Hindawi

Applied Bionics and Biomechanics

Volume 2022, Article ID 8963656, 6 pages
https://doi.org/10.1155/2022/8963656

Research Article
Effect of Music Therapy Combined with Free Position Delivery on
Labor Pain and Birth Outcomes

Huimin Guo,1 Mochun Que,2 Jie Shen,1 Qiaole Nie,3 Youguo Chen,1 Qin Huang,1
and Aiying Jin 1
1
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Jiangsu, China
2
Department of Physiology and Neurobiology, Medical College of Soochow University, China
3
Beijing Yuedi Music Analgesia Labor Institute, Beijing, China

Correspondence should be addressed to Aiying Jin; aiyingjin@163.com

Received 28 February 2022; Revised 18 April 2022; Accepted 27 April 2022; Published 11 May 2022

Academic Editor: Fahd Abd Algalil

Copyright © 2022 Huimin Guo et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective. At present, the clinical effect of music therapy combined with free position to assist delivery is rarely reported. Based on
evidence-based nursing, this study is aimed at exploring the effect of the combination of music therapy and free position delivery
on labor pain and maternal and fetal outcomes. Methods. A total of 440 primiparas with vaginal delivery in the Department of
Obstetrics and Gynecology of the First Affiliated Hospital of Soochow University between July 2018 and July 2019 were
selected. They were divided into music therapy, free position delivery group (n = 201) and traditional delivery group (n = 239).
Subsequently, the two groups were compared in terms of the Chinese Perception of Labor Pain Questionnaire (PLPQ) score,
bleeding amount at 2 hours after birth, perineal injury, labor stage duration, and 1 minute Apgar score. Results. The
combination group had better results of the Chinese PLPQ score, postpartum hemorrhage, and perineum condition. However,
compared with traditional delivery, a longer duration of the first stage and total stage of labor was found in the combination
group. Music therapy combined with free position delivery required less medical intervention during delivery, and there was
no significant difference in 1 minute Apgar score between the two groups. Conclusions. Music therapy combined with free
position delivery, an intervention based on evidence-based nursing, can effectively reduce maternal labor pain, postpartum
hemorrhage, soft birth canal injury, and medical intervention during labor. It is, therefore, a safe intervention to assist delivery.

1. Introduction sity. Labor pain causes strong subjective discomfort of partu-

Labor pain is a complex physiopsychological experience dur-
ing delivery in women, and high-level and long-lasting pain
will have a markedly adverse effect on delivery. It has been
reported that 60% of primipara have experienced severe labor
pain [1]. Unlike other types of pain, labor pain cannot be pre-
dicted and controlled and is enhanced with the progress of
labor [2]. Labor pain is not only affected by physiological
factors such as prostacyclin, birth canal, fetal position, and
uterine contraction intensity but also involves psychological
factors. To be specific, emotions such as prenatal anxiety
and fear will stimulate the sympathetic-adrenal medullary
system, thus leading to increased levels of pain mediators
and hypoxic metabolites and ultimately increased pain inten-
rients. It can induce adverse birth outcomes such as maternal
and fetal hypoxia and failure of a trial of labor and even
maternal emotional disorders in severe cases [3]. The Amer-
ican College of Obstetricians and Gynecologists (ACOG)
points out that after exclusion of medical contraindications,
maternal needs are the sufficient indication for labor analge-
sia. At present, the most commonly used method of labor
analgesia in clinical practice is spinal anesthesia, which takes
effect quickly and blocks nerve conduction to relieve mater-
nal pain [4]. However, it may prolong the second stage of
labor and results in increased oxytocin dosage, with disad-
vantages such as traumatic injury, puncture risk, and anes-
thesia risk [5]. Therefore, it is necessary to find other safe
and effective methods to assist delivery.
2 Applied Bionics and Biomechanics
The World Health Organization (WHO) proposes that
some relaxation skills can be used to relieve pain according
to their willingness for healthy parturients who require anal-
gesia during labor, such as progressive muscle relaxation,
breathing regulation, music, meditation, appropriate exer-
cise, and upright position [6]. Domestic and foreign scholars
have reported that music can promote maternal relaxation in
the early stages of labor and serve as a stimulus for uterine
action in the later stages of physical exertion, reducing anxi-
ety and pain during labor [7]. The effect of music on human
physiology is achieved by stimulating the auditory center and
then acting directly on the limbic system, reticular formation,
hypothalamus, and cerebral cortex of the brain. Because the
auditory center and pain center of the cerebral cortex are
adjacent, stimulating the auditory center can inhibit the pain
center, thereby reducing the level of β-endorphin immunore-
activity, increasing oxygen supply to tissues and organs, inhi-
biting the production of endogenous pain-suppressing
substances and promoting the metabolism of pain-inducing
substances, and ultimately decreasing pain perception [8].
Delivery in free position is recommended by WHO in Care
in normal birth: a practical guide, and this position can
reduce cesarean section, postpartum hemorrhage, and the
use of painkillers and oxytocin during delivery and promote
spontaneous delivery [9]. At present, the clinical effect of
music therapy combined with free position to assist delivery
is rarely reported, so we explored this based on evidence-
based nursing.
2. Materials and Methods
2.1. Collection of Patient Information. We selected 440 pri-
miparas who underwent vaginal delivery in the Department
of Obstetrics and Gynecology of the First Affiliated Hospital
of Soochow University during July 2018-July 2019. They
were divided into music therapy, free position delivery
(n = 201) and traditional delivery group (n = 239) according
to the principle of randomized control. Inclusion criteria
were as follows: (1) primipara with spontaneous vaginal
delivery, (2) singleton pregnancy, and (3) no pregnancy
complications. Exclusion criteria were as follows: (1) prema-
ture delivery; (2) abnormal maternal mental status; and (3)
patients receiving drug analgesia, assisted vaginal delivery.
Informed consent was obtained from all patients and their
families, and this study was approved by the Ethics Commit-
tee of the First Affiliated Hospital of Soochow University
(No. 2022-075).
2.2. Intervention Methods. Music therapy experts designed
personalized music therapy based on maternal personal
experiences and preferences. Before birth, efforts were taken
to pacify the mood of primiparas. When the cervix dilated to
2 mm, the parturient patient has entered a single-room
delivery room. Appropriate medical treatment such as intra-
venous oxytocin and artificial rupture of membranes was
given during delivery based on the status of uterine contrac-
tions, progress of labor, and the requirements of family
members.
In the traditional delivery group, the parturient was in a
supine position during the whole stage of labor and in a
semirecumbent position (50°) during the second stage of
labor.
By contrast, in the music therapy, free position delivery
group, in the early stage of the first stage of labor, the partu-
rient was instructed to take the lateral decubitus position,
semirecumbent position, or semi-Fowler’s position, with
gentle and comfortable meditation or hypnotic music for
relaxation. In the middle and late stages of the first stage of
labor, the parturient was instructed to choose different posi-
tions such as walking, kneeling, sitting, or lying prone on a
birthing ball and change the position once in 15-20 minutes,
with intense rhythmic music played. In the second and third
stages of labor, lateral decubitus position or semirecumbent
position (50°) was used, with parent-child music played.
The postpartum conditions of all parturients were
recorded, including presence or absence of medical interven-
tion and the length of labor.
2.3. Perception of Labor Pain Questionnaire (PLPQ)
(Chinesized). The perception of labor pain questionnaire
[10] Chinesized and verified by Jin et al. [11] was employed
for evaluating the parturient’s perception of labor pain. The
scale consists of 2 components (pain response and pain toler-
ance) including 16 items. By using Likert 5-level scoring, each
item was rated as 1 (quite correct), 2 (correct), 3 (uncertain),
4 (incorrect), and 5 points (quite incorrect), respectively. The
higher the score, the more severe the labor pain.
2.4. Apgar Score at 1 min [12]. On completion of airway
clearance, amniotic fluid drying, and tactile stimulation,
Apgar score was checked within 1 minute after birth. Neo-
nates were assessed from 5 aspects: heart rate, reflex
response, muscle tone, respiration, and skin color. Each item
was rated as 0-2 points, with a total score of 10 points, and
lower scores represent worse neonatal status.
2.5. Perineal Pain Score [13]. The degree of postpartum per-
ineal tear was recorded: 0 point: third-degree perineal lacer-
ation or above, 1 point: lateral episiotomy, 2 points: median
episiotomy or second-degree perineal laceration, 3 points:
first-degree perineal laceration, and 4 points: intact
perineum.
2.6. Amount of Bleeding at 2 Hours after Birth [14]. The
amount of blood loss at 2 hours after birth was calculated
and recorded: volume of bleeding at 2 hours after birth =
blood loss in blood collection drape placed under the
woman’ s buttocks + ðwet weight of blood − soaked dressings
− dry weight of dressingsÞ/1:05.
2.7. Statistical Analysis. All data were analyzed using SPSS
26.0. Measurement data were expressed as mean ± standard
deviation (mean ± SD), with paired t-test used for compari-
son between the two groups. Enumeration data were
expressed as frequency (n) or rate (%), with a chi-square test
for statistical analysis. The difference was regarded as signif-
icant if P values < 0.05.
Applied Bionics and Biomechanics 3

Table 1: General information of parturients in the two groups.

Music therapy, free position delivery Traditional delivery P

Items Statistics
group (n = 201) group (n = 239) value
Age (year, x̅ss) 27:85 ± 3:53 27:99 ± 3:60 -0.4011) 0.688
Height (cm, x̅ss) 160:03 ± 16:59 161:76 ± 10:26 -0.7901) 0.404
Weight (kg, x̅ss) 58:17 ± 15:40 56:54 ± 8:02 1.4201) 0.156
1)
Gestational age (week, x̅ss) 39:26 ± 0:98 39:07 ± 2:70 1.052 0.294
Gravidity (time, x̅ss) 1:36 ± 0:60 1:37 ± 0:63 -0.2141) 0.830
Education
Primary school 1 0 2.6482) 0.754
Junior high school 6 11
Senior high school/technical school/technical
18 17
secondary school
Junior college 78 90
Undergraduate 82 103
Master’s degree or above 16 18
Occupation
Full-time wife 15 18 2.1812) 0.336
In-service 166 186
Unemployed/between jobs 20 35
Income (RMB)
10,000 or above 21 34 3.4342) 0.329
5000-10,000 129 133
2000-5000 34 50
<2000 17 22
Household registration
Nonagricultural 127 137 1.4742) 0.225
Agricultural 74 102
Note: 1) represents t value, while 2) represents χ2 value.

3. Results
3.1. General Information of Parturients in the Two Groups
Had No Significant Differences. A total of 440 primiparas
were included, including 201 in the music therapy, free posi-
tion delivery group and 239 in the traditional delivery group.
There were no significant differences in age, height, weight,
gestational age, gravidity, education, occupation, and
income between the two groups, indicating that the two
groups were comparable (Table 1).
3.2. Effect of Two Delivery Modes on Maternal Labor Pain
Response and Tolerance. The Chinese PLPQ score was used
to evaluate the effect of the two modes of delivery on mater-
nal labor pain. The results showed that in comparison with
traditional delivery, a combination of music therapy and free
position could obtain lower levels of pain response, pain tol-
erance, and total pain score of parturients, suggesting the
combination could effectively relieve labor pain (Table 2).
3.3. Effect of the Two Delivery Modes on Maternal and
Fetal Outcomes. The differences in the maternal and fetal
outcomes between the two groups were further compared.
We found the combination group had a longer duration in
the first stage and total stage of labor, but the bleeding
amount at 2 hours after the delivery was significantly
reduced, and the perineum condition score was significantly
increased. Additionally, compared with the traditional deliv-
ery, music therapy combined with free position delivery
resulted in a lower proportion of parturients requiring med-
ical intervention during delivery. But there was no significant
difference in 1-minute Apgar score between the two groups
of newborns (Table 3). The above results indicated that
music therapy combined with free position delivery could
reduce maternal labor pain and improve maternal and fetal
outcomes.
4. Discussion
Studies of Hu [15] and Peng [16] have shown that music
therapy can relieve anxiety and pain-induced stress reactions
during delivery. Also, Zhang et al. [17] believe that personal-
ized music intervention can stimulate the senses of patients
through the rhythm and melody and emotions in music,
thereby regulating the function of the brainstem reticular
formation to achieve sedation and analgesia and improving
of blood pressure and heart rate. By adopting a free position,
parturients can freely change the center of gravity and adjust
4 Applied Bionics and Biomechanics

Table 2: Chinese PLPQ score of parturients in two groups.

Group n Pain response Pain tolerance Total pain score

Music therapy, free position delivery group 201 24:73 ± 7:28 9:93 ± 3:91 34:65 ± 10:20
Traditional delivery group 239 27:06 ± 7:49 10:40 ± 4:29 37:46 ± 10:70
t value 3.303 1.207 2.801
P value 0.01∗∗ 0.228 0.05∗
Note: ∗ P < 0:5; ∗∗
P < 0:01.

Table 3: Maternal and fetal outcomes in the two groups.

Music therapy, free position Traditional delivery

Items t / χ2 value P value
delivery group (n = 201) (n = 239)
First stage of labor (min) 478:76 ± 161:67 396:48 ± 159:21 -5.355 ≤0.001∗∗∗
Second stage of labor (min) 60:88 ± 34:85 62:47 ± 40:92 0.441 0.660
Third stage of labor (min) 5:29 ± 3:85 6:07 ± 5:55 1.718 0.087
Total stage of labor (min) 544:93 ± 171:05 465:02 ± 170:87 -4.884 ≤0.001∗∗∗
Bleeding amount at 2 hours after birth (ml) 234:65 ± 109:77 262:34 ± 129:27 2.430 0.016∗
Perineal condition score 2:50 ± 0:99 2:25 ± 1:08 -2.49 0.013∗
1 min Apgar score 9:89 ± 0:43 9:82 ± 0:58 1.379 0.169
Medical intervention during delivery 16 (8%) 106 (44.4%) 72.153 ≤0.001∗∗∗
Note: ∗ P < 0:05 and ∗∗∗
P < 0:001 vs. traditional delivery group.

to a comfortable position, thus achieving the goals of relax-
ing the body, relieving pain and numbness in the lower back
and lower limb, and diverting attention from pain to gain
[18, 19]. According to our study, the humanized interven-
tion method using music therapy combined with free posi-
tion delivery could effectively reduce the perception of
labor pain which was consistent with a previous study using
doula combined with free position to relieve maternal deliv-
ery discomfort and anxiety [20]. Consistent results further
verify that a combined therapy can successfully reduce labor
pain and improve delivery experience.
From the perspective of delivery mechanism, an upright
position is more helpful for fetal delivery. Because such posi-
tion can maximize gravitational effects and therefore facili-
tate fetal descent and reduce muscle work and oxygen
consumption, contributing to perineal relaxation [21] and
reduction of perineal laceration. Music is a special language
whose frequency, rhythm, and regular acoustic vibration
produce physical energy acting on people’s physiology and
psychology. Music used during labor can reduce maternal
excessive tension and anxiety associated with loss of confi-
dence in delivery, excessive physical exertion, and uterine
atony [22]. The uterine atony and soft birth canal injury
are the two vital factors of postpartum hemorrhage [23].
The results of this study revealed that music therapy com-
bined with free position was helpful in reducing postpartum
hemorrhage and soft birth canal injury, as well as medical
intervention during delivery, which is consistent with the
study by Zhu [24] using music therapy to achieve decreases
of duration of labor, bleeding volume, and labor pain and an
increased probability of spontaneous delivery.
Some studies have reported that free position delivery
can enhance the contractility of abdominal muscles, pelvic
floor muscles, and limb muscle groups and thus improve
uterine action. Additionally, upright position of the upper
body is conducive to the fetus descent with the help of its
own weight and gravity, thereby increasing head-to-cervix
pressure and effective contractions and ultimately accelerat-
ing labor [25]. However, we found the combined group had
a longer duration in the first stage and total stage of labor,
but no significant difference was identified in the second
and third stages of labor between the two groups. Our results
are different from previous studies [13, 14], which may be
due to the fact that compared with the traditional delivery
group, the lower proportion of medical intervention with
artificial rupture of membranes and intravenous infusion
of oxytocin in the first stage of labor in the combined group
results in labor lasting longer. This is consistent with the new
standard of labor stage advocated by WHO. The new stan-
dard refers to less medical intervention during the first stage
of labor, especially during the incubation period [26], and
more humanistic care measures during labor such as
encouraging the parturient to take a free position, stabilizing
maternal mood, eating, distraction, interaction between the
parturient and her family, and encouraging doula and family
members to accompany patients during delivery [27]. Our
findings indicate that combining music therapy with a free
position delivery can successfully relieve labor pain, prevent
postpartum hemorrhage, and provide a positive maternal
delivery experience with no adverse effects on maternal or
infant safety. Our results, however, have certain limitations,
particularly in terms of the lack of systematic treatment
Applied Bionics and Biomechanics
guidelines for standardized treatment, such as music mode
selection and music therapy duration. Although in terms of
individualized treatment, we can provide personalized music
mode for puerpera, and there is still a need to synthesize the
experience and develop acceptable treatment protocols for
the standardization of treatment modalities.
5. Conclusions
Music therapy combined with free position delivery can
effectively relieve maternal mental stress and thus relieve
labor pain. Such combination requires fewer medical inter-
ventions, results in less postpartum hemorrhage and better
maternal delivery experience, and has no adverse effects on
the safety of mothers and infants. The above results suggest
that music therapy combined with free position delivery can
improve maternal labor pain and birth outcomes, providing
a reference for the application of this new delivery method
for clinical parturients.
Data Availability
The data used to support the findings of this study are avail-
able from the corresponding author upon request.
Conflicts of Interest
The authors declared that they have no conflicts of interest
to this work.
Authors’ Contributions
Huimin Guo and Mochun Que contributed equally to this
work.
References
[1] R. Melzack, “Labour pain as a model of acute pain,” Pain,
vol. 53, no. 2, pp. 117–120, 1993.
[2] B. N. Bahri, R. Latifnegad, and H. Esmaili, “Effect of continu-
ous support during labor on behavioral and physiological
responses to pain response moderated birth,” Journal of Sabze-
var University of Medical Sciences, vol. 11, pp. 33-34, 2005.
[3] D. N. Zhu and T. H. Wang, Physiology (8th Edition), [M.S. The-
sis], People's Medical Publishing House, Beijing, 2013.
[4] J. He, “Clinical observation on the effect of spinal anesthesia on
labor and maternal and fetal outcomes,” Modern Diagnosis &
Treatment, vol. 31, no. 19, pp. 3127–3129, 2020.
[5] X. Q. Zhou, X. L. Liu, and X. J. Lin, “Clinical study on spinal
anesthesia delivery and water birth,” Practical Clinical Journal
of Integrated Traditional Chinese and Western Medicine,
vol. 20, no. 12, pp. 130-131, 2020.
[6] R. Duan and H. B. Qi, “Interpretation of recommendations
related to the first stage of labor in WHO model of intrapar-
tum care for a positive childbirth experience,” Chinese Journal
of Practical Gynecology and Obstetrics, vol. 35, no. 4, pp. 431–
434, 2019.
[7] S. Simavli, I. Gumus, I. Kaygusuz, M. Yildirim, B. Usluogullari,
and H. Kafali, “Effect of music on labor pain relief, anxiety
level and postpartum analgesic requirement: a randomized
5
controlled clinical trial,” Gynecologic and Obstetric Investiga-
tion, vol. 78, no. 4, pp. 244–250, 2014.
[8] L. L. Wu and J. P. Wang, “Current status and progress of music
therapy in clinical nursing,” Shanghai Nursing, vol. 13, no. 3,
pp. 62–66, 2013.
[9] C. X. Zhang, “Observation on the clinical effect of free position
during the first stage of labor,” Journal of Bethune Military
Medical College, vol. 11, no. 4, pp. 379-380, 2013.
[10] P. Yadollahi, Z. Khalaginia, A. Vedadhir, A. Ariashekouh,
Z. Taghizadeh, and F. Khormaei, “The study of predicting role
of personality traits in the perception of labor pain,” Iranian
Journal of Nursing and Midwifery Research, vol. 19, 7 Suppl
1, pp. S97–S102, 2014.
[11] A. Y. Jin, M. C. Que, H. M. Guo, L. B. Huimin, Y. Chen, and
Q. Huang, “Chinesization of Perception of Labor Pain Ques-
tionnaire and study on its reliability and validity,” Nursing
and Rehabilitation Journal, vol. 20, no. 4, pp. 5–9, 2021.
[12] J. Q. Su, X. Y. Zhu, Q. S. Zhang, and C. Z. Yang, “Understand-
ings of application of Apgar score at 1 minute,” Chinese Jour-
nal of Neonatology, vol. 1, pp. 39–41, 2007.
[13] Y. P. Tian, Y. F. Xiong, X. F. Xu et al., “Guideline of repairing
techniques and material selection in episiotomy and perineal
tears,” Chinese Nursing Management, vol. 19, no. 3, pp. 453–
457, 2019.
[14] Y. Xiong, M. Chen, and X. H. Liu, “Interpretation of National
Partnership for Maternal Safety: consensus bundle on obstetric
hemorrhage issued by ACOG in 2015,” Chinese Journal of
Perinatal Medicine, vol. 19, no. 4, pp. 247–251, 2016.
[15] M. Hu, “Effect of companion combined with music therapy on
psychological state and pain stress in women undergoing
cesarean section,” Maternal & Child Health Care of China,
vol. 6, pp. 1251–1254, 2018.
[16] X. Peng, “Effect of music therapy in the first stage of labor,”
China Practical Medical, vol. 8, no. 13, pp. 255–255, 2013.
[17] C. L. Zhang, Y. J. Qu, Y. Chen, and Z. W. Xiong, “Application
of music in operating room,” Journal of Hebei North University
(Medical Edition), vol. 4, pp. 53-54, 2006.
[18] E. D. Hodnett, S. Gates, G. J. Hofmeyr, and C. Sakala, “Contin-
uous support for women during childbirth,” The Cochrane
Database of Systematic Reviews, vol. 7, article Cd003766, 2013.
[19] Y. H. Li, N. Wu, and W. Zhuang, “Effect of birth ball exercise
combined with free maternal position on labour pain, sense of
labor self-control and gestational outcomes,” Chinese Journal
of Nursing, vol. 48, no. 9, pp. 793–796, 2013.
[20] L. Ye and J. Sha, “The control effect of doula delivery combined
with free position on maternal discomfort and negative emo-
tion during labor,” Maternal & Child Health Care of China,
vol. 36, no. 23, pp. 5414–5417, 2021.
[21] O. M. C. Vargens, A. C. V. Silva, and J. M. Progianti, “Non-
invasive nursing technologies for pain relief during child-
birth—the Brazilian nurse midwives' view [J],” Midwifery,
vol. 29, no. 11, pp. e99–106, 2013.
[22] P. J. Chen, “Study on the application of music and hypnother-
apy in labor analgesia,” Chinese Community Doctors, vol. 33,
no. 22, pp. 155-156, 2017.
[23] X. X. Zheng, Gynecologic and Obstetric Nursing (6th Edition),
[M.S. Thesis], People's Medical Publishing House, Beijing,
2017.
[24] F. F. Zhu, “Effect of music therapy used by midwives on labor
analgesia and birth outcome,” Chinese Baby, vol. 18, p. 174,
2019.
6 Applied Bionics and Biomechanics

[25] L. Liao, D. L. Liao, H. M. Li et al., “Clinical study on analgesia

delivery coordinate position nursing in stage of labor,” Journal
of Nurses Training, vol. 27, no. 16, pp. 1472–1474, 2012.
[26] C. Y. Shi and B. Y. Li, “Expert consensus on the new standard
and treatment of labor stage,” Chinese Journal of Obstetrics
and Gynecology, vol. 7, p. 1, 2014.
[27] G. L. He and X. H. Liu, “Management of incubation period
under the guidance of new labor standards,” Journal of Practi-
cal Obstetrics and Gynecology, vol. 33, no. 3, p. 3, 2017.