Abstract
The use of music as healing modality was first documented in an ancient Egyptian papyrus from the 19 century BCE.
1
Some 800 years later (late 11th century) the book of Samuel recounted how the youthful shepherd lad David soothed King Saul's, the first king of the United Kingdom of Israel ill discontent by playing the lyre:
“And it came to pass, when the evil spirit from God was upon Saul, that David took the harp, and played with his hand; so Saul found relief, and it was well with him, and the evil spirit departed from him.”
2
In more modern times as illness was conceptualized to be the result of the disharmony of the mind–body system, the role of music to restore harmony, well-being, and health became more standard and acceptable. 3 Thus, today certified music therapists are recognized as vital paraprofessionals and are an integral part of the health care team.
To date, music therapy has been mostly incorporated into medical settings where reduction of the patients' anxiety and perception of pain are the primary goals. As such, surgical and oncologic wards have been the main focus. Clinical observation of reduced symptoms of stress and pain has been complimented by controlled laboratory studies that included measurements of improved vital signs, oxygen levels, and most importantly reduced salivary cortisol level in those patients exposed to appropriate soothing music. 4
More recently, the understanding that maternal anxiety and feelings of undue stress can affect breast milk secretion has led to an exploration of the potential positive value of utilizing music therapy to facilitate more successful breastfeeding rates. In 2018, Aki and colleagues reported that use of music in the breast milk pumping room in the newborn intensive care units (NICUs) would increase amount of milk that the mothers could successfully express. In 2020, Duzgun and Ozer, 5 in a comprehensive meta-analysis, concluded similarly that music can “be effective way to increase breast milk production” in mothers.
Of particular interest is the intriguing study from 2009 by Nisson 4 who documented, in a randomized controlled trial, that soothing music increases the level of oxytocin in postoperative open heart surgical cases. These data suggest that the benefits of music in the breastfeeding situation may be beyond the nonspecific benefit of reducing stress and its concomitant cortisol level. What may be happening is that the comparable increase in oxytocin in the breastfeeding mother exposed to proper music may well result in a more robust let-down reflex and, in turn, a more successful and productive breastfeeding experience and/or pumping session.
In this issue of Breastfeeding Medicine, Chawanpaiboon and colleagues report on the results of a controlled study on the effect of playing music during cesarean sections and in the two subsequent postsurgical days. They noted that exposure to music per se during the operative procedure did not subsequently affect breastfeeding rates but that exposure of mothers to music in the two postsurgical days in certain circumstances did enhance exclusive breastfeeding success.
In reviewing the current reported use of music therapy, it is clear that the data support its more routine standardized use in the NICU particularly in the breast milk pumping rooms and with appropriately selected mothers who are demonstrating an increase in anxiety state or are suffering from a measure of undue pain. What is needed, however, are more data to delineate more specifically what type of music should be used and what should be its genre, degree of rhythmicity, duration, and decibel level to be most effective. Even the most basic question needs to answered, should it be the music the mother chooses as her “favorite” or should it be a standardized audio menu that is selected and provided by the hospital staff.
Shakespeare has declared, in Twelve Night, that “If music be the food of love, play on,” and if oxytocin had been termed the ultimate “love hormone,” 6 then more routine playing of music will lead to increasing oxytocin and, in turn, facilitate more successful breastfeeding and loving bonding of the maternal–infant dyad, then surely we have our order to “play on!”