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For the past six years, music therapy has been an effective intervention
for referred premature infants during their stay in the NICU at Mount Sinai Beth Israel and at a growing number of medical centers in the United
The use of live music, and in particular the effects that intrauterine
sounds may have when implemented in conjunction with music therapy techniques
may have a great impact on the growing premature infant. Pilot study indicates
that newborn infants, particularly infants born prematurely, may have
a notable response explicitly to the voice and intrauterine sounds especially
when these sounds are entrained to the babies' heart rate and respiratory
rate. The Louis Armstrong team is investigating the use of music therapy,
and three specific interventions on the vital signs and developmental
parameters of growing premature infants. Furthermore, this study will
include the use of mother's voice, father's voice and the effect of continuity
of care through musical parameters (key, timbre, melodic structure), as
indicated through assessment. Lullabies and songs of kin (Loewy et al,
2005) will be used as a transitional object as needed and thus will be
implemented as a controlled variable.
Working with the emotional concerns of pregnant mothers has demonstrated
efficacy in reducing the stress and anxiety that may be transferred to
the fetus during pregnancy. Since the fetus responds to the mother's blood
flow that is influenced by emotion and affect, music psychotherapy for
expectant mothers and parents has been shown to be a useful forum for
addressing physiological measures through affective means. When a pregnant
mother experiences fear, her physiological system may be shut down which
can cause altercations in her eating and sleeping patterns. Clements (1996,
in Pratt, 1999) reported that fetuses responded positively to tonal music
and became more agitated when presented with atonal music. This has important
implications for the music therapist working with pregnant women.
The developing relationship between mother and fetus has important implications
for the neonatal music therapist. McKinney (1990) provided a review of
music therapy used in obstetrics and cited three studies that incorporated
GIM (Linquist, 1985), music therapy using directed imagery and recorded
music (Winslow, 1986), and progressive muscle relaxation using recorded
music (Liebman, 1989). She provided insight not only about how music therapy
may be used but, in addition, provided psychological rationale supporting
the recognition that high anxiety and unresolved conflicts during pregnancy
may have negative effects on the progress of labor and the incidence of
obstetric complications. When an infant is born prematurely, a parent/caretaker
might feel hopeless and powerless. As the infant is in need of round-the-clock
medical attention, the relationship, in particular the ability to bond,
The positive implications noted in these three music therapy studies provide
compelling case material that supports the use of music therapy, particularly
to empower and strengthen a pregnant mother's sense of well-being during
a time of increased vulnerability. McKinney notes that interventions designed
to have a positive impact on psychological variables may also positively
affect physical variables. When one considers implementing music therapy
in the NICU, the conditions of the environment cannot be overlooked. The
sound environment must be nurturing and womb-like.
The role of the parent/s and staff in enhancing growth for premature infants
should reduce stress for the neonate and parent/s. Parent/s of premature
babies might feel that their role is minimal. This may setup feelings
of guilt and inadequacy; parents often feel powerless at a time when they
thought they would have full control (pregnancy). Therefore, teaching
ways to provide and nurture within the baby's sound environment may be
medically advantageous, while at the same time may serve to be critical
in the bonding process.
Music Therapy at Beth Israel: A Team-Centered Context
The Neonatal Intensive Care Unit is an environment of great need.
The implementation and inclusion of music therapy in a team-centered context
is essential to the growth of service in the NICU. Intensive care units
maintain procedures that include accountability and documentation of services.
It is therefore useful to have a formal structure in the referral process.
The Referral form at Mount Sinai Beth Israel which accompanies the
Criteria for Referral ensures that the
referred infants will be treated, and additionally provides the music
therapist with a clear direction regarding the area of greatest need from
a medical and psychosocial perspective.
More pages on NICU Music Therapy at Beth Israel:
Calabro, L., Wolfe, R. & Shoemark, Helen (2003). The effects of recorded
sedative music on the physiology and behaviour of premature infants with
a respiratory disorder. Australian Journal of Music Therapy, 14, 3-19.
Clements, A. (1996). New sense out of old sense. In R. Pratt & Groke,
D. (eds.) Musicmedicine 3: Expanding Horizons, pp101-119. Melbourne, Australia:
University of Melbourne.
Liebman, S. (1989). The effects of music and relaxation on third trimester
anxirty in 3rd trimester anxiety in adolescent pregnancy. Unpublished
doctoral thesis. Miami.
Linquist, R. (1985). The role of GIM in the birthing process. Unpublished
fellows paper. Institute for music and consciousness. Townsend, WA.
Loewy, J. Hallan, C., Friedman, E. & Martinez, C. Sleep/Sedation in
Children Undergoing EEG Testing: A Comparison of Chloral Hydrate
and Music Therapy. Journal of Perianesthesia Nursing, 20 (5),
McKinney, C. (1990). Music therapy in obstetrics: A review. Music Therapy
Perspectives. 8: 57-60.
Pratt, RR. (1999). Music and infant well-being. In R.R. Pratt & D
Grocke, (Eds), MusicMedicine 3-Expanding horizons. Melbourne , Australia
: University of Melbourne.
Shoemark, Helen (2004). Family-centred music therapy for infants with
complex medical and surgical needs. In M. Nocker (Ed). Music therapy for
premature and newborn infants. (141-157). Gilsum, NH: Barcelona.
Shoemark, Helen (2000). The use of music therapy in treating infants with
complex bowel complaints. In J. Loewy (Ed.). Music Therapy in the Neonatal
Intensive Care Unit. (pp.101 - 107). New York: Satchnote Press.
Standley, J.M. (2000). Music therapy in medical treatment. In Smith. D.
(Ed.) Effectiveness of Music Therapy Procedures: Documentation of
Research and Clinical Practice. American Music Therapy Association:
Silver Spring, MD.
Winslow, G. (1986). Music therapy in the treatment of anxiety in hospitalized
high-risk mothers. Music Therapy Perspective 3:29-33.