Formas o instrumentos utilizados para medir los aspectos informales

Research question four: What impacthas music had in reducing the effects of PND among rural Tasmanian women?

As outlined in chapter four, section seven the HCPs shared experiences of music involvement in their personal and professional lives. However, very few of the mainstream HCPs recognised that music could be used within or as part of the healing process. This suggests again that the medical model has a powerful

discourse, which determines what is deemed appropriate and medically sanctioned health care. Alternatively, within section four of chapter four, the women who participated in this study shared experiences of music use throughout their lives, including the postpartum period. Despite some women noting a reduction in music use after the birth of their baby, those who continued to use music recognised that music had been helpful in reducing the impact of PND symptoms. Music assisted these women with relaxation, sleeping and settling baby, and as a mood enhancer.

5.5.1 Relaxation

For some women, including the mothers in this study, breastfeeding may be

regarded as stressful in the early postpartum period. Relaxation has been linked to successful breastfeeding, which has in turn been linked to a greater bond between mother and baby. Breastfeeding may increase the amount of time the mother holds the baby, and thus, face to face interactions, and may result in greater maternal self-esteem due to the mother’s sense that they are able to meet the needs of the baby (Lauwers & Swisher, 2011; Procelli, 2005). However, breastfeeding has been found to be reduced among women with PND. As identified in a case control study , music listening or music therapy may be an effective tool to aid in relaxation,

particularly prior to and during breastfeeding (Procelli, 2005). Music use may also be more widely acceptable for mothers who have concerns about continued breastfeeding (Friedman et al., 2010).

Relaxation techniques, including the use of music, have also been found to reduce anxiety (Kemper & Danhauer, 2005). Some women with PND also experience heightened anxiety, which may lead to intrusive parenting (Field, 2010; Milgrom, Ericksen, McCarthy, & Gemmill, 2006). Regardless of whether the PND presents in withdrawn or intrusive parenting, there is a reported lack of physical contact, vocal stimulation, and a delayed response to baby’s cues (Field, 2010; Friedman et al.,

2010). However, the use of music may assist in enhancing relaxation for the mother, and include the baby by presenting opportunities for touch, vocal stimulation, and responding to baby’s cues (Abad & Edwards, 2004).

5.5.2 Sleeping and settling baby

Sleeping and settling of baby is often a challenge for mothers. This was also the case for the mothers who took part in this study. As highlighted in chapter four section four, one mother was given instruction on using music to help calm and soothe her baby. She reported that this was effective for her baby as well as providing relaxation for herself – she continues to use the music she was given by the music therapist. Lullabies are an ancient and culturally universal method of providing comfort and bonding experiences between mother and baby (Friedman et al., 2010). The use of lullabies to calm and sedate babies while facilitating maternal relaxation has been well documented (Arnon et al., 2006; Collins & Kuck, 1991; MacKinley & Baker, 2005; Shoemark & Hanson-Abromeit, 2015).

In an Australian study conducted by (Baker & Mackinlay, 2006), it was found that although personal singing is in decline and being replaced by pre-recorded music, lullabies are an effective method of calming and settling baby while promoting relaxation in mothers. Although the mothers in Baker and Mackinlay’s (2006) study were not depressed, another study in the United States conducted by (Friedman et al., 2010) specifically included mothers who had been diagnosed with mental illnesses either during or after pregnancy. It was concluded that within this cohort, singing lullabies was effective in calming and settling baby, promoting maternal relaxation, and giving opportunities for attachment and bonding by enabling the mother to respond to baby’s cues (Friedman et al., 2010).

Some mothers noted a decrease in music use in order to keep a quiet place for the baby to sleep. However, it has been noted that there is considerable noise

generated by the mother’s body while a baby is in the womb. A baby’s hearing is typically developed by the 24th week in utero, which allows an understanding of rhythm and the baby is comforted by it (Liu, Gujjula, Thanigai, & Kuo, 2008).

Therefore, while noise should not be excessive, appropriate music may be conducive to sleep, growth and development of the baby (Liu et al., 2008).

5.5.3 Reduce depressive mood

The women who took part in this study all agreed that listening to various types of preferred music reduced feelings of depression. It was noted that music choice was diverse, reflecting the age and likes and dislikes of the individual mothers. For some, it was heavy mental and rock and roll, for others, it was country, or soothing music. These findings are consistent with a study which determined that two of the top five reasons for music use relate to mood management; specifically:

that people use music both as a means to cope with, and alleviate negative feelings (e.g., anxiety, loneliness, stress, etc.), as well as a way for individuals to create and optimize a positive mood (e.g. to relax). (Lonsdale & North, 2011, p. 111)

This same study goes on to reveal that listening to music is utilised the most to regulate mood, as music is employed to “optimize positive mood as well as to alleviate negative feelings” (Lonsdale & North, 2011, p. 116).

5.6 Conclusion

The chapter has discussed the results from chapter four in relation to the lived experience of women living in the north and northwest of Tasmania, and the perspectives of HCPs regarding the positives and challenges concerning service provision in rural and regional Tasmania. It has highlighted the principal findings and provided explanations where applicable. It has also compared these findings with those of previous research and theories within the relevant literature. The following chapter is the conclusion of the thesis. It will provide a summary of the research findings and highlight the significance of the study in terms of its contributions to and implications for research and the actions required to improve service provision for women experiencing PND in rural and remote Tasmania. It will

detail the personal experiences and development of the researcher associated with the study. Lastly, it will discuss future directions for research.