Music elements addressing selected physiological breastfeeding challenges: a systematic review
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Background Scientific information underlying the beneficial uses of therapeutic music has been widely published, but its application to enhance lactation and breastfeeding outcomes still need to be studied. Breastfeeding difficulties can be ascribed to pain, hormonal imbalance, stress, and anxiety experienced by the breastfeeding mother. Pain experienced by the breastfeeding mother could cause early cessation of breastfeeding before the neonate reaches the age of six months. The neonate's suckling could cause pain or pain could be related to the birth process. Analgesics inhibit human milk production, making non-pharmacological pain management very important. The use of music reportedly could reduce the lactating woman's pain levels without using any analgesics. Increased secretion of oxytocin and prolactin hormones (improving human milk production) occurs when listening to music. Reduced levels of stress and anxiety, achieved while listening to music, could enhance lactation and breastfeeding outcomes. However, limited research was found about the impact of listening to music on the physiology of lactation and breastfeeding outcomes. Objectives The study aimed to identify and describe the specific elements ideally comprising a music intervention programme for enhancing the physiology of lactation and breastfeeding outcomes. Method A systematic literature review was conducted to obtain evidence about specific musical elements influencing the physiology of lactation and breastfeeding outcomes. Five phases were followed during the systematic review, namely (i) problem formulation, (ii) literature search and sampling, (iii) critical analyses, (iv) evaluation of data, and (v) data interpretation and presentation of results. The identified data sources were analysed and critically appraised according to the inclusion criteria and the Johns Hopkins Appraisal Instrument. Results The results of the systematic review indicated that music could have a positive effect on lactation and breastfeeding outcomes. Relevant musical elements were identified as slow, soft music with repetitive tempo replicating the normal heartbeat of a person (60-80 beats per minute). Also, without voices and preferably using piano or string instruments. By stimulating a calming environment, music could help to decrease pain and reduce stress and anxiety levels. Conclusion Appropriate musical elements could enhance lactation and breastfeeding outcomes. Thus, music therapy could help to extend the duration of breastfeeding when used at home as a cost-effective strategy by the lactating mother.
- Health Sciences 
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