A substantial body of evidence indicates that music interventions during pregnancy are associated with a decrease in maternal anxiety (25). A meta-analysis analysed five studies involving 1261 pregnant women and reported that music interventions significantly reduced levels of maternal anxiety (SMD = -0.21, 95% CI: -0.39 to -0.03) (32). A similar effect (SMD=-0.42, 95% CI: -0.47 to -0.08) was reported from another meta-analysis of 11 studies with 1482 participants and noted the significant anxiety-reducing effects of music listening at home (33). Additionally, research indicates that listening to relaxing or preferred music can effectively decrease anxiety in women awaiting amniocentesis (34) and during transvaginal ultrasound (35). Besides anxiolytic benefits, music interventions have been shown to reduce blood pressure and pregnancy-induced hypertension (36), improve sleep quality in pregnant women with disturbed sleep (37), improve lower back pain and increase quality of life during pregnancy (38). The specialist practice of music therapy has also been shown to significantly reduce pregnancy-related distress for women with high-risk pregnancy experiencing extended antepartum hospitalisation (39, 40).

Evidence also suggests that the positive effect of antenatal music engagement can continue beyond pregnancy. For maternal wellbeing and childbirth experience, a RCT found that music listening during pregnancy was associated with a more positive birth experience, characterised by shorter labour duration, higher likelihood of natural onset of delivery, and reduced need for medication (41). Postnatally, listening to music and singing during pregnancy were associated with higher levels of postnatal maternal wellbeing and lower symptoms of postnatal depression during the first three months after birth (42).

In terms of neonatal outcomes, singing lullabies during pregnancy was linked to stronger postnatal attachment between mother and infant, and a decrease in neonatal crying episodes, infantile colic, and nightly awakenings (43). Infants whose mothers listened to music during pregnancy scored better on the Neonatal Behavioural Assessment Scale (NBAS), indicating enhanced neonatal behaviours (44). Moreover, antenatal music exposure led to long-term neural effects in infants, suggesting that the benefits of such exposure extend well beyond birth (45). This is supported by a recent systematic review that found antenatal sound stimulation, including music, can form stimulus-specific memory traces during the foetal period and affect neonatal neural systems (46). Lastly, a recent study found that antenatal music exposure may facilitate early language processing and acquisition (47). These findings suggest that antenatal music engagement not only benefits maternal mental health but also has a profound impact on infant development and behaviour, with effects that may persist well into childhood.

A targeted literature search identified 10 records of antenatal music therapy practice in English. This section provides an overview of these specialised interventions, which differ from other music-based intervention by involving a qualified music therapist who uses specific music techniques tailored to the unique needs and experiences of pregnant women, their foetuses, and families within a therapeutic relationship. Of the 10 records, five focused on bedside music therapy (39, 40, 48–50), three described group programmes (51–53), one reported home/family-based therapy (54), and one addressed perinatal palliative music therapy (55). These programmes are discussed in detail below and summarised in Table 1.

Perinatal mental health challenges in Ireland mirror global trends, with approximately one in five women experiencing mental health conditions during the perinatal period, with one in seven reporting moderate to severe depression, and one in ten reporting moderate to severe anxiety (59). A recent survey in Ireland indicated that certain indices of sociodemographic and socioeconomic disadvantages such as being a young, single or first-time mother, lower education background, unemployment, or having relationship difficulties, increased the likelihood of poor mental health during the perinatal period (59).

In response to these challenges, the Department of Health in Ireland published the first National Maternity Strategy 2016–2026 to advocate for a holistic, women-centred, and biopsychosocial model of care, aiming to reduce the medicalisation of pregnancy and childbirth by promoting preventive measures and early intervention, particularly in relation to mental health (60, 61). Complementing mental health policies, Sharing the Vision: A Mental Health Policy for Everyone (61) emphasises the need for a comprehensive, multidisciplinary approach that considers biological, psychological, and social factors contributing to mental illness.

Building on these strategic frameworks, Ireland launched the Specialist Perinatal Mental Health: Model of Care in 2017 (Health Service Executive, 2017) (62). This initiative led to the establishment of Specialist Perinatal Mental Health Services (SPMHS) across six major hospital groups, including the National Maternity Hospital, Rotunda Hospital, Coombe Women & Infants University Maternity Hospital, University Maternity Hospital Limerick, Cork University Maternity Hospital, and Galway University Hospital. These services support women experiencing new onset, relapse, or recurrence of mental health disorders during the perinatal period. Each SPMHS team is led by a consultant psychiatrist in perinatal psychiatry and includes a multidisciplinary team comprising a non-consultant hospital doctor, advanced midwife practitioner, mental health nurse, senior clinical psychologist, mental health social worker, and occupational therapist. The primary focus is on the early support, assessment, and treatment of perinatal mental health disorders. Referrals to the service are accepted from healthcare professionals such as general practitioners, obstetricians, public health nurses, and midwives for various mental health difficulties, primarily perinatal mood and anxiety disorders (PMADs), including pregnancy-related anxiety and tokophobia.

Despite these advancements in awareness and service provision (5), recent studies (59, 63, 64) indicate that perinatal mental health services in Ireland remain insufficient. The surge in referrals to SPMHS has led to prioritisation of women with more severe symptoms, potentially delaying care for those with milder presentations (65). Additionally, stigma and shame surrounding mental health diagnoses often deter women from seeking help (66). Many avoid or discontinue psychotropic medication during pregnancy or breastfeeding due to concerns about potential risks, expressing a preference for non-pharmacological interventions (66). These findings underscore the pressing need for holistic, accessible, and effective treatment options for women requiring additional mental health support during the perinatal period.

The MRC framework highlights that stakeholder involvement is critical to ensuring an intervention is contextually relevant and adaptable, responsive to the needs, values, and contexts of those they are intended to serve. To achieve this, a mixed-methods cross-sectional study named Music and Perinatal Wellbeing was carried out to explore stakeholders’ experiences and perspectives on music and music therapy in perinatal care. In the context of SAMT, key stakeholders are maternity service users, including both parents, and providers such as perinatal healthcare professionals and other perinatal care providers in Ireland. The Music and Perinatal Wellbeing study consisted of online surveys with 254 women and 11 partners, and 46 healthcare practitioners and follow-up interviews with six stakeholders recruited from the survey respondents (67–69).

Findings revealed widespread recognition of music’s benefits during pregnancy and childbirth, including support for relaxation, mood regulation, sleep, energy, bonding, labour, and the clinical environment. However, many respondents noted a lack of guidance on how to use music effectively during the perinatal period and expressed strong interest in the integration of music therapy into standard maternity care. Preferred programme features included support for relaxation, parent-infant bonding, and childbirth preparation (67, 68).

Semi-structured interviews with two new mothers and four perinatal healthcare professionals further identified practical considerations for implementation. Stakeholders emphasised the importance of safe, holistic, and accessible support for women experiencing psychological distress, particularly when this affects bonding or maternal self-care. The third trimester and hospital admission were highlighted as key windows for intervention. Additionally, stakeholders stressed the need for structured guidelines and public awareness to support sustainable integration of music therapy into maternity care (69).

Building on the insights gained from stakeholder engagement and contextual analysis, the next critical step in the development of SAMT was co-creating the intervention directly with the women it aimed to support. This ensured that the design was not only informed by broader policy and service structures but also deeply attuned to individual experiences and preferences.

Co-creation involves working directly with end-users to tailor interventions to specific contexts, ensuring that the content and delivery are meaningful, relevant, and adaptable. This approach has been increasingly applied in health intervention development and has been shown to enhance both effectiveness and sustainability (70).

In the development of SAMT, co-creation was embedded in the therapeutic process. Pregnant participants were actively involved in shaping the intervention through co-designing the session structure, and the selection and creation of personalised music resources, including playlists and original songs that reflected their emotional and relational experiences. Session structures were flexibly adapted to accommodate individual preferences, evolving needs, and feedback over time. This dynamic and responsive approach allowed participants to engage meaningfully in the intervention and to influence its direction.

Importantly, co-creation fostered a sense of ownership among participants, which emerges through an empowerment process that supports openness, shared decision-making, and perceived control (70). By involving participants in the design and delivery of SAMT, the intervention was not only grounded in evidence and clinical expertise but also enriched by the voices and values of those it aimed to support.

The concept of salutogenesis, as introduced by Antonovsky in the late 1970s, focuses on individuals’ resources and capacity to create health rather than the focus on risks and disease (71). Complementing this, the concept of matrescence recognises the transition to motherhood as a normative developmental process involving significant physical, emotional, and social change rather than a condition or disease to be treated (72). This shift highlights the importance of resilience, adaptation, and the mobilisation of internal and external resources (73).

Within this framework, the resource-oriented music therapy approach is adopted as the theoretical foundation for SAMT. Resource-oriented music therapy is a therapeutic approach that focuses on identifying and utilising the inherent resources and strengths of individuals rather than solely addressing deficits or problems (74). Individual preferences, experiences and abilities are emphasised. The music therapist’s role is to guide and support individuals in their musical journey and help them to recognise and utilise their musical resources. By focusing on strengths rather than limitation, resource-oriented music therapy promotes empowerment, self-awareness, and resilience. By leveraging music as a resource, music therapists can help pregnant women develop a sense of coherence and access generalised resistance resources to cope with the challenges from pregnancy onward. Mastnak (75) proposes that antenatal music therapy can achieve these through four focuses: 1. management of antenatal stress, anxiety, and depression through music; 2, mental and physical birth preparation through cognitive adjustment, emotional regulation, physical activity, relaxation, pain management, and social inclusion; 3. music-associated bonding and self-efficacy; and 4. acoustic stimulation to support foetal development.

Another theoretical framework that underpins SAMT is humanistic person-centred music therapy that is built on Carl Roger’s (76) humanistic person-centred theory and SDT (77). The humanistic person-centred approach is rooted in the belief that each individual possesses inherent worth and the capacity for growth and self-actualisation. Drawing on Carl Roger’s person-centred therapy, the therapeutic relationship and environment are characterised by empathy (experiencing life from the client’s perspective), unconditional positive regard (nonjudgemental and respectful acceptance), and congruence (transparency and trustworthiness). In humanistic music therapy (78), the psychotherapeutic space can facilitate “personal and transpersonal development of the person through sound and music is facilitated, using an approach emphasising respect, acceptance, empathy and congruence”. In the context of SAMT, these principles inform the therapeutic orientation of the music therapist who facilitates a supportive, safe and respectful space for musical and psychological exploration. Sessions are tailored to each woman’s unique emotional experiences, cultural background, and personal preferences, allowing music to become a medium for self-expression, emotional processing, and connection. The “music” in SAMT is considered an embodiment of human agency and a resource in the form of social capital, through which individuals can work toward self-actualisation (79).

In addition, SAMT supports the basic psychological needs outlined in the SDT. SDT posits that wellbeing is fostered when three basic psychological needs are met: autonomy, competence, and relatedness (77). To support these needs, the person-centred, co-creative approach of SAMT allows individuals to choose which health needs they wish to address in each session and how they engage with music through an open, adaptable session structure. This freedom promotes autonomy by giving individuals control over their therapeutic experience, which is particularly important in mental health contexts and for those affected by trauma. In SAMT, competence may be reflected in women feeling empowered to express themselves, engage with their foetus through musical experiences, and experience a sense of accomplishment from singing, playing, or composing music for their baby. Relatedness is nurtured through shared musical experiences, attuned listening, and co-creation with both the music therapist and the foetus.

Attachment theory, first proposed by Bowlby (80), describes the dynamic and reciprocal relationship between the primary caregivers and their infant, with the aims to seek proximity and provide safe, security, protection, and affect regulation to the child (81, 82). Secure attachment develops when caregivers respond promptly and consistently to an infant’s distress signals, such as crying or seeking proximity, creating a reliable sense of safety that supports socio-emotional development throughout life (80, 81). When these early bonds are disrupted due to factors such as maternal mental health difficulties, trauma, high-risk pregnancy, or social stressors, infants often develop insecure patterns such as avoidant (characterised by emotional withdrawal and suppression of attachment needs), ambivalent (marked by heightened anxiety and preoccupation with caregiver availability), or disorganised (involving contradictory, fear-based behaviours) attachment as adaptive responses to inconsistent, unavailable, or frightening caregiving (81, 83).

Many scholars propose that the attachment bond begins during pregnancy, as the foetus is perceived as an individual with its own identity and distinct needs (84). The concept of “mother-foetal attachment” was first introduced by Cranley (85), who described it as “the extent to which women engage in behaviours that represent an affiliation and interaction with their unborn child” (p. 282). Muller (82)expanded on this by highlighting the role of preparedness, fantasies, affection, and interaction. Antenatal attachment is characterised by the parents’ emotional states, cognitive processes, and behavioural patterns directed towards the foetus, including activities such as naming the foetus, engaging in interaction, initiating communication, tenderly touching the abdomen, providing care, and undertaking preparations for the forthcoming arrival of the newborn. Strengthening this bond during pregnancy has been shown to positively influence postnatal attachment and reduce the risk of bonding disorders (84).

Communicative musicality, as described by Malloch and Trevarthen (86), refers to the innate musical qualities of human interaction that support emotional connection through rhythm, timing, and expressive contour. Affect attunement, introduced by Daniel Stern (87), describes how caregivers synchronise their emotional expressions and responses with those of infants, fostering emotional connection and attunement. These two concepts originally applied to the interaction between an infant and the caregiver after birth. Emerging evidence that foetuses respond to auditory stimuli from around 16 weeks’ gestation (88) suggests that these communicative processes may begin before birth, providing a foundation for early affective attunement through sound (89). In SAMT, singing and musical engagement are used to foster antenatal attachment by creating opportunities for emotional connection and rhythmic interaction. Maternal singing serves as a natural medium for soothing, bonding, and shared emotional expression (90). The soothing melodies and rhythmic patterns of music can help regulate the foetus emotional state and promote feelings of security and comfort, supporting positive emotional bonding even before birth (91). These theories and findings underscore the potential of SAMT during pregnancy on the formation and enrichment of the mother-foetal relationship, highlighting its important role in early intervention to prevent and repair disrupted attachment (92).

The in-person sessions were held in a quiet, accessible outpatient clinic located outside the maternity hospital environment to reduce medicalisation and potential triggering of trauma memories. The clinic provided transport access, parking, toilet and nappy changing facilities, and a private therapeutic space.

Participants were encouraged to attend the online sessions at a private, quiet, and comfortable space where they could engage fully in therapeutic activities such as singing, music-making, deep relaxation, and discussion of sensitive matters. To support emotional safety and physical comfort, the following recommendations were provided: