Abstract
Objective:
To investigate the effect of incorporating noise-canceling headphones into the delivery process for natural childbirth puerperae.
Methods:
We conducted a retrospective analysis of clinical data encompassing natural childbirth puerperae in the People’s Hospital of Suzhou New District from January 2021 to February 2023. The implementation of routine noise reduction management was done from January 2021 to January 2022. During this interval, 69 natural childbirth puerperae were selected as subjects, with 7 excluded, resulting in 62 participants constituting the reference group. Subsequently, noise-canceling headphones were distributed to natural childbirth puerperae from February 2022 to February 2023. In this phase, 66 subjects were selected, and 6 were excluded, resulting in 60 participants forming the observation group. Following admission, both groups underwent corresponding nursing management. Emotional states, pain levels, and various indicators were systematically collected and meticulously compared.
Results:
The observation group exhibited significantly lower Hamilton Anxiety Rating Scale scores than the reference group before delivery and during the first stage of labor (P < 0.05). The observation group demonstrated significantly lower visual analog scale scores and substance P, nitric oxide, and prostaglandin E2 levels than the reference group during the first stage of labor (P < 0.001). During the second stage of labor, the visual analog) scale scores were significantly lower in the observation group than in the reference group (P < 0.05). The durations of first and second labor stages were significantly shorter in the observation group than in the reference group (P < 0.05). No significant difference existed in Apgar scores between the two groups (P > 0.05).
Conclusion:
The utilization of noise-canceling headphones emerges as an effective intervention, alleviating anxiety, reducing pain during T1, and abbreviating total labor time in natural childbirth puerperae, suggesting its substantial clinical application value and potential as a beneficial addition to maternity care practices.
Keywords: natural childbirth, noise, pregnancy, labor stage
KEY MESSAGES:
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(1)
The application of noise-canceling headphones can soothe the emotions of puerperae.
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(2)
The application of noise-canceling headphones can reduce the pain degree of natural childbirth puerperae at the first stage of labor to a certain extent.
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(3)
The application of noise-canceling headphones can shorten the total labor time.
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(4)
The application of noise-canceling headphones can provide references for clinical management in natural childbirth puerperae.
INTRODUCTION
Environmental noise pollution is a prevalent stressor,[1] with elevated noise levels becoming a growing global concern.[2] The escalation of hospital noise worldwide has led to physiological reactions and compromised sleep quality.[3] This issue is particularly pertinent for patients, notably puerperae, as high ward noise intensity can significantly impact their well-being. The process of natural childbirth is intricate and poses potential risks, significantly influencing the well-being of both the puerperae and the fetus. Due to its complexities, natural childbirth has garnered considerable attention within the medical community.
Noise-induced mental stress may increase stress hormone levels, blood pressure, and heart rate, thereby increasing the risk of stress-related prenatal effects and adverse obstetric outcomes.[4] The period before and after delivery is marked by profound changes and is often experienced as stressful and overwhelming.[5] The delivery itself acts as an objective stressor, exacerbating stress in the endocrine system. This is evidenced by elevated serum 17-hydroxycorticosteroid, increased urinary excretion of epinephrine and norepinephrine, and a significant rise in cholesterol, free fatty acids, or triglycerides in liver tissue after stimulation,[6] resulting in endocrine imbalance. The unavoidable noise in delivery rooms, stemming from a multitude of equipment and medical staff, can be mitigated by the use of noise-canceling headphones. These headphones effectively receive auditory input and release opposing sound waves, diminishing the amplitude and frequency of unwanted sounds. This, in turn, minimizes the adverse effects of noise on puerperae. The application of noise-canceling headphones holds promise as a valuable tool in delivery room management. We herein aimed to investigate the effect of wearing noise-canceling headphones on the delivery process in natural childbirth puerperae, hoping to offer valuable insights for optimizing delivery room management practices.
MATERIALS AND METHODS
General information
This study initially analyzed the clinical data of 135 natural childbirth puerperae from January 2021 to February 2023; 13 puerperae were excluded for not meeting the inclusion criteria (2 cases with multiple births, 6 with a history of uterine surgery, and 5 with gestational hypertension), resulting in the inclusion of 122 puerperae. Informed consent was obtained from all participants in this study.
Inclusion and exclusion criteria
The inclusion criteria were as follows:
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(1)
Puerperae with singleton pregnancy in a normal fetal position without serious complications during delivery (e.g., uterine rupture or amniotic fluid embolism).
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(2)
Puerperae aged 22–36 years.
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(3)
Puerperae has normal cognitive ability and speech expression.
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(4)
Puerperae with complete clinical data.
The exclusion criteria were as follows:
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(1)
Puerperae with gestational hypertension and diabetes mellitus.
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(2)
Puerperae with a previous history of uterine surgery.
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(3)
Puerperae, who took analgesics and sedatives during pregnancy.
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(4)
Puerperae who underwent painless delivery.
METHODS
The reference group underwent the following routine delivery management:
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(1)
Prenatal Health Education: Midwives provided comprehensive knowledge about childbirth and offered guidance on the appropriate combination of diet and nutrition. Puerperae were instructed in the Lamaze breathing pain reduction method, and their vital signs, such as blood pressure, heart rate, and oxygen saturation, were monitored.
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(2)
Delivery Room Protocol: In the delivery room, midwives maintained a low volume, minimized unnecessary conversation, and provided guidance tailored to the specific situation of each puerpera.
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(3)
First Stage of Labor Management (T1): Midwives alleviated the psychological burden of puerperae by explaining relevant knowledge about delivery and cooperation skills. Attention diversion techniques, including appropriate massage, were employed.
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(4)
Second Stage of Labor Management (T2): Puerperae assumed the semi-recumbent bladder lithotomy position, with legs on the leg frame, bent upward, and buttocks slightly raised by 15° to expose the vulva. Midwives instructed puerperae to cooperate with the doctor’s operation movements, emphasizing correct breathing techniques and positioning.
The observation group, in addition to routine delivery management, wore noise-canceling headphones, following specific steps:
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(1)
Puerperae wore BOSE QC 45 noise-canceling headphones (model: 866724-0200; Bose Corporation, Shanghai, China) between 12:00 pm to 1:00 pm and 7:00 pm to 9:00 pm every day until the beginning of T1.
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(2)
During T1, puerperae received necessary comfort and nursing and were distracted with massage and noise-canceling headphones for 3 h.
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(3)
After smooth delivery, the mothers had immediate contact with the child and then wore noise-canceling headphones (30 min) for mood soothing and rest.
Evaluation indicators
Comparison of clinical data in both groups
Age, education level, height, weight, timing of childbirth, payment method for medical expenses, number of pregnancies, and average family monthly income were compared between the two groups.
Hamilton Anxiety Rating Scale (HAMA)
The anxiety levels at admission, before delivery, at T1, and after delivery were compared using the HAMA,[7] which uses a five-level scoring method of 0–4 points (0 points: no anxiety; 1 point: mild anxiety; 2 points: moderate anxiety; 3 points: severe anxiety; and 4 points: extremely severe anxiety), with a total HAMA score reflecting the severity of anxiety symptoms. Scores of ≥29, ≥21, ≥14, ≥7, and ≤7 indicated severe anxiety, obvious anxiety, presence of anxiety, possible anxiety, and no anxiety, respectively.
Visual analog scale (VAS)
VAS was employed to evaluate both groups’ pain degrees during T1 and T2. The pain degree, ranging from mild to severe, was expressed on a scale of 0–100 mm,[8] with lower scores indicating milder pain.
Pain biochemical indicators
From the puerperae of both groups, 2 mL of elbow vein blood was extracted at admission, at T1 and T2. After centrifugation, serum substance P (SP), nitric oxide (NO), and prostaglandin E2 (PGE2) were detected using an immunoassay kit (Wuhan Fine Biotechnology Co., Ltd., Wuhan, Hubei, China).
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(1)
SP kit (Batch No.: SP0041; Specification: 18 mL).
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(2)
NO kit (Batch No.: ZC5258KI; Specification: 96 T).
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(3)
PGE2 kit (Batch No.: EU2554; Specification: 48/96 T).
Clinical related indicators
Clinical-related indicators included hospitalization time and the time of T1, T2, the third stage of labor (T3), and total labor (T0) in both groups.
Delivery outcomes
Apgar score[9] was used to assess newborns’ physiological indexes and physical quality of life, including skin color, heart rate, response to stimulation, muscle tension, and respiration. It also determined the presence or absence of neonatal asphyxia and its severity. Each item was scored 0–2 points, with a full score of 10 points. A lower score indicated a higher risk of neonatal asphyxia.
Statistical methods
Data were processed using SPSS 26.0 (IBM Corp., Armonk, New York, USA). The Shapiro–Wilk method assessed normal distribution, with normal data expressed as (‘x ± s) and non-normal data as (M (P25, P75)). Continuous variables were tested using the Mann–Whitney U test, while categorical variables were assessed through the Pearson chi-square test or Fisher’s exact test. A significance level of P < 0.05 was considered statistically significant.
RESULTS
General information in both groups
Table 1 presents the comparison of clinical data, including age, education level, height, and weight, between the two groups. Statistical analysis indicated no significant differences in these parameters (P > 0.05). Please refer to Table 1 for detailed information.
Table 1.
General Characteristics of Both Groups
| Groups | Observation Group (n = 60) | Reference Group (n = 62) | z/χ2/F | P |
|---|---|---|---|---|
| Age (years, M (P25, P75)) | 28.00 (26.00, 32.50) | 29.00 (27.00, 32.00) | −0.254 | 0.799 |
| Gestational age (weeks, M (P25, P75)) | 39.00 (38.00, 39.00) | 38.00 (37.00, 40.00) | −0.691 | 0.490 |
| Education level | 0.171 | 0.918 | ||
| Junior college and above | 34 (56.67) | 37 (59.68) | ||
| High school and secondary school | 19 (31.67) | 19 (30.64) | ||
| Primary school and below | 7 (11.66) | 6 (9.68) | ||
| Height (cm, M (P25, P75)) | 160.00 (156.00, 165.00) | 159.00 (157.00, 163.00) | −1.173 | 0.241 |
| Weight (kg, M (P25, P75)) | 68.00 (66.00, 71.00) | 69.00 (65.00, 71.00) | −0.335 | 0.738 |
| Number of pregnancies | - | 0.940* | ||
| 1 time | 47 (78.33) | 49 (79.03) | ||
| 2–3 times | 10 (16.67) | 11 (17.74) | ||
| >3 times | 3 (5.00) | 2 (3.23) | ||
| Childbirth experience | 0.104 | 0.747 | ||
| Pregnant women | 49 (81.67) | 52 (83.87) | ||
| Maternity women | 11 (18.33) | 10 (16.13) | ||
| Timing of childbirth | 0.024 | 0.876 | ||
| During the day (5:30–18:30) | 34 (56.67) | 36 (58.06) | ||
| At night (18:31–5:29 the next day) | 26 (43.33) | 26 (41.94) | ||
| Medical expenses | 0.914 | 0.633 | ||
| Employee’s medical system | 27 (45.00) | 27 (43.55) | ||
| Cooperative medical system | 20 (33.33) | 25 (40.32) | ||
| Self-pay | 13 (21.67) | 10 (16.13) | ||
| Family average monthly income | 0.107 | 0.948 | ||
| >4000 CNY | 16 (26.66) | 17 (27.42) | ||
| 1800–4000 CNY | 34 (56.67) | 36 (58.06) | ||
| <1800 CNY | 10 (16.67) | 9 (14.52) |
CNY = Chinese Yuan. *Tested by Fisher exact probability test.
HAMA scores in both groups
Table 2 illustrates the comparison of HAMA scores between the two groups. No significant difference was observed in HAMA scores at admission (P > 0.05). However, following distinct clinical management, the observation group exhibited significantly lower HAMA scores than the reference group before delivery and at T1 (P < 0.05). After delivery, although the observation group maintained relatively lower HAMA scores, the difference was not statistically significant between both groups (P > 0.05), as shown in Table 2.
Table 2.
HAMA scores in both groups (points, M (P25, P75))
| Groups | Observation Group (n = 60) | Reference Group (n = 62) | z | P |
|---|---|---|---|---|
| At admission | 19.00 (15.50, 22.00) | 17.00 (15.00, 21.00) | −1.561 | 0.118 |
| Before delivery | 13.00 (11.00, 14.00) | 15.00 (12.00, 18.00) | −4.541 | <0.001 |
| T1 | 14.00 (10.00, 16.00) | 16.00 (12.00, 19.00) | −2.894 | 0.004 |
| After delivery | 10.00 (5.00, 11.00) | 10.00 (7.00, 12.00) | −1.850 | 0.064 |
VAS scores and pain biochemical indicators
At admission, there was no significant difference in VAS scores and pain biochemical indicators between the two groups (P > 0.05). At T1, the observation group demonstrated significantly lower VAS scores and SP, NO, and PGE2 levels than the reference group, with a notable difference in both groups (P < 0.001). Additionally, at T2, the observation group exhibited a significantly lower VAS score than the reference group (P < 0.05), whereas there was no significant difference in SP, NO, and PGE2 between the two groups (P > 0.05). Detailed data are provided in Table 3.
Table 3.
VAS Scores and Pain Biochemical Indicators (M (P25, P75))
| Groups | Observation group (n = 60) | Reference group (n = 62) | z | P | |
|---|---|---|---|---|---|
| At admission | VAS (mm) | 18.50 (13.00, 25.50) | 19.00 (13.00, 26.00) | −0.103 | 0.918 |
| SP (µg × mL−1) | 2.08 (1.67, 2.41) | 1.82 (1.53, 2.26) | −1.700 | 0.089 | |
| NO (µg × mL−1) | 14.32 (12.61, 16.72) | 14.41 (12.64, 16.67) | −0.100 | 0.920 | |
| PGE2 (pg × mL−1) | 13.74 (11.23, 15.26) | 13.49 (11.18, 15.95) | −0.261 | 0.794 | |
| T1 | VAS (mm) | 63.00 (58.50, 66.50) | 69.00 (64.00, 74.00) | −5.333 | <0.001 |
| SP (µg × mL−1) | 4.42 (3.30, 5.19) | 5.03 (4.38, 6.05) | −3.698 | <0.001 | |
| NO (µg × mL−1) | 55.70 (53.30, 57.66) | 64.54 (58.08, 67.64) | −6.827 | <0.001 | |
| PGE2 (pg × mL−1) | 125.63 (118.38, 132.24) | 133.47 (123.80, 141.69) | −3.915 | <0.001 | |
| T2 | VAS (mm) | 85.00 (80.50, 89.00) | 86.00 (82.00, 91.00) | −2.027 | 0.043 |
| SP (µg × mL−1) | 6.72 (6.02, 7.68) | 6.82 (6.21, 8.54) | −1.851 | 0.064 | |
| NO (µg × mL−1) | 81.88 (78.31, 84.04) | 82.65 (77.52, 86.24) | −1.772 | 0.076 | |
| PGE2 (pg × mL−1) | 198.00 (195.88, 200.02) | 199.21 (195.93, 201.52) | −1.501 | 0.133 |
Clinical indicators
No significant difference was observed in hospitalization time and the time of T3 (P > 0.05). However, the observation group exhibited significantly lower times for T1, T2, and T0 than the reference group (P < 0.05). Refer to Table 4 for detailed information.
Table 4.
Clinical indicators (M (P25, P75))
| Groups | Observation Group (n = 60) | Reference Group (n = 62) | z/t | P |
|---|---|---|---|---|
| Hospitalization time (days) | 2.00 (1.00, 3.00) | 2.00 (1.00, 3.00) | −0.446 | 0.656 |
| T1 (min) | 558.50 (531.50, 587.50) | 590.00 (537.00, 644.00) | −2.574 | 0.010 |
| T2 (min) | 77.00 (66.50, 85.50) | 90.00 (73.00, 100.00) | −3.825 | <0.001 |
| T3 (min) | 9.00 (7.00, 10.00) | 9.00 (7.00, 11.00) | −1.338 | 0.181 |
| T0 (min) | 644.12 ± 38.97 | 682.71 ± 70.56 | −3.722 | <0.001 |
Apgar score
The median (interquartile range) of newborns’ Apgar scores in the observation group and the reference group were 8.00 (7.00, 9.00) and 8.50 (8.00, 9.00), respectively. Statistical analysis revealed no significant difference between the groups (z = −0.741, P = 0.458), indicating no difference in delivery outcomes.
DISCUSSION
Childbirth represents a continuous and intense stressor, with noise recognized as a common environmental stressor.[10] Noise reduction strategies include diminishing sound at the source, obstructing its spread, and shielding the ear from the sound.[11] In delivery room management, current measures primarily focus on reducing noise at the source, leaving the spread of noise largely unaddressed, thereby still affecting puerperae. Active noise-canceling headphones, by generating reverse sound waves to neutralize external noise, offer a promising solution to actively eliminate interference. Moreover, the use of active noise-canceling headphones reduces discomfort during dental scaling.[12] This study provides a novel approach for natural childbirth delivery room management.
The close relationship between noise annoyance and poor mental health and high perceived stress has been highlighted,[13] emphasizing the effect of noise on mental well-being. Neuronal activities created by the neuronal ensemble are affected by various noise sources.[14] This impact of noise can significantly affect the mental health of puerperae, particularly in the realm of emotional states. Our study findings revealed that the observation group, subjected to different clinical management, exhibited significantly lower HAMA scores before delivery and at T1 than the reference group (P < 0.05). However, no significant difference was observed after delivery in both groups (P > 0.05), suggesting that wearing noise-canceling headphones has a certain effect in alleviating the anxiety of puerperae. The mechanism suggests that compared with women who give birth in a noisy environment, women who wear noise-canceling headphones are able to maintain a balance of excitability and inhibition in the cerebral cortex, thus reducing adverse effects of vagal and sympathetic dysfunction, resulting in more stable blood pressure and decreased likelihood of irritability, fatigue, sluggishness, and anxiety. However, we found no significant difference in mood between the two groups after delivery. This could be attributed to the short duration of noise reduction management, indicating the need for further exploration of the long-term effects of this intervention.
Noise in the delivery room can independently contribute to impaired clinical manifestations.[15] The initial acute psychosocial stress response to noise involves the activation of the sympathetic nervous system, followed by the subsequent activation of the hypothalamic–pituitary–adrenal axis, leading to a delayed increase in circulating cytokines.[16] Concurrently, increased adrenal cortical activity in puerperae, driven by anxiety and depression, can result in adrenal medullary diseases, such as a sharp rise in catecholamine concentration. Excessive catecholamine release is associated with various degrees of endocrine disorders, increasing the incidence of complications for both mother and fetus.[17] Our study results revealed that the observation group had significantly lower VAS scores and SP, NO, and PGE2 levels than the reference group at T1 (P < 0.001), with a significant difference in both groups. Moreover, the observation group exhibited a significantly lower VAS score at T2 than the reference group (P < 0.05). The duration of T1, T2, and T0 in the observation group was significantly lower than in the reference group (P < 0.05), suggesting that wearing noise-canceling headphones reduces labor pain and shortens labor time. The efficacy could be attributed to active noise reduction, effectively mitigating the effect of noise on puerperae, enhancing pain tolerance, reducing psychological burden, diminishing sympathetic nerve sensitivity, and elevating the pain threshold. Puerperae in good physical and mental states could actively cope with the delivery environment, facilitating a smoother delivery.
Regarding delivery outcomes, the study revealed no significant difference in Apgar scores between the two groups (P > 0.05), suggesting that wearing noise-canceling headphones does not significantly affect delivery outcomes. This could be attributed to childbirth being a natural physiological process influenced by multiple factors such as the force of labor, birth canal, fetus, and the mental and psychological status of the puerperae.[18] These factors are interconnected, and managing only one of them may not significantly affect the overall result.
Nonetheless, our study has several limitations. First, the single screening scope of subjects may introduce regional deviations and cultural differences. Second, the retrospective nature of the study introduces the potential for confounding bias due to the complex interplay of various factors. To mitigate these limitations, future research should aim to expand the sample size, conduct multicenter studies, and use prospective study designs. This would contribute to a more comprehensive understanding of the effect of noise-canceling headphones on natural childbirth puerperae.
CONCLUSION
In summary, our findings suggest that wearing noise-canceling headphones during the delivery process for natural childbirth puerperae can have positive effects. This intervention demonstrates potential benefits in reducing pain and anxiety, providing a novel approach to clinical management in the delivery room. However, considering the limitations mentioned, further research with larger and more diverse samples is necessary to strengthen the evidence base and inform clinical decision-making.
Financial support and sponsorship
This research was funded by Suzhou Medical Key Support Discipline (Grant number: SZFCXK202110).
Conflict of interest
The authors have no conflicts of interest to declare.
Author contributions
Beibei Zhang: Conceptualization, methodology, writing—original draft, experimental studies, editing, and project administration. Qinfang Qu: Conceptualization, methodology, writing—original draft, editing, and project administration. Yan Shu: Writing—original draft, editing, data curation, experimental studies, and literature search. Yun Zhang: Visualization, literature search, writing—review, formal analysis, editing, and supervision. Jie Zhang: Visualization, literature search, writing—review, formal analysis, editing, and supervision. Jia Sun: Literature search, writing—review, formal analysis, editing, and supervision. Caixia Zhang: Data curation, experimental studies, visualization, editing, and supervision.
Availability of data and materials
The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.
Ethical committee approval
This study, conforming to the principles of the Declaration of Helsinki (2013), has been approved by the ethical committee of the People’s Hospital of Suzhou New District (approval no. 20201103).
Informed consent
Patients who were aware of the purpose and significance signed an informed consent.
Acknowledgment
Not applicable.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.