According to Federico and Whitwell, there are three different types of pregnancies: normal, high-risk, and special pregnancies. Music therapy can be beneficial for each group as long as the music therapist is careful of how music is being facilitated. While a music therapist should be cautious with all mothers and unborn babies, special precautions should be taken for high-risk and special pregnancies. For instance, if instruments playing is utilized, the instruments should be carefully selected to make sure the tones and frequencies would not cause distress for the mother or baby. Additionally, for high-risk mothers, further considerations would need to be made since the mother might be on bed rest. These mothers might need to be seen in their own homes or in the hospital, wherever they are staying. The same could be true for some special pregnancy mothers (for instance overweight mothers who can’t get out easily). When it comes to facilitating interventions, personally, I would not recommend putting speakers directly on the mother’s belly no matter if it’s a high-risk pregnancy or not. Singing to the baby and music assisted relaxation should be appropriate in most all pregnancies. Other interventions could be adjusted according to the needs and limitations of each pregnancy.
It seems like some of the research is set up with speakers on the mother's belly. correct? I probably would never set it up that way either. My thinking would be that the music would be too powerful and overstimulating. Is this correct? Are there any other reasons to be aware of? How would you recommend setting up recorded music?
I recently came across a company that sells a portable music player/belt to put the music player in for a mom's belly. I've wondered if the vibrations from music (and certain instruments) could be just as harmful as loud sounds.
The three different types of pregnancies are normal, high-risk and special pregnancies. First an initial interview or assessment should be done to determine the therapeutic needs of the mother and baby. Someone who is categorized as a normal pregnancy could be preparing for the birth and bonding with baby. For those in the high-risk or special category may be preparing for a cesarian birth, premature birth or may have bed restrictions that will not allow her to attend a group session. A mother who has bed rest restrictions may need a private session in the home or hospital room. Those who have special needs within a group will benefit from being with others who are going through similar experiences. It is more therapeutic to have mothers in a group from the same category. As the Author says, "It is quite different to work with an homogeneous group of pregnant women (with similar characteristics) than with an heterogeneous group." Those in the special pregnancy category may be seen more often and may benefit from smaller groups or individual sessions.
Yes Melissa the first step is identifying the therapeutic needs of mother and baby. This will guide your treatment plan. Yes for women in special categories I see them individually always as I find their needs are so different.
The three different types of pregnancy include Normal, High-Risk, and Specialty pregnancies. Special considerations should maybe on an individual basis for each type of pregnancy you are dealing with. I think Normal Pregnancies would be the only type that might be appropriate for group sessions. The focus in this category would be on mother-child bonding, safe fetal simulation, and relaxation. Lullaby singing programs is one idea for group sessions with this category. High-Risk pregnancies might need to focus most of their time on relaxation exercises to try and manage blood pressure issues or reduce anxiety about early delivery and/or cesarean delivery. Specialty pregnancies might want to focus most of their time on mother-child bonding activities. I would only hold group sessions with women in the high-risk and specialty categories if they have similar circumstances. Otherwise the needs of each women would vary to much for a group session to be therapeutic.
Yes I only do groups for normal pregnancies. High risk and Special pregnancies have special circumstances and needs which are better served in the 1:1 session.
When working in sessions with high-risk and special pregnancies, I believe it is better to give special attention to each case, making special considerations from the research relating to the situation. I also believe it will take special management of stress relief and emotional regulation of the mother, as the anxiety that comes with high maintenance situations. So for me, the session goals and objectives for high risk and special pregnancies would definitely be twofold, always including an emotional component.
Here are my thoughts: There are three different types of pregnancies: High risk, Special pregnancies, and normal pregnancies. In a normal pregnancy, the focus could be on many things. The focus could be on mother-child bonding, on relaxation, on reducing any anxieties or worries about the pregnancy. Basically, the needs would be determined after an assessment of the mother and baby. Even if the pregnancy is normal, we need to determine the goals for mother and child. For example, the mother may have anxieties around never having given birth before. If this were the case, I would work with her on relaxation techniques, as well as mother-child bonding.
In a high risk pregnancy, I would focus on working with the mother through potential trauma. I would place the main focus on relaxation and stress/anxiety reduction. I would work with the mother heavily on positive visualizations, especially with visualizing the best and least trauma-inducing birth.
For a special pregnancy, I would assess the mother and child and determine what the focus would be on depending on the special circumstance. If the mother had a hearing impairment, I would use vibrational work, maybe with calm drumming or with an ocean drum. If the mother was overweight, I would help her work on positive visualizations and relaxations. If the mother had conceived in-vitro or through assisted fertilization, I would focus heavily on bonding with the child and resolving any negative emotions surrounding difficulty in conception. If it were multiple births, I'd make sure to focus on each child and special bonding with the mother.
Just also weighing in on some previous comments here. I wouldn't conduct group therapy, even with normal pregnancies. My personal feelings are that the therapy would be more beneficial for the mother and child if it is 1:1 therapy.
I would love to focus on songwriting with all three groups, and I love Dr. DiCamillo's "womb song". :-)
Yes I agree Dorian. In my practice I only work with individual family units as I find that each family has their own unique needs in the therapeutic context. However, if not working from a therapeutic perspective but instead working from a more educational model it would be possible to have parents practice bonding techniques and group singing in a small group format.
As others mentioned above, music therapists always need to tailor their sessions and approach to the specific needs of the individual (in this case individuals: at least 2 clients!) With different needs, the goals change as well, as do the interventions. I do, however, feel that group sessions, as well as 2:1 (including baby) could be beneficial in all cases, if mothers can relate to one another, as peer support and building a sense of community can be very helpful when having a child. I love the ideas mentioned already, and might add emphasizing group support and bonding through songwriting and active music making for emotional release. Certainly, using the music for entrainment can help with physical goals in relationship to vital signs for both mother and child, depending on the circumstance. I might recommend family sessions if it could be beneficial/healing for siblings. A previous blog about clearing trauma could be relevant here as well in special pregnancies or high risk pregnancies. As mentioned before,creative arts with music, guided imagery, songwriting, music and relaxation and music with movement could all be useful depending on the specific area of focus. As music therapists we always need to be ready to adapt and be flexible to meet the varying and unique needs of our clients. It's also important to make sure we are assessing what our client wants to get out of the session, beyond what we think would be helpful, and always remember the baby as half of the equation :)
Yes adaptability, flexibility, and designing experiences to meet our clients needs are very important. A good assessment process will help determine client's needs and desires as well help create a plan for the interventions you will choose. I love combining creative arts with music as a way to deepen awareness, express feelings, and establish connections. For those of you who are also interested in Creative Arts- check out the Sound Birthing Creative Arts Birthing program for childbirth preparation. This is an in person workshop and it is taught in Orange County each year in May. This year it is 5/26-28. Contact me for more details if you are interested in attending. Would love to have you join us in California!
The three categories of pregnancies are: normal, high-risk, and special and the approach and needs will fluctuate depending on the type. With normal and high risk pregnancies you have the option to offer group services with a maximum of 10 mothers. High risk pregnancies will more than likely be provided either in the families home or hospital because they are unable to move. Personally I almost prefer in home services, especially if the family plans to have a home birth. Mothers will already be more relaxed in their own home than a facility because they are surrounded by the things they love and you can incorporate elements of the home into their sessions. Maybe their is a scent that they enjoy that also aids in relaxation which they plan to use during the birth which could be incorporated. Some adaptations to consider: high risk pregnancies the mother may not be able to participate in as many active activities due to bedrest. Maybe the father could do some of the instrument play instead to provide that stimulation. At no time will speakers be used to provide music to the child. A clear assessment and constant monitoring of how the child is responding is important with the high risk pregnancies as the baby is just as important as mom so be prepared to adapt as you go. I would also include a lot of relaxation and making sure the mother has a way to express her fears and/or concerns. Bedrest can drive a mother crazy and having an outlet for her emotions would be helpful and beneficial for the child so they are not living in the same emotion throughout that period. Special pregnancies need to have an assessment that covers a variety of areas to make sure the most appropriate needs are being met. If you are working with a teenager your focus might start with their fears and becoming a young mother and helping to work through their stress and anxiety. Whereas someone in their 40's might work on their fears of the chances of a prenatal condition and the chances of Down syndrome and how that would effect and change their lives.
In all cases be ready to adapt to the needs and concerns of each situation. No two cases will be the same so having a full bag of tricks will help things be more successful.
Excellent recommendations Heather. Yes every client has a unique experience. I have done group work in the past but now work with individual families exclusively. You bring up important points in working with mothers of different age groups that they may have anxiety for different reasons. Having knowledge and background in these areas is helpful. Using music to help these mothers work through their feelings and prepare for birth will help both mother and baby, and have positive effects on the family as well.
As we have seen there are three types of pregnencies:normal, special and high risk pregnancies. First of all an initial interview or assessment should be done to determine the therapeutic needs of the mother and baby which is one of the main music therapy goal. According to that music therapy treatment should have to be designed different for all three types. We should have to have in mind setting, type of intervention and approach, instruments, tones, frequencies, emotional state of the mother, father cooperation…Some mother can t visit sessions as they need to lay down (high risk pregnancy). Also mother with special or high risk pregnancies need sometimes our personal assistance and attention so we should have to work with them personally not in a group. Those mothers who have special needs within a group will have therapeutic benefits from just being with others who are going through similar experiences. Definitely in any case I would not use speakers on the belly (many web “mothering” articles also publishing pictures like “headphones on the belly” which is, in my opinion, not the right pick choice). As the singing, to the baby, and music assisted relaxation to the mother, song writing should be appropriate in most all pregnancies I would definitely choose that as my first choice at the beginning also having in mind all the limitations and characteristics of every single pregnancy because every pregnancy is unique experience. Also important information for me is one that you, Mary said in one comment: “Yes I only do groups for normal pregnancies. High risk and Special pregnancies have special circumstances and needs which are better served in the 1:1 session.” I have one question. One of your comments was: “If not working from a therapeutic perspective but instead working from a more educational model it would be possible to have parents practice bonding techniques and group singing in a small group format.” Can you explain to me what is educational model?
Oh! Mary I didn't see your comment till Nana pointed it out - that you only do group sessions "with normal pregnancies. High risk and special pregnancies have special circumstances and needs which are better served in the 1:1 session." That is a great perspective to have. One thing the readings taught, however, was that emotional support was one thing that offset highly stressful situations (i.e. teen pregnancy). Wouldn't group sessions encourage that emotional support for special pregnancies? I agree that high risk pregnancy groups wouldn't work, as many of them would have medical limitations from attending group sessions. But a group of pregnant teens might work.
Yes working with teens would be a completely different kind of program. Adolescents do well with group support. I would consider that if I ever had the opportunity to do so. :)
The three types of pregnancy discussed in the reading are normal, high-risk, and special (multiples, ART, under 15 or over 40, etc). When assessing expecting mamas I believe we should take previous pregnancies or miscarriages into account before classifying as "normal" as these mamas may have more to work through. Group therapy would be most appropriate for the "normal" group and may be a great way for moms to bond!
When working with high risk and special pregnancies we need to be extra vigilant about instrument use, language, and music choice. Patient preference should be our main guide, coupled with knowledge of how baby will react to volume, tempo, or surprises in the music.
With special and high risk pregnancies, I would focus on bonding with baby, recognizing potential "sticking points" that may hinder labor, and practicing relaxation. With normal pregnancies I would address all these with the addition of adding more "fun" activities like introducing baby to their parents favorite music.
Prenatal Music Therapy will be tailored for each group. As several people have already stated, an assessment will need to be done with each individual case to determine specific needs and goals. The assessment will also include musical preferences, as well as other relaxation techniques the client already uses.
As a general guess, prenatal MT for normal pregnancies will probably include the partner and/or siblings or other family members. The focus will probably be on increasing the bond between the prenate and the family, especially the parents, decreasing anxiety/stress, and increasing relaxation. Some approaches that may be appropriate for this group might include: ---songwriting (for example, a womb song for the baby); this would be written by both parents ---guided meditation accompanied by live or supportive recorded music; this would be done with both parents ---movement and/or dancing to music (if movement is cleared by their provider); this would be done with each parent separately and then together ---journaling to music; the parents would do this either separately or together in a joint journal for their child ---chanting positive affirmations; both parents would do this together ---using art to express positive affirmations, accompanied by supportive recorded music; the parents could do this as an independent art project, or one they collaborate on together
Prenatal Music Therapy for high-risk pregnancies would probably include just the prenate and parents. The focus would be on decreasing pain/discomfort, decreasing anxiety/stress, increasing bonding with the baby with both parents, increasing bonding with their partner, and increasing relaxation. Some approaches that may be appropriate for this group include: ---Sensory stimulation: scents, sounds, visual stimulation, tactile stimulation, and perhaps tastes that all work together for the purpose of relaxation. For example, if the client says they enjoy going to the beach to relax, then recreate the scene of a beach in the client's room by lighting an ocean scent candle, playing ocean/beach nature music, blowing a fan on low to simulate wind, looking at pictures of the beach (or using guided imagery to conjure images of the beach), and providing a small sample of salty beach food to taste (if cleared by doctor). This would be done with just the mother, and/or with both parents. ---Guided Imagery with supportive music. Guided imagery could be used to help the mother and/or partner to relax, or it could be a way to help the mother and/or partner identify their anxieties/fears, or it could be a way to communicate with their baby. This would be done with just the mother, and/or with both parents. ---Lyric analysis to help provide insight into fears, stress, and/or anticipation and joy at meeting the unborn child. ---Journaling to music; the parents would do this either separately or together in a joint journal for their child ---Chanting positive affirmations; both parents would do this together ---Using art to express positive affirmations, accompanied by supportive recorded music; the parents could do this as an independent art project, or one they collaborate on together ---Songwriting: This could be used in several ways. The mother and partner could write a womb song for their child, and also write other songs to help them get through the stress of the pregnancy, or to help them get through difficult procedures (i.e. amniocentesis), etc. Their chants, journaling, and/or positive affirmations could be incorporated into their songs.
Prenatal Music Therapy for special pregnancies would be the best candidate for group sessions, rather than individual or family sessions. Group sessions would be especially beneficial for teens, surrogate families, mothers intending to place their child for adoption, and perhaps clients who became pregnant through some sort of artificial means (IVF or an adopted embryo, etc). If the mother placing her child for adoption already has a family in place to adopt the child, the group session would just be the mother and the adoptive family. The groups would not be mixed, i.e. one teen, one adopted embryo, one surrogate, etc. The groups would be as homogeneous as possible, i.e. all teens, or all adopted embryos, etc. The focus would be on increasing bonding with the baby, decreasing anxiety/stress, increasing emotional support, and increasing relaxation. Some approaches that may be appropriate for this group include:
---Group instrument improvisation, keeping the tempo and dynamic levels within a safe limit for the unborn babies to absorb ---Group vocal improvisation ---Group song parodying, taking a familiar song and having each member of the group fill in a blank ---Group song writing ---Individual song writing (womb songs for the babies!). If this was a group of women intending to place their babies for adoption, this womb song could be taught to the adoptive family to make the adoption transition easier ---Lyric analysis to help provide insight into fears, stress, grief, and/or anticipation/joy at meeting the child ---Journaling to music ---Chanting positive affirmations ---Using art to express positive affirmations, accompanied by supportive recorded music
Prenatal music therapy approaches and considerations will certainly vary between the normal, special, and high-risk pregnancies. And, in fact, the number of variances in pregnancies are equal to the number of families!
I've enjoyed pondering the conversation re: group verses individual treatment. And in perhaps all categories (although the high-risk is less practical due to physical restraints), I can see the benefit of group therapy in certain situations in all groups (mostly the more educational purposes like Mary D. mentioned). It's just less-likely that the same mothers that might work well in a group together are needing/seeking services at the same time in the high-risk and special category. But, Federico said, "The hyper-sensitivity and vulnerability of pregnant women is a very important factor, which can be relieved by a group setting. The value of such groups lies in the exchange of experiences with the other mothers during the sessions providing support, reassurance, and insight for one another." I can imagine that some of the movement exercises and singing might be more comfortable and safe in numbers. Also, there's nothing like having a good mother friend to confide in and gain insight from.
As far as the other considerations, you all covered it well. A good assessment will give lots of clues to successful choices in approach, style, preferences, music selections, sensitivity, medical concerns, etc. And, of course, a particular pregnancy could quickly change categories (normal to high-risk)! In general, normal pregnancies have a lot of opportunity for interventions (full range of movement, normal sound sensitivity, etc.) and usually the mother is more emotionally stable about the situation than the other categories. High-risk pregnancies will take lots of medical precautions including reduced (or no) movement, sounds that are more quiet, less startling, and less likely to over-stimulate. Emotionally, focusing on relaxation and maintaining hope are key here. Special pregnancies will also have many unique medical and emotional considerations. Situations such a hearing problems in the mother will take a unique therapy approach, perhaps involving more gentle vibrations. As will a pregnancy with multiples, making it therapy with 3+ clients!
As is the principle for all therapy sessions, every client will have their own unique needs and strengths and the therapist will certainly strive to be well-educated and recognize and be flexible in their approach and interventions.
Yes Sarah I totally agree that woman can relieve much stress and anxiety through group support, however there are some mothers who have unique situations who may also need an individualized approach. :)
How does prenatal music therapy differ for the three different types of pregnancies? How might you adjust your approach when working with each group?
The three pregnancy groups in question are "normal pregnancy", "high risk pregnancy" and "special pregnancy". These three are the umbrella groups over a fantastic amount of specific pregnancy situations. An example of a "normal pregnancy" would be someone who is expecting and in good health with healthy support systems and no major extenuating circumstances.The child in utero would be developing at a typical pace. An example of a "high risk" pregnancy" would be the expecting caregiver and child struggling are struggling with a threatening condition such as serious pre-existing condition in the adult, being in an at risk living situation, a pregnancy complication like Placenta Previa, etc. There is a direct threat to the well being and possible the life of either or both the expecting adult and child. A special pregnancy would be one that is not high risk but the circumstances are not "typical", like a surrogate mother, a transgender male expecting person or a severally mentally ill person.
For all three, there are elements of prenatal music therapy that would be applicable for all. Adaptions, exceptions and improvisation would be required for each group.
"Normal Pregnancy" - I would approach this with typical sessions designed to help the pregnant process their journey and build a relationship with their child. Interventions would also address typical pregnancy themes such as relaxation, healthy exercise, putting together a birth tape and/or lullaby, etc. These sessions could be one on one, didactic, group or commununal.
"High Risk Pregnancy" : sessions would feature the typical themes with a greater emphasis on relaxation and any interventions relevant to the themes of the risk. For instance Placental Abruption can be related to long standing high blood pressure. Sessions could be utilized to help the adult to find music that lowers their blood pressure and base interventions around that. Music listening, improvisation in that style or with that instrument, etc would all be appropriate. It is important to give this group a sense of control and hope by helping them process their experience and feel like they are an active participant in reducing risk. All types of sessions could be recommended, strongly suggested the pregnant adult include significant persons or use community sessions to build support.
"Special Pregnancy" : Typical themes with focus on grounding and acceptance. Songwriting and guided imagery interventions could be used to help the adult process their unique experience and find their identity as a pregnant person. Sessions should build their self-worth and confidence. For example, surrogates could write songs to their child, explaining things and expressing their affection. Similar songs could also be used towards the end of the pregnancy to offer adult and child closure and the child's parent(s) prepare to receive the newborn. In this surrogate situation, one on one or small group sessions would be recommended. It might be encouraged that some sessions include the child's parents who are preparing to receive their gift. (guided imagery is only recommended for one on one sessions)
Yes I am interested in research on prenatal music bonding in surrogacy and adoption. It is so important for these babies who experience a different journey. Thank you for your thorough response Christine. :)
Even 'normal' pregnancies involve concerns from the mother for the health and safety of her baby and the delivery. Therefore, a similar considerations could be taken for the three pregnancy types: normal, high risk, and special. High risk is defined as needing bed or medicine to continue the pregnancy. Special is defined as overweight women, women who have hearing problems, multiple pregnancies, pregnancies achieved through assisted fertilization or in-vitro fertilization, and women under 15 or over 40 years of age.
But there will be some variation in approach. When it comes to groups, it is best to make them heterogenous as possible: in age, and whether or not they used a fertilization treatment.
When it comes to high risk pregnancies, fast movement/music activities will be avoided, choosing more relaxing and restful music with visualizations to lower anxiety. Since she may be on bedrest, the ability to visit her home or hospital bed would be something to take into account. Art and affirmations to soothing music might be one option with this client group.
When it comes to special pregnancies, getting a group of women with similar special needs would be a wonderful opportunity for bonding and support. However, it's also an opportunity to really get to know your client's individual preferences and situation and work with their music, whether through music listening and analysis, or songwriting.
Normal pregnancies will not require special language or considerations, but an awareness of the possibility of equal emotional distress as someone with a high risk pregnancy. Every individual is a case by case basis; and most important, letting the client's needs dictate the session more than a label.
First, I think it's important to consider that each person is going to have a very different pregnancy and birthing experience so taking a person centered approach regardless of the "type" is imperative in my opinion. However as music therapists we can use this information to help provide the most effective techniques for working with all three pregnancy groups.
Normal pregnancies - I would start with a typical assessment and decipher what ways we could use music therapy to best benefit the mother/child. I would use interventions to promote relaxation, increase bonding, exercise, reduce anxiety, and create a holistic environment for the development of the baby. This could include songwriting, improvisation, movement, and guided relaxation techniques in both a one on one or group setting.
High risk pregnancies- I would still use a typical assessment, I would however shift my focus from using any movement interventions and instead use techniques to help the mother relax and focus her energy on surrounding herself and her baby with love, acceptance, and support. As an MT, I would encourage the mother to be an active participant in reducing risk for her and her child. I think songwriting, improvisation, and guided imagery would be great for this group. Any fast paced movements or songs should be avoided with this group. Both individual and group sessions for support could be encouraged.
Special pregnancies- Since this group includes women under 15 and over 40 it's important to consider age when doing group sessions. If possible try to avoid groups with vastly different ages since they will be having very different experiences. When considering individual sessions within this group I think techniques such as songwriting (including writing a lullaby for the unborn child), improvisation, guided imagery, and movement activities can be used. The MT should focus on empowering and supporting the individual through these interventions. Every pregnancy is special and making them feel supported throughout their process can make all the difference.
Yes individualized and personalized is my approach as well. Currently in my practice I only work with individual families. Yet this work can be done in a group with consideration for individual needs. Yes when grouping it is important to bring together mothers with similar experiences and ages. I find that this work is so personal and I find it most effective when working with individual families. But group support and bonding through music can also be an amazing experience and can also give women a future support group for after the child is born. :)
Normal Pregnancies: I think that even with normal pregnancies there will be individual anxieties and concerns that mom and both parents will have about their baby so although mom and baby may be in good health, there may likely be other psychological effects to take into consideration. After an assessment, we can determine what will be most beneficial to the family of the expected baby. We can absolutely work on bonding and connection and how to best utilize music whether pre-recorded selections are chosen or live music to be utilized at birth to help express pain and further relaxation during labor.
High Risk Pregnancies: Physically we would have to be very careful for the obvious reasons of the mother needing to keep her movements to a limit so we can conduct sessions in the comfort of home or at the hospital at bedside. We can use music in a very gentle way encouraging relaxation, positive affirmations and doing what we can to minimize anxiety and worries that will come naturally with childbirth but especially in this high risk situation. I'm thinking there could be a lot of feelings of anxiety, worry and stress that music therapy could help minimize for mom and family.
Special Pregnancies- Since each person that would be classified under "special pregnancy" has a wide range of needs from overweight women to women with hearing impairments to women younger than 15 an older than 40, a proper assessment would need to be done (as of course with any group) and we'd have to group people together appropriately so they can receive maximum therapeutic benefit from the sessions. Overweight women may be dealing with some anxieties over health issues while pregnant and so I think that positive affirmations in conjunction with chosen music could be beneficial. Women with hearing problems may still be encouraged to utilize their voice as much as possible and as music therapists we can support their expression of their voice as the primary instrument that will get through to the baby. Maybe we can put most emphasis on this as opposed to other modes of music use. It would of course all depend on the degree of hearing impairment and would vary case to case. For women who have been successful with fertilization or invitro measures for becoming pregnant, there may be a lot of happiness around the pregnancy but also concern for the pregnancy making it to full term since it may have been difficult to become pregnant. Working around those anxieties and using relaxation techniques, imagery and positive affirmations to ease anxieties, increase self-expression and surround the family with beauty, love and joy all seem like beneficial techniques.
Yes Jillian thank you for reminding us about the anxieties that all women experience in pregnancy and that there are definitely special considerations for specific groups of clients in the special pregnancies group. It will be important to approach each client and group with care and concern for the mother, baby and family unit and help them to ease their worry and stress to communicate openly and freely with love with the baby. It is important to help the baby understand that he/she is wanted and loved even though it may be a stressful time for the mother.
Within each of the three categories there are very different and specific things to consider when assessing and creating programs. It would first be extremely important to do a proper assessment for each client to understand not only how best they might be treated, but which category they may fall into, as it is not enough to simply assume that even though a pregnancy may be ‘high risk’ or a ‘special pregnancy’ doesn’t’ mean that a 40+ women and teenage pregnancy should be treated within the same group for example. Some details that are important to ascertain through assessment would be things like current week, expected date of birth, any medication they may taking and any special circumstances regarding their present pregnancy. It would also be important to know if the pregnancy was conceived through IVF and if there had been any previous pregnancies and complications. I actually think it would be beneficial to have a group specifically for women who have previously experienced loss and allowing them the opportunity to work through existing fears in their current pregnancy, which would also provide an opportunity to connect with other women who have experienced something similar. I would also consider other specialist groups such as those for young parents (under 21)
In regards to the three specified pregnancy groups, I would address them as follows:
All groups would have some degree of focus on bonding and relaxation, using interventions such as visualisation, relaxation, music listening and song writing.
Normal – Pregnancies that are developing normally would focus on group work that centres on bonding, relaxation and guided meditation. Instrumental and vocal improvisation; chanting, lyric analysis, music listening and song writing would be used, including working towards a womb song.
High Risk - these are cause for even greater care and attention and may often be carried out bedside in a client’s home or hospital, because of a risk of bleeding and abortion and little movement from the client may not be possible. Extreme care would be taken when choosing music – an emphasis on gentle music that focuses on positive lyrics and perhaps instrumental string. As there is such a strong connection between our emotional responses and physiological impact, lots of very positive imagery and visualisations about positive outcomes and the birthing experience would be used. The creation of a womb song would be encouraged, as this is something that could be worked on over time – great for helping to pass long days bedridden and also the creation of lullaby playlists which could be played both pre and post-natally.
Special – Would also include many of the above interventions, but it is more likely that clients would be seen individually, rather than through group work, as each case may be unique and require specialist considerations. However, if there are enough common characteristics between clients, it might be beneficial to connect them. The focus with these clients would be to work through any feelings of fear through positive imagery and relaxation. I feel that encouraging attachment and bonding would be particularly important with this group and things like affirmations and womb song writing would be really beneficial to this. Special consideration should be given to the client-therapist relationship in these situations, as the music-therapist will likely see the client more often than their obstetrician.
Yes Rebecca exactly! Just because a birth mother is a certain age doesn't mean she will necessarily fit a "category". These are general guidelines of course. I have worked with many women over 40 who had completely normal (not high risk) births. All of your suggestions are wonderful. Yes I use birth affirmation cards and womb songs for all of the clients I work with. Also, song writing, movement (if ok for mother) imagery and mandalas. We teach all of these experiences in our Creative Arts Birthing Workshop- which also includes birth art experiences. I am working to offer this class in a Blended Learning Format in 2018. :) MD
I found the discussion in the book on normal vs special and high risk pregnancies a bit annoying. I think I took umbrage because I had my son at age 41 and I was perfectly healthy ! However, this brings up the issue of when it might be more appropriate to do individual vs groups sessions. For the women who are high risk , it makes sense to do individual sessions and really focus on the specifics of the medical issue. As with all pregnancies, decreasing anxiety has to be in the forefront and this will be heightened in a high risk pregnancy. Also since the woman is likely to be at bed rest or less mobile, individual sessions at her home or bedside makes the most sense. I find the teenage group to be particularly interesting because they are at high risk for poor bonding and attachment for a variety of reasons. Based on this, I have made it a priority to do my first program with this group. I am hoping to bring it to a local high school that has a special school for teenage mothers. I think a prenatal MT program for this group will really help them connect and bond with their babies and with the other young mothers to be. These are young women who are likely to have insufficient support by a partner. These mothers need a lot of extra support and education about mothering in general and about self-care. It also might make sense to include the woman's own mother since in many of these cases, the grandmother because very instrumental in caring for the child. I would also emphasize to the teenage moms that the music they might be most interested in may not be the most pleasing to the baby. So they might need special encouragement to expand their musical horizon and tastes.
The three types of pregnancies include normal pregnancy, high risk pregnancies and special pregnancies. Normal pregnancies are when there are no known complications and normal care is given. These pregnancies can benefit from focusing on mother/baby bonding and finding support in a group of other mothers with normal pregnancies. High risk pregnancies are those that require special care. There might be a risk of miscarriage, they might be mothers put on bedrest, mothers with high blood pressure or those diagnosed with placenta previa. In these cases, you may have to adjust by offering services at home or in the hospital because these women generally have difficulties traveling. Special pregnancies include a myriad of situations - mothers who experience obesity, blindness, hearing loss, multiple pregnancies, pregnancies attained by assisted fertilization or artificial insemination, HIV positive, under 15, over 40, scheduled c section, previous stillbirth, had a child with disability or lost a child.
Being aware of these categories of pregnancies is important so that we do not place women together in groups that are in completely different situations. You might have to adjust your techniques by recommending 1:1 sessions for special pregnancies or recommending a particular group that has mothers with similar situations. There may be different fears to work through in different pregnancies.
For example, hearing impaired women might be concerned about knowing if their child is alive at birth since they can't hear them cry. Or they might be concerned about not being able to hear them cry at home and respond to them when they need to. As another example, a mother who has experienced a stillborn might have many more anxieties about their pregnancy and fears to work through. These are some examples where situations might not be applicable at all to someone with a normal pregnancy or in a completely different special situation and therefore, it may not be appropriate to pair these women together. They may even be counter-productive to each other.
After going through what essentially turned out to be a high risk birth, I feel that the correct therapeutic set up would be a one on one session with special needs or high risk pregnancy. I became the music therapist in our situation but in hindsight we would of benefitted from having a separate mt and or Dula. In general there are so many things to consider that the initial assessment is of the most importance. For a normal pregnancy I still would rather a one on one session as coming from a music psychotherapy background I feel that the relationship between MT and family is such an important aspect that ultimately informs all of the work and that it would be hard to facilitate a group session and reach everyone completely. Maybe group sessions for all three types of pregnancies, normal, high-risk, & special to supplement the one on one work?
I like your ideas for groups for all and supplement 1:1 work as needed. Great! As a music therapy student (at the time of giving birth) I would agree with you also and highly recommend a separate MT and/or doula to assist. (I was blessed to have Mary and Summer as my MTs) I don't think I could have been my own. I also have my doula training and one thing I always tell parents to consider is, yes, you may have your special thing as a couple and know how you want your spouse to support you, so that's all the MORE reason to have an MT with sound birthing experience or a doula present to simply hold space so that the couple can focus on each other and the momentous occasion. Then that extra set of hands is there to handle all the other things so the couple is not disturbed when they're in their groove. I ended up with a cesarean and would not have know what on earth to do if it hadn't been for Mary & Summer.
And I hope everything is well for you and your wife and baby. :)
I think the biggest difference in prenatal music therapy with different types of pregnancies would be whether it takes place individually or in a group. It seems like high risk pregnancies would mostly be done individually, due to health issues that might keep a woman at home or in a hospital setting. I think "normal" and "special" pregnancies could both be done in groups. If a music therapist wanted to conduct a prenatal music therapy group, it would definitely be necessary to have very detailed intake paperwork to be able to place a mom into an appropriate group setting, based on her needs. "Special" groups might need specific processing through music based on the common denominator in the group. "Normal" groups would also need to be able to process through the pregnancy and all the changes that were happening, but may be able to focus more on just bonding with their baby through music.
Prenatal music therapy will be individualized for each woman depending on the category she is in. Any of these classifications would benefit from 1:1 music therapy sessions. I would consider group settings for the normal group. This can be an opportunity for women to bond and create a circle of support within their community. They will still take home the knowledge they receive and individualized their bonding with the baby.
I know I was reading some of the past comments on how some people felt groups setting would not be beneficial for the high risk and special group. I would have to politely disagree, and here’s why (but Mary, please correct me if my thinking is incorrect). I would of course ALWAYS consult with a physician or social worker or psychologist, but many women who are in the latter two groups may be hospitalized (just depends). In these settings a 1:1 session would be great. However, I feel that group settings could also be beneficial in the hospital setting as long as 1) a physician or social worker or psychologist has been consulted as to the stability and or appropriateness of the woman’s participation in a group and 2) the woman’s consent in being part of a group 3) the group be constructed based upon the two previous factors so that women are group according to conditions, type of pregnancy, etc. These women may greatly benefit from the support of the other women and the overarching theme of music therapy.
Normal Pregnancies: these women could work individually or within a small group outside of the home. Music bonding would be “typical” of what we have been studying; bonding through favorite music, playing instruments, relaxation, lullabies, song writing, etc. I would find appropriate speakers to use for surround sound and create experiences for bonding which could be done with me in a group or at home on their own.
High Risk Pregnancies: these women will have special considerations and may need to work with a MT in a hospital setting due to bed rest. Or 1:1 sessions at home could be arranged. Music and experiences would be modified accordingly and a doctor would be consulted if necessary.
Special Pregnancies: again this will be individualized depending on the need of the mother. Mothers with visual or hearing impairments may require special considerations for how they receive the musical input. And young women (as he suggests, under 15, but I’d say 17 and under even) would probably require 1:1 sessions depending on factors such as cause of pregnancy, mental/emotional stability, etc.
And because multiples are on my mind, that these women especially need care in the realm of relaxation music and not stimulating music, as if you have two or three babies rockin’ out in a womb…well…poor mama! And it may not be good for the mom depending on her conditions (I’m thinking preeclampsia, etc.) due to the doctors not wanting contractions to start or the woman/babies be over-stimulated in any way. Calm Mama. :)
Yes I agree there are no rules. And women on antepartum units need to connect so they are not isolated... however if they are on bedrest that might be easier said than done. However if they are allowed to get up in a wheel chair or perhaps through the use of technology, zoom or skype sessions, connecting with other women for support in addition to the music therapist would be ideal.
The three types of pregnancies are normal, high risk, and special pregnancies. With all of these classifications, the first step is getting an understanding of what the woman's goals are for her pregnancy and delivery. With high risk and special pregnancies, getting an understanding of what considerations their doctor has put in place, as well as why they are in this category. For instance, a mother that is high risk because of a history of instant loss or several miscarriages, is going to come to pregnancy different than a mom who is high risk due to obesity or pre-eclempsia. Additional considerations may need to be implemented for moms who need bed rest (home or hospitalized), frequent stress tests, etc. 1:1 sessions, unusual session times, and modified implementation schedule are all considerations that might need to be used.
I think the overarching theme (as it often is in birth work, and music therapy) is to come to a situation prepared for change. Even with low-risk/normal pregnancies, I always work out potential plans A, B, and C, but am prepared mentally for plan D to come into the picture.
Absolutely, it's all about awareness, openness and understanding to the situation and to what the client presents. And yes have a big tool kits and the ability to switch gears in a moment is so important. :)
According to Federico and Whitwell, there are three different types of pregnancies: normal, high-risk, and special pregnancies. Music therapy can be beneficial for each group as long as the music therapist is careful of how music is being facilitated. While a music therapist should be cautious with all mothers and unborn babies, special precautions should be taken for high-risk and special pregnancies. For instance, if instruments playing is utilized, the instruments should be carefully selected to make sure the tones and frequencies would not cause distress for the mother or baby. Additionally, for high-risk mothers, further considerations would need to be made since the mother might be on bed rest. These mothers might need to be seen in their own homes or in the hospital, wherever they are staying. The same could be true for some special pregnancy mothers (for instance overweight mothers who can’t get out easily). When it comes to facilitating interventions, personally, I would not recommend putting speakers directly on the mother’s belly no matter if it’s a high-risk pregnancy or not. Singing to the baby and music assisted relaxation should be appropriate in most all pregnancies. Other interventions could be adjusted according to the needs and limitations of each pregnancy.
ReplyDeleteNo speakers on mama's belly ever....
ReplyDeleteYes we must be extra cautious when working with high risk pregnancies. Thank you for reminding us Katie.
It seems like some of the research is set up with speakers on the mother's belly. correct? I probably would never set it up that way either. My thinking would be that the music would be too powerful and overstimulating. Is this correct? Are there any other reasons to be aware of? How would you recommend setting up recorded music?
DeleteI recently came across a company that sells a portable music player/belt to put the music player in for a mom's belly. I've wondered if the vibrations from music (and certain instruments) could be just as harmful as loud sounds.
DeleteI just happened to see something like that too. It was called lullabelly.
DeleteThe website is lullabelly.com
ugh! No speakers on bellies ever! Just say no to that junk!
DeleteYes, that's the one I saw! I agree...ugh!!
DeleteThe three different types of pregnancies are normal, high-risk and special pregnancies. First an initial interview or assessment should be done to determine the therapeutic needs of the mother and baby. Someone who is categorized as a normal pregnancy could be preparing for the birth and bonding with baby. For those in the high-risk or special category may be preparing for a cesarian birth, premature birth or may have bed restrictions that will not allow her to attend a group session. A mother who has bed rest restrictions may need a private session in the home or hospital room. Those who have special needs within a group will benefit from being with others who are going through similar experiences. It is more therapeutic to have mothers in a group from the same category. As the Author says, "It is quite different to work with an homogeneous group of pregnant women (with similar characteristics) than with an heterogeneous group." Those in the special pregnancy category may be seen more often and may benefit from smaller groups or individual sessions.
ReplyDeleteYes Melissa the first step is identifying the therapeutic needs of mother and baby. This will guide your treatment plan. Yes for women in special categories I see them individually always as I find their needs are so different.
ReplyDeleteThe three different types of pregnancy include Normal, High-Risk, and Specialty pregnancies. Special considerations should maybe on an individual basis for each type of pregnancy you are dealing with. I think Normal Pregnancies would be the only type that might be appropriate for group sessions. The focus in this category would be on mother-child bonding, safe fetal simulation, and relaxation. Lullaby singing programs is one idea for group sessions with this category.
ReplyDeleteHigh-Risk pregnancies might need to focus most of their time on relaxation exercises to try and manage blood pressure issues or reduce anxiety about early delivery and/or cesarean delivery. Specialty pregnancies might want to focus most of their time on mother-child bonding activities. I would only hold group sessions with women in the high-risk and specialty categories if they have similar circumstances. Otherwise the needs of each women would vary to much for a group session to be therapeutic.
Yes I only do groups for normal pregnancies. High risk and Special pregnancies have special circumstances and needs which are better served in the 1:1 session.
ReplyDeleteWhen working in sessions with high-risk and special pregnancies, I believe it is better to give special attention to each case, making special considerations from the research relating to the situation. I also believe it will take special management of stress relief and emotional regulation of the mother, as the anxiety that comes with high maintenance situations. So for me, the session goals and objectives for high risk and special pregnancies would definitely be twofold, always including an emotional component.
ReplyDeleteAbsolutely. Also there is an emotional component when working with normal pregnancies as well. :)
ReplyDeleteHere are my thoughts: There are three different types of pregnancies: High risk, Special pregnancies, and normal pregnancies. In a normal pregnancy, the focus could be on many things. The focus could be on mother-child bonding, on relaxation, on reducing any anxieties or worries about the pregnancy. Basically, the needs would be determined after an assessment of the mother and baby. Even if the pregnancy is normal, we need to determine the goals for mother and child. For example, the mother may have anxieties around never having given birth before. If this were the case, I would work with her on relaxation techniques, as well as mother-child bonding.
ReplyDeleteIn a high risk pregnancy, I would focus on working with the mother through potential trauma. I would place the main focus on relaxation and stress/anxiety reduction. I would work with the mother heavily on positive visualizations, especially with visualizing the best and least trauma-inducing birth.
For a special pregnancy, I would assess the mother and child and determine what the focus would be on depending on the special circumstance. If the mother had a hearing impairment, I would use vibrational work, maybe with calm drumming or with an ocean drum. If the mother was overweight, I would help her work on positive visualizations and relaxations. If the mother had conceived in-vitro or through assisted fertilization, I would focus heavily on bonding with the child and resolving any negative emotions surrounding difficulty in conception. If it were multiple births, I'd make sure to focus on each child and special bonding with the mother.
Just also weighing in on some previous comments here. I wouldn't conduct group therapy, even with normal pregnancies. My personal feelings are that the therapy would be more beneficial for the mother and child if it is 1:1 therapy.
I would love to focus on songwriting with all three groups, and I love Dr. DiCamillo's "womb song". :-)
Dorian Campbell
Yes I agree Dorian. In my practice I only work with individual family units as I find that each family has their own unique needs in the therapeutic context. However, if not working from a therapeutic perspective but instead working from a more educational model it would be possible to have parents practice bonding techniques and group singing in a small group format.
DeleteSo smart to think about working through potential trauma for the high risk pregnancies! Great insight, Dorian!
DeleteAs others mentioned above, music therapists always need to tailor their sessions and approach to the specific needs of the individual (in this case individuals: at least 2 clients!) With different needs, the goals change as well, as do the interventions. I do, however, feel that group sessions, as well as 2:1 (including baby) could be beneficial in all cases, if mothers can relate to one another, as peer support and building a sense of community can be very helpful when having a child. I love the ideas mentioned already, and might add emphasizing group support and bonding through songwriting and active music making for emotional release. Certainly, using the music for entrainment can help with physical goals in relationship to vital signs for both mother and child, depending on the circumstance. I might recommend family sessions if it could be beneficial/healing for siblings. A previous blog about clearing trauma could be relevant here as well in special pregnancies or high risk pregnancies. As mentioned before,creative arts with music, guided imagery, songwriting, music and relaxation and music with movement could all be useful depending on the specific area of focus. As music therapists we always need to be ready to adapt and be flexible to meet the varying and unique needs of our clients. It's also important to make sure we are assessing what our client wants to get out of the session, beyond what we think would be helpful, and always remember the baby as half of the equation :)
ReplyDeleteYes adaptability, flexibility, and designing experiences to meet our clients needs are very important. A good assessment process will help determine client's needs and desires as well help create a plan for the interventions you will choose. I love combining creative arts with music as a way to deepen awareness, express feelings, and establish connections. For those of you who are also interested in Creative Arts- check out the Sound Birthing Creative Arts Birthing program for childbirth preparation. This is an in person workshop and it is taught in Orange County each year in May. This year it is 5/26-28. Contact me for more details if you are interested in attending. Would love to have you join us in California!
ReplyDeleteIs there a book or resource you have used to integrate the Creative Arts into your practice?
DeleteI have been inspired by the work of Pam England in New Mexico. She has several books about art in the birth process. http://www.bfwnewmexico.com/
DeleteThe three categories of pregnancies are: normal, high-risk, and special and the approach and needs will fluctuate depending on the type. With normal and high risk pregnancies you have the option to offer group services with a maximum of 10 mothers. High risk pregnancies will more than likely be provided either in the families home or hospital because they are unable to move. Personally I almost prefer in home services, especially if the family plans to have a home birth. Mothers will already be more relaxed in their own home than a facility because they are surrounded by the things they love and you can incorporate elements of the home into their sessions. Maybe their is a scent that they enjoy that also aids in relaxation which they plan to use during the birth which could be incorporated.
ReplyDeleteSome adaptations to consider: high risk pregnancies the mother may not be able to participate in as many active activities due to bedrest. Maybe the father could do some of the instrument play instead to provide that stimulation. At no time will speakers be used to provide music to the child. A clear assessment and constant monitoring of how the child is responding is important with the high risk pregnancies as the baby is just as important as mom so be prepared to adapt as you go. I would also include a lot of relaxation and making sure the mother has a way to express her fears and/or concerns. Bedrest can drive a mother crazy and having an outlet for her emotions would be helpful and beneficial for the child so they are not living in the same emotion throughout that period.
Special pregnancies need to have an assessment that covers a variety of areas to make sure the most appropriate needs are being met. If you are working with a teenager your focus might start with their fears and becoming a young mother and helping to work through their stress and anxiety. Whereas someone in their 40's might work on their fears of the chances of a prenatal condition and the chances of Down syndrome and how that would effect and change their lives.
In all cases be ready to adapt to the needs and concerns of each situation. No two cases will be the same so having a full bag of tricks will help things be more successful.
Excellent recommendations Heather. Yes every client has a unique experience. I have done group work in the past but now work with individual families exclusively. You bring up important points in working with mothers of different age groups that they may have anxiety for different reasons. Having knowledge and background in these areas is helpful. Using music to help these mothers work through their feelings and prepare for birth will help both mother and baby, and have positive effects on the family as well.
ReplyDeleteAs we have seen there are three types of pregnencies:normal, special and high risk pregnancies. First of all an initial interview or assessment should be done to determine the therapeutic needs of the mother and baby which is one of the main music therapy goal. According to that music therapy treatment should have to be designed different for all three types. We should have to have in mind setting, type of intervention and approach, instruments, tones, frequencies, emotional state of the mother, father cooperation…Some mother can t visit sessions as they need to lay down (high risk pregnancy). Also mother with special or high risk pregnancies need sometimes our personal assistance and attention so we should have to work with them personally not in a group. Those mothers who have special needs within a group will have therapeutic benefits from just being with others who are going through similar experiences.
ReplyDeleteDefinitely in any case I would not use speakers on the belly (many web “mothering” articles also publishing pictures like “headphones on the belly” which is, in my opinion, not the right pick choice).
As the singing, to the baby, and music assisted relaxation to the mother, song writing should be appropriate in most all pregnancies I would definitely choose that as my first choice at the beginning also having in mind all the limitations and characteristics of every single pregnancy because every pregnancy is unique experience.
Also important information for me is one that you, Mary said in one comment: “Yes I only do groups for normal pregnancies. High risk and Special pregnancies have special circumstances and needs which are better served in the 1:1 session.”
I have one question. One of your comments was: “If not working from a therapeutic perspective but instead working from a more educational model it would be possible to have parents practice bonding techniques and group singing in a small group format.” Can you explain to me what is educational model?
Oh! Mary I didn't see your comment till Nana pointed it out - that you only do group sessions "with normal pregnancies. High risk and special pregnancies have special circumstances and needs which are better served in the 1:1 session." That is a great perspective to have. One thing the readings taught, however, was that emotional support was one thing that offset highly stressful situations (i.e. teen pregnancy). Wouldn't group sessions encourage that emotional support for special pregnancies? I agree that high risk pregnancy groups wouldn't work, as many of them would have medical limitations from attending group sessions. But a group of pregnant teens might work.
DeleteYes working with teens would be a completely different kind of program. Adolescents do well with group support. I would consider that if I ever had the opportunity to do so. :)
DeleteThe three types of pregnancy discussed in the reading are normal, high-risk, and special (multiples, ART, under 15 or over 40, etc). When assessing expecting mamas I believe we should take previous pregnancies or miscarriages into account before classifying as "normal" as these mamas may have more to work through. Group therapy would be most appropriate for the "normal" group and may be a great way for moms to bond!
ReplyDeleteWhen working with high risk and special pregnancies we need to be extra vigilant about instrument use, language, and music choice. Patient preference should be our main guide, coupled with knowledge of how baby will react to volume, tempo, or surprises in the music.
With special and high risk pregnancies, I would focus on bonding with baby, recognizing potential "sticking points" that may hinder labor, and practicing relaxation. With normal pregnancies I would address all these with the addition of adding more "fun" activities like introducing baby to their parents favorite music.
Thanks for that reminder, Laura. Yes, "normal" pregnancies still may have many concerns to work through!
DeleteYes I like the idea of introducing the baby to their parents favorite music!
DeletePrenatal Music Therapy will be tailored for each group. As several people have already stated, an assessment will need to be done with each individual case to determine specific needs and goals. The assessment will also include musical preferences, as well as other relaxation techniques the client already uses.
ReplyDeleteAs a general guess, prenatal MT for normal pregnancies will probably include the partner and/or siblings or other family members. The focus will probably be on increasing the bond between the prenate and the family, especially the parents, decreasing anxiety/stress, and increasing relaxation. Some approaches that may be appropriate for this group might include:
---songwriting (for example, a womb song for the baby); this would be written by both parents
---guided meditation accompanied by live or supportive recorded music; this would be done with both parents
---movement and/or dancing to music (if movement is cleared by their provider); this would be done with each parent separately and then together
---journaling to music; the parents would do this either separately or together in a joint journal for their child
---chanting positive affirmations; both parents would do this together
---using art to express positive affirmations, accompanied by supportive recorded music; the parents could do this as an independent art project, or one they collaborate on together
Prenatal Music Therapy for high-risk pregnancies would probably include just the prenate and parents. The focus would be on decreasing pain/discomfort, decreasing anxiety/stress, increasing bonding with the baby with both parents, increasing bonding with their partner, and increasing relaxation. Some approaches that may be appropriate for this group include:
ReplyDelete---Sensory stimulation: scents, sounds, visual stimulation, tactile stimulation, and perhaps tastes that all work together for the purpose of relaxation. For example, if the client says they enjoy going to the beach to relax, then recreate the scene of a beach in the client's room by lighting an ocean scent candle, playing ocean/beach nature music, blowing a fan on low to simulate wind, looking at pictures of the beach (or using guided imagery to conjure images of the beach), and providing a small sample of salty beach food to taste (if cleared by doctor). This would be done with just the mother, and/or with both parents.
---Guided Imagery with supportive music. Guided imagery could be used to help the mother and/or partner to relax, or it could be a way to help the mother and/or partner identify their anxieties/fears, or it could be a way to communicate with their baby. This would be done with just the mother, and/or with both parents.
---Lyric analysis to help provide insight into fears, stress, and/or anticipation and joy at meeting the unborn child.
---Journaling to music; the parents would do this either separately or together in a joint journal for their child
---Chanting positive affirmations; both parents would do this together
---Using art to express positive affirmations, accompanied by supportive recorded music; the parents could do this as an independent art project, or one they collaborate on together
---Songwriting: This could be used in several ways. The mother and partner could write a womb song for their child, and also write other songs to help them get through the stress of the pregnancy, or to help them get through difficult procedures (i.e. amniocentesis), etc. Their chants, journaling, and/or positive affirmations could be incorporated into their songs.
Prenatal Music Therapy for special pregnancies would be the best candidate for group sessions, rather than individual or family sessions. Group sessions would be especially beneficial for teens, surrogate families, mothers intending to place their child for adoption, and perhaps clients who became pregnant through some sort of artificial means (IVF or an adopted embryo, etc). If the mother placing her child for adoption already has a family in place to adopt the child, the group session would just be the mother and the adoptive family. The groups would not be mixed, i.e. one teen, one adopted embryo, one surrogate, etc. The groups would be as homogeneous as possible, i.e. all teens, or all adopted embryos, etc. The focus would be on increasing bonding with the baby, decreasing anxiety/stress, increasing emotional support, and increasing relaxation. Some approaches that may be appropriate for this group include:
---Group instrument improvisation, keeping the tempo and dynamic levels within a safe limit for the unborn babies to absorb
---Group vocal improvisation
---Group song parodying, taking a familiar song and having each member of the group fill in a blank
---Group song writing
---Individual song writing (womb songs for the babies!). If this was a group of women intending to place their babies for adoption, this womb song could be taught to the adoptive family to make the adoption transition easier
---Lyric analysis to help provide insight into fears, stress, grief, and/or anticipation/joy at meeting the child
---Journaling to music
---Chanting positive affirmations
---Using art to express positive affirmations, accompanied by supportive recorded music
I had too many characters for Blogger to post this as one long post. So I had to break it up into 2 posts.
DeleteWhat a neat idea about using the womb song with both the birth family and adoptive family!
DeleteYes this will be so important for baby's transition after birth!
DeletePrenatal music therapy approaches and considerations will certainly vary between the normal, special, and high-risk pregnancies. And, in fact, the number of variances in pregnancies are equal to the number of families!
ReplyDeleteI've enjoyed pondering the conversation re: group verses individual treatment. And in perhaps all categories (although the high-risk is less practical due to physical restraints), I can see the benefit of group therapy in certain situations in all groups (mostly the more educational purposes like Mary D. mentioned). It's just less-likely that the same mothers that might work well in a group together are needing/seeking services at the same time in the high-risk and special category. But, Federico said, "The hyper-sensitivity and vulnerability of pregnant women is a very important factor, which can be relieved by a group setting. The value of such groups lies in the exchange of experiences with the other mothers during the sessions providing support, reassurance, and insight for one another." I can imagine that some of the movement exercises and singing might be more comfortable and safe in numbers. Also, there's nothing like having a good mother friend to confide in and gain insight from.
As far as the other considerations, you all covered it well. A good assessment will give lots of clues to successful choices in approach, style, preferences, music selections, sensitivity, medical concerns, etc. And, of course, a particular pregnancy could quickly change categories (normal to high-risk)! In general, normal pregnancies have a lot of opportunity for interventions (full range of movement, normal sound sensitivity, etc.) and usually the mother is more emotionally stable about the situation than the other categories. High-risk pregnancies will take lots of medical precautions including reduced (or no) movement, sounds that are more quiet, less startling, and less likely to over-stimulate. Emotionally, focusing on relaxation and maintaining hope are key here. Special pregnancies will also have many unique medical and emotional considerations. Situations such a hearing problems in the mother will take a unique therapy approach, perhaps involving more gentle vibrations. As will a pregnancy with multiples, making it therapy with 3+ clients!
As is the principle for all therapy sessions, every client will have their own unique needs and strengths and the therapist will certainly strive to be well-educated and recognize and be flexible in their approach and interventions.
Yes Sarah I totally agree that woman can relieve much stress and anxiety through group support, however there are some mothers who have unique situations who may also need an individualized approach. :)
DeleteHow does prenatal music therapy differ for the three different types of pregnancies? How might you adjust your approach when working with each group?
ReplyDeleteThe three pregnancy groups in question are "normal pregnancy", "high risk pregnancy" and "special pregnancy". These three are the umbrella groups over a fantastic amount of specific pregnancy situations. An example of a "normal pregnancy" would be someone who is expecting and in good health with healthy support systems and no major extenuating circumstances.The child in utero would be developing at a typical pace. An example of a "high risk" pregnancy" would be the expecting caregiver and child struggling are struggling with a threatening condition such as serious pre-existing condition in the adult, being in an at risk living situation, a pregnancy complication like Placenta Previa, etc. There is a direct threat to the well being and possible the life of either or both the expecting adult and child. A special pregnancy would be one that is not high risk but the circumstances are not "typical", like a surrogate mother, a transgender male expecting person or a severally mentally ill person.
For all three, there are elements of prenatal music therapy that would be applicable for all. Adaptions, exceptions and improvisation would be required for each group.
"Normal Pregnancy" - I would approach this with typical sessions designed to help the pregnant process their journey and build a relationship with their child. Interventions would also address typical pregnancy themes such as relaxation, healthy exercise, putting together a birth tape and/or lullaby, etc. These sessions could be one on one, didactic, group or commununal.
"High Risk Pregnancy" : sessions would feature the typical themes with a greater emphasis on relaxation and any interventions relevant to the themes of the risk. For instance Placental Abruption can be related to long standing high blood pressure. Sessions could be utilized to help the adult to find music that lowers their blood pressure and base interventions around that. Music listening, improvisation in that style or with that instrument, etc would all be appropriate. It is important to give this group a sense of control and hope by helping them process their experience and feel like they are an active participant in reducing risk. All types of sessions could be recommended, strongly suggested the pregnant adult include significant persons or use community sessions to build support.
"Special Pregnancy" : Typical themes with focus on grounding and acceptance. Songwriting and guided imagery interventions could be used to help the adult process their unique experience and find their identity as a pregnant person. Sessions should build their self-worth and confidence. For example, surrogates could write songs to their child, explaining things and expressing their affection. Similar songs could also be used towards the end of the pregnancy to offer adult and child closure and the child's parent(s) prepare to receive the newborn. In this surrogate situation, one on one or small group sessions would be recommended. It might be encouraged that some sessions include the child's parents who are preparing to receive their gift. (guided imagery is only recommended for one on one sessions)
Yes I am interested in research on prenatal music bonding in surrogacy and adoption. It is so important for these babies who experience a different journey. Thank you for your thorough response Christine. :)
ReplyDeleteEven 'normal' pregnancies involve concerns from the mother for the health and safety of her baby and the delivery. Therefore, a similar considerations could be taken for the three pregnancy types: normal, high risk, and special. High risk is defined as needing bed or medicine to continue the pregnancy. Special is defined as overweight women, women who have hearing problems, multiple pregnancies, pregnancies achieved through assisted fertilization or in-vitro fertilization, and women under 15 or over 40 years of age.
ReplyDeleteBut there will be some variation in approach. When it comes to groups, it is best to make them heterogenous as possible: in age, and whether or not they used a fertilization treatment.
When it comes to high risk pregnancies, fast movement/music activities will be avoided, choosing more relaxing and restful music with visualizations to lower anxiety. Since she may be on bedrest, the ability to visit her home or hospital bed would be something to take into account. Art and affirmations to soothing music might be one option with this client group.
When it comes to special pregnancies, getting a group of women with similar special needs would be a wonderful opportunity for bonding and support. However, it's also an opportunity to really get to know your client's individual preferences and situation and work with their music, whether through music listening and analysis, or songwriting.
Normal pregnancies will not require special language or considerations, but an awareness of the possibility of equal emotional distress as someone with a high risk pregnancy. Every individual is a case by case basis; and most important, letting the client's needs dictate the session more than a label.
First, I think it's important to consider that each person is going to have a very different pregnancy and birthing experience so taking a person centered approach regardless of the "type" is imperative in my opinion. However as music therapists we can use this information to help provide the most effective techniques for working with all three pregnancy groups.
ReplyDeleteNormal pregnancies - I would start with a typical assessment and decipher what ways we could use music therapy to best benefit the mother/child. I would use interventions to promote relaxation, increase bonding, exercise, reduce anxiety, and create a holistic environment for the development of the baby. This could include songwriting, improvisation, movement, and guided relaxation techniques in both a one on one or group setting.
High risk pregnancies- I would still use a typical assessment, I would however shift my focus from using any movement interventions and instead use techniques to help the mother relax and focus her energy on surrounding herself and her baby with love, acceptance, and support. As an MT, I would encourage the mother to be an active participant in reducing risk for her and her child. I think songwriting, improvisation, and guided imagery would be great for this group. Any fast paced movements or songs should be avoided with this group. Both individual and group sessions for support could be encouraged.
Special pregnancies- Since this group includes women under 15 and over 40 it's important to consider age when doing group sessions. If possible try to avoid groups with vastly different ages since they will be having very different experiences. When considering individual sessions within this group I think techniques such as songwriting (including writing a lullaby for the unborn child), improvisation, guided imagery, and movement activities can be used. The MT should focus on empowering and supporting the individual through these interventions. Every pregnancy is special and making them feel supported throughout their process can make all the difference.
Yes individualized and personalized is my approach as well. Currently in my practice I only work with individual families. Yet this work can be done in a group with consideration for individual needs. Yes when grouping it is important to bring together mothers with similar experiences and ages. I find that this work is so personal and I find it most effective when working with individual families. But group support and bonding through music can also be an amazing experience and can also give women a future support group for after the child is born. :)
DeleteNormal Pregnancies: I think that even with normal pregnancies there will be individual anxieties and concerns that mom and both parents will have about their baby so although mom and baby may be in good health, there may likely be other psychological effects to take into consideration. After an assessment, we can determine what will be most beneficial to the family of the expected baby. We can absolutely work on bonding and connection and how to best utilize music whether pre-recorded selections are chosen or live music to be utilized at birth to help express pain and further relaxation during labor.
ReplyDeleteHigh Risk Pregnancies: Physically we would have to be very careful for the obvious reasons of the mother needing to keep her movements to a limit so we can conduct sessions in the comfort of home or at the hospital at bedside. We can use music in a very gentle way encouraging relaxation, positive affirmations and doing what we can to minimize anxiety and worries that will come naturally with childbirth but especially in this high risk situation. I'm thinking there could be a lot of feelings of anxiety, worry and stress that music therapy could help minimize for mom and family.
Special Pregnancies- Since each person that would be classified under "special pregnancy" has a wide range of needs from overweight women to women with hearing impairments to women younger than 15 an older than 40, a proper assessment would need to be done (as of course with any group) and we'd have to group people together appropriately so they can receive maximum therapeutic benefit from the sessions. Overweight women may be dealing with some anxieties over health issues while pregnant and so I think that positive affirmations in conjunction with chosen music could be beneficial. Women with hearing problems may still be encouraged to utilize their voice as much as possible and as music therapists we can support their expression of their voice as the primary instrument that will get through to the baby. Maybe we can put most emphasis on this as opposed to other modes of music use. It would of course all depend on the degree of hearing impairment and would vary case to case. For women who have been successful with fertilization or invitro measures for becoming pregnant, there may be a lot of happiness around the pregnancy but also concern for the pregnancy making it to full term since it may have been difficult to become pregnant. Working around those anxieties and using relaxation techniques, imagery and positive affirmations to ease anxieties, increase self-expression and surround the family with beauty, love and joy all seem like beneficial techniques.
Yes Jillian thank you for reminding us about the anxieties that all women experience in pregnancy and that there are definitely special considerations for specific groups of clients in the special pregnancies group. It will be important to approach each client and group with care and concern for the mother, baby and family unit and help them to ease their worry and stress to communicate openly and freely with love with the baby. It is important to help the baby understand that he/she is wanted and loved even though it may be a stressful time for the mother.
DeleteWithin each of the three categories there are very different and specific things to consider when assessing and creating programs. It would first be extremely important to do a proper assessment for each client to understand not only how best they might be treated, but which category they may fall into, as it is not enough to simply assume that even though a pregnancy may be ‘high risk’ or a ‘special pregnancy’ doesn’t’ mean that a 40+ women and teenage pregnancy should be treated within the same group for example. Some details that are important to ascertain through assessment would be things like current week, expected date of birth, any medication they may taking and any special circumstances regarding their present pregnancy. It would also be important to know if the pregnancy was conceived through IVF and if there had been any previous pregnancies and complications. I actually think it would be beneficial to have a group specifically for women who have previously experienced loss and allowing them the opportunity to work through existing fears in their current pregnancy, which would also provide an opportunity to connect with other women who have experienced something similar. I would also consider other specialist groups such as those for young parents (under 21)
ReplyDeleteIn regards to the three specified pregnancy groups, I would address them as follows:
All groups would have some degree of focus on bonding and relaxation, using interventions such as visualisation, relaxation, music listening and song writing.
Normal – Pregnancies that are developing normally would focus on group work that centres on bonding, relaxation and guided meditation. Instrumental and vocal improvisation; chanting, lyric analysis, music listening and song writing would be used, including working towards a womb song.
High Risk - these are cause for even greater care and attention and may often be carried out bedside in a client’s home or hospital, because of a risk of bleeding and abortion and little movement from the client may not be possible. Extreme care would be taken when choosing music – an emphasis on gentle music that focuses on positive lyrics and perhaps instrumental string. As there is such a strong connection between our emotional responses and physiological impact, lots of very positive imagery and visualisations about positive outcomes and the birthing experience would be used. The creation of a womb song would be encouraged, as this is something that could be worked on over time – great for helping to pass long days bedridden and also the creation of lullaby playlists which could be played both pre and post-natally.
Special – Would also include many of the above interventions, but it is more likely that clients would be seen individually, rather than through group work, as each case may be unique and require specialist considerations. However, if there are enough common characteristics between clients, it might be beneficial to connect them. The focus with these clients would be to work through any feelings of fear through positive imagery and relaxation. I feel that encouraging attachment and bonding would be particularly important with this group and things like affirmations and womb song writing would be really beneficial to this. Special consideration should be given to the client-therapist relationship in these situations, as the music-therapist will likely see the client more often than their obstetrician.
Yes Rebecca exactly! Just because a birth mother is a certain age doesn't mean she will necessarily fit a "category". These are general guidelines of course. I have worked with many women over 40 who had completely normal (not high risk) births. All of your suggestions are wonderful. Yes I use birth affirmation cards and womb songs for all of the clients I work with. Also, song writing, movement (if ok for mother) imagery and mandalas. We teach all of these experiences in our Creative Arts Birthing Workshop- which also includes birth art experiences. I am working to offer this class in a Blended Learning Format in 2018. :) MD
ReplyDeleteI found the discussion in the book on normal vs special and high risk pregnancies a bit annoying. I think I took umbrage because I had my son at age 41 and I was perfectly healthy !
ReplyDeleteHowever, this brings up the issue of when it might be more appropriate to do individual vs groups sessions. For the women who are high risk , it makes sense to do individual sessions and really focus on the specifics of the medical issue. As with all pregnancies, decreasing anxiety has to be in the forefront and this will be heightened in a high risk pregnancy. Also since the woman is likely to be at bed rest or less mobile, individual sessions at her home or bedside makes the most sense.
I find the teenage group to be particularly interesting because they are at high risk for poor bonding and attachment for a variety of reasons. Based on this, I have made it a priority to do my first program with this group. I am hoping to bring it to a local high school that has a special school for teenage mothers. I think a prenatal MT program for this group will really help them connect and bond with their babies and with the other young mothers to be. These are young women who are likely to have insufficient support by a partner. These mothers need a lot of extra support and education about mothering in general and about self-care. It also might make sense to include the woman's own mother since in many of these cases, the grandmother because very instrumental in caring for the child.
I would also emphasize to the teenage moms that the music they might be most interested in may not be the most pleasing to the baby. So they might need special encouragement to expand their musical horizon and tastes.
Me too Kathleen! Your work with teens is so important and needed.
DeleteThe three types of pregnancies include normal pregnancy, high risk pregnancies and special pregnancies. Normal pregnancies are when there are no known complications and normal care is given. These pregnancies can benefit from focusing on mother/baby bonding and finding support in a group of other mothers with normal pregnancies. High risk pregnancies are those that require special care. There might be a risk of miscarriage, they might be mothers put on bedrest, mothers with high blood pressure or those diagnosed with placenta previa. In these cases, you may have to adjust by offering services at home or in the hospital because these women generally have difficulties traveling. Special pregnancies include a myriad of situations - mothers who experience obesity, blindness, hearing loss, multiple pregnancies, pregnancies attained by assisted fertilization or artificial insemination, HIV positive, under 15, over 40, scheduled c section, previous stillbirth, had a child with disability or lost a child.
ReplyDeleteBeing aware of these categories of pregnancies is important so that we do not place women together in groups that are in completely different situations. You might have to adjust your techniques by recommending 1:1 sessions for special pregnancies or recommending a particular group that has mothers with similar situations. There may be different fears to work through in different pregnancies.
For example, hearing impaired women might be concerned about knowing if their child is alive at birth since they can't hear them cry. Or they might be concerned about not being able to hear them cry at home and respond to them when they need to. As another example, a mother who has experienced a stillborn might have many more anxieties about their pregnancy and fears to work through. These are some examples where situations might not be applicable at all to someone with a normal pregnancy or in a completely different special situation and therefore, it may not be appropriate to pair these women together. They may even be counter-productive to each other.
Yes it is important to take care when placing clients in groups because experiences can be so different. And taking a thorough intake is a must.
DeleteAfter going through what essentially turned out to be a high risk birth, I feel that the correct therapeutic set up would be a one on one session with special needs or high risk pregnancy. I became the music therapist in our situation but in hindsight we would of benefitted from having a separate mt and or Dula. In general there are so many things to consider that the initial assessment is of the most importance. For a normal pregnancy I still would rather a one on one session as coming from a music psychotherapy background I feel that the relationship between MT and family is such an important aspect that ultimately informs all of the work and that it would be hard to facilitate a group session and reach everyone completely. Maybe group sessions for all three types of pregnancies, normal, high-risk, & special to supplement the one on one work?
ReplyDeleteI like your ideas for groups for all and supplement 1:1 work as needed. Great! As a music therapy student (at the time of giving birth) I would agree with you also and highly recommend a separate MT and/or doula to assist. (I was blessed to have Mary and Summer as my MTs) I don't think I could have been my own. I also have my doula training and one thing I always tell parents to consider is, yes, you may have your special thing as a couple and know how you want your spouse to support you, so that's all the MORE reason to have an MT with sound birthing experience or a doula present to simply hold space so that the couple can focus on each other and the momentous occasion. Then that extra set of hands is there to handle all the other things so the couple is not disturbed when they're in their groove. I ended up with a cesarean and would not have know what on earth to do if it hadn't been for Mary & Summer.
DeleteAnd I hope everything is well for you and your wife and baby. :)
I think the biggest difference in prenatal music therapy with different types of pregnancies would be whether it takes place individually or in a group. It seems like high risk pregnancies would mostly be done individually, due to health issues that might keep a woman at home or in a hospital setting. I think "normal" and "special" pregnancies could both be done in groups. If a music therapist wanted to conduct a prenatal music therapy group, it would definitely be necessary to have very detailed intake paperwork to be able to place a mom into an appropriate group setting, based on her needs. "Special" groups might need specific processing through music based on the common denominator in the group. "Normal" groups would also need to be able to process through the pregnancy and all the changes that were happening, but may be able to focus more on just bonding with their baby through music.
ReplyDeleteYes it is always important to plan your sessions to meet the unique needs of the group. :)
DeletePrenatal music therapy will be individualized for each woman depending on the category she is in. Any of these classifications would benefit from 1:1 music therapy sessions. I would consider group settings for the normal group. This can be an opportunity for women to bond and create a circle of support within their community. They will still take home the knowledge they receive and individualized their bonding with the baby.
ReplyDeleteI know I was reading some of the past comments on how some people felt groups setting would not be beneficial for the high risk and special group. I would have to politely disagree, and here’s why (but Mary, please correct me if my thinking is incorrect). I would of course ALWAYS consult with a physician or social worker or psychologist, but many women who are in the latter two groups may be hospitalized (just depends). In these settings a 1:1 session would be great. However, I feel that group settings could also be beneficial in the hospital setting as long as 1) a physician or social worker or psychologist has been consulted as to the stability and or appropriateness of the woman’s participation in a group and 2) the woman’s consent in being part of a group 3) the group be constructed based upon the two previous factors so that women are group according to conditions, type of pregnancy, etc. These women may greatly benefit from the support of the other women and the overarching theme of music therapy.
Normal Pregnancies: these women could work individually or within a small group outside of the home. Music bonding would be “typical” of what we have been studying; bonding through favorite music, playing instruments, relaxation, lullabies, song writing, etc. I would find appropriate speakers to use for surround sound and create experiences for bonding which could be done with me in a group or at home on their own.
High Risk Pregnancies: these women will have special considerations and may need to work with a MT in a hospital setting due to bed rest. Or 1:1 sessions at home could be arranged. Music and experiences would be modified accordingly and a doctor would be consulted if necessary.
Special Pregnancies: again this will be individualized depending on the need of the mother. Mothers with visual or hearing impairments may require special considerations for how they receive the musical input. And young women (as he suggests, under 15, but I’d say 17 and under even) would probably require 1:1 sessions depending on factors such as cause of pregnancy, mental/emotional stability, etc.
And because multiples are on my mind, that these women especially need care in the realm of relaxation music and not stimulating music, as if you have two or three babies rockin’ out in a womb…well…poor mama! And it may not be good for the mom depending on her conditions (I’m thinking preeclampsia, etc.) due to the doctors not wanting contractions to start or the woman/babies be over-stimulated in any way. Calm Mama. :)
Yes I agree there are no rules. And women on antepartum units need to connect so they are not isolated... however if they are on bedrest that might be easier said than done. However if they are allowed to get up in a wheel chair or perhaps through the use of technology, zoom or skype sessions, connecting with other women for support in addition to the music therapist would be ideal.
DeleteThe three types of pregnancies are normal, high risk, and special pregnancies. With all of these classifications, the first step is getting an understanding of what the woman's goals are for her pregnancy and delivery. With high risk and special pregnancies, getting an understanding of what considerations their doctor has put in place, as well as why they are in this category. For instance, a mother that is high risk because of a history of instant loss or several miscarriages, is going to come to pregnancy different than a mom who is high risk due to obesity or pre-eclempsia. Additional considerations may need to be implemented for moms who need bed rest (home or hospitalized), frequent stress tests, etc. 1:1 sessions, unusual session times, and modified implementation schedule are all considerations that might need to be used.
ReplyDeleteI think the overarching theme (as it often is in birth work, and music therapy) is to come to a situation prepared for change. Even with low-risk/normal pregnancies, I always work out potential plans A, B, and C, but am prepared mentally for plan D to come into the picture.
Absolutely, it's all about awareness, openness and understanding to the situation and to what the client presents. And yes have a big tool kits and the ability to switch gears in a moment is so important. :)
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