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[eng] Research for Lullabies

April 28, 2017

It is common knowledge that mothers and grandmothers sing lullabies to babies. It is a shared practice around the world and we all take it for granted, somehow.

 

Yet, I wonder if this perception is grounded in contemporary real life experience or if it is channeled as a topos by the entertainment industry: we assume that mothers sing to their babies, but do they really do it?

 

It is not uncommon to associate the practice of singing to stigma: often a person, a child or an adult, will withdraw from singing because of the feeling of shame connected to their ability to sing or because they perceive spontaneous singing as culturally inappropriate behavior. Think about the representation of the “lunatic” character: he or she is uncontrollably singing, often lullabies. Historically, we don’t need to go much further back in time to recall how women were disciplined in their maternal behaviors and asylums were far too often the places where they were confined. My daughter felt she had to apologize to her 4 years old friend because her mom and dad were singing and playing a guitar at the dinner table: “My parents are like this”. We were among artists and we were in Rome.

 

When a woman becomes a mother she certainly changes yet she carries her cultural values with her on this journey. She is even more sensitive to the plethora of stimuli coming from her surrounding. And the surrounding of a newly born mother can be freaking hostile in many ways.

 

I feel confident in asserting that scientific research on the impact of lullabies on maternal-infant bonding is far from being obvious or unnecessary. Instead, it is crucial to keep remembering what makes us humans, what is “normal” in childbirth and motherhood (as in current scientific research), which practices are salutogenic, making and keeping us healthy. Singing seams to be one of them.

 

We live in times where we need scientific evidence to claim that breastfeeding is a good thing but at the same time we have to be careful not to call it “natural”, in order not to offend or shame anyone or induce further “naturalistic” behaviors. Accordingly, if the research claims that singing is good for mothers and babies this does not mean that we want to insinuate that mothers who do not sing to their babies are not “good mothers”. OK?

 

But why would mothers (or anyone) need scientific evidence confirming that lullabies are good for mothers and babies? I have interviewed Giuseppina Persico, an Italian midwife-researcher who has spent three years on a doctoral study to provide some answers on this topic. The outcomes of her PhD theses have recently been published as “Maternal singing of lullabies during pregnancy and after birth: Effects on mother-infant bonding and on newborns’ behaviour. Concurrent cohort study” in Women and Birth (Australian College of Midwives’ publication) at the beginning of 2017. The paper ends with the following acknowledgement: “The main author is deeply grateful to her mother for the lullaby that she used to sing to her when she was a child and which remains one of her most precious memories”.

 

I started to be passionate about scientific research and evidence on childbirth since midwifery research came into the field and started playing the big game. It is only in the recent years that we can see the impact of midwifery research on international guidelines, recommendations, policies and practices concerning maternity health care provision. This is why more and more evidence is provided on the topic of physiology of birth instead of pathology, a predominant research until recent times. By focusing on what was “dangerous” in childbirth, the science and the health care providers forgot (or never really investigated) what was “normal”, and, in practice, medical interventions became the norm.

 

Nowadays, midwifery research comes in rescue and suggests that even a simple practice such as singing of lullabies can have a major impact on the wellbeing of mother and babies, as the author of the study summarizes: “Mothers singing lullabies could improve maternal-infant bonding. It could also have positive effects on neonatal behavior and maternal stress”.

 

Giuseppina Persico and colleagues have conducted a “concurrent cohort study”, a study “where the subjects have been followed up for a period and the outcomes of interest are recorded”. In a hospital in Monza, Italy, they have recruited 196 pregnant women who participated in prenatal education classes. They have divided them in two groups: 97 in a singing cohort and 99 in the concurrent (parallel) cohort where singing was not actively promoted. However, for ethical raisons, subjects of the concurrent group were left free to decide if they wanted to sing to their babies. In fact, 8% of the concurrent group spontaneously sang lullabies everyday. Interestingly, the data suggest what might be the percentage of mothers who sing to their babies without being purposely “trained” to do so. Going back to our introductory notes, singing lullabies to the babies might not be that common as we think.

 

I asked Giuseppina to tell me which repertoire of lullabies she used in the study, since she explains in the paper that at the first meeting a musicologist taught the mothers nine traditional lullabies in Italian language. “It is not important which lullaby one chooses, nor for the content that can be freely personalized and modified by the mother according to her attitude or inspiration, or even completely made up, nor for the melodic composition. What matters is the voice of the mom that sings the lullaby to her baby. Otherwise, the odds are to miss the purpose and induce women into a sort of ‘performance anxiety’, besides the risk to assign to the lullabies chosen in my study some kind of “magical and miraculous powers’”.

 

I was amused by her answer that confirmed the first impression I had of this generous and poetic senior midwife who dedicated three years of her life to prove that maternal voice matters, and who was immediately available for the interview because, “I am not just a researcher, I am a midwife. By the way, I read your book Memoirs of a Singing Birth and I really appreciated it”. Melting...

 

Lullabies where sung without accompaniment, meaning no instruments or musical background were used to enhance the voices, nor during the meetings nor in the everyday practice with the belly and the baby. “I wanted to measure the impact of the voices of the mothers, since the research suggest that among all the acoustic signals perceived during pregnancy, the maternal voice is the predominant one and the main source of sensory stimulation”. Good-bye musical baby belts and Mozart in the headphones around the belly.

 

The researcher have chosen lullabies as a repertoire because of “their communicative value and their importance as one of the symbols of mother-infant relationship in all the countries around the world”. “Lullabies are differentiated from other types of songs due to their repetitiveness, soothing quality, softness, simplicity and slow tempo. Infant-directed play songs and lullabies are part of traditions and cultures all around the world. However, in contemporary society, the maternal singing tradition in Italian culture is changing due to increased modernisation and the tendency of women to go back to work soon after the birth of their baby.” The author suggests that we might in fact be losing an important part of our common human culture, something we are erroneously taking for granted. In the similar way our culture considers maternal behavior (post-partum recovery, the care of the newborn, breastfeeding, baby soothing…) as something innate and spontaneous while these skills appear to be less “instinctual” and more acquired and learned by witnessing them in action. While I agree with the author that modernization have minimized the role of mothers and their skills in the successful upbringing of new humans, I am not sure if going back to work soon after the birth of the baby would be a mother’s preferred choice if she had valid options. In the society that gives no value (intended in a monetary sense as well) to motherhood we lost more then traditional musical repertoire, we lost the mothers.

 

“Mothers in the singing group unanimously emphasized the strong emotions and feelings they experienced while singing, both in pregnancy and after birth”. The study shows that singing makes mothers feel good and it makes them cope better with pregnancy and post-partum stress. The author personally reported to me that mothers in the study often sang their preferred lullabies during labor and birth at the hospital, and they reported benefits from this activity. I asked her how the hospital staff accepted this mode of birthing. “Well, in the first place, at that specific maternity hospital they are used to holistic midwifery since many years and they have the physiological approach to uncomplicated pregnancies. All of the selected moms had that characteristic. They did appreciated mothers singing in labor. But they though I was weird by doing this research.” I asked her if the hospital continued to offer the option of singing lullabies during prenatal courses after her research. Not yet.

 

The novelty of Persico’s study lies in the provision of data from pregnancy to postpartum. The benefits were perceived all along the way. “A remarkable percentage of women (90.6%) reported positive emotions after singing, such as: serenity, relaxation or a feeling of being on the same wavelength as their baby.” While during pregnancy there was no significant difference between the two groups in mothers’ attachment to the fetus (Prenatal Attachment Inventory, PAI), a slight difference was recorded at 48 hours from birth in favor of the singing group. The perceived benefits (Mother-To-Infant Bonding Scale, MIBS) were significantly higher up to three months after birth.

 

When interviewed, Giuseppina recalled: “After giving birth, mothers in the hospital immediately started singing to their newborn babies, this produced a relaxed atmosphere all around. They were also more confident with their babies and with breastfeeding. I noticed it, though this was not part of the study. Moms used the lullabies to interact with their babies, not only to soothe them, or to make them sleep. The lullabies were perceived as a mode of interaction and the babies reacted as in a dialogue with their mothers”.

 

Interestingly, 52.4% of women reported a change in the perceived fetal movements. I asked the author if she could further explain this process. She specified that if the fetus was moving before, when the mother started singing it would stop. The opposite would happen when there were no fetal movements: after hearing the mother’s voice the fetus would suddenly move. “It was as if they were having a conversation”.

 

In relation to newborns, the study shows that the proportion of babies suffering from neonatal colic was significantly higher in the concurrent cohort, both in the first month and in the second month. At three months after birth, the percentage of neonatal colic was 8,6% in the singing cohort and 17,9% in the concurrent cohort. The author concludes, “Since maternal singing was proved to have a positive effect on both the reduction of perceived maternal stress and on the frequency of neonatal colic, this research corroborates the hypothesis that maternal stress has a direct impact on the occurrence of neonatal colic”.

 

I shall suggest that the opposite might be true as well. I vividly remember endless nights when my baby would wake me up in the middle of the sleep with her “colic” that would not calm down for hours until the point when I would almost lose it, I would stop using the maternal voice, I would stop lulling, I would stop - still as a rock, and look at her (I spare you my thoughts). She would stop crying, she would look back at me, eyes into eyes, with a visible concern for what seamed to both as a very long moment. I would then come back to “normal” and start singing again, our usual lully, with my usual maternal voice. And she would calm down. It must have been the voice of the Ancestors coming into rescue, since I was somewhere else, due to stress and exhaustion. The colic. 

 

I wish to thank Giuseppina Persico for being so open and available for a chat with me, and I express my sincere gratitude to her for her amazing work and dedication. Science for mothers!

 

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