1. INTRODUCTION
The cesarean section (C-section) rate in Turkey is 51.2%1, well above the rate of 5-15% of deliveries suggested by the World Health Organization2. Births are a source of stress for women, and a C-section causes an increase in stress and anxiety for patients due to the fact that it is a major abdominal surgery and critical situations may occur3,4. High preoperative anxiety levels have been reported in many women who are prepared for a C-section5. Since it is not possible for the father or other supporter to attend a patient’s C-section in Turkey, it can be expected that patients have higher anxiety levels due to isolation. There may also be potential negative side effects of premedication to deal with anxiety6. Due to the increased prevalence of C-sections, choosing non-pharmacological, non-invasive interventions for anxiety treatment would be advantageous for both the expectant mother and the baby.
Compared to general anesthesia, spinal anesthesia is a more preferred form of anesthesia because it reduces intraoperative blood loss and causes less nausea and vomiting, less respiratory depression, and less postoperative pain7. However, sounds originating from the surgical environment (white noise), such as the sounds of surgical instruments, are known to increase patient anxiety8. This situation occurs especially more frequently for pregnant women.
Music intervention as a stress management technique is an easy-to-apply, cost-effective, non-pharmacological, and non-invasive method that has been used for centuries9. While it positively supports the psychological well-being of the person, it may also improve physical parameters such as blood pressure, heart rate, and respiration10. It has been shown in some studies that listening to music increases the threshold of pain during an operation by distracting the patient’s attention11. Music is effective in reducing pain by stimulating the autonomic nervous system and releasing endorphins and natural opioids from the pituitary gland12,13. It causes a decrease in blood pressure and heart rate by reducing catecholamines14. These effects generally vary depending on the tempo of the music; slow-paced and intermittent music has been associated with a decrease in heart rate, respiratory rate, and blood pressure, while fast-paced music has been associated with an increase in these parameters6. Music can have physiological effects on many areas of life and mental health. It can affect tension depending on the type, and it can also be used to create specific emotions15. The potential therapeutic effect of music has been attributed to its ability to reduce stress and alter arousal16.
There are studies showing that Sufi music is widely used in the treatment of various psychiatric diseases17. Turkish music played on traditional Sufi instruments (combined with the sounds of water flowing from a fountain) was used throughout the times of both the Seljuk and Ottoman Empires, from the 11th to 18th century, to treat mental illnesses18. Sufis often engaged in music and treated psychological disorders with music. Turkish music types used in hospitals in Amasya, Sivas, Istanbul, and Edirne were classified and started to be used in treatments. In addition, Farabi Musiki-ul-kebir, the inventor of the oud instrument, studied music together with astronomy and associated it with psychology according to its effects on people19. However, there are currently limited studies on C-sections and music. This study aimed to compare patients receiving music therapy with a control group and to investigate the effects of Sufi music on anxiety scores and vital signs of patients undergoing C-sections for elective reasons.
During the study, we had two main goals:
1: To compare state anxiety scores before and after the operation in the music and control groups.
2: To determine whether music causes changes in patients’ blood pressure, heart rate, respiratory rate, or partial O2pressure level.