Applications of White Noise in Maternal and Neonatal Care: A Comprehensive Review on Sleep, Stress, and Pain Outcomes

Abstract

This review aimed to systematically synthesize the current literature on the physiological and psychological effects of white noise on sleep quality, stress levels, and pain perception in both mothers and newborns. The primary objective was to critically examine existing evidence on the use of white noise in maternal and neonatal care interventions. A comprehensive literature search was conducted across major electronic databases, including PubMed, Web of Science, and Scopus, using keywords such as “white noise,” “sleep,” “stress,” and “pain.” After screening titles, abstracts, and full texts according to the selection criteria, 12 articles were selected for critical review. Findings from randomized controlled trials (RCTs) consistently indicate that white noise can shorten sleep latency, improve sleep onset, and reduce pain perception in both mothers and newborns. Additional randomized studies demonstrated benefits for physiological indicators, such as heart rate variability and oxygen saturation, particularly in neonatal intensive care settings. In contrast, evidence from reviews and expert opinions highlights potential risks associated with prolonged or high-intensity white noise exposure, including possible hearing impairment, negative impacts on cognitive functions, and neurodevelopmental delays. These differences highlight the importance of interpreting findings in light of the study design and methodological rigor. White noise presents itself as a practical, low-cost, non-invasive, and easily implementable method for improving maternal and neonatal care outcomes, particularly in sleep, stress, and pain management, provided it is applied within safe sound levels. Nevertheless, its effectiveness may vary across individuals and contexts. Future directions should focus on large-sample, long-term RCTs to establish definitive evidence and to differentiate between short-term benefits and potential long-term harms. The development of standardized protocols with evidence-based safety thresholds will be crucial in maximizing therapeutic benefits while minimizing risks.

KEY MESSAGES

• (1)White noise facilitates and accelerates the transition to sleep for both mothers and newborns, reduces sleep disruptions, prolongs sleep duration, and improves sleep quality.
• (2)White noise accelerates postpartum recovery by reducing stress levels in mothers during the postpartum period.
• (3)White noise application significantly reduces pain scores during painful procedures (heel prick, vaccination).
• (4)White noise should be used cautiously and within safe limits, as prolonged and high-intensity exposure can have adverse effects on hearing health, neurodevelopmental processes, and cognitive development.

INTRODUCTION

White noise is defined as sound generated by combining equal amounts of sounds similar to wind, rain, airplane engines, and radio waves in a laboratory environment, and transmitted at a constant intensity across the frequency range perceivable by human hearing. The term “white noise” originates from the auditory equivalent of the color “white,” which is formed by combining all colors in the light spectrum. Just as white encompasses all colors, white noise encompasses all audible frequencies. In this sense, it can be described as a continuous, steady auditory stimulus containing all frequencies of equal amplitude within the human hearing range (20–20,000 Hz), thereby providing a stable auditory background. White noise is a type of sound that covers all frequency ranges, effectively masking environmental noises and providing a consistent, uniform background sound.[1,2,3] In an environment where many people speak simultaneously, the human brain cannot distinguish these sounds individually, and the combination of these sounds creates the perception of noise. White noise prevents the brain from perceiving these irregular and high-intensity sounds, allowing the individual to focus on a more stable, continuous, and relaxing sound environment.[4,5] Due to its calming properties, white noise is widely used to reduce anxiety and promote relaxation.[6] Today, white noise is widely used in medical settings, psychotherapy, infant care, and daily life to help individuals cope more effectively with stress and anxiety. In this context, Lazar Barzegar et al.[7] reported that white noise, as a nonpharmacological intervention, can significantly reduce anxiety before surgical examinations.

White noise has recently been used as a complementary therapeutic approach. With its soothing and resonant properties, white noise is primarily perceived by the right hemisphere of the brain and transmitted to all body cells, stimulating the release of endorphins from the pituitary gland.[8] This process contributes to autonomic regulation by influencing catecholamine activity and suppressing sympathetic nervous system responses. In experimental settings, exposure to white noise has been associated with reduced physiological arousal, including lower heart rate and stress indicators, suggesting a relaxation-inducing effect through modulation of autonomic activity.[9]

White noise is a type of sound that maximizes the auditory arousal threshold. This means that when white noise is present in the background of the environment, the potential for other distracting sounds to stimulate the cerebral cortex is significantly reduced. In other words, by raising the auditory arousal threshold, white noise reduces the discomfort caused by environmental sounds, particularly those to which patients in intensive care units (ICUs) are exposed.[10] It is generally regarded as a practical and easy-to-implement intervention with minimal risk of complications, rather than repeatedly emphasizing its low cost.[11,12]

In maternal and neonatal care, sleep disturbances, heightened stress levels, and pain management are critical issues. Against this background, white noise has emerged as a potentially useful nonpharmacological intervention. This article therefore examines the results regarding its effects on sleep, stress, and pain outcomes in mothers and newborns.

MATERIALS AND METHODS

This comprehensive review aims to comprehensively examine the existing literature on the effects of white noise on sleep, stress, and pain in mothers and newborns. We searched multiple electronic databases, including PubMed, Web of Science, and Scopus, using keywords such as “white noise,” “sleep,” “stress,” and “pain” to identify relevant publications. The initial search identified 187 articles. All titles and abstracts identified from the database were independently appraised against the inclusion criteria. All articles and their references were reviewed and evaluated. Finally, 12 articles were critically reviewed. Figure 1 illustrates the literature search and selection process.

Figure 1.

Literature search and selection process using PRISMA.

We specifically searched for articles that were randomized controlled trials (RCTs) and meta-analyses. This review focused on the most recent studies published within the last 5 years, up to August 2025.

Eligibility Criteria

We selected keywords for the study according to the Medical Association guidelines. According to PICOT-SD, the study inclusion criteria were as follows:

• Population (P): Mothers and newborns exposed to white noise

• Intervention (I): White noise applied for sleep, stress, and pain

• Comparison (C): Routine care and interventions

• Outcomes (O): Improvement of sleep quality and prevention/management of stress and pain

• Time (T): During the hospital care process

• Study design (SD): RCTs; experimental; and quasi-experimental studies

We excluded nonexperimental studies, qualitative studies, reviews, case studies, English or non-English articles, and articles without full text.

During the screening process, studies were excluded mainly due to unrelated populations (e.g., adults or nonmaternal samples), nonexperimental or descriptive designs, duplicated data, or insufficient methodological and outcome information. These exclusion criteria are summarized in Figure 1.

PHYSIOLOGICAL AND PSYCHOLOGICAL EFFECTS OF WHITE NOISE ON SLEEP, STRESS, AND PAIN

White Noise and Sleep Quality

White noise is a type of sound in which different frequency components are presented at a constant intensity, generally masking environmental sounds. This masking effect reduces the ability of background sounds to stimulate the cerebral cortex, helping individuals fall asleep more easily and improve sleep quality. Numerous studies have demonstrated that white noise enhances sleep quality, particularly in environments with disruptive background sounds. For example, a study conducted in an ICU found that white noise improved patients’ sleep quality even when overall noise levels increased.[13]

Studies conducted in student dormitories and among hospitalized individuals have confirmed that the application of white noise improves sleep quality.[14,15] One RCT concluded that patients who listened to white noise had better sleep quality compared to those using earplugs, and that this method could be an effective nursing intervention in the hospital setting.[15] Similarly, sleep quality and related questionnaire scores significantly improved in patients undergoing coronary artery bypass surgery when white noise was applied in the ICU.[16]

A study on newborns found that white noise increased sleep duration and efficiency while reducing stress scores in infants receiving nasal continuous positive airway pressure (CPAP).[17] Current evidence strongly supports the idea that white noise, when applied at safe sound levels, is a safe and accessible method to improve sleep quality. A systematic review by Strait[18] further confirms these benefits, highlighting white noise as a valuable tool for enhancing sleep quality in hospitalized patients, with direct implications for maternal care settings. Another systematic review also supports the use of noise as a sleep aid.[1]

White Noise and Stress Management

White noise is a type of sound with the potential to reduce both physiological and psychological stress. owing to its calming resonance properties, white noise exerts a suppressive effect on the sympathetic nervous system. This effect leads to decreased levels of catecholamines (adrenaline and norepinephrine), which trigger the stress response.[8] Additionally, some studies have reported that exposure to white noise significantly reduces physiological stress indicators, such as heart rate, blood pressure, and respiratory rate.[10]

The stress-reducing effect of white noise is associated with its ability to mask disruptive environmental sounds, thereby reducing the perceived noise level. This increases individuals’ sense of control over environmental stimuli, thereby reducing psychological stress. Integrating sounds from nature (such as rain, wind, or ocean waves) into white noise can promote relaxation in both healthy and ill individuals, further reducing stress levels.

In a study evaluating the effects of white noise on pain scores and salivary cortisol levels in surgical neonates, white noise was reported to have potential as an additional soothing measure after surgery, as evidenced by decreased pain scores and salivary cortisol concentrations following white noise intervention.[8] A study investigating the effects of listening to white noise and lullabies during the breastfeeding on neonatal stress, breastfeeding success, and the mother’s comfort reported that white noise significantly reduced neonatal stress and enhanced the mother’s comfort in the early postpartum period.[19] This finding strongly suggests that white noise can be integrated into clinical practice as an effective nonpharmacological intervention for managing neonatal stress and postpartum adaptation in mothers.

White Noise and Reducing Pain Perception

Pain is a complex condition that can occur with or without tissue damage, is influenced by an individual’s past experiences, and negatively impacts physical, emotional, and social life.[20] Premature infants admitted to neonatal intensive care units (NICUs) are repeatedly exposed to painful procedures and agitation over extended periods during hospitalization. The adverse neurobiological effects of pain and stress in premature infants have been well documented, including alterations in neuroimaging findings and neurobehavioral outcomes.[21] Crying, a complex behavioral response consisting of a series of four movements similar to the Valsalva maneuver, represents a physiological reaction to distress. Documented short- and long-term consequences of crying include increased heart rate and blood pressure, decreased oxygen saturation, elevated cerebral blood pressure, activation of the stress response, depletion of oxygen and energy reserves, disruption of maternal–infant interaction, and potential risks for brain injury and cardiac dysfunction.[22] Therefore, caregivers are encouraged to respond promptly, consistently, and comprehensively to infant crying to mitigate physiological stress and support neurodevelopment.

Both pharmacological and non-pharmacological methods are used for pain management. International guidelines for acute procedural pain management, especially in newborns, strongly recommend nonpharmacological methods due to their low risk of side effects.[23] White noise is considered a calming nonpharmacological intervention with the potential to reduce pain perception. Because fetuses are constantly exposed to monotonous, rhythmic sounds in utero, similar acoustic stimuli may have a soothing effect on infants in the postnatal period. A study evaluating the effectiveness of white noise as a distraction method in relieving pain associated with vaccination procedures in premature infants reported its effectiveness.[24]

White noise has been reported to provide an analgesic or relaxation effect by influencing stress-related physiological responses, potentially through mechanisms such as endorphin release.[8,9] In an RCT examining the effect of the maternal breast milk odor and white noise on pain management during heel prick in premature infants, the combined application of white noise and breast milk odor was reported to significantly reduce pain scores.[25] Another study indicated that the use of white noise combined with swaddling during orogastric tube placement was particularly effective in alleviating invasive pain and adverse changes in related physiological parameters.[26] Based on this evidence, white noise can be recommended as a supportive non-pharmacological method for pain management in maternal and neonatal care. Table 1 presents a summary of studies on white noise applications.

Table 1.

Summary of Studies on White Noise Applications.

Author / Year	Reference	Population	Intervention	Outcome Measures	Results	Level of Evidence
Liao et al., (2021)	35	Premature infants	Mother’s voice vs. white noise	Physiological parameters, weight gain	White noise was more effective for weight gain	RCT
Ren et al., (2022)	5	Preterm infants	White noise vs. control	Cortical response, pain scores	White noise significantly reduced pain scores and cortical responses	RCT
Pekyiğit and Açikgöz (2023)	33	Term newborns	White noise + facilitated tucking	Heel prick pain scores	Combination provided the lowest pain scores	RCT
Kirli et al., (2024)	26	Preterm infants.	White noise, swaddling, combination	Pain and physiological parameters during orogastric tube insertion	White noise + swaddling was the most effective	RCT
Ekici and Süzer Özkan (2024)	27	Primiparous mothers	White noise	Anxiety levels, breastfeeding success	White noise reduced anxiety and improved breastfeeding success	RCT
Erol and Özalp Gerçeker (2024)	37	Term neonates	White noise + therapeutic touch	Heel prick pain and comfort	Combination reduced pain and improved comfort	RCT
Göktürk and Sarialioğlu (2024)	38	Term neonates	White noise	Pain and stress during CPAP	White noise significantly reduced pain and stress	RCT
Düken and Yayan, (2024)	34	Preterm infants	Massage + white noise	Sleep duration and efficiency	Sleep duration increased by ∼2 hours, efficiency Improved	RCT
De Jong et al., (2024)	41	Children (review)	White noise devices	Hearing health, developmental outcomes	Long-term, high-volume use posed hearing and developmental risks	Systematic Review
Karakuş Selçuk et al., (2025)	19	Newborns + mothers	White noise + lullaby	Stress levels, breastfeeding success, maternal comfort	White noise reduced stress and improved breastfeeding success	RCT
Otlu and Esenay (2025)	25	Preterm neonates	Mother’s milk odor + white noise	Heel prick pain scores	Combination significantly reduced pain	RCT
Mohseni et al., (2025)	40	Preterm infants	White noise vs. sound reduction	Behavioral responses	Sound reduction was more effective	RCT

RCT = randomized controlled trial

EFFECTS OF WHITE NOISE ON MATERNAL AND NEWBORN HEALTH

Effects on Maternal Health

White noise can have positive effects on maternal health by masking sudden and disruptive environmental sounds. During the postpartum period, mothers may experience significant sleep problems due to both hormonal changes and irregular sleep patterns related to caring for their babies. By masking external sounds, white noise shortens the time it takes to fall asleep and helps increase total sleep time by reducing wakefulness during the night.[13] A study examining the effect of white noise on sleep quality in patients admitted to the ICU recommended that white noise be used as a method to mask environmental noises, improve sleep, and maintain sleep in the coronary care unit.[12] White noise has been shown to improve sleep by masking disruptive sounds in various populations, including patients exposed to high levels of environmental noise.[12,13] These mechanisms may similarly benefit postpartum mothers who experience frequent awakenings due to environmental and caregiving-related disturbances.

Postpartum pain (such as episiotomy pain, post-cesarean section pain, or nipple cracks due to breastfeeding) can negatively impact mothers’ overall well-being. This state of relaxation and calmness may also contribute to improved mood, particularly in mothers at risk for postpartum depression. Improvements in sleep quality and reductions in stress levels indirectly support these effects.

A study involving mothers who delivered vaginally found that the application of white noise significantly reduced maternal anxiety and increased breastfeeding success.[27] This finding suggests that white noise may serve as a practical nonpharmacological approach to support psychosocial adjustment and breastfeeding during the postpartum period. Overall, white noise can be considered a preferable intervention for improving mothers’ sleep, reducing stress, and supporting pain management during pregnancy and the postpartum period.

Effects on Neonatal Health

Various nonpharmacological interventions are recommended to enhance comfort and support the neurophysiological stability of premature infants in the NICU. Among these, auditory-based approaches, such as music and white noise, have been shown to influence infants’ brain activity and behavioral organization, thereby contributing to improved adaptation and reduced physiological stress responses.[28,29] Given that the fetus begins to perceive sounds around 26 to 28 weeks of gestation, the effects of auditory stimuli on the newborn are essential.

White noise has been used as a nonpharmacological intervention in newborns to support pain management and promote relaxation during medical procedures. Studies have shown that exposure to white noise can reduce physiological indicators of pain and distress in premature infants during interventions such as vaccinations or retinopathy screenings.[24,30] An RCT investigated the effects of three interventions (white noise, recorded maternal voice, MiniMuffs) on pain and comfort in premature infants hospitalized in neonatal intensive care units. A study examining the effects of minimuffs applied during heel prick on pain and comfort in premature infants hospitalized in NICUs found that premature infants exposed to white noise during heel prick had significantly lower heart rate, crying duration, NIPS (Neonatal Infant Pain Scale), and COMFORT neo scores, and higher oxygen saturation compared to the control group.[31]

Another study showed that kangaroo mother care and white noise applications reduced physiological stress parameters during heel prick blood collection in newborns. Research findings revealed that these two nonpharmacological interventions, both when applied alone and in combination, helped reduce physiological stress levels in newborns.[32]

An RCT by Pekyiğit and Açikgöz[33] compared the effects of white noise and fetal positioning interventions on pain during heel prick blood collection in term infants. White noise was found to be more effective than fetal positioning alone, and the combination of the two methods resulted in the lowest NIPS scores.

A study on sleep parameters in premature infants found that sleep duration was extended by approximately 2 hours in the white noise group compared to the pretreatment period, and a significant increase in sleep efficiency was also observed.[34] These results indicate that, in this study, white noise was associated with both prolonged sleep duration and a significant improvement in sleep efficiency.

In a study comparing the effects of maternal voice and white noise on physiological responses in premature infants admitted to the NICU, greater weight gain was observed in the infants in the white noise group.[35] This result suggests a potential role for white noise in promoting growth.

Rahimi et al.[36] investigated the impact of white noise on premature infants undergoing peripheral intravenous catheter insertion. Their findings demonstrated that physiological parameters, including respiratory rate, heart rate, and mean arterial pressure, returned to baseline values more rapidly in infants exposed to white noise compared to the control group. This highlights the supportive role of white noise in facilitating physiological recovery during invasive procedures.[36]

Similarly, Erol and Özalp Gerçeker[37] conducted an RCT study exploring the combined effects of white noise and therapeutic touch on pain and comfort during heel lance in newborns. The results indicated that this combination significantly reduced pain levels and improved overall comfort, suggesting a synergistic benefit of multimodal nonpharmacological approaches.[37]

Another study examining the effects of white noise on newborns’ pain and stress levels, physiological parameters, and crying duration during nasal CPAP application reported that white noise reduced pain and stress levels before, during, and after nasal CPAP application.[38]

In conclusion, white noise is a safe and effective non-pharmacological intervention that offers multifaceted benefits for the health of both mothers and newborns. These benefits include improved sleep, reduced stress, and support for pain management. This evidence suggests that white noise should be more widely utilized as a valuable tool in maternal and neonatal care.

THE BALANCE BETWEEN THE BENEFITS AND RISKS OF WHITE NOISE

While white noise is widely used to calm newborns and infants, helping them transition to sleep, concerns have been raised about the potential adverse effects of long-term exposure. The sensitivity of the auditory system, especially in early life, and the long-term effects of loud noise exposure on hearing and quality of life make this issue a significant pediatric concern. The American Academy of Pediatrics (AAP) and the Division of Otolaryngology–Head and Neck Surgery emphasize that repeated exposure to loud noise can cause progressive hearing loss and may be associated with neurological and cognitive problems, including impaired learning and memory functions.[39]

A study comparing the effects of white noise and sound reduction on behavioral responses during noninvasive ventilation in newborns found that both interventions affected the infant behavior at different stages. However, analyses determined that sound reduction was more effective than white noise in reducing restlessness and promoting behavioral regulation.[40]

Research highlights the need to regulate the safe use of white noise devices. A study by De Jong et al.[41] demonstrated that prolonged exposure to loud noise devices can result in permanent hearing loss and developmental delays. These findings highlight the importance of early intervention and regulatory measures for public health.[41]

At the neurological level, a study by Pinardi et al.’s[42] reported that white noise reduced connectivity between the primary auditory and motor cortices, as well as other cortical regions. This reduction was most notably observed in the right hemisphere of the primary motor cortex.[42]

These findings underscore the importance of carefully evaluating the use of white noise and balancing its potential benefits with its potential risks. Factors such as volume level and duration of use should be considered to ensure safety, especially for infants and young children, and parents should be informed accordingly. While white noise can be a helpful tool, it carries the risk of causing permanent health problems if misused.

GENERAL ASSESSMENT AND FUTURE DIRECTIONS FOR THE CLINICAL USE OF WHITE NOISE

While white noise offers promising results with its positive effects on sleep, stress, and pain management, it is clear that this method should be approached with caution in clinical practice. This synthesis highlights the practical challenges associated with the routine use of white noise in maternal and neonatal care and highlights the urgent need for standardized application protocols.

While current research supports the benefits of white noise, it also points to potential risks, particularly from prolonged exposure to high volumes. These risks can range from adverse effects on the auditory system to neurodevelopmental problems. Therefore, to maximize the clinical benefits of white noise while minimizing its potential harms, it is critical to determine parameters such as appropriate volume levels, duration of use, and application methods based on scientific evidence.

In conclusion, the benefits of white noise are not to be ignored. Still, clear guidelines for clinical use must be established to ensure patient safety. Future research should evaluate the efficacy and safety of white noise in a broader range of patients and across various clinical conditions, focusing on determining the most suitable application protocols. This will enable white noise to establish itself as a safe and effective non-pharmacological tool for supporting maternal and neonatal health.

CONCLUSION

White noise stands out as a promising nonpharmacological method with its positive effects on maternal and newborn health. The findings indicate that this method provides therapeutic effects on both physiological (heart rate, oxygen saturation) and psychological (sleep, stress, pain) indicators. It is particularly effective in improving newborn comfort and reducing physiological stress responses during invasive clinical situations such as heel prick, intravenous interventions, or nasal CPAP. Using white noise in conjunction with other methods, such as the smell of breast milk, swaddling, or the mother’s voice, can create a synergistic effect and enhance its benefits.

In this context, white noise can be integrated into routine care protocols, especially for premature and newborn babies. However, this integration should be performed under standardized sound levels and duration limits to ensure safe use. Properly informing families about appropriate home application methods is critical to avoiding potential risks. White noise should be considered a temporary and complementary supportive method rather than a permanent solution.

Future research should confirm the long-term effects of white noise using larger sample sizes and randomized controlled designs. Long-term effects should be examined, particularly across different populations including term infants, premature infants, and mothers. Furthermore, focus should be placed on synergistic applications with other nonpharmacological methods, such as lullabies and kangaroo care, as well as potential risks to auditory health. Since no universally accepted safety threshold exists, it is crucial to establish standardized guidelines that balance the effectiveness and safety of white noise.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Author contributions

TÖ: conceptualization, methodology, literature search (screening, selecting, and extracting data from studies in review), manuscript original draft, review, and editing.

ND: Conceptualization, methodology, manuscript review, supervision.

Ethics approval and consent to participate

Not applicable.

Financial Support and Sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

The authors declare no conflicts of interest.