatment. pregnancies achieved through assisted
fertilization or in-vitro fertilization, and
As previously stated, groups are divided women under 15 or over 40 years of age.
intothreecategories:normalpregnancies,high-
risk pregnancies and special pregnancies. It is Since groups never exceed more than
quite different to work with an homogeneous ten pregnant women, we can give them
group of pregnant women (with similar personal assistance and attention. They
characteristics) than with an heterogeneous come to music therapy sessions once a
group. For example, women who have week and they see us more often than they
received a fertilization treatment and are 40 see their obstetrician. This creates a strong
or 42 years old, perhaps this being their last bond between client and therapist. In some
chance to become a mother, and women who cases, the music therapists assume the role
are 20 to 22 years old who are going to have of doulas in a hospital setting.
their first baby. Likewise, it is not therapeutic
to have in the same group a mother who is
expecting triplets, an adolescent of 14 years of Fetal Hearing
age, and one with hearing problems because
in such cases the activities would be entirely Before explaining the practice of music
different for each one of them. Therefore, therapists, it is important to understand
the activities and the subjects, as well as the how fetal hearing functions. The hearing
therapeutic approach would be quite different system of the fetus is physically developed
for each of them. at approximately four and a half months;
it then starts catching the sounds, inner
Normal Pregnancies sounds first then the outer. Through sound,
the fetus receives the richest and most
Generally, normal pregnancies do not varied information. According to Deliege
show any type of obstetrical complications, and Sloboda (1996), the early research in the
mothers and babies are in excellent health, 1970’s describes the womb as noisy, between
and only need continued optimal care for 72 and 96 dB. But more recent investigation
the normal development of pregnancy. using hydrophones has indicated the
contrary, placing the womb in a relatively
High Risk Pregnancies quiet space, especially when the mother is
calm and there are no abdominal gurgles,
These pregnancies require special care ranging between 50 to 60 dB. The internal
because of the danger of abortion, bleeding, fetal and maternal noises are comprised of
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respiratory, movement, gastrointestinal, sensation produced by the sound on its
cardiovascular and laryngeal sounds, mostly mother. Continuous use of relaxing music
in the lower frequencies between 500 to with different exercises allows her to bond
700 Hz. Among these sounds, the mother’s more deeply with her baby. In turn, the
heartbeat is a predominant feature. The baby will develop a memory track for this
external sounds include all those in our music that will acquire increased meaning
daily environment, including music, all of after birth.
which stimulate the fetal auditory system.
As a point of reference, the normal
The mother’s voice is unique in that ear generally can detect sounds ranging
her speech and songs stimulate her unborn from 16 to 20,000 hertz. The piano’s lowest
baby, both through bone conduction keys measure 27.5 hertz and the highest at
internally and by airborne sound waves. 4,186 hertz. According to A.Tomatis, the
The father’s voice is known only by the higher sound frequencies, those between
airwave resonance and therefore remains 3,000 to 8,000 Hertz, generally resonate in
less intimate than the mother’s, but can be the brain and affect cognitive functions.
bridged if he consciously devotes time to The middle frequency, sounds between 750
bond with his baby. This can be achieved to 3,000 Hertz, stimulate the heart, lungs
by talking in close proximity to the skin of and emotions while the low frequencies,
the womb, touching and caressing it, and between 125 to 750 Hertz, affect physical
singing. For our purposes, it is also important movement.
to remember that sound energy dissipates
more quickly in the air than it does in most Hearing is the only sense that connects the
solid mediums. Solids and liquids are better baby with the “outer world” and it is also
transmitting mediums than air because they the sense that we can stimulate the most. It
are denser and have an elastic quality. is possible to see very small babies capable of
mental associations and relationships long
Altogether, the sounds that are before logical expectations. For example,
present throughout the 24 hours may range the capability of associating melodies with
between 30 to 96 dB. As far as frequencies the intra-uterine experience and the ability
are concerned, there are some sounds to focus attention or to recognize voices.
provided by musical instruments whose
frequencies are below the 500 Hz. range. Using sonograms, we have been able to
This frequency creates a vibration that check how the fetus reacts to this type of
produces a physical sensation felt by the musical stimuli. We apply directly on the
fetus and the mother’s body but are more mother’s belly different kinds of music using
difficult to hear. On the other hand, there two small speakers placed according to the
are also frequencies that are better “heard” position of the fetus. Our first conclusion
but not “felt” which are at the other end is that in all cases, there was a 10 to 15
of the Hz. spectrum, whose vibrations are % increase in the heart rate of the fetus
not so strong. In our work, we select music produced simultaneously as the stimulus.
whose vibratory frequencies can be “felt” We also discovered that when the fetus
and also “heard” by the fetus. In some of recognizes the music, it produces sucking,
the relaxation exercises there is a sensation intra uterine breathing movements, closing
felt by the mother through the music and and opening of the eye lids, moving the
the baby receives directly the emotional head as if responding to the sound source
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and moving its upper and lower limbs the amniotic fluid. Intensity and awareness
slowly. The only change we noticed when are qualities that increase from period to
the music was not recognized by the fetus period, paralleling the development of
was an increase in the heart rate. All these the baby in utero. We work from general
signs show good fetal vitality, and they also themes to more specific ones towards the
let us know whether the fetus has hearing end of pregnancy. During the first period,
problems or not, even as early as the seventh we begin the focus on bonding and
month of pregnancy. This information has establishing a connection with the life that
been obtained with the assistance of an is developing within, exploring qualities of
obstetrician, and verified by using over 40 beauty, love, creativity, and others. There
hours of ultrasound recordings of music is also a conscious effort to sensitize the
applied to the womb of pregnant women. body, to bring more awareness to it. In the
second period we introduce activities that
will empower mothers to believe in their
Relaxation Through Movement ability to give birth naturally, if they so
choose. The connection of body, mind and
We have created a technique called feelings is another important aspect at this
relaxation through movement (RTM). time, a theme that continues until the end
RTM. is the awareness of hearing music of pregnancy. The last period is very active
and creating movements with the arms for both mother and child, preparing for
as if reflecting this music in the air, trying birth, facing the questions of mothering,
to achieve an active musical meditation pain, and other issues that arise.
directed towards the different sensations in
the womb. Most frequently it is used while Since music has lasting effects, its
sitting or in a reclining position. continuous sounding in the psyche, often in
the subconscious after frequent listening,
To achieve most effective results, we provides the same effect as experienced
divide pregnancy into three periods: originally. The R.T.M. technique includes
guided imagery with the music focusing
First period: conception to four and a on subjects dealing with typical pregnancy
half months. fantasies.
Second period: from four and a half to
the seventh months, when the baby rotates This preparation for mothers through
and the so called internal rotation takes music has no stimulus response criteria, in
place. other words, we are not looking for a fetal
Third period: from the seventh month to response to a stimulus but are rather trying
birth (end of pregnancy). to provide a pleasant feeling through the
mother’s experience. In providing her with a
Each period of pregnancy has its musical environment imbued with qualities
particular music and themes that supports of beauty, calm and joy, her endorphin
the ongoing transformation of mother and levels are likely to rise and thus affecting
child. Music has also specific characteristics, her baby favorably. The encouragement
for example, music that is performed only by and enjoyment the mother receives during
string instruments. This medium has a very this time also gets her more involved with
good conduction quality traversing through the care of her pregnancy and becomes
the abdominal wall and vibrating through more connected to her baby. The hyper-
4/10APPPAH VIII C o n f e r e n c e , S a n F r a n cisco , USA , 1999
sensibility and vulnerability of pregnant Finally, the mother’s own voice is the most
women is a very important factor, which suitable instrument to express her own
can be relieved by a group setting. The process, and her love, through humming,
value of such groups lies in the exchange of toning, chanting and singing, which in turn
experiences with the other mothers during can be supported and encouraged by the
the sessions providing support, reassurance music therapist.
and insight for one another.
The choices of available music offer many
As music therapists, we work with possibilities. The benefits of Baroque and
three basic premises: Classical music are widely known, especially
the slow movements to which babies have
1) The transmission of the vibration responded positively. One can find selective
from the stimulus to the fetus. music from almost every major composer,
2) The fetus’s hearing capabilities. compositions which may not be well known,
3) What the future mother transmits and this is for the better, as familiar music
while listening to music. often brings recollections of events and
feelings that may interfere with the intended
We try to combine the exercises for work. The lullaby is a genre of music all
optimum benefit. For example, the last of its own, which should be reintroduced
period of pregnancy, when the hearing of into our lives as it provides great pleasure
the baby is most developed is also the time and soothes infants after birth, especially if
when the fetus responds most actively, even sung while the babies were in the womb.
to the father’s voice. Therefore, it is during The genres of music to be avoided during
this time that directed communication pregnancy are rock, opera and jazz. Reports
through music is optimal. of mother’s having to leave rock concerts
because the babies became agitated in the
The R.T.M technique through movement womb have been acknowledged in the
is very helpful in reducing the level of stress research literature. This also applies to any
produced by labor, because the relaxation is loud sounds. In general, jazz music is not
not achieved through a passive conditioning, suited during pregnancy because of the
it is rather active and self-initiated. It is rhythmic displacements we call syncopation,
equally effective in other positions such as however, there are always exceptions.
lying down and walking. Likewise, grand opera is too dramatic and
may cause more irritation than pleasure.
Music may be used during labor in These musical genres may bring pleasure to
numerous ways. Recorded and specially the parents but they will not be appropriate
prepared tapes with music selected by the for fetal nurturing. The greatest benefit to
parents can be of great assistance to the the babies in utero will be derived from live
mother during each stage of labor, thus music. The mother’s voice is the first choice,
lowering her anxiety level, relieving her as it is the most soothing and stimulating to
stress and tension, focusing her attention her baby, followed by the father’s voice. In
inwards, supporting her breathing patterns, the future we need to focus more on the voice
and changing her state of consciousness. A because it is the most musical instrument we
music therapist accompanying the mother possess. All great conductors have always
to the hospital or birthing center may also conveyed their feelings of the music to their
provide live music for the same purpose. players not by explaining but by singing a
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phrase or the passage in question, precisely Working Aims
because a physical instrument is already
once removed from its true source, the As music therapists, we strive towards the
voice. Playing an instrument can become following aims regarding future mothers
mechanical and frozen. The voice, like the and their unborn babies:
personality, develops patterns of sounding,
limiting its expression. We need to free the To allow the development of an early
voice of these constraints so that the body awareness of the intra uterine connection.
and the personality can express themselves To stimulate the baby with pleasant
fully and genuinely. Future mothers are sensations and experiences through the
introduced to toning and chanting. These mother.
styles of singing are good vehicles for the To develop and enjoy a deeper connection
mother to express an extensive range of between mother and child.
emotions from fear to joy and pain, besides To reduce the levels of anxiety.
helping her focus and relax. Toning is the To help reduce perinatal stress by
extended breath and sound on one tone providing the newborn with a familiar
while chanting includes simple melodies sound which was experienced in utero
contained within a small range of pitches before birth.
with no meter. Instrumental improvisation To prepare women for labor and birth
during group sessions will provide a creative with different psycho- musical techniques.
and supportive environment to both To obtain further relaxation during
parents. At least half of the music to which labor.
babies are exposed to in the womb should To allow and support expressions of pain
be performed live. whenever they surface.
To achieve further awareness of physical
After the birth, the parents may sensations.
welcome their baby by singing their special To nurture mother and child with
womb song. A new stage in their lives take qualities such as beauty, joy, and love.
place when the mother first holds the baby To create a holistic physical, emotional,
against her chest and the child hears the mental and spiritual environment for the
heartbeat. There is an immediate recognition emerging family.
of this rhythm and the baby calms down To foster creativity and imagination.
because he knows this sound; he has listened
to it for a long time in the womb. The baby All this will help future mothers and
also starts connecting the sense of smell their babies during pregnancy and birth
with the breast and his mom. The senses of because all of the above mentioned factors
touch, smell and sound become more alive. are fundamental to this process. Women’s
When the baby opens his eyes and meets attitudes towards birth will be more open
his mother’s gaze and hears her voice, he and empowering.
recognizes the special inflections of her
language, the inner bond has now emerged
into his outer world. Whenever the music The Arts as an Holistic Paradigm
formerly heard in the womb is now played
in his new environment, the baby will be at The arts in general have always been
ease, the comfort of the known will bring regarded as mediums of expression for a
him peace and with it pleasure. given culture playing a specific function.
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In the past, they were held in high esteem partner, etc. Through shared movement
often associated with healing, religion and in a group, the mother’s pleasure, self-
rituals of passage from birth to expiration. confidence and body image are increased.
They held meaning in daily life and were Self-expression by the mother through
fully integrated in the spectrum of one’s movement will often lead to deeper
life span. Through time we have lost this bonding and dialoguing with her baby.
connection, the gifts, the meaning, their This kind of activity may also support the
value. And as we face a new millennium we integration of body, mind, and feelings.
are rediscovering the need we have for them
in order to become whole again. Reflecting Color vibrates in wave lengths as well,
our modern world of specialization, it is more abstract and subtler than sound.
individualism, political, economic and Color, in the form of light, is part of the
social instability, our personalities are in electro-magnetic spectrum, that includes
need of finding our true selves. In search x-rays, ultra-violet and infrared rays, radio
of meaningful paths, the arts are becoming and television rays. I am referring to the color
windows for self-exploration as seen, for spectrum as seen through a prism revealing
example, in the numerous drumming the seven basic colors of the rainbow. Color
circles that have been burgeoning around has been observed to relieve tension and
the country and music therapy becoming anxiety as well as to increase energy levels
a closer ally of the medical establishment. (Birren). Transformation and stimulation
This process stimulates our creativity and through color in pregnancy is predominantly
imagination enriching our lives and giving experienced by mandala drawing and in the
us a feeling of vitality. It is this synergistic use of large colored silk scarves. As this is a
quality of the arts that heals us and gives new area of development, therefore, there
us a sense of well being; it is a holistic is no data other than anecdotal evidence.
paradigm.
Many philosophers throughout history, such
Music, as mentioned earlier, is an as Sir Isaac Newton, have intuitively believed
expressive and communicative art. It has the that there is some correspondence between
power to evoke deep non-verbal feelings, color and music. The Pythagorean theory of
and in order to process these it is sometime color and music, though controversial, suggests
helpful to explore other artistic mediums. that the vibrational frequencies between the
Movement and color are of particular seven spectrum colors have a correspondence
significance in this regard, although in our in the seven notes of the scale starting from
work we also include poetry, myths and middle “c” on the keyboard. In other words,
modeling in clay. middle “c” correlates to the color red, “d”
with orange and so on. Therefore, when color
Movement is life, for all that is living and music are used together, their vibrational
vibrates, which is motion. In the work with energy is increased and intensified. Fabien
pregnant women, the most meaningful Maman, a musician, composer, acupuncturist
movement emerges from their creative and bioenergetician, in his Academy of
impulses being improvised in the moment, Sound, Color and Movement, has obtained
supported by music. For those who are self- positive benefits using the color and sound
conscious in the beginning, guidance is given correspondences as mentioned above. However,
through simple folk-dances, belly dance research is needed to validate this energy field.
movements, mirroring movement with a
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Conclusion in this fluid quality that music bestows on us
all. Upon birth, these babies appear to be alert
Music is a vehicle of consciousness. and aware but we really don’t know how
The auditory consciousness is our first pre and perinatal babies experience music.
awareness as our sense of hearing is the There are more questions than answers in
first to fully develop in utero and is the this regard. But above all, these babies are
last to relinquish its role during our earthly nurtured consciously with love and this alone
existence. Barbara Crowe, a music therapist, makes them special. In the womb song we
makes the following observations: have created a modern ritual of welcome to
their earthly life. In the original lullabies and
“to hear is to be, it is a fundamental rocking motions we have provided for their
awareness of being… we are born emotional support.
listeners and we remain switched listeners
continuously throughout our lives, we never In the last decades of this century
shut our ears like we shut our eyes. The important ground work has been laid in the
world of sound is as old as humanity. Music pre and perinatal field with the research of
sums up the experience of listening and Thomas Verny, David Chamberlain, Michel
communicating in sound. Music becomes a Odent, and so many others to mention. Pre
world for the knowing of consciousness.” and Perinatal Psychology has established
itself and opened windows through which
we can look at ourselves in our earliest
Further on, she comments humanity, namely the prenate as a sentient
and intelligent being. The windows are
“Auditory consciousness is a multi- growing larger to include the exploration
dimensional awareness of time and space, a of our spiritual selves. And as we move
nonlinear reaction that is unitary in nature. forward in this unknown territory, we
The consciousness of listening is continuous, will probably find that science, art and
ever present and unavoidable. It is an religion will one day converge into a larger
awareness of wholeness and simultaneously understanding of consciousness which will
of the relationships inherent in sound and encompass them all, without creating a
particularly music.” separation between them.
Music, in its fluid nature, is like a river that
The reintroduction and involvement of
waters the valleys, our daily consciousness; the arts during pregnancy is reminiscent
has great depth in the ocean, our unconscious of the practice of ancient traditions such
and subconscious selves; and bestows a as the Japanese Tai-kyo, the “Tranquility
greater vision from the mountain peaks, our Centers” of the Chinese, and the “Thought
super consciousness. Another quality that Rooms” of the Hindus. In our present wordly
is unique to music is that it gives focus to circumstances each couple individually is
the present moment, to the here and now. called upon to create in their own homes a
This present awareness can be capitalized center for peace and joy during the period
by pregnant women when giving birth and of gestation; and the responsibility of
tuning into their own processes. practicing the arts lies with them. Our role is
to support and encourage this exploration
Unborn babies nurtured with music and celebration of ushering into this world
during pregnancy by their parents participate babies that are truly conscious.
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Video
In the video you are going to see
now, you will be able to observe some of
the exercises carried out with pregnant
women, as well as segments made with
ultrasound and music. Finally, you will see a
woman giving birth without anesthesia or
an episiotomy.
Postlude: Final Words.
When a mother sings to her baby a
lullaby, she is not only sheltering him and
providing for his safety and transmitting her
love, she is also conveying to him what we
human beings cherish as most essential:
Our folklore
Our race
Our warmth
Our word
Our gesture
Our purity
Our silences
Our essences
Our sense of time and space
Our song
Our rhythm
Our gesture
Our body’s touch
The beginning of education.
The basis of our moral and ethical
principles
The very essence of our life.
We are strengthening an eternal link.
We are transmitting a feeling that has
passed from one generation to another.
We are transmitting the history of our
humanity and we are not even aware of it.
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