More international insights. Guest author Pernilla Hugoson from Sweden shares her thoughts and experiences with music therapy in neonatal care. Learn more about how family-centered care works using the NIDCAP approach. Interested about a unique feature for parents at Swedish neonatal care units? Find out in Pernilla’s blog…

Caring for the vulnerable

In my clinical work I meet parents and babies in a vulnerable situation. Suddenly life has changed and everything is about survival from one day to another. In this situation, parents can need support to find their innate role as a parent to a premature born or/and severely sick baby. They also need to have space where they can share feelings and thoughts about their situation. It is not easy to become a parent in this hightech environment and therefore it is important to create possibilities for parents and babies to experience each other through the senses, smell, touch and hearing and to be able to connect emotionally.

Towards family-centered care using NIDCAP

Since many years, we practice family-centered and developmentally supportive care in Swedish neonatal units. Our care is based on NIDCAP (The Newborn Individualized Developmental Care and Assesment Program). From the very beginning, Swedish parents are supported in being the primary caregivers to their newborn baby.

I am working with a family-centered music therapy intervention. Its aim is to support and strengthen parents to sing and hum for their baby during skin-to-skin contact, the so called kangaroo care. The focus is to encourage or even to empower the parents to using their unique voices as a possibility for them to be in touch with their baby both physically and emotionally.

Of course, the meeting with each family is individualized and formed out of their unique situation. I always work with both parents and baby present. This is easy for us in Sweden as the parents can be present at the ward 24/7. It can be both when the baby is taken care of in the acute care room or when the family has been moving to a family room.

«What is family-centered care? Experts from the United States describe it as a partnership approach to health care decision-making between the family and health care provider (Kuo et al. Matern Child Health J 2012). Some of their general principles that characterize family-centered care in pediatric health care are listed in my blog post

Kaisamari Kostilainen, Helsinki University Hospital

Working as music therapist in Swedish NICUs

As a music therapist, I work closely with the other professionals of the NICU team to offer each family what they need. This helps to create moments of closeness for the family so they can relax. I use my voice for singing, for humming and for improvising.

Sometimes, I use a monochord to accompany both my own and the parents‘ voices. You need to be very flexible and creative in finding ways to inspire and encourage parents to dare using their voices in the environment of the NICU.

It can be challenging for parents. Not everybody has the courage to use her or his voice. Sometimes, they are also emotionally blocked and it is difficult for them to sing. Then I start with the breathing and very cautiously guide them to simply breathe in and out.

Picture Music Therapy and Family

Pernilla working with preterm infants and families in Swedish NICUs | © Photo: Jonas Nyhav

When the parents feel ready, we add sound during the exhalation. I often encourage parents to try this when they are on their own or during kangarooing when no one else is present except their baby.

It is imperative to not put any pressure on the parents! Just gently, smoothly and with great respect for their integrity offer a way to start using their voice and a way to get used to how it sounds. One should also encourage parents to talk motherese («baby talk») to their baby.

For some parents, letting the melody of the spoken language be transformed into a singinglike manner is helpful. Others simply listen to my voice and the monochord, which gives them an opportunity to relax together with their baby. Yet, some parents love to mutually sing lullabies or other childrens songs. Again, the parents are in charge of what songs we sing. Many Swedish parents like to sing childrens‘ songs for their babies and they appreciate support to recall them from their own childhood memories.

Empowering parents

Picture Family Kangarooing

Kangarooing supports bonding and empowers parents | © Photo: Clas Fröhling

When parents are given the space to be just parents and to experience how important they are for their baby’s development it can give them a strong feeling of self-confidence and self-esteem in their parenthood. It supports and sometimes even eases the transition to parenthood.

Singing or humming during kangaroo care can also create peace and give both parent and baby a moment of relaxation where they can be in «a present moment» (using Daniel Stern’s words). They are all given the possibility to attune to each other emotionally. These moments are of high importance for attachment and bonding to develop.

What motivates me

It is inspiring to be part of a journey, in which each family develops unique strategies for handling their situation. Parents also strongly express their need to be parents in the NICU and to take care of their baby. It is such a grace to be invited to share and to follow a family through their time at our ward, in both sorrow and happiness. I really appreciate the humble possibility to contribute to the parents‘ support of their baby’s development, through moments of emotional harmony where the relationship between parents and baby can grow and develop.

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