4.DISCUSSION
The presented study is one of the few randomized controlled studies
investigating the effect of music on anxiety during C-section in Turkey.
In this study, it was observed that the postoperative anxiety scores of
pregnant women who underwent C-sections while listening to Sufi music
were significantly lower than those of the control group. In the music
group, the postoperative anxiety score was also lower than the
preoperative anxiety score.
It is generally known that waiting for and undergoing surgical
procedures can be stressful situations. Patients who undergo surgical
procedures usually experience anxiety because of the fear of
experiencing complications21. Many anesthesiologists
prefer epidural or spinal anesthesia during C-sections. Especially
during uterine manipulation or the birth of the baby, the mother feels
some discomfort. It is important for the expectant mother to be
comfortable and cooperative in a C-section delivery to be performed with
regional anesthesia. With music used as a relaxation tool, the mother
may be better able to participate in the events of the surgical
procedure22. Relaxing features of music include a
fluent lyrical melody, simple harmony, and easy rhythm with soft tone
(about 60-80 beats/min). Music can stimulate the release of endorphins
from the brain, lowering ACTH levels in the blood. Nerve impulses
triggered by calming music can trigger muscle tone, brainwave frequency,
galvanic skin response, pilomotor reflexes, and autonomic nervous system
reactions21.
In a previous study, it was shown that there was a significant decrease
in systolic blood pressure in the music group, which listened to a
40-minute music recording before undergoing C-section, while diastolic
blood pressure and respiratory rate increased in the control
group22. It has been shown that heart rate, systolic
and diastolic blood pressure, and the need for sedation are
significantly reduced in patients who listen to music recordings during
colonoscopy procedures. Additionally, in both of these previous studies,
anxiety levels were found to be lower in the groups listening to
music23. In the present study, however, music was
played for the patients intraoperatively, and no difference was observed
between heart rate, systolic and diastolic blood pressure, respiratory
rate, or partial O2 pressure between the groups. The
reason for this is that uterotonic drugs (oxytocin) administered during
spinal anesthesia and postpartum cause hypotension, reflex tachycardia,
and respiratory changes, which may have affected the accuracy of the
analysis.
The effect of listening to music on patient anxiety before and during
surgery has been the subject of various studies. There are some
contradictions in the literature regarding the effectiveness of
listening to music on patients’ anxiety during surgery. Some authors
report that music is effective in reducing anxiety before and during
surgery22,24. Music has been used to reduce stress,
anxiety, and depression in pregnant women. In a metanalysis, it was
suggested that music has a positive and statistically significant effect
in reducing the psychological parameters of state anxiety before
surgical procedures25. In another systematic review,
it was concluded that music played with headphones reduced the anxiety
of patients during normal labor26. However, there are
also studies stating that listening to music does not affect anxiety and
pain outcomes26,27. In the present study, no
difference was observed between the music group’s mean anxiety score and
that of the control group according to the STAI-1 questionnaire applied
to the pregnant woman before the operation. This finding may be due to
the intraoperative application of the music in this study. After the
operation, the anxiety score of the music group was found to be
statistically significantly lower than the anxiety score of the control
group. Additionally, in the music group, the postoperative anxiety score
was found to be lower than the preoperative anxiety score. In other
words, listening to music reduced the anxiety scores of the patients in
the intervention group.
It is not clearly known whether a specific type of music has a superior
effect on anxiety27. There are studies showing that
the effect of Sufi music on anxiety is insufficient to create a
significant difference in state and trait
anxiety28,29. However, there are also studies showing
the effect of Sufi music in reducing state anxiety during surgical
procedures30,31. There is evidence that Sufi music
therapy has a positive effect on state anxiety. This suggests that Sufi
music therapy may be useful in reducing anxiety in certain situations
such as surgery or medical procedures. In a metaanalysis, Gürbüz et al.
concluded that Sufi music may have a more beneficial effect when played
once rather than repeatedly during a medical or surgical
procedure30. In the present study, in accordance with
these results, music was applied only during the operation. The positive
effect of intraoperative music has been seen in our study, but it cannot
be said whether this effect is specific to Sufi music, since we did not
apply and compare other types of music. Therefore, new comparative
research is needed to evaluate the impact of Sufi music on state anxiety
during C-section compared to other music genres. Sufi music was chosen
in this study because it is a relaxing type of music.
Conclusion: This study supports the hypothesis that slow
rhythmic music (Sufi music) can reduce the anxiety of patients during
C-section. It is possible to distract the patient from negative thoughts
and reduce stress. The study results show that patients who listen to
music during surgery have significantly lower anxiety levels than
patients who do not listen to music. It was determined that music
performance did not cause changes in heart rate and blood pressure or
partial O2 pressure level. As a result, music appears to
be beneficial to aid in patient relaxation during cesarean delivery. We
think that it can be easily applied perioperatively by the assisting
staff of the anesthesia or surgical team.
Limitations of the study: An important limitation of this study
was the process of determining how anxious participants felt during the
surgical procedure with the postoperative questionnaire. Participants
may not have been able to report exactly how anxious they felt during
surgery, already experiencing relief with the birth of the baby. Another
important factor that may have affected the results is that although the
term “anxiety” does not appear in the STAI scale, some questions posed
may have caused patients to predict the hypothesis of a research study
on anxiety and change their behavior. The researcher’s presence
throughout the procedure may also have contributed to the participants
having a more positive response.