Accepted Manuscript

The effect of music on pain and anxiety of women in labor during their first pregnancy:
A study from Turkey

Sule Gokyildiz Surucu, Melike Ozturk, Burcu Avcibay Vurgec, Sultan Alan, Meltem
Akbas

PII: S1744-3881(17)30355-9
DOI: 10.1016/j.ctcp.2017.12.015
Reference: CTCP 802

To appear in: Complementary Therapies in Clinical Practice

Received Date: 8 August 2017

Revised Date: 12 December 2017
Accepted Date: 14 December 2017

Please cite this article as: Surucu SG, Ozturk M, Vurgec BA, Alan S, Akbas M, The effect of music on
pain and anxiety of women in labor during their first pregnancy: A study from Turkey, Complementary
Therapies in Clinical Practice (2018), doi: 10.1016/j.ctcp.2017.12.015.

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 ACCEPTED MANUSCRIPT
THE EFFECT OF MUSIC ON PAIN AND ANXIETY OF WOMEN DURING
LABOUR ON FIRST TIME PREGNANCY: A STUDY FROM TURKEY

THE EFFECT OF MUSIC DURING LABOUR

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Sule GOKYILDIZ SURUCU1, Melike OZTURK2, Burcu AVCIBAY VURGEC2
Sultan ALAN1, , Meltem AKBAS3

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1

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Assoc. Prof. Dr., RN, Cukurova University Faculty of Health Sciences, Midwifery
Department, Adana, Turkey
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PhD, Midwife, Cukurova University Faculty of Health Sciences, Midwifery Department,
Adana, Turkey

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Assist. Prof. Dr., RN, Cukurova University Faculty of Health Sciences, Midwifery
Department, Adana, Turkey
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Sule GOKYILDIZ SURUCU(Corresponding author)

Postal address: Cukurova Universitesi Saglik Bilimleri Fakultesi
Balcali Kampusu 01330 Saricam-Adana / TURKEY
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Tel: 90 322 3386484

Fax: 90 322 3386970
E-mail: sgokyildiz@cu.edu.tr / gokyildizsule@gmail.com
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THE EFFECT OF MUSIC ON PAIN ANDMANUSCRIPT
ANXIETY OF WOMEN IN LABOR DURING
2 THEIR FIRST PREGNANCY: A STUDY FROM TURKEY
3
4 ABSTRACT
5 Objective: This study aims at analyzing the effect of music on pain and anxiety felt by women in
6 labor during their first pregnancy. Method: When the pregnant women in the experimental group
7 progressed into the active phase of the labor, they were made to listen to music in Acemasiran

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8 mode with earplugs for 3 hours (20 minutes of listening with 10-minute breaks). Findings: It
9 was observed that after the first-hour women indicated that their pain was statistically less in the
10 experimental group. Trait anxiety scores of the women in labor were similar for experimental

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11 and control groups. Following the practice, state anxiety average scores became lower in favor of
12 the experimental group and the correlation was statistically significant. Conclusion: In order to

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13 facilitate women’s coping with labor pain and improve their wellbeing with the activity during
14 the labor, musicotherapy, a non-pharmacological method, is an effective, simple and economical

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15 method.
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16 Key Words: Pain, anxiety, labor, music
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1 INTRODUCTION ACCEPTED MANUSCRIPT
2 Labor is one of the most intense pain sources that is known, especially uterine
3 contractions in primigravidas and labor. Pain is the primary symptom that motivates people to
4 seek professional help [5].
5 Labor pain, both a universal phenomenon and a subjective experience, differs from other
6 serious pain. Labor pain is a part of a normal process. While other forms of pain imply an
7 abnormal state such as injury or disease, labor pain is completely usual. It motivates the pregnant

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8 women to make an effort to overcome the situation and enables the baby to progress during the
9 process. Pregnant women have time to ready themselves for the labor and can develop skills to
10 achieve pain control within this time period. Labor pain is not continuous, but intermittent.

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11 Labor pains are less discomforting at the beginning of labor; as time progresses, the pain
12 becomes more frequent, and the resting period between contractions becomes shorter. Women

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13 play an important role in pain management and cooperation with the health professionals. A
14 pregnant woman's concern for her baby motivates her to tolerate the pain she experiences during

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15 the labor [24].
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16 Despite the expectation of pain during labor, irregular pains that exceed women's
17 tolerance may result in adverse physiological and psychological effects on both the mother and
18 the fetus [5,6,24].
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19 Non-pharmacological and pharmacological methods are used in controlling labor pain.

20 Essential criteria for the eradication of labor pain are the provision of good analgesia, securing
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21 the safety of the mother and baby, continuous and predictable effects, simple methods and
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22 mother’s control over the process. Pharmacological methods are invasive and financially costly.
23 It was found that the use of epidural anesthesia and narcotic agents prolong the labor duration
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24 and increase the need for oxygen and oxytocin. Non-pharmacological methods, on the other
25 hand, do not need medical rules and are harmless for mother and baby. They do not slow down
26 the labor and they affect the progression of the labor positively. Moreover, they do not cause side
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27 effects or allergy [5,6,11,24].

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28 Music plays an important role in people's life. It has been used to help people’s well-
29 being and provide pain relief since antiquity. Directly or indirectly, it affects physiological and
30 clinical symptoms. Music and musicotherapy can provide direct physiological, psychological
31 and socio-emotional benefits for the patients. In addition, by affecting attitudes and behaviors
32 of care providers, it can affect the patients indirectly. Carefully selected music can reduce
33 stress, improve comfort, provide relaxation, ease the intensity of pain and improve the
34 performance of clinicians [5,6,24]. In a review on therapeutic effects of music on nursing
35 practices, it is stated that music is used widely in various fields such as intensive care units,

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surgical operations, dental clinics, MANUSCRIPT
mental health, pain control, anxiety control and relaxation
2 [2].
3 Musicotherapy is one of the non-pharmacological methods used during labor [2,3,11,12].
4 While the exact effect of music is not known, it is believed that it is effective as it causes
5 relaxing or draws one’s attention away from the pain. Music affects the painful stimuli the
6 women experience and results in relief by increasing the secretion of endorphin [6,7,12].
7 Another way that music directly represses pain is by the aural stimulus. The studies indicate

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8 that music reduces anxiety, pain and the problems of women during labor [6,7,14,19-21].
9 However, there are not enough evidence-based studies that investigate the effects of music on
10 labor. Only one study was found that took place in Turkey. It was conducted in western part of

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11 the country and a different music genre was used [6]. The present study is the first in Turkey to
12 investigate the effects of Acemasiran mode music on the pain and anxiety of women during

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13 labor in their first pregnancy. In their studies, researchers used the various genre of music
14 during labor. In a study conducted in Turkey, Ersanli (2007) [6] used music in Rehavi (Turkish

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15 music) mood. In their study, Hosseini et al. (2013) [10] played classical music in Iran. Labrague
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16 et al. (2013) [13] played a calming music in their study conducted in the Philippines. Their
17 study which aimed at analysing the effect of music on anxiety and pain during labor and
18 included 60 primipara pregnant women, Liu et al. (2010) [14] asked the participants to choose
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19 amongst 5 types of music: classical music, light music, pop music, traditional Chinese music,
20 crystal child music. 20% of the participants chose classical music, 16.7% pop music, 30%
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21 crystal child music and 20% traditional Chinese music

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22 An analysis of music theory studies on Turkish music moods reveals that Acemaşiran
23 mood was first spotted in the works of Dimitrius Kantemir. It is a compound mode. Peşrevi
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24 (introduction) by Tamburi Emin Aga and compositions by Dede Efendi may be examples of
25 musical pieces in Acemaşiran mode [9].
26 In the literature, it is underlined that Acemasiran mode provides a feeling of creativity and
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27 inspiration, and eases labor. Acemasiran mode has features for pain and spasm relief, it gives
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28 pleasure and facilitates relaxation [4,8].

29 As a consequence, the present study was conducted as a randomised controlled trial to
30 identify the effects of Acemasiran mode music on pain and anxiety of women during labor on
31 their first pregnancy.
32 The research hypotheses were:
33 Music in Acemasiran mode listened during the active phase of labor is effective in
34 reducing labor pain.

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Music in Acemasiran mode listened MANUSCRIPT
during the active phase of labor is effective in
2 reducing anxiety during labor.
3
4 METHOD
5 The research population consisted of pregnant women who consulted a maternal and
6 children hospital located in the southern part of Turkey. The sample consisted of healthy
7 pregnant women who complied with the research criteria. The research was conducted with 50

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8 primipara women (25 for experimental, 25 for the control group). Coin flipping method was
9 used in randomization. Heads were for experimental and tails were for the control group. The
10 participants were not informed about the randomization process of the groups. In the hospital

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11 where the study took place, each labor unit was for one person and the pregnant women in both
12 experimental and control groups were in separate rooms. The participants in different groups did

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13 not see or communicate with each other during the experiment. The pregnant women in the
14 experimental group were asked whether they would like to listen to music and their participation

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15 was voluntary. None of the participants refused to listen to music.
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16
17 Criteria for inclusion in the research:
18 • Voluntary participation
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19 • Being in term pregnancy (37- 41 pregnancy week)

20 • Being primipara
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21 • Pregnancy without risk

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22 Criteria for exclusion:

23 • Having hearing problems
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24 • Inducing labor
25 • Using analgesia/anesthesia during labor
26 • Delivery by C-section
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27 • Delivering while listening to music

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28
29 Confirmation of Ethics Committee
30 The confirmation of Çukurova University Ethics Committee for Non-invasive Clinical
31 Trials was obtained in order to conduct the research.
32 Data Collection Tools
33 In data collection, “Pregnant Introductory Form” was used for identifying socio-
34 demographic features of pregnant women, “Evaluation Form on Labor” for evaluating
35 progression of the labor, “Visual Comparison Scale" for identifying perceived level of pain,

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1 "STAI I-II State-Trait Anxiety ACCEPTED MANUSCRIPT
Scale" developed by Spielberger et al., "Faces Anxiety Scale” for
2 identifying anxiety levels and “Post-Delivery Evaluation Form” for evaluating the practise after
3 delivery.
4 Pregnant Introductory Form
5 The form developed by the researchers consisted of 31 items on pregnant women’s socio-
6 demographic features, their state of fear, the information they had received about pregnancy,
7 their knowledge level of non-pharmacological methods in coping with labor pain and their music

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8 listening habits.
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10 Evaluation Form on Labor

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11 The form developed by the researchers evaluated the labor process. The data looked at the
12 babies’ heart rate, blood pressure, body temperature, pulse, respiration, dilation, effacement, the

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13 position of the babies’ head and the length and frequency of contracts were recorded on the form.
14 Visual Analogue Scale

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15 Visual Analogue Scale (VAS) is a simple and effective measurement method that
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16 requires minimal equipment and can be repeated to measure the intensity of pain. In cases where
17 the intensity of the pain needs to be measured quickly in clinical and laboratory conditions, VAS
18 is often used. VAS consists of a 10 cm line that is drawn horizontally or vertically. Two defining
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19 sets of words for the subjective category are written on two ends of the line as "no pain" and
20 "most intense pain possible" or "unbearable pain". The patients are instructed to draw a mark on
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21 this line in accordance with the intensity of the pain. The distance from the lowest point on VAS
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22 to the patient’s mark is measured with a ruler in cm or mm, and numerical pain index of the pain
23 intensity is obtained [1].
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24 State-Trait Anxiety Inventory

25 The state-trait anxiety inventory was developed by Spielberger, Gorsuch, and Lushene in
26 1970. Spielberg enabled the measurement of acute anxiety thanks to the state-trait anxiety
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27 inventory. Thus, it became possible to analyze the influence of anxiety stemming from temporary
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28 stressful situations such as an operation. The inventory was translated by Oner and Le Compte
29 (1985) into Turkish and was adjusted for Turkish society. The average points obtained in the
30 studies conducted by Oner and Le Compte (1985) on patients in surgery services ranged between
31 30 and 41. Oner and Le Compte’s reliability study indicated that the reliability coefficiency
32 ranges between 0.83-0.87 for the trait anxiety scale and 0.94-0.96 for the state anxiety scale [17].
33 Faces Anxiety Scale
34 The faces anxiety scale was developed by McKinley, Coote, and Stein-Parbury. The scale
35 is a single item scale with five possible responses ranging from a neutral face to one showing

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extreme fear. When patient scores MANUSCRIPT
were three or above, their anxiety was determined to be
2 medium to high [15].
3 Post-Delivery Evaluation Form
4 The form developed by the researchers was filled out when the women felt comfortable
5 following the delivery. The form included 13 items on the effects of music on labor pain and the
6 process.
7 Application

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8 The procedures were followed by the women included in the study. All questionnaire forms
9 were filled by the pregnant women at the beginning of the research. The women in the
10 experimental group were made to listen to music in Acemasiran mode for 3 hours (20 minutes

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11 listening, 10 minutes resting) with earphones(dilation 4 cm) when they progressed into the active
12 phase of labor. 30 minutes after they started listening to music and with 1-hour intervals during

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13 the labor, pain perception of the pregnant women was measured with VAS and the labor process
14 was examined with the evaluation form on labor. 30 minutes after completing the music session,

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15 anxiety level was examined by the state anxiety scale and the faces anxiety scale. No additional
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16 practices were followed for the control group other than the routine. In parallel with the
17 experimental group, 30 minutes after the beginning and with 1-hour intervals during the labor,
18 pain perception of the pregnant women were measured with VAS and the labor process was
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19 examined with evaluation form on labor; 30 minutes after completing the music session, anxiety
20 level was examined through the state anxiety scale and the faces anxiety scale. All of the women
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21 in the experimental and control groups filled out the post-delivery evaluation form after the
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22 delivery when they felt comfortable (around 1 hour later).

23 Data Analysis
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24 The data were analyzed using SPSS (Statistical Program for Social Science) 19 for
25 Windows package program. Categorical measurements were expressed using numbers and
26 percentages while numerical measurements were displayed using means and standard deviations.
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27 Comparison of the categorical variables between the groups was performed with the chi-square
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28 test. Independent group's t-test was applied when the hypotheses were met in the comparison of
29 the numerical measurements. Level of significance was taken as 0.05 in all tests [18].
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31 RESULTS
32 No statistically significant difference was found between average ages of participants.
33 The average age for the experimental group was 22.08±2.32 (min:17-max28) and for the
34 control group was 21.04±3.06 (min:16-max26).

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The data on socio-demographic MANUSCRIPT
characteristics of the participants are presented in Table1.
2 The socio-demographic characteristics of experimental and control groups are similar to each
3 other. An analysis of work status for the pregnant women and their husbands reveal that none of
4 the pregnant women were employed (100%) and all the husbands worked (100%).
5 Table 2 includes the distribution of participants' fear regarding labor and the reasons for
6 their fear. An analysis of the pregnant women’s fear indicates that both of the groups have very
7 high levels of fear. All of the experimental group and 92% of the control group stated that they

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8 were very afraid of labor. No statistically significant difference was found between experimental
9 and control groups about their fear of labor.
10 Table 3 demonstrates pregnant women’s status for receiving information and the source

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11 of this information. More than half of the women in both groups received information regarding
12 labor and there is no statistically significant difference between them. The pregnant women in the

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13 experimental group received information mostly from their friends (52%), while the women in
14 the control group received information online (%32). The sources for receiving information are

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15 alike for the women in experimental and control groups. Receiving information from health
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16 professionals is low for both groups. In addition, all of the pregnant women stated that they did
17 not hear about non-pharmacological methods used in labor and thus they did not have any
18 information about them.
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19 The distribution of participants’ relation with the music is provided in Table 4. All of the
20 pregnant women stated that they like listening to music. The distribution of music types that
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21 participants enjoy listening indicates that the folkloric music is the favorite music type for the
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22 experimental group at 36%, while pop music is preferred by the control group at 40%. No
23 statistically significant difference was found between the experimental and control groups about
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24 the music types they enjoy listening to. The analysis of when the participants listen to music
25 revealed that the women in both the experimental and control groups listen to music mostly
26 while doing work. When they were asked what kind of music is relaxing for them, more than half
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27 of the women in both groups stated that they relax while listening to slow music. It was found
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28 that the women in experimental and control groups have similar characteristics about when they
29 listen to music and the kind of music that helps them relax. None of the participants or their
30 husbands received any musical education or was able to play a musical instrument.
31 When the pain of pregnant women in experimental and control groups are analyzed
32 according to the visual analog scale (VAS), it was found that the average score for pain was
33 similar for both of the groups at the beginning and during the first 30 minutes of labor. However,
34 statistically significant difference was observed between the experimental and control groups'

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1 average scores on VAS after ACCEPTED MANUSCRIPT
the 1st hour of labor (p<0.05). Listening to music reduced the
2 feeling of pain for the pregnant women in the experimental group (Table 5).
3 When the pregnant women in experimental and control groups are analyzed in terms of
4 their anxiety level, it was found that their trait anxiety scores were similar, and the state anxiety
5 average scores changed in favor of experimental group after the practice. This difference between
6 the groups was statistically significant (p<0.05). While there was no difference between
7 experimental and control groups in terms of the faces anxiety scale before the practice, after the

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8 practice the faces anxiety scale score of the experimental group became lower and the difference
9 between the groups was statistically significant (p<0.05). After listening to music, the anxiety
10 level of pregnant women in the experimental group was reduced significantly. The participants

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11 were asked to evaluate the difficulty of their labor by grading it between 0-10, 0 referring to the
12 easiest labor and 10 referring to the most difficult. The average score for the difficulty of their

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13 labor was 8.12±1.24 for the participants in the experimental group and it was 8.12±1.24 for the
14 control group. There was a statistically significant difference between the experimental and

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15 control groups about their average scores for the difficulty level of the labor (p<0.05). The
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16 pregnant women in the experimental group stated that their labor was easier (Table 6).
17 Table 7 presents the data regarding the labor process and vital signs of the participants in
18 experimental and control groups. The analysis of dilation and effacement findings of the
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19 pregnant women reveal that no statistically significant difference was found between
20 experimental and control groups at the end of the 1st hour of labor, while dilation and effacement
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21 were found to be more for pregnant women in control group when compared with experimental
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22 group in the 3rd, 5th and 7th hours (p<0.05). The labor process progressed faster for the women
23 in the experimental group. When the pregnant women in the experimental and control groups are
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24 analyzed in terms of contraction periods, no significant difference was found between the groups
25 in the 1st and 7th hours. The contraction period was found to be longer for the participants in the
26 experimental group when compared with the control group in the 3rd and 5th hours (p<0.05).
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27 The analysis of diastolic blood pressure measurements reveals that the diastolic blood pressure of
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28 the participants in the experimental group was lower in comparison to the control group in the
29 1st, 3rd and 5th hours and the difference was statistically significant (p<0.05). No statistically
30 significant difference was found between the participants in experimental and control groups in
31 terms of fetal heart rate, pulse, and respiration rate.
32 Table 8 includes data regarding experimental group’s evaluation of the music following
33 delivery. The pregnant women in the experimental group responded to the question “Can you
34 claim that the music you listened to had an effect on your pain?” as “partially effective” at 88%
35 and “not effective” at 12%. 88% of the pregnant women stated that listening to music helped

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1 them relax. 88% also stated ACCEPTED
it helped themMANUSCRIPT
adjust to the environment, while 72% stated it
2 provided tranquility as well as a sense of trust and 64% stated it helped them reduce their level of
3 pain. 36% said they would like to listen to a different genre of music. While 4 women wanted the
4 music to be religious, 5 women wanted upbeat music. 56% of the women stated they would like
5 to make their babies listen to the music; 7 of them said they would like their babies to listen to
6 the music when they have pain, while 7 said they would like their babies to listen to it when they
7 cannot fall asleep.

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8 At the end of the study, it was found that the women who listened to music in Acemasiran
9 mode during labor expressed their level of pain was lower, had lower anxiety levels, evaluated
10 the labor as easier, had longer periods of contraction and their labor progressed faster.

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11 DISCUSSION
12 Cultures have produced music throughout history and incorporated music into life cycles

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13 from cradle-songs to lament songs. Each culture developed their own genre of music [23]. In a
14 study which aimed at analyzing the effects of light music on pain during the active phase of the

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15 labor of primipara Thai women, Phumdoung and Good (2003) [19] included a total of 110
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16 pregnant women in their study; 55 in the experimental group and 55 in the control group. At the
17 end of the research, 98% of the women stated that the music they listened to helped them and
18 92% stated they liked the music. In a thesis study which aimed at analyzing the effect of training
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19 and music on the labor process for primipara pregnant women who had induction, Ersanli (2007)
20 [6] found that after the delivery 92.5% of the pregnant women in the experimental group stated
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21 that the music helped their pain. 30.2% of the women in the experimental group stated that the
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22 music helped them relax, 26.9% stated it gave them tranquility and assurance, 23.8% said it
23 reduced the feeling of pain and 14.3% claimed it helped them adjust to the environment. The
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24 study by Ersanli (2007) [6] found that the pregnant women listened to music while working and
25 when they had problems. In our study, 88% of the pregnant women stated that listening to music
26 helped them relax, 88% stated it helped them adjust to the environment, while 72% stated it
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27 provided tranquility as well as a sense of trust and 64% stated it helped them reduce their level of
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28 pain. The results of our study are in line with this literature. Listening to music helps women
29 relax during labor.
30 In line with the other studies [22-24], it was found that women who participated in our
31 study also had a fear of pain during labor. In a study conducted by Phumdoung and Good (2003)
32 [19], it was found that the pregnant women's pain perception was lower in the group that listened
33 to music and that there was a significant difference between this group and the control group. In
34 their study, Liu et al (2010) [14] found that the average scores of pregnant women for anxiety
35 and pain were significantly lower in the experimental group in the latent phase of labor, while

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1 there was no difference duringACCEPTED MANUSCRIPT
the active phase. In their study on the effects of music on labor
2 and the baby, Tabarro et al. (2010) [21] found that the participants' pain, anxiety, and fear
3 lessened during contractions, and they adjusted to the hospital more easily. In Fulton’s study
4 (2005) [7], which aimed at identifying the effects of music on physiological measurements, pain
5 and fatigue perception at the early phase of labor (less than 6 cm dilated), 20 pregnant women
6 were included in the experimental group and 20 in the control group. It was found that the
7 perceptions of pain and anxiety were lower for the pregnant women in the experimental group

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8 and the difference between the two groups was statistically significant. In addition to lower pain
9 perception for the participants in experimental group when compared with the control group, it
10 was also found that the uterine contraction intensity was higher. No statistically significant

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11 difference was found between fetal heart sounds. In their study which aimed at identifying the
12 effects of music on pain perception and anxiety levels of primipara women in the first phase of

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13 labor, Nayak et al. (2014) [16] found a significant decrease in pain perception and anxiety level
14 of women after listening to music. In their studies on the effect of music on pain and labor

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15 processes of primipara women during the active phase of the labor, Hosseini et al. (2013) [10]
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16 included 30 people in their study; 15 for the experimental and 15 for the control group. The study
17 indicated that pain levels of women in the experimental group were significantly lower and their
18 labor progressed more effectively after listening to music. In their study on the effect of music on
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19 the perception of labor pain during the latent phase of labor, Labrague et al. (2013) [13] found
20 that the perception of pain of women in the experimental group was significantly lower after
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21 listening to music. The findings in our study are in line with this literature. Our study indicated
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22 that the pregnant women who listened to music in Acemasiran mode during labor stated that their
23 level of pain was lower, evaluated their anxiety levels as lower, the labor as easier, had longer
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24 contraction periods and their labor progressed faster.

25 The type of music listened to during labor was selected by The Group for the Research
26 and Promotion of Turkish Music, and the pregnant women were not asked which type of music
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27 they would like to listen to. This can be considered a limitation of the study. In upcoming studies,
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28 the music that pregnant women enjoy can be played during labor and its effect on labor pain and
29 anxiety can be analyzed. Moreover, the study was conducted only on healthy primiparas. The
30 study can be repeated by including multipara and at-risk pregnancies as well.
31
32 CONFLICT OF INTEREST
33 The authors declared no conflicts of interest with respect to the authorship and/or
34 publication of this article.
35

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2 ACKNOWLEDGEMENTS
3 We would like to thank all the women who volunteered to participate in the study.
4
5 FUNDING STATEMENT
6 This study was funded by Cukurova University Department of Scientific Research Project
7 with ASYO2012BAP7 number.

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30 12. Kemper, K. J., Danhau, S. C. (2005). Music as a therapy. Southern Medical Journal,98, 282-
31 288.
32 13. Labrague, L. J., Rosales, R. A., Rosales, G. L., Fiel, G. B. (2013). Effects of soothing music on
33 labor pain among Filipino mothers. Clinical Nursing Studies, 1, 35-42.
34 14. Liu, Y. H., Chang, M. Y., Chen, C. H. (2010). Effects of music therapy on labour pain and
35 anxiety in Taiwanese first-time mothers. Journal of Clinical Nursing, 19, 1065–1072.

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1 15. Mckinley, S., Coote, K., Stein-Parbury, (2003). Development and testing of a Faces Scale
2 for the assessment of anxiety in critically ill patients. Journal of Advanced Nursing, 41, 73-79.
3 16. Nayak, D., Rastogi, S., Kathuria, O. K. (2014). Effectiveness of music therapy on anxiety level,
4 and pain perception in primipara mothers during first stage of labor inselected hospitals of
5 Odisha. OSR Journal of Nursing and Health Science, 3, 7-14.
6 17. Oner, N., Lecompte, A. (1998). State-Trait Anxiety Inventory. (2nd ed.). Istanbul: Bogazici
7 University Publishing.

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8 18. Ozdamar, K. (2003). Biostatistics with SPSS. (5th ed.). Eskisehir: Kaan Publishing.
9 19. Phumdoung, S., Good, M. (2003). Music reduces sensation and distress of labor pain. Pain
Management Nursing, 4, 54–61.

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11 20. Phumdoung, S., Youngvanichsate, S., Jongpaiboonpatana, W., Leetanaporn, R. (2007). The

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12 Effects of the PSU Cat Position and Music on Length of Time in the Active Phase of Labor and
13 Labor Pain. Thai J Nurs Res, 11, 96-105.
14 21. Tabarro CS, Campos LB, Galli NO, Novo NF, Pereira VM. (2010). Effect of the music in labor

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15 and newborn. Rev Esc Enferm USP, 44, 441-448.
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16 22. Toohill, J., Fenwick, J., Gamble, J., Creedy, D. K, Buist, A., Ryding, E. L. (2014). Psycho-
17 Social predictors of childbirth fear in pregnant women: An Australian study. Open Journal of
18 Obstetrics and Gynecology, 531-543. http://dx.doi.org/10.4236/ojog.2014.49075.
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19 23. Wolf, L., Wolf, T. (2011). Music and Health Care. Copyright: Carnegie Hall and WolfBrown.
20 24. Yildirim, G. (2001). The effects of breathing and tactile stimulation techniques on the pain
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21 perception of pregnant women during labor. Istanbul University Institutes of Health Sciences
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22 Master Thesis. Istanbul, Turkey.

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Table 1. Socio-demographic characteristics of MANUSCRIPT
the participants

Experimental Control
Characteristics
n % n % χ² p
Education
Illiterate 2 8.0 2 8.0
Literate 3 12.0 2 8.0
0.420 0.936
Primary School 13 52.0 15 60.0
High School 7 28.0 6 24.0
Education of Partner

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Literate 7 28.0 4 16.0
Primary School 11 44.0 6 24.0 5.198 0.074
High School 7 28.0 15 60.0
Economic Status

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Minimum 3 12.0 3 12.0
Middle 19 76.0 15 60.0 2.071 0.355
Good 3 12.0 7 28.0

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Planning of
Pregnancy
Yes 22 88.0 21 84.0
0.166 0.684

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No 3 12.0 4 16.0
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Table 2. Distribution of Participants’ Fear Regarding Labour and The Reasons of Their Fear
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Fear Regarding Labour and The Experimental Control

Reasons of Their Fear n % n % χ² p
Fear Regarding Labour
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Yes 25 100.0 23 92.0

2.083 0.149
No - - 2 8.0
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Reasons of Fear
Pain 5 20.0 10 40.0
First pregnancy 10 40.0 5 20.0
5.733 0.220
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Labor 6 24.0 4 16.0

Birthing chair 4 16.0 4 16.0

Table 3. Distribution of Pregnant Women’s Status for Receiving Information and Their
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Sources of Information
Experimental Control
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χ² p
n % n %
Receiving Information
Yes 14 56.0 13 52.0
0.081 0.777
No 11 44.0 12 48.0
Sources of Information*
Friend 13 52.0 7 28.0 3.000 0.083
Internet 8 32.0 9 36.0 0.089 0.765
Health Professional 5 20.0 7 28.0 4.140 0.064
Mother 1 4.0 5 20.0 3.030 0.082
TV-Radio 1 4.0 2 8.0 2.083 0.149
* More than one option is marked.

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Table 4. Distribution of Participants’ Relation with the Music
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Experimental Control
χ² p
n % n %
Like listening to music
Yes 25 100.0 25 100.0
Enjoy listening music types
Folkloric music 9 36.0 4 16.0
Pop music 3 12.0 10 40.0
Arabesque music 4 16.0 2 8.0 6.593 0.159
Hymn 3 12.0 4 16.0
It doesn't matter/All of them 6 24.0 5 20.0

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Time the listening to music
Doing work 11 52.4 10 47.6
Rest 9 36.0 7 28.0 0.990 0.610

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When I am sad/bored 5 20.0 8 32.0
Kind of music is relaxing for them
Slow music 16 64.0 13 52.0

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Folkloric music 5 20.0 6 24.0 0.801 0.670
Pop music 4 16.0 6 24.0

Table 5. Findings of Visual Analogue Scale

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Experimental Control
Time of VAS
X ±SD X ±SD t p
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Beginning 4.32±0.476 3.72±1.595 27.616 0.078

First 30 minutes 4.32±0.476 3.96±1.620 24.877 0.292
1. Hour 3.28±0.458 4.56±2.083 36.028 0.004
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2. Hour 2.64±0.952 5.32±1.909 18.340 0.000

3. Hour 2.60±0.577 5.76±2.260 38.637 0.000
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4. Hour 3.24±0.436 6.68±2.410 57.464 0.000

5. Hour 3.76±0.831 7.40±2.179 50.097 0.000
6. Hour 4.04±1.020 7.40±2.887 15.190 0.000
7. Hour 4.52±0.510 7.96±3.434 17.437 0.001
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8. Hour 4.60±2.102 7.40±3.841 7.253 0.002

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Table 6. Findings About Scales Anxiety of Participants’ and Scores for Difficulty Level of the
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Labour
Experimental Control
X ±SD X ±SD t p
Trait Anxiety 43.52±4.91 43.76±5.27 0.137 0.868
State Anxiety
Before listening to music 56.96±10.48 52.44±11.96 0.003 0.162
After listening to music 43.20±6.91 66.48±7.81 0.134 0.000
Face anxiety scale
Before listening to music 4.24±0.66 3.44±1.35 18.698 0.111
After listening to music 5.60±1.82 8.40±1.52 3.427 0.000
Scores for Difficulty Level
6.64±1.04 8.12±1.24 0.126 0.000
of the Labour

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Table 7. Findings About Labor Process and Vitals of Participants

1. Hour 3. Hour 5. Hour 7. Hour

Exp* Cont** t Exp* Cont** t Exp* Cont** t Exp* Cont** t
X ±SD X ±SD p X ±SD X ±SD p X ±SD X ±SD p X ±SD X ±SD p

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121.121 118.409 3.789 0.053
Dilatation 4.00±0.00 3.86±0.65 6.00±0.00 4.68±0.85 7.44±0.51 6.28±0.89 8.88±1.01 8.08±1.15
0.068 0.000 0.000 0.012
58.80±13.3 62.40±10.9 5.822 74.00±10.4 16.208 83.20±12.4 16.798 100.00±0.0 53.720

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Effacement 85.60±5.07 98.00±4.08 92.00±7.07
4 1 0.301 1 0.000 9 0.000 0 0.000
Fetal Hearth 146.64±4.7 146.96±6.1 2.375 145.44±3.2 144.96±3.7 0.414 143.44±2.1 142.16±4.8 12.725 139.60±6.7 137.04±7.7 0.374

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Rate 1 4 0.837 4 0 0.628 2 6 0.234 6 4 0.219
Period of 0.129 100.724 46.219 55.983
39.00±11.0 68.60±21.1
contraction 11.60±6.28 12.96±5.16 30.00±0.12 25.36±6.42 43.80±2.18 75.20±7.14
0.066 0.001 9 0.039 4 0.146

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(second)
Frequency of 7.438 2.571 3.003 9.292

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1.56±0.44 1.44±0.51 2.06±0.51 1.88±0.60 3.64±0.81 2.92±0.70 4.64±0.76 4.40±1.78
contraction 0.124 0.248 0.002 0.538
0.848 8.998 1.623 4.226
Pulse 75.20±2.45 77.68±2.81 80.16±2.58 81.04±2.01 84.16±2.70 83.68±3.68 89.12±1.01 89.28±1.62

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0.002 0.185 0.602 0.677
1.261 2.000 21.297 85.338
Breath 17.92±1.35 18.32±1.49 20.40±0.82 20.40±1.41 22.40±0.82 22.08±1.78 24.00±0.22 23.12±1.30
0.325 1.000 0.417 0.001

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Systolic tension 104.00±8.1 108.80±7.8 0.002 104.40±5.0 110.00±5.7 3.241 112.00±4.0 112.00±6.4 4.527 112.40±4.3 109.60±6.7 0.803
arterial 6 1 0.039 7 7 0.001 8 5 1.000 6 6 0.088

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Diastolic 27.034 0.311 3.218 2.571
62.00±4.08 66.40±8.60 64.40±5.07 69.20±6.40 62.00±4.08 70.00±5.77 72.40±4.36 70.40±7.35
tension arterial 0.025 0.005 0.000 0.248
* Experimental **Control
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Table 8. Findings About Experimental MANUSCRIPT
Evaluation for the Music Following the
Delivery

n:25 %
Can you claim that the music you listened Partially effective 22 88.0
had an effect on your pain? Not effective 3 12.0
What do you think about musictherapy on your labor?
Yes 22 88.0
Helped me relax
No 3 12.0

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Yes 22 88.0
Helped me adjust to the environment,
No 3 12.0
Yes 18 72.0
Provided peace and trust

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No 7 28.0
Yes 16 64.0
Helped me reduce my feeling of pain
No 9 36.0

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Would you like to listen to a different Yes 9 36.0
music? No 16 64.0
What kind of music would you like to Hymn 4 44.0
listen? Upbeat 5 56.0

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Yes 14 56.0
Would you like to make your babies listen
No 6 24.0
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to the music?
I don’t know 5 20.0
When they cannot
7 50.0
When would you like to make your babies fall into sleep
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listen to the music? When they have

7 50.0
pain
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Highlights

• Labor is one of the most intense pain sources that is known, and it is important to
support the women during labor.
• Musicotherapy might be used to reduce pain and anxiety in labor.
• The present study is the first in our country to investigate the effects of Acemasiran
mode music on the pain and anxiety of women during labor in their first pregnancy.

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