Running head: MUSIC AND MILK 1

Music and Milk: A Winning Combination

Caitlynne Scott

April 23, 2021

Jackson College, School of Nursing

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Music and Milk: A Winning Combination

For centuries mothers have breastfed their babies and it is one of the most basic human

instincts newborns have. The World Health Organization (WHO) currently recommends that

breastfeeding should be initiated within the first hour of birth and continued up until the age of

two with exclusivity up to six months (Breastfeeding, n.d.). Breastmilk provides nutrients,

enzymes, antioxidants, and antibodies for the infant to survive that other sources of infant

nutrition does not offer. Although, breastfeeding is natural and the simplest way to positively

impact an infants overall growth and development, there are many other factors that play into a

successful breastfeeding journey. Internal and external variables can be major key players in a

mothers ability to lactate and produce the “liquid gold” (Somberg, 2020)

PICOT Question

Nurses are one of the first to give supportive care to a new breastfeeding mother and her

newborn. They understand the importance of providing adequate nutrition to the infant and see

the struggling mothers that battle their own bodies to produce that nutrition. There is often a

wonder if more could be done by nurses to promote lactation post-delivery. This raises the

question: Could the introduction of music therapy increase lactation in new mothers during the

postnatal period?

Therapy Question

The PICOT question being researched is a therapy style question. This type of question

addresses a specific therapy intervention and whether or not it produces a result different when

compared to no therapy intervention. In this paper, the PICOT question looks to answer if a

musical therapy intervention increases milk production in postpartum mothers.

Evidence
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Therapy style questions are best answered with well-designed random control tests and

evidence based clinical practice based on random control tests. For this PICOT question, random

control studies and evidence-based practice revolving around lactation and milk production in

mothers that use music therapy versus mothers that do not would be most applicable.

Databases

The two databases used for this paper were CINAHL and Google Scholar. The CINAHL

database was used for the first search, using the terms “lactation + music therapy” for seven

results and one full text hit in Spanish. The final search in CINAHL used the terms

“breastfeeding or breast-feeding or infant feeding or lactation or lactating + music therapy or

music intervention or musical therapy” resulting in 46 hits and 17 full text hits with 3 relevant to

the PICOT question.

The Google Scholar database was difficult to narrow down numbers. The first search

terms used were “music therapy + lactation” with a 2015 to 2021 date range. This search resulted

in 2,100 full text articles with the first five articles being pertinent to the research. The final

search terms were “music therapy + lactation + breastfeeding” that produced 1,180 full text

results with similar articles as the first search, many being relevant to the PICOT inquiry.

Research Methods

Of the seven articles used for this paper, one was a systematic review of a randomized

controlled trial, one was a systematic review and a meta-analysis of randomized controlled trials,

one was a qualitative analysis and four were randomized controlled trial studies.

Level of Evidence

The majority of evidence available for this PICOT question includes evidence at Levels I

and II. The Level I evidence founded for this paper was a systematic review of a randomized
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controlled trial and a meta-analysis of a randomized controlled trial. All but one article was

based on a randomized controlled trial which is Level II. The article that was not Level I or II

was based on a controlled trial non-randomized study which is Level III evidence. Considering

the number of trials completed around this subject, the overall level of evidence is high.

Most evidence founded for this paper revolved around a group of lactating women

randomly chosen to be a part of a study where music therapy was introduced while

breastfeeding.

Summary of Findings

The databases show that there has been multiple studies completed in the last forty years

and across numerous different countries involving music therapy and lactation. Most articles

focused on lactation, music interventions, and relaxation for the mother.

A 2020 study, completed by Haley Nguyen, RN, BSN, RNC-MNN and Sharon Aduna,

RN, MSN, focused on music therapy and its effects on relaxation and breastfeeding anxiety. The

objective of the study was to determine whether music therapy increased relaxation and reduced

breastfeeding anxiety (Nguyen et al., 2020). Evidence supporting this PICOT question is that

“scientific literature demonstrates that music therapy is an effective evidenced-based intervention

to improve the following outcomes: milk volume, cortisol level, anxiety-related behaviors, and

self-reported relaxation and anxiety (Nguyen et al., 2020).” It is discussed that maternal anxiety

decreases the milk production by inhibiting the milk ejection reflex or “let-down”. During the

study, all breastfeeding women that were admitted into the postpartum unit was offered to

participate. Within 24 to 96 hours postpartum, the participants listened, through headphones, to

their choice of musical audio: lullaby, instrumental, or piano with nature sounds. This would

continue for five minutes prior to breastfeeding. The participants would then began breastfeeding
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and listen to the same choice of music through a speaker. Post feeding, a survey was completed

which allowed the mothers to report their level of relaxation. Nguyen and Aduna found that

music therapy did decreases anxieties, promote relaxation, and strengthen the milk ejection

reflex (2020.)

304 women of full-term infants participated in a randomized controlled trial completed in

Thailand. All had vaginal births and were at least 37 weeks gestation. Of those women, 152 of

them listened to three versions of the song “Im Oon,” which in Thai translates to “full warmth,”

immediately postnatal for 11 minutes (Kittithanesuan et al., 2017). “The lyrics in this song are

meant to convey the feelings of warmth and security that a mother is able to provide for her

child, whether physical (such as a simple hug or a kiss) or emotional (such as maternal-child

bonding during breastfeeding)” (Kittithanesuan et al., 2017). Post music and infant suckling

46.7% had a milk eject more than 3 drops of milk without flow, 14.5% had more than 3 drops

with flow, and 31.6% had 1 to 2 drops. The control group, without music, had significantly less

at 28.9% ejection more than 3 drops without flow, 9.9% had more than 3 drops with flow, and

40.1% had 1 to 2 drops (Kittithanesuan et al., 2017). In this study it shows the combination of

music and infant suckling to drastically increase milk production.

In another randomized controlled trial in Thailand, the focus shifts from vaginal full-term

births to full-term cesarean section births. For this study, a total of 185 women participated and

were separated into three groups: mothers who did not listen to music, mothers who listened to

music during cesarean section, and mothers who listened to music during the cesarean section

and in the postpartum unit (Chawanpaiboon et al., 2021). This trial did not show the same trends

with an increase in milk production as previous trials with no significant difference during the

first 6 months of breastfeeding, however, an interesting study of sub-groups showed promising

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results. Of the women who listened to music in the postpartum unit, half were admitted to a

common ward and the other half were admitted to a private ward. The women in the private

ward had more success in exclusively breastfeeding than those who were not (Chawanpaiboon et

al., 2021).

A study completed by Douglas Keith, PhD, Barbara Weaver, RN, and Robert Vogel,

PhD, focused on music-based listening and what effect it has on the volume, fat content, and

caloric content of breastmilk produce by mothers of premature and critically ill infants (2012). In

a 14-day randomized controlled trial, 162 mothers of preterm infants were placed into 3

experimental groups and 1 control group. The 3 experimental groups involved music-based

listening and guided imagery interventions, whereas the control group received standard nursing

care. The mothers in the experimental groups produced significantly more milk than those of the

control group. In day one of the trial, all four groups produced roughly the same amount of

breast milk. By the end of day 14, the groups that were subject to music-based listening and

guided imagery produced 600 milliliters, 900 milliliters, and 1000 milliliters, respectfully,

whereas the control group produced 300 milliliters (Keith et al., 2012). Not only was there a

significant increase of milk production from all three music-based listening groups but there was

also found to be an increase in fat content during the first 6 days of lactation. The control group

had an average fat content between 40 and 50 grams per liter of fat. Two of the experimental

groups averaged between 45 and 60 grams per liter of fat and the fourth group had an astounding

fat production climbing from 50 grams per liter to over 90 grams per liter of fat (Keith et al.,

2012).

Lastly, a randomized controlled trial that took place from December 2012 to May of 2013

focused on mothers of premature infants in a Neonatal Intensive Care Unit (NICU) that used a
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breast pump for expression of breastmilk (Jayamala et al., 2015). Thirty women participated and

each women involved in the study completed eight pumping sessions, four with music therapy

and four without music therapy. The music used for this study was a thirty minute instrumental

audio recording of a flute. This study was completed over four days. For day one, the session

without music therapy produced 6.56 milliliters compared to 7.04 milliliters (mL) with music

therapy. This pattern continues throughout the trial: day two without music therapy produced

6.26 mL, with music therapy produced 6.71 mL; day three without music therapy produced 6.55

mL, with music therapy produces 6.85 mL; day four without music therapy produced 7.34, with

music therapy produced 7.86 mL (Jayamala et al., 2015).

There has been no negative effects from using music therapy found during the studies

researched for this paper. Overall, the research gathered for this paper does show support in

music therapy improving lactation in mothers during the postnatal period. Therefore, the PICOT

questioned has been answered in support of musical intervention for postnatal women.

Clinical Implications and Conclusion

The clinical implications for the use of music therapy with postpartum clients could be a

revolutionary force in the world of lactation. The research in this paper shows an overwhelming

support for music therapy and its ability to induce the production of high-fat, high-quality breast

milk compared to the option of no therapeutic intervention. Nurses across multiple spectrums –

labor and delivery, NICU, nurse lactation specialists, pediatric nurses – could implement some

form of musical therapy in their care that would support their patient’s needs. This could be

implemented by playing audio recordings of relaxing music, or recording of the mother’s choice,

it could also be the mother singing or humming to their infant. Hospitals could implement

policies for the immediate introduction of music post-delivery and in postpartum units while
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allowing patient autonomy for the choice of music. Patient education about the impact of music

on lactation would be beneficial to mothers as well as the actual act of listening as it would

increase the mother’s breastfeeding knowledge and increase confidence with caring for their

newborn. This addition to postpartum care could help eliminate or decrease maternal stress and

anxiety related to breastfeeding.

Many of these studies focused on the first six months of lactation and further research is

needed to see if the benefit of music therapy is still applicable the longer the mother is

breastfeeding and if different types of music create different results but it is obvious that any

music therapy can change how a mother begins her breastfeeding journey and increase the

nutritious milk she produces for her newborn. If music therapy is brought into postpartum units

the benefits would come full circle improving the mother’s and infant’s health.
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References

Breastfeeding. (2019, November 11). World Health Organization. https://www.who.int/health-

topics/breastfeeding#tab=tab_2

Chawanpaiboon, S., Titapant, V., & Pooliam, J. (2021). A Randomized Controlled Trial of the

Effect of Music During Cesarean Sections and the Early Postpartum Period on

Breastfeeding Rates. Breastfeeding Medicine, 16(3), 200–214.

https://doi.org/10.1089/bfm.2020.0299

Düzgün, M. V., & Özer, Z. (2020). The effects of music intervention on breast milk production

in breastfeeding mothers: A systematic review and meta‐analysis of randomized

controlled trials. Journal of Advanced Nursing, 76(12), 3307–3316.

https://doi.org/10.1111/jan.14589

Keith, D. R., Weaver, B. S., & Vogel, R. L. (2012). The Effect of Music-Based Listening

Interventions on the Volume, Fat Content, and Caloric Content of Breast Milk–Produced

by Mothers of Premature and Critically Ill Infants. Advances in Neonatal Care, 12(2),

112–119. https://doi.org/10.1097/anc.0b013e31824d9842

Kittithanesuan Y, Chiarakul S, Kaewkungwal J, Poovorawan Y. Effect of Music on Immediately

Postpartum Lactation by Term Mothers after Giving Birth: A Randomized Controlled

Trial. J Med Assoc Thai 2017;100:834.

Jayamala, A., Preethi, B., Pradeep, G. C. M., & Jaisri, G. (2015). Impact of Music Therapy on

Breast Milk Secretion in Mothers of Premature Newborns. JOURNAL OF CLINICAL

AND DIAGNOSTIC RESEARCH, 4–6. https://doi.org/10.7860/jcdr/2015/11642.5776

Nguyen, H., & Aduna, S. (2020). Effect of Music Therapy on Relaxation and Breastfeeding

Anxiety. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6), S62–S63.

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https://doi.org/10.1016/j.jogn.2020.09.109

Somberg, H. (2020). Investigating the Benefits of Music Therapy for Mothers of Babies in the

Neonatal Intensive Care Unit. https://doi.org/10.17615/g2v3-3h15