Music during caesarean section under regional anaesthesia for improving maternal and infant outcomes

 

Abstract

Background

Evidence on the benefits of music during caesarean section under regional anaesthesia to improve clinical and psychological outcomes for mothers and infants has not been established.

Objectives

To evaluate the effectiveness of music during caesarean section under regional anaesthesia for improving clinical and psychological outcomes for mothers and infants.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2008).

Selection criteria

We included randomised controlled trials comparing music added to standard care during caesarean section under regional anaesthesia to standard care alone.

Data collection and analysis

Two review authors, Malinee Laopaiboon and Ruth Martis, independently assessed eligibility, risk of bias in included trials and extracted data. We analysed continuous outcomes using a mean difference (MD) with a 95% confidence interval (CI).

Main results

One trial involving 76 women who planned to have their babies delivered by caesarean section met the inclusion criteria, but data were available for only 64 women. This trial was of low quality with unclear allocation concealment and only a few main clinical outcomes reported for the women. The trial did not report any infant outcomes. It appears that music added to standard care during caesarean section under regional anaesthesia had some impact on pulse rate at the end of maternal contact with the neonate in the intra-operative period (MD -7.50 fewer beats per minute, 95% CI -14.08 to -0.92) and after completion of skin suture for the caesarean section (MD -7.37 fewer beats per minute, 95% CI -13.37 to -1.37). There was also an improvement in the birth satisfaction score (maximum possible score of 35) (MD of 3.38, 95%CI 1.59 to 5.17). Effects on other outcomes were either not significant or not reported in the one included trial.

Authors' conclusions

The findings indicate that music during planned caesarean section under regional anaesthesia may improve pulse rate and birth satisfaction score. However, the magnitude of these benefits is small and the methodological quality of the one included trial is questionable. Therefore, the clinical significance of music is unclear. More research is needed to investigate the effects of music during caesarean section under regional anaesthesia on both maternal and infant outcomes, in various ethnic pregnant women, and with adequate sample sizes.

 

Plain language summary

Music during caesarean section under regional anaesthesia for improving maternal and infant outcomes

Caesarean section is a surgical procedure for delivering a baby. It involves making surgical incisions into the mother's abdominal wall and uterus. These operations are performed if there is a serious medical concern for the mother or baby. Caesarean sections are generally done with regional anaesthesia, either a spinal or epidural block with anaesthetic injected into the area around the spine in the lower back, which makes the mother feel numb from the waist down. Women have increased risks associated with anaesthesia and surgery, and the baby may be more likely to be admitted to a neonatal unit or separated from the mother. 

Women having a caesarean section under regional anaesthesia are often highly anxious during the operation and may feel some discomfort. Listening to relaxing music of the woman's choice may lead to better outcomes and less need for treatment.

The review findings indicate that listening to music during planned caesarean section under regional anaesthesia may improve pulse rates and birth satisfaction scores, although the effect sizes were not large enough to indicate a clinically beneficial effect. The review authors identified one controlled trial that randomly assigned 76 women who listened to their preferred music through earphones, or to standard care, but data were available for only 64 women. The music was provided from the beginning of anaesthesia to the end of surgery. The women's heart rates were reduced by some seven beats/minute when measured at the end of contact with the newborn during the intra-operative period and after the surgeon had completed skin suture. Birth satisfaction scores were increased by a mean of 3.4 points on a 35-point scale when women listened to music. Respiration rates were no different for the two groups and neither were levels of anxiety, which decreased at the end of contact with the newborn and again after closing the skin, with no clear difference with or without music. The trial was from Taiwan and reporting of trial methodology was poor.

 

摘要

背景

區域麻醉剖腹產時聽音樂對母嬰的影響

區域麻醉剖腹產時，聽音樂在臨床和心理方面有助於母嬰的證據還未確立。

目標

評估區域麻醉剖腹產時，聽音樂在臨床和心理方面對母嬰的效益。

搜尋策略

我們搜尋 Cochrane Pregnancy and Childbirth Group's Trials Register (30 Septembe 008)。

選擇標準

納入比較區域麻醉剖腹產時,有加聽音樂與單純標準照護的隨機控制試驗。

資料收集與分析

由兩位回顧者Malinee Laopaiboon和 Ruth Martis獨立評估試驗的適用性，納入之試驗的偏差風險及摘錄資料。使用平均差(MD)和95% 信賴區間(CI)分析結果。

主要結論

納入一篇有76名孕婦參與的試驗，但只有64名孕婦的資料分析。這篇試驗的隨機分派方式說明並不清楚也只報告很少的結果，試驗品質低，沒有任何有關嬰兒結果資料。區域麻醉剖腹產時,有加聽音樂相較單純標準照，孕婦脈膊在手術中母嬰肌膚接觸結束時(MD −7.50 fewer beats per minute, 95% CI −14.08 to −0.92)及手術結束時(MD −7.37 fewer beats per minute, 95% CI −13.37 to −1.37)有降低，孕婦的生產滿意度提高(maximum possible score of 35) (MD of 3.38, 95% CI 1.59 to 5.17)。這篇試驗中兩組之間的其它結果沒有報告或是沒有顯著的差異。

作者結論

這些結果顯示，區域麻醉剖腹產時,有聽音樂相較單純標準照護，改善孕婦心率及生產滿意度。然而，這篇試驗的研究品質上有疑慮，其結果顯現對母嬰的效益有限，所以，聽音樂在剖腹產時的臨床應用效果還不清楚。需要有更多可以包含各人種孕婦且樣本數足夠的研究，探討區域麻醉剖腹產時,聽音樂對母嬰生產結果的影響。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

剖腹產是一種手術性生產方式，手術過程會切開孕婦的腹部及子宮，通常是在母親或胎兒有醫療上的需求時,就會進行剖腹產。剖腹產一般使用區域麻醉，通過脊髓麻醉或硬膜外麻醉的方式，注射麻醉藥物作用在下背部脊髓區域，使孕婦的腰部以下感覺麻木。這會增加孕婦麻醉及手術的風險、新生兒住院及不能母嬰同室的機會。 孕婦麻醉下接受剖腹生產手術，常在過程中出現焦慮及心理上的不適感覺，聽一些孕婦喜歡的放鬆音樂，可以獲得更好的生產結果，減少治療的需求。 回顧研究的結果顯示，區域麻醉剖腹產時,聽音樂相較單純標準照護，改善了孕婦脈搏及生產滿意度，然而這樣的改善尚不足以產生臨床上的效益。本篇作者檢視的這一對照試驗中，有76名孕婦被隨機分派在手術中用耳機聽自己喜歡的音樂或僅接受標準照護，但只有64名孕婦的資料可用於分析。試驗中，聽音樂的時間是從麻醉開始直到手術結束，孕婦脈搏的測量分別安排在手術中母嬰肌膚接觸結束時及皮膚傷口縫合完成時，聽音樂組的孕婦脈搏每分鐘平均減少7次，生產滿意度增加3.4分(35分的滿意度量表)，兩組間孕婦呼吸頻率及焦慮程度沒有差異。孕婦焦慮程度母嬰肌膚接觸結束時及皮膚傷口縫合完成時會有降低，但在兩組間比較沒有明顯差異。這是台灣的一篇試驗，試驗方法品質不佳。