Nurturing Bonds: Transformative power of a mother’s voice
By: Anduin Anderle, Neonatal Marketing Manager, Neonatal Care and Thermoregulation, Dräger Inc.
Introduction
The mother-baby bond is a fundamental aspect of human development, with bonding critical to baby’s growth and mother’s wellbeing. However, some births may not go as planned and a baby may end up requiring care in the neonatal intensive unit (NICU). While NICU care may be essential to preserve life, the circumstances create barriers to physical and emotional bonding.
Emerging, evidence-based interventions aimed at fostering mother-baby attachment and connection include use of the mother’s voice as a therapeutic tool in the NICU. Whether the mother is speaking directly to her baby, or her voice is recorded and played to the infant during the NICU stay, the cognitive, socioemotional and physical development benefits are well documented.
The NICU Challenge: Developing “Normally” in an “Abnormal” Environment
For babies born healthy and placed into the care of their mothers, the mother-infant attachment begins at birth and continues after they head home. Conversely babies requiring admission to the NICU following birth, “are challenged to develop normally without constant contact with their parents, particularly their mother, as their primary caregiver.”1
Mothers of neonates admitted to the NICU are shown to suffer negative impacts as well, including stress, anxiety, depression and post-traumatic stress syndrome (PTSD).2
NICU teams not only bear the responsibility of caring for the physical and neurodevelopmental health of the babies in their units but also providing emotional and physical support to the babies’ mothers and other caregivers at the bedside.
Mother’s Voice Interventions
Based on decades of research into the importance of maternal-infant attachment, neonatal therapists have at their disposal a variety of interventions they can leverage to support physical and emotional connections between mothers and babies in the NICU. One key intervention that neonatal therapists can employ is the application of the maternal voice as a therapeutic agent.3
While some sounds are harmful to NICU babies, the mother’s voice has been proven beneficial when applied according to evidence-based guidelines.4 Researchers have documented the positive impacts of both5:
- A mother’s voice spoken live at their baby’s bedside
- An audio recording of the mother’s voice played to the baby
A key benefit of recording the mother’s voice is that it can be played to the baby when the mother is unable to be at the bedside. 6
The Power of a Mother’s Voice
Selena Williamson, BSN, RN and Jacqueline M. McGrath, PhD, RN, FNAP, FAAN published the results of their systematic search and synthesis of literature on the use of maternal voice as a therapeutic agent in the NICU.
The resulting Evidence Based Practice Brief, What Are the Effects of the Maternal Voice on Preterm Infants in the NICU, offers documented evidence of the power of a mother’s recorded voice and biological sounds. Benefits of this intervention include7:
- Better feeding tolerance: Babies experienced fewer episodes of feeding intolerance when played a recording of their mother’s voice reciting nursery rhymes twice a day
- Greater weight gain: Infants exposed to the maternal sounds gained significantly more weight
- Improved physiological measures: Babies’ oxygen saturation increased, and heart rates and respiration decreased when recordings of their mother’s voice were played
- Fewer respiratory events: Infants who were played a recording of their mother reading and singing combined with their mother’s heartbeat (with sounds filtered together to mimic how they would sound in the womb) experienced a lower number of critical respiratory events (CREs)
- Increased stability and attending behaviors: There was an increase in babies’ stability behaviors (foot clasp, handclasp, sigh, ooh face, open face, flexion, grasping and smile) and attending behavior (eyes wide, eyes brightening, eyes toward source, suckling, stilling, visual locking, hand to face/mouth) when maternal recordings were played
The Positive Impact on NICU Moms
Research into the use of mother’s voice audio recordings in the NICU demonstrate benefits not only to the babies but to their mothers as well. Williamson and McGrath wrote in their Evidence Based Practice Brief 8:
“Recordings serve as a parenting participation strategy that the mothers can control, reducing not only their anxiety but also reinforcing their attachment to their child and alleviating their fear or discomfort of not being able to more fully participate in the care of their child.”
Mother’s Voice in Practice at Advent Health
Dr. Narendra Dereddy and his team at AdventHealth for Children studied the effects of maternal voice recordings on NICU preterm infants and maternal mental health. Twenty mothers recorded messages, stories or songs, which were played to their babies via Babyleo® TN500 IncuWarmers in accordance with evidence-based guidelines. The recordings, played four times daily, aimed to assess maternal anxiety using the DASS-21 questionnaire.
Results showed reduced maternal anxiety and no adverse effects on infants’ vital signs, supporting the intervention’s safety. Researchers recommend further trials, particularly for older gestational-age babies, to explore the benefits of positive sound stimulation.
Dereddy, N., Moats, R. A., Ruth, D., Pokelsek, A., Pepe, J., Wadhawan, R., & Oh, W. (2024). Maternal recorded voice played to preterm infants in incubators reduces her own depression, anxiety and stress: a pilot randomized control trial. The Journal of Maternal-Fetal & Neonatal Medicine, 37(1). https://doi.org/10.1080/14767058.2024.2362933
Evidence Based Recommendations for NICU Teams
While Williamson and McGrath’s literature found, “use of maternal voice did not appear to produce any negative effects or outcomes for the preterm infants; even in the cases where the interventions did not produce significant results, there is the potential for harm when any intervention is applied incorrectly.”
As with evidence-based recorded music guidelines for premature infants in the NICU, therapeutic sound using the mother’s voice should be administered with consideration of baby’s gestational age in no more than 20–30-minute intervals.9
Williamson and McGrath offer these evidence-based recommendations for playing maternal voice recordings to NICU babies10:
- Use engaging “motherese” tone for recording (soothing tone as if they were speaking to their baby directly)
- Use recordings during periods of no parental contact (rounds, report)
- Use recordings during feedings and caregiving activities
- Use recordings before, during and after painful procedures (heel lance, surgeries)
- Do not choose all the above; target intervention choice to best support the individual needs of infant
Conclusion
The NICU experience presents profound challenges for both babies and their families, yet it also offers opportunities for transformative care. Harnessing the therapeutic potential of the mother’s voice underscores the resilience of the maternal-infant bond, even in the most trying circumstances.
By implementing evidence-based strategies, such as recordings of maternal speech and biological sounds, and encouraging skin-to-skin contact, NICU teams are not only fostering improved outcomes for infants but also empowering mothers to participate in their child’s care, alleviating their stress and reinforcing attachment.
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The material presented in this blog represents the opinion of the author(s) and not necessarily the views of Synova Associates. Synova Associates does not endorse any specific products or organizations but strives to connect its industry partners with leaders interested in product/educational innovation.
