Effective Practice – a snapshot of the ESMBH project 2 Oct 2013

This is a project to encourage mothers to bond with their babies through shared music in the Neonatal Unit at Gloucester Hospital, UK

What has made this effective?

  • Playing without a written score: focus of attention is on the audience, the environment and our relationships; focus on the dynamics of the room, response, baby movement; music as embodied rather than performing a piece; being able to converse and play simultaneously;
  • Exploring the technical aspects of playing an instrument: Choosing a key that doesn’t clash with monitors (multiples of 500Hz, between Bb and B); the right volume not to alarm babies; the right register not to interfere with clinical conversations; measuring spacial / stereo / phase / binaural effects of a large instrument including how it sounds in an incubator; making ad-hoc ipod recordings of the music in the hospital, to help get the music at the same pace when recording at home;
  • Ethical, careful approach: Resisting early publicity; gently easing into the project; finding out information at the right time; gaining experience with Opus and with other musicians in the Derby Children’s hospital; having staff with us in the initial visits; translating medical ethics into musical ones (informed choice, dignity, non-malfeasance);
  • Extending the research: extensive reading of published research; developing aspects that weren’t fully researched (eg lowering of heartrate more than 30 mins after hearing live music / the importance or not of time of day in a hospital); being aware of work on the clinical effects of music, the effects on staff, the effects on parents and on the musician, and from all these groups, the assumptions / anticipations around music;
  • Working in a time-based medium: noticing and responding, moment-to-moment, to the environment and audience; potential for new research around how babies gain a sense of time in an otherwise temporally undifferentiated environment;
  • The impact of our presence: being there could be a statement that we value the parents; having a book which anyone (parents / nurses / consultants / us) can comment in; the impact of the music in the room and beyond, and the further recorded work and followup work with parents in early start groups; freely offered photographs from the parents and the hospital press office; comments made to us as we play; facebook post on Glos NHS Trust facebook page;
  • The impact on me as musician: informing the pace and gentleness of how I play; being more responsive to the environment; creating new compositions and making them available through recordings and website; refreshing a previous idea (nametunes); recognising the professionalism of the medical staff as something that frees me from feeling emotionally involved in the babies’ progress;
  • Focus on social impact: focussing on the relationships at a very testing time for parents; addressing spiritual needs of parents; encouraging medical staff to notice, enjoy and even sing / hum the music;
  • Recognising clinical impact: not therapy, but helpful to people; inviting positive relationships between doctors / parents / hospital; being asked to play for procedures;
  • Quality observation: project leader (Alison) has often been there to take notes during my visits; the value of an observer who might be elsewhere in the room (musical value) or hearing things I can’t (for example, difficult conversations which may happen outside the ward); my own notes written in retrospect; comments in project book; ad-hoc conversations in the ward; conversations with professional musicians / therapists around the world;
  • Creating new musical audiences: creating music in places in which is not usual to people who may never have encountered a live musician; encouraging people to be musical with their babies (eg as part of Kangaroo care or more generally, after they leave the hospital);
  • Challenging assumptions about music: that it’s performed from a score; inviting people to join in where they can; introducing positive qualities such as grace, kindness, time for people, stimulation; challenging the less-rigorous research such as “music making you smarter” or “Mozart is good for babies”; being willing to experiment with original music; recognising the way babies respond to a large instrument and low bass notes, and not the “tinkly” sounds people assume babies like; talking about the project to general and specialist audiences and getting a sense of where people are enthused.

Suggested new areas for clinical / musical research coming out of our experience in the NNU:

  • the effect of music on patients beyond 30 mins after music finishes
  • the effects of music on movement in premature babies
  • the role of repetition in building a sense of time / anticipation in a temporally undifferentiated environment
  • the role of measurement – including what / for what purpose – in a music project
  • how best to initiate, manage, publicise and sustain a music project in a hospital
  • the effect of music on hospital staff practices
  • the role of music in hospitals (social / clinical / artistic)
  • the role of infrasound and phase effects in live music and how babies perceive it at different ages
  • how parents can be encouraged to play / sing / hum in a hospital (eg during Kangaroo care) – potentially including visual environment and other factors
  • testing of babies’ responses to see how they respond to / anticipate musical phrases

ESMBH site (for parents)

And a question:

How can a musical project like this be made sustainable or even “of interest” to medical people when it’s so far outside the clinical processes of a hospital?

2 thoughts on “Effective Practice – a snapshot of the ESMBH project 2 Oct 2013

  1. What wonderful work, Mark. And your music is incredibly beautiful!! I am a Certified Music Practitioner myself – harper. I play often at our area hospital. Who made your harp? The tone is ethereal. Is it wire strung? I picked up your link on the Harp List. Thanks!!

    1. Hi Allen,

      Thanks so much for the lovely comment. The music is all very quickly written on the spot – which I like because it adds a pressure to the whole thing! My work in a way is as much for the parents as the babies, so more about the relationship between them (I figure the babies get all the medical attention!) although of course I do play for babies on their own too. My experience suggests there’s a lot of research which could still be done on very young children, but of course that is really for someone with a medical head to do. The harp is a Dusty Strings Ravenna 34. I really love the sound of it – it can sparkle but also has a lot of bass (depending where I play it). I notice in different places even in the same room, it sounds different. And of course the wonderful thing about an acoustic instrument is that you can respond to the sounds going on around you, and the sound carried in a way that I am convinced is unique to the harp. It’s actually a nylon-strung harp but the tension is quite high. I certainly like the sparkly sound it produces!

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