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.