INTRODUCTION:

Pregnancy, though a joyful experience, can also bring discomfort and redefine the concept of beauty. It is a unique yet stressful period for many expectant mothers. The journey is not always smooth, as women undergo significant physical and emotional changes, making them more sensitive to emotional stimuli and prone to psychological distress. Increased stress and anxiety can contribute to depression. The maternal psychological state plays a crucial role in shaping the intrauterine environment, directly influencing fetal growth and health.^1,2 Pregnant women experience higher levels of anxiety compared to those who are not pregnant. This transitional phase can lead to increased anxiety. In some instances, maternal stress and anxiety can negatively impact the developing baby, potentially resulting in complications like preterm birth, low birth weight, and being small for gestational-age infants.^3,4

The introduction of ultrasound in obstetrics has allowed for the non-invasive examination of the human fetus and enhanced the study of how maternal psychological conditions affect fetal development. The non-stress test (NST) is the most widely used antenatal screening tool for assessing fetal well-being and aims to reduce fetal complications at birth caused by placental insufficiency.^5,6 However, as a screening method, fetal heart rate (FHR) analysis can be time-consuming, monotonous, and anxiety-inducing for mothers due to the procedure’s duration and the perceived risk of abnormal results. Additionally, its interpretation can be challenging due to low sensitivity. While NST is generally considered a non-invasive and straightforward test, its potential to cause anxiety has not been thoroughly evaluated. Clinical observations suggest that, despite its reputation, the procedure can sometimes be frustrating for mothers.^7,8

Music therapy helps reduce immediate maternal anxiety during NST procedures but has limited effects on long-term anxiety and fetal well-being. Anxiety levels remain consistent across different demographic groups. Integrating music therapy into routine care could benefit primigravida mothers.^9,10 However, NST can sometimes induce anxiety due to its duration and the fear of abnormal results.

Although it is considered a non-invasive and routine test, many women find it stressful, which may influence test outcomes. While maternal mortality has significantly declined, modern obstetric care now places greater emphasis on fetal health, recognizing the fetus as a second patient who requires equal attention.⁹

Research has shown that auditory stimuli, particularly music, can promote relaxation, improve psychological well-being, regulate physiological responses, reduce stress, lower blood pressure, and enhance emotional health, making it an effective intervention for alleviating maternal anxiety.^11,12 Evidence suggests that Indian classical music, especially certain ragas, has a calming effect and positively influences emotional states. Listening to music during pregnancy has been linked to reduced maternal stress and improved fetal neurodevelopment, memory formation, and learning abilities.^13,14 Studies indicate that integrating music therapy during NST can help ease maternal anxiety, fostering a more relaxed and supportive intrauterine environment. However, despite its recognized benefits, research specifically examining the effects of music therapy during NST remains limited.^13,15

This research investigates how music therapy impacts maternal anxiety levels during non-stress tests, utilizing an actual experimental approach design. Integrating music therapy into prenatal care may enhance maternal well-being and create a more positive pregnancy experience. Research indicates that music benefits the mother and fetus, as stress and anxiety during NST can lower fetal activity.^16,17 Studies have shown that music therapy promotes relaxation and reduces maternal anxiety, supporting maternal and fetal health. Despite these benefits, limited research has explored the impact of listening to music before or during NST. Incorporating music therapy into prenatal care could improve the NST experience and contribute to better outcomes for both mother and baby.

PROBLEM STATEMENT:

"A study to evaluate the effectiveness of music therapy in reducing maternal anxiety and improving fetal well-being among primigravida mothers undergoing a Non-Stress Test at a selected tertiary care hospital in Bangalore."

OBJECTIVES:

1. To assess pre-intervention levels of maternal anxiety in primigravida mothers undergoing NST using the State-Trait Anxiety Scale.

2. To determine the effectiveness of music therapy on maternal anxiety and enhancing fetal well-being during NST by comparing the control and experimental groups.

3. To investigate the correlation between maternal anxiety levels and specific demographic characteristics in primigravida mothers undergoing non-stress tests.

HYPOTHESES:

H1- There will be a notable disparity in post-interventional maternal anxiety scores of primigravida women having NST procedures between the experimental and control groups.

H2- A substantial disparity will exist in the post-interventional foetal welfare scores of primigravida women undertaking the NST technique between the experimental and control groups.

H3- A substantial correlation exists between mother anxiety scores and specific demographic characteristics.

MATERIALS AND METHODS:

Research Approach:

A quantitative research approach was selected as it is the most appropriate method to determine the effectiveness of music therapy on maternal anxiety and enhancing fetal well-being among primigravida mothers during the Non-Stress Test (NST).

Research Design: The study applied an original experimental research methodology.

Study Setting: The research was conducted in the Obstetrics and Gynecology department of a selected tertiary care hospital in Bangalore. A total of 60 primigravida mothers participated in the study.

Sample: The present investigation was carried out in a designated tertiary care hospital in Bangalore among sixty primigravida mothers taking NST treatments.

Sampling Technique: In the current study, the researcher selected 60 samples using simple random sampling using the lottery method.

Sampling Criteria:

Inclusion Criteria:

· Maternal age group between 21 to 40 years women in first-time pregnancy.

· Primigravida mothers who have gestational age between 28 to 36 weeks.

· Primigravida mothers who are advised for NST procedures during antenatal check-ups at the selected tertiary care hospital, Bangalore.

· Primigravida women who voluntarily chose to participate in the study.

Exclusion criteria

· Primigravida mothers with complications such as antepartum, bleeding, eclampsia, and multiple gestations.

· Mothers who are posted for emergency cesarean section.

· Mothers who are in labor pain.

· Mothers who don’t like music.

Development of Data Collection Tools:

In this study, the State-Trait Anxiety Inventory (STAI) for mothers was selected as a standardized and reliable tool to accurately measure the study’s outcome variables.

The following tools were used for data collection:

Section I: Demographic characteristics.

Section II: State-Trait Anxiety Scale for Primigravida Mothers.

Section III: NST Interpretation.

Validity and Reliability of the Instrument:

Validity: The content validity of the tool was assessed by a panel of 10 experts from obstetrics, gynecology, nursing, and research fields to ensure its accuracy and relevance.

Reliability: The reliability of the tool was evaluated using the inter-rater reliability method with a sample of 10 participants. The calculated reliability coefficient (r) was 0.81, confirming the tool's consistency and reliability.

Pilot Study: Six first-time mothers who were getting NST in the labour room or maternity outpatient department of certain tertiary care hospitals in Bangalore took part in a pilot study. For both the pre-test and post-test tests in the experimental and control groups, data were collected. The results showed that the experimental group's mean anxiety score after the intervention was significantly lower than its score before the intervention. This shows that music therapy can help reduce maternal anxiety in first-time moms. Based on the goals of the study, descriptive statistics (like frequency, percentage, mean, and standard deviation) and inferential statistics (like t-test and McNemar's chi-square) were used to look at the results. The researcher concluded that the study could be done and would be useful for the main research.

Data Collection Procedure: The study was conducted at a tertiary care hospital in Bangalore. Using a simple random sampling technique, 60 primigravida mothers were selected, with 30 assigned to the experimental group and 30 to the control group. The researcher established rapport with the participants and explained the benefits of the intervention. A pre-test was conducted in both groups using the State-Trait Anxiety Inventory (STAI) to assess maternal anxiety levels. The experimental group received music therapy through headphones for 20 minutes during NST procedure, while the control group received only routine care. A post-test was performed on the same day using the same questionnaire to reassess maternal anxiety levels, fetal heart rate, and fetal movements in both groups. The collected data were systematically tabulated and analyzed using descriptive and inferential statistical methods.

RESULTS:

The data collected from the participants were analyzed using descriptive and inferential statistical methods. The obtained data were systematically entered into a master sheet for tabulation and statistical processing. The analysis was organized and presented in the following sections:

Section A: Description of demographic variables among primigravida mothers.

Section B: Assessment of pre-intervention maternal anxiety levels among primigravida mothers.

Section C: Effectiveness of music therapy on primigravida mothers undergoing the NST procedure:

· Post-intervention maternal anxiety levels in control and experimental groups.

· Comparison of pre-and post-intervention maternal anxiety scores between the experimental and control groups.

· Comparison of post-intervention mean anxiety scores within the experimental group.

Section D:

· Effectiveness of music therapy on fetal well-being among primigravida mothers.

· Comparison of post-intervention fetal well-being among primigravida mothers undergoing NST procedures.

Section E: Association between pre-intervention maternal anxiety scores and selected demographic variables among primigravida mothers.

Section A: Description of a demographic variable among the primigravida mothers.

Among 60 samples, 23.33% (7) in the control and 36.63% (11) in experimental group were aged 20-25, while 53.33% (16) and 46.67% (14) were 26-30 years. Hindus made up 53.33% (16) of control group and 70% (21) of experimental group. Urban residents were 50% (15) in the control and 36.67% (11) in the experimental group. Postgraduates comprised 10% (3) and 53.33% (6) respectively. Professionals were 50% (15) in the experimental group. Co-morbidities were found in 13.33% (4) of both groups. Most mothers were non-vegetarian, with no smoking or alcohol habits

Section B: Assessment of pre-intervention maternal anxiety levels among primigravida mothers

Table 1: Frequency and percentage distribution of pre-interventional level of maternal anxiety among control and experimental group N=60

	Control group (n=30)		Experimental group (n=30)
Levels of S-anxiety	f	%	f	%
Lower anxiety (20-37)	3	10.00	3	10.00
Moderate anxiety (38-44)	2	6.67	5	16.67
Higher anxiety (45-80)	25	83.33	22	73.33
Levels of T-anxiety	f	%	f	%
Lower anxiety (20-37)	6	20.00	5	16.67
Moderate anxiety (38-44)	14	46.67	9	30.00
Higher anxiety (45-80)	10	33.33	16	53.33

Table 1 shows that 10% (3) of primigravida mothers in both groups had lower S-anxiety, while 83.33% (25) in control and 73.33% (22) in experimental group had higher S-anxiety. Most had moderate T-anxiety, with 53.33% (16) in the experimental group having higher T-anxiety than 33.33% (10) in the control group.

Section C: Impact of music therapy on primigravida moms undergoing the non-stress test procedure

Table 2: Frequency and percentage distribution of post-intervention maternal anxiety levels in control and experimental groups N=60

	Control group (n=30)		Experimental group (n=30)
Levels of S-anxiety	f	%	f	%
Lower anxiety (20-37)	2	6.67	6	20.00
Moderate anxiety (38-44)	4	13.33	13	43.33
Higher anxiety (45-80)	24	80.00	11	36.67
Levels of T-anxiety	f	%	f	%
Lower anxiety (20-37)	5	16.67	4	13.33
Moderate anxiety (38-44)	15	50.00	10	33.33
Higher anxiety (45-80)	10	33.33	16	53.33

Table 2 shows that 6.67% (2) of the control and 20% (6) of the experimental group had lower S-anxiety post-test, while 80% (24) in control and 36.67% (11) in experimental group had higher S-anxiety. Higher T-anxiety was 53.33% (16) in the experimental and 33.33% (10) in the control group.

Table 3. Comparison of the post-interventional level of maternal anxiety among the primigravida mothers between the experimental and control group N= 60

Anxiety	Control Group (n=30)
Anxiety	Mean	SD	Mean Difference	‘t’ value	P Value
S-Anxiety	54.70	10.52	0.60	-0.86	0.002*
T-Anxiety	42.57	7.25	0.13	0.52	0.61

Anxiety	Experimental Group (n=30)
Anxiety	Mean	SD	Mean Difference	‘t’ value	P Value
S-Anxiety	42.40	6.36	12.80	8.67	0.002*
T-Anxiety	43.97	6.65	0.30	1.36	0.25

Table 3 shows that music therapy is effective for the post-interventional maternal S-anxiety of the control group of mean and SD values 54.70 and 10.52 at its t value shows -0.86 respectively then the experimental mean and SD value 42.40 and 6.36 at its t value1.36 respectively. Similarly, maternal T-anxiety of the control group mean and SD values 42.57 and 7.25 at its t value shows 0.52 respectively then the experimental mean and SD value 6.65 and 0.30 at its t value 0.25 respectively.

Table 4: Comparison of pre-and post-intervention mean maternal anxiety scores among primigravida mothers within the experimental group

S-Anxiety score	Experimental Group (N=30)		‘t’ value	P value
	Mean	SD
Pre-intervention	55.20	12.29	8.67	<0.05*
Post-intervention	42.40	6.35
T-Anxiety score	Experimental Group (N=30)		‘t’ value	P value
	Mean	SD
Pre-intervention	44.27	6.80	1.36	0.18
Post-intervention	43.97	6.65

In the experimental group, the mean score for mother S-anxiety was 55.20 before the intervention and 42.40 after it. The standard deviation was 12.29 before and 6.35 after the intervention (Table 4). It was found that the t value was 8.67, which is significant at the 0.05 level. In the control group, too, maternal T-anxiety was 44.27 and 43.97 before and after the intervention, with a standard deviation of 6.80 and 6.65. There was no significance at the 0.05 level of significance for the t result, which was 1.36.

Section D: Effectiveness of music therapy on fetal well-being among primigravida mothers undergoing NST procedure between control and experimental group.

Table 5: Comparison of post-interventional fetal well-being among the primigravida mothers undergoing the NST procedure N=60

NST Parameters	Control Group (n=30)		Experimental Group (n=30)		P value
NST Parameters	Mean	SD	Mean	SD	P value
Baseline FHR	134.9	9.75	138.43	9.70	0.16
Baseline Variability	11.70	3.09	12.30	3.58	0.49
Acceleration	2.00	0.69	2.07	0.64	0.70
Deceleration	0	0	0	0	-
Number of Fetal Movement	10.10	2.23	10.20	2.06	0.85

Table 5 shows NST parameters of baseline fetal heart rate in the experimental and control groups with the values 134.9±9.75 and 138.43±9.70 respectively. Further, the baseline variability of mean and standard deviation in the control group (11.70±3.09) and experimental group (12.30±3.58) was not significant. In that acceleration mean and standard deviation in the control group (2.00±0.69) and experimental group (2.07±0.64) were not significant. The number of fetal movements in the control group (10.10±2.23) and the experimental group (10.20±2.06) was not significant.

Section E: Association between pre-interventional maternal anxiety score in selected demographic variable

Chi-square analyses revealed no statistically significant association between age and pre-intervention maternal anxiety (S=1.74, T=1.84), nor between religion and pre-intervention anxiety (S=0.02, T=0.11). Similarly, residency status did not demonstrate a significant association (S=0.12, T=0.02). The alpha level for all analyses was set at 0.005.

The association between the pre-interventional maternal anxiety score and education with the value of chi-square (S=1.60, T=1.88) was not significant. Furthermore, the association between the co-morbid disease's chi-square value (S=5.35, T=6.77) was not significant.

Association with income with the value of chi-square (S=8.24, T=10.66). The chi-square value of habit (S=34.36, T=32.54) was not significant. Further, the association with the dietary habit chi-square value (S=4.76, T=5.60) is not significant.

DISCUSSION:

This study assessed the effectiveness of music therapy in alleviating maternal anxiety and enhancing fetal well-being among first-time mothers undergoing NST procedures. Among the 60 participants, those in the experimental group showed a marked decrease in immediate maternal anxiety (S-anxiety) after the intervention, with 20% (6 mothers) reporting reduced anxiety levels, compared to 6.67% (2 mothers) in the control group. Furthermore, the percentage of participants experiencing higher anxiety levels dropped significantly from 73.33% (22 mothers) before the intervention to 36.67% (11 mothers) afterward in the experimental group.

However, the therapy had limited effects on long-term anxiety (T-anxiety), with 53.33% (16 mothers) in the experimental group still showing elevated anxiety levels post-intervention. Additionally, parameters related to fetal well-being, such as baseline fetal heart rate and movements, did not exhibit significant improvements as a result of music therapy. Moreover, no meaningful association was identified between maternal anxiety levels and demographic variables.

These findings indicate that while music therapy effectively reduces immediate maternal anxiety during NST procedures, its long-term advantages and impact on fetal well-being appear to be restricted.

CONCLUSION:

Music therapy helps mothers feel less anxious during NST procedures, but it doesn't have much of an effect on long-term worry or the health of the baby. Anxiety levels do not show significant variation across different demographic profiles. Integrating music therapy into routine prenatal care for primigravida mothers may offer benefits. Further research is recommended to explore its long-term effects and potential influence on fetal health.

RECOMMENDATION:

Based on the findings of this study, the following recommendations are suggested for future research.

· Conduct a similar study in different settings with a larger sample size to enhance generalizability.

· Assess the effectiveness of music therapy in reducing anxiety among primigravida mothers undergoing NST procedures.

· Compare the impact of music therapy on maternal anxiety with other anxiety-relief techniques, such as guided imagery and yoga.

· Conduct an evaluative study to examine the effects of music therapy on the psychological and intellectual development of the baby.

· Further research should incorporate physiological variables, such as vital signs and levels of discomfort, to assess the impact of music therapy more comprehensively.

ACKNOWLEDGEMENT:

The authors sincerely express their gratitude to the authorities and participants of the selected hospitals in Bangalore for their cooperation and support in this study. We also express our gratitude to the Director of Newredmars Education for the technical assistance in this research study composition.

CONFLICT OF INTEREST:

The authors declare no conflicts of interest in this study.

ETHICAL CLEARANCE:

Ethical approval was obtained from the institutional ethics committee.

RESEARCH INVOLVING HUMAN PARTICIPANTS AND / OR ANIMALS

This study involved human participants for data collection.

INFORMED CONSENT:

Written informed consent was obtained from all study participants.

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