Story Behind My CD & BYU M.A. Research

"Lullabies that Send Babies Home"
by: Jacquelyn M. Coleman & Rosalie R. Pratt

If you have any ?'s or wish to know how to purchase a MusicBabies CD,
please contact me ~

Or visit Best in Music (Utah County). Be sure to tell Ruby I sent you! ;-)
A few more links of interest:
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Where’s the Volume Button?/Can you Please Hit the Volume button!

When I first walked into the Newborn Intensive Care Unit (NICU), I was struck
by the many aisles of clear, plastic cribs holding tiny babies covered with wires attached to noisy machines that sent out startling and piercing loud beeps every few seconds. As I glanced at these rows of babies I quickly found myself desiring to hold and soothe each infant, one by one, in my arms. But all I could do was stand and stare. I looked over at the doctors addressing medical concerns and then at the nurses tending to anxious parents, and the conversations among them seemed only to grow louder and louder. Suddenly my mind flashbacked to a time when I was very ill and I thought about what it was I most wanted then: peace, lot’s of uninterrupted sleep, quiet, and someone to care for me. It was my mother who always took care of me and rubbed me with Vicks when I had a sore throat and brought 7-Up to my room when my stomach hurt. When my Dad came home his voice always cheered me up. As I thought about those times, I realized how, though cared for by competent hospital staff, these tiny infants needed their parents so much.

My attention came back to the busy NICU, and I stood, waited and listened. What could be done to counter so much noise in the midst of a population so sick, helpless, and struggling? I wondered if anyone among the nurses, doctors, visitors, and parents even noticed as I did the constant stream of beeping, laughing, talking, and other random sound that surrounded these infants, whose only way of showing their response to a sudden burst of noise was to squint their eyes or jerk their thin, frail bodies. I wondered how these infants survived, let alone coped with these annoying sounds. Their underdeveloped bodies just looked so vulnerable to it all. At this initial moment of observation, I realized how truly remarkable it was that I had ventured on a thesis study about the influence of beautifully sung lullabies on the tiniest of all human populations/hospital patients, the premature infant.

Changing Channels/Finding the Right Station

Upon entering graduate school with a major in violin performance and pedagogy, I became very discouraged about what it was I was about to do. I was coming out of my bachelors unhappy as a single violinist struggling both with tendenitus and stage fright as well as with a broken relationship, and didn’t know that I really wanted to devote another two years or more to a Masters in music. I was searching for meaning. Why was I performing anyway? One night it seemed my world was sinking when I happened to receive a phonecall from a friend. It was Kristin Erickson Weber who was doing a thesis in a new field of MusicMedicine that was attracting a lot of attention among the music students at BYU. She immediately could see I wasn’t feeling well.

“Jackie, what’s wrong . . . you sound down.”

“Kristin, I don’t know what I’m going to do. I know a Masters seems logical, but today I told my orchestra conductor that I quit and don’t want to do the violin.”

“Oh, Jackie . . . don’t despair, you’ll find the right thing for you! Hey, what about checking out a degree in MusicMedicine? I absolutely love my program and my advisor is a dream to work with. I’ve never had a teacher like Dr. Pratt. I could introduce you to her tomorrow and you can go in and talk with her about options . . . she’ll inspire you!”

I did just that. “Hi, I’m here to find out about your program in MusicMedicine.” Jill Peterson Lex, another graduate student, was sitting typing at the computer, “Hey, you’ve come to the right place!” turning to me while Dr. Pratt handed me a syllabus. As I read a light instantaneously turned on in my mind, and I became intrigued with the potential music had of positively impacting human populations. I knew music had a profound effect on me. The more I read the more I knew this program was for me. It filled me with a hope I hadn’t had for a long time. Every word just seemed to ring true with previous thoughts, particularly the healing aspect of music. Healing other’s hearts through my music was foremost in my mind. I often found myself enjoying performing in hospitals more than other places, much more than in the concert hall – where I always seemed to feel uncomfortable.

The Potential in All of Us/Something of Worth

We discussed other possible thesis topics Dr. Pratt researched and worked on. She told me about Kristin’s study with cardiology patients in the hospital and Jill’s with pregnant women, studies I would later become involved with. She mentioned troubled teenagers and the premature infant – that really intrigued me. I related my stage fright and pain during practicing. She directed me to Keola’s study on overuse injury. I was becoming more and more excited about the endless possibilities that lay before me in this new field of MusicMedicine. This was right! She encouraged me to think about what I might want to do for my research topic.

I stewed for weeks about what I wanted to do. As previously mentioned, I had experienced pain in the practice room while getting ready for my senior violin recital; this coupled with performance anxiety. I considered doing more with that topic of research. But something inside kept steering me towards the babies. I did not know the first thing about a premature baby or what one even looked like. Not many do. Most people think of a developing fetus rather than a baby born early. The research had to be something beneficial and worthwhile, that's all I knew! I kept thinking about my ultimate dream (to be a great wife and mother). There is something so fresh and inviting about children, especially newborn babies. I found I couldn't resist the study involving premature infants. Little did I know what impact this would have on the lives of many struggling with these challenges.

Learning the Ropes/Parental Guidance

Preparation for experimental research study is lengthy and exhausting. Sifting through studies previously done seems endless. My first step was signing up for an independent readings class in the nursing department. I worked with professor, Roseanne Swartz, who had written her own thesis on the premature infant.

“What is it you need to know for your study?” I handed Roseanne a list of terms highlighting music and the premature infant, not knowing where to start. We looked them all up on her computer. After finding a few articles, Roseanne exclaimed, “Ah ha!” getting up to take a book off her shelf. She handed it to me assigning me certain chapters to read, one particularly on parental anxiety.

While reading the chapters, something jumped out at me. I learned I felt deeply for those who give birth to a premature infant. The anxiety experienced is very real. It is difficult when parents find out how underdeveloped and sick their infant or infants (most prematurity occurs because of multiple births) may be; some even to the point of denial ~ even to the point of abandoning/separating emotionally from the child.

These parents long to hold their infants, not have paid nurses do most of that, and they want to be able to do so in the comforts of their own home in their own carefully planned out and prepared nursery. I gained more compassion and empathy for people who experience giving birth to a premature and often sickly baby under these trying circumstances, stressed by the constant artificial supervision and monitoring of their child. The disappointment, trauma, and worry can be great, while many parents suffer from loss of natural bonding or attachment when first setting eyes upon an underdeveloped infant they know they cannot take home for days, weeks, or even months at a time. These topics were "foreign" to me as well as other sensitive issues I gained knowledge about through our conversations and preliminary study. Even our walks through the unit together taught me a lot about what it was I wasn't expecting in viewing a population so sick and malnourished outside the natural and instinctive couching of the womb.

No One Likes the Bill Collector/Bill Collecting

As I continued reading on, I soon found something else that intrigued me, the outrageous cost factor of keeping one of these infants alive. Most premature infants need the 24-hour specialized care of a hospital unit. The noisy machines were doing more than just keeping these infants from dying; they were elevating costs to a maximum. I was shocked to find that premature infants, the most expensive patient in the hospital, cost medical care facilities and insurance companies literally tens of thousands of dollars per day. Parents without any insurance naturally find this fact very overwhelming. These parents may be burdened knowing that tax dollars go into funding the majority of their child’s hospital expenses.

Years later, after my study was completed, I talked to one parent who told me it cost over $200,000 to keep their 4 and 4 and ½ lbs. set of twins in the hospital for less than two weeks. The most difficult aspect of being the parent of a premature baby, I learned from him, though, was not the cost factor alone, but the separation from the child and the concern of leaving him or her in the hands of professional caregivers who, however competent, are still not the parents or family. It is hard for most parents to deal with the protocol of the NICU when they most want to take care of that infant, or infants, in the privacy of their own home. Depending on the size and circumstance surrounding the birth, no one is ever really sure what developmental problems a premature infant is likely to have. The initial shock of an extended separation is bad enough. Add, on top of that, surgeries or potential developmental delays and a parent definitely has cause to worry . . . a lot.

Making a Difference/Finding Pies in the Sky

The whole idea of adding music to the hospital opened my eyes to a lot of things. Before I ever set foot in the NICU, Roseanne warned me I may not be ready for what I would see. The site did alarm me, but what she didn’t know was the potential I also envisioned in affecting these infants positively. It seemed to me that beautiful music might be a way to bring comfort into the unit and offer an alternative to the costly, noisy machines. Sometimes simple beauty, particularly that of the creative arts is a good complementary medicine. I knew the technology was all necessary, I just wondered if music might help add some warmth to the hospital and even aid these infants in the growth they required. I wondered if it could even help these babies leave the unit earlier than they would have normally otherwise.

People have asked me why I chose to look at the premature infant rather than full-term babies in my investigation. I did this primarily b/c these babies have a more immediate need for assistance and healing than normal babies. Infants with full-term births also do not stay in the hospital for extended periods as these infants do, thus making them particularly difficult to study. I thought that if the music helped premature babies it could help all babies, not just sick ones. And I wanted to see if the intimacy of the human voice could encourage parents to truly nurture their children as a team.

What’s Your Preference?/What Should We Listen to Now?

Once I had learned about the premature infant through my independent readings and previous hospital visits, the next question was developing . . . what choice of music should be administered to the babies. Although in frustration I had nearly tossed my violin aside during my undergraduate years, I still was curious how the sound of that sweet instrument might soothe a struggling infant. But would that be the best choice of music? What type of music would be the most soothing and comforting to a sick infant? One day as I was reading over a few studies I started to see a trend stick/pop out at me. Up to that point I had never even considered using singing, and yet it appeared the human voice was having more of an effect on these little patients than instrumental music alone. When listening to a female singing to them, infants appeared to conserve more energy, make more efficient use of calories, increase weight, and have shorter hospital stays. Classical music had helped premature infants achieve these desired results, but women’s voices singing Disney songs seemed to help them the most.

Throughout the centuries, lullabies have been the most treasured melodies sung to infants. They have loved them, slept to them, and therefore seemed the most logical selection of music to use in research. Lullabies were the tried and true way of soothing infants, and no one had put this tradition to a real test in any of the studies that I read. But I noticed something even more important that stood out at me, only the female voice was ever being tested. The music studies I read (endnote -- Malloy, 1979 & Chapman, 1975 & Sarah Lopez' Father presence --SARAH LOPEZ' DISSERTATION SPOKE ABOUT THE PHENOMENON OF FATHER PRESENCE, THAT IS, THE SPECIFIC BENEFITS ABOUT THE EFFECT OF THE FATHER'S PRESENCE AND VOICE ON THE BABY) did not pay any attention to the importance of a father's involvement in nurturing a newborn, only the mother's.

What About Dad?

I pray to God at night. In fact my whole life is centered around becoming like God, and so I thought, “How would it feel if I could not pray and hear the influence of my Father in Heaven’s ‘voice’?” I thought of my own earthly father. What kind of an influence had he had on me besides going to work and taking care of me, providing for me . . . financially? Shouldn’t fathers be more naturally involved than this in some way with their children? What is their role and how do they influence a child? What kind of an impact can they have in the life of a tiny infant?

The highlight of my life when I was a little girl was when my dad would come home from work. He would scoop me up in his arms and set me on his lap, asking me how I was while he hugged me. My Dad’s voice communicated a lot to me. I always knew when he was angry, I always knew when he was sad, I always knew when he was happy just by the way his voice came across or sounded to me. My Dad had a bright and cheery tone to his voice most often whenever he would communicate with me, his little girl. The mellow, soothing quality of his voice will always remain with me. And I have never forgotten the way he whistled as if he were singing with the most lush vibrato, like a bird!

Fostering Positive Memories and Other Bonding Issues

What memories, if any, will premature babies take home with them when they leave the hospital? What will they remember about their experience way down the road? Will they remember their mother’s or father’s voices or the incessant sounds of the machinery they are hooked up to? In the absence of their parents, I wanted to lessen the trauma of these infant's earliest memories of being hospitalized by bringing as much light and beauty to them as possible through music.

As I thought about this, I also wondered what other benefits the music could possibly have on the development of the child. I had been intrigued with what my cousin had been doing exposing flashcards of Italian to her babies in the crib. I thought of my brother and his wife, who had sung and read stories night after night to their children before they drifted off to sleep, forming a habit that has undoubtedly fostered family unity and the children’s interests in singing throughout the years. I thought of my mother who had read somewhere that the first three years of life may help shape a child’s personality for life. I didn’t know if these things were true, but they still got me thinking how was the father to be involved in shaping and influencing his child’s life? Should the father be involved, or was it primarily the mother’s role to nurture and take care of that infant? The burden naturally rests on the mother to take care of the infant’s biological needs, so does the father really have any influence during this time of life?

My parenting class answered some of these questions for me. I learned that important bonding occurs between a parent and its infant at the onset of life. As I thought more about this phenomenon and how music could potentially enhance the earliest bonding that occurs with an infant, I became even more intent on knowing if the male voice could have an important role in helping the premature infant. I was bothered that the studies I read paid little attention to the role of the male in the life of a newborn baby. I was led to believe that this might be part of a larger sociological problem. Were we excluding males in the process of rearing an infant and considering them less needed just because the mother is the primary and biological caretaker? If so, does this discourage males from being part of the process, thereby causing them to feel less needed, whether real or imagined, and have more reason to abandon their wives and leave their children either physically or emotionally? Having always believed that the father's and mother's differing roles are equally important to the development of the baby, I reasoned that males needed to be included and encouraged more in the nurturing of their infants, if they do indeed have an impact beyond that of mere provider. This has important implications for the mothers of these infants who need instruction then on helping their husbands become more involved and including them in on the process. Although I believe the mother should be the primary nurturer, being the natural, biological tie that she is, both parents need to be encouraged more in their influence so that this special bonding can occur.

Making Our Voices Known

Singing is a positive way to influence the bonding process between a father and a baby. I still have that childhood memory of my own father singing and whistling to me as he held me in his arms. I know this contributed greatly to the warm relationship I now have with him. My mother tells me that there was just one song, “My Cherie Amour,” that could calm me. Now I see this same wonder happening with my brother and his wife, when they sing to their children when traveling in the car or getting ready for bed. Although he never considered himself a singer, my brother has actually improved his voice through the years as he has continued singing to his children. Trained or untrained, my father’s and brother’s voices are very important to their children, as mine and my future husband’s will be to our babies. These tender moments are remembered and treasured for a lifetime.

Involving males early in the process of nurturing and raising children may be a positive step toward helping these men feel that they are as important as women in building strong families. Singing is the most natural and loving way to express love and care. It had worked with my father and brother and it was a unique way of praying to a Father in Heaven, whether through my own voice or the ‘voice’ I expressed through my heart and my music. I knew at this point that I wanted very much to make the male singing voice part of my thesis study.

The Singer in You/Let it All Out

There is a singer in all of us – all of us naturally want to sing, whether we are trained singers or mere amateurs trying out our vocal skills. The Kareoke machine is evidence enough of that. People flock to Kareoke machines for their one big chance to be a star! We all somehow secretly dream of having a natural singing voice and being behind a microphone with a million lights, whether we are in reality shy about singing or made for the stage. But there definitely is something special that occurs when a parent bonds with his or her baby through singing. This was the most important reason for doing the research: to help mothers and fathers unite in love and nurturing of their infants through music. Their voice in melody would certainly carry on a tradition of fostering love and warmth in the home, whether they be trained singers or not. And since good music is one of the greatest of all art forms moving people in all walks of life, I thought I could expose these infants to virtually nothing greater. It was only after my initial visit to the NICU that I took courage in the hope that the lullabies we would soon be introducing to these infants might have some positive effect in also combating the surrounding noise with their comforting sounds.

Details, Details!

I remember the day I discussed my plan to incorporate both the male and the female singing voice into my study and rule out instrumental music altogether. I was walking across campus with Dr. Pratt, brimming with excitement, as we talked for the first time about the father’s role. Other important things were determined later, such as using recorded rather than live music. Since each performance would be exactly the same every time with a recording, it would be much easier to defend the results later to other researchers. We would have greater control with recorded music.

Then there were questions about the way we would set up the study so that we could learn as much as possible about how the music was affecting the infants’ physiological nature. We wanted results that were as complete as possible; that would make a difference to the medical profession and stand the test of time. Dr. Pratt and I discussed our ideas thoroughly with the two neonatologists with whom we would work very closely during the entire project. Together, with Drs. Ron Stoddard and Dale Gerstmann, we decided to address the following points:

1. Would reciting the words of the lullabies have the same effect as the
singing of them?
2. Should we include more than one male and female voice so that we were sure it was not one specific voice type making all the difference?
3. Would a lower rather than a higher voice be more soothing to the infants?
4. Would time-tested lullabies be the best choice over, say, Disney tunes?

After a lengthy discussion, we concluded that all of these questions needed to be addressed somehow in the study. Each baby would be presented randomly selected renditions of some combination of male or female voice, singing or reciting the lyrics. Traditional lullabies would be pre-recorded in a studio by professionally trained vocalists by three males and three females. Our singers' voices would be in the medium range, closest to that of most people. On one side of the recording the singers would recite the words of fifteen well-known lullabies, and then sing the same songs on the other side, totaling 20 minutes on each side of the tape. The singers chosen were either vocal performance majors that I knew or teachers I had worked with at BYU, while some were even KBYU radio announcers. I picked voices with soothing, soft vocal qualities that fit right in with what we were trying to do. After the tapes were made, they were then labeled and designated by each of the singers’ names. Included in the selection of lullabies were such popular tunes as the Brahms' Lullaby; Twinkle, Twinkle Little Star; and Rockabye Baby on the Tree Top.

My First SONY

Several factors presented themselves in choosing the kind of equipment we would use to play the music. Cost was one thing, the amount of space the equipment occupied in the unit was another, and finally the way the music came out, or was heard, became the last consideration. The isolettes were filled with blankets and padding and had little room for much else. It was clear each infant would need an audiotape player and speakers small enough to fit into the isolette, yet transmit the music at the right loudness level. The audiologist who established a method for testing the babies' hearing ability also helped us determine the sound equipment and maintain the proper volume level for each playing device that was placed in a crib. Sound pressure would be set at approximately 65 decibels, which is the level of normal speaking, and also about the safest point for the infants' delicate ears. The cassette player called "My First SONY" with minispeakers seemed especially the perfect choice for introducing music to newborn infants. We considered our options and decided the recorder and speakers would be best placed at the back of the isolette, behind the babies' heads. We wanted the infants to hear the music from the best vantage point.

The audiologists then showed me a machine, compact and convenient enough to fit into the size of my hand, one that I could even carry with me to test the infants' hearing. Before I ever began playing the recordings, I had to be certain that the baby could hear!

Order in the Court/Let’s Have Some Order

Just before entering the unit for the first day, Dr. Pratt and I met with another medical doctor, Hans Abel, and several statisticians. Since the project study involved a number of different interventions, for example, male voice singing, female voice reciting, etc., it was important to randomize the order of all the possibilities. This method ensures that the study is free from what statisticians call “order effects.” From a computer-generated system I picked the number that came up next in the randomized sequence. It was good to know that the results of this approach eliminated any bias on my part. We decided that giving each baby four consecutive days of intervention was just the right amount. Each day the regimen was the same: a 20-minute segment of listening to recited or sung lullabies was followed by 20 minutes of no listening or the babies hearing only the regular NICU noises, with a final 20 minutes of intervention to cap off the night. The reason for a 20-minute segment where the infants heard only NICU noises was to allow them to readjust to their normal sound routine before introducing another 20 minutes of intervention for that day. We hoped this hour-long period would be enough time for us to learn if music intervention really made any difference to the physiological and behavioral measures we would be looking at, and whether the infants responded better to the music or speech of either a male or a female.

Previous research has looked at the possibility that classical music, and most particularly singing of Disney songs, helped premature infants gain weight, take in more nourishment, and even leave the NICU days earlier than other babies in the unit who did not experience any music listening. We wanted to include these and other physiological evidence that would provide the most compelling results, validating or adding to what had already been investigated. We wanted actual data that looked at measurable physical changes (hard data) that would take place in an infant. Since premature babies are already hooked up to expensive equipment that monitors physical functioning, it would be fairly easy to pick up this information without adding anything more artificial to these infants' already mechanically invaded world.

Blinking Lights

The heart rate machines were on constantly supervising through blinking monitors, flashing green digital numbers every second and beeping loudly at the slightest malfunctioning of the infants' heart. Younger infants suffering from insufficient breathing patterns received digital readouts of their oxygen intake as well to ensure they were taking in enough oxygen and breathing normally at all times. Too much oxygen can cause blindness, so the sooner these infants can reach the level of oxygen dosages they need in order to be taken off oxygenators the better.

A numbered chart of different behavioral responses of the infants to music aided us in our study of the movement patterns while listening to the music. To be on the safe side we videotaped to assure accurate assessment of the infants' behaviors, which fit nicely into a few broad categories. These included: 1) asleep with no movement 2) asleep with some movement 3) awake with no movement 4) awake with some movement 5) light and hard crying and 6) nurse intervention or pacifier needed. When the baby moved any part of its body, a specific number defined the movement according to whether the baby was asleep or awake. Each movement corresponded with a number that we were able to then easily record. For instance, when the baby moved its hand and was also awake it received a certain number, such as an 11, or when it moved its head and was asleep it got a 4, or when it slept calmly with no movement I recorded a 1, etc. The main categories of movements that had assigned numbers were those of the eye, mouth, head, hand or feet, and arms or legs.

Observing movement helped us determine if the infants were more inclined to relax and therefore sleep as a result of/during the music. All three elements combined, heart rate, oxygen saturation, and behavior response, would give us a good idea if that was happening because when an infant sleeps we see all three move in a positive direction: heart rate goes down, breathing improves, and movement becomes less. Data were already being collected daily by the nurse concerning weight gain, caloric intake, and length of stay in the unit. All I had to do was be sure to check the charts in the infants’ individual records and write down the correct numbers on these three measures.

New Discoveries

These individual books containing all of the information on each baby became a very handy tool. The first time I perused one I was pleasantly surprised to discover how simple it was to record these important areas of research assessment I had read about in other music studies. I wanted to collect as much physiological evidence as I could so our data would be complete and there it all was before my eyes so easy to look for and write down everyday. I was thrilled to find that caloric intake and weight gain was recorded daily by the nurses. All I had to do was count up the days the baby was in the unit and record the length of time in the NICU as well. Initially my observance of the NICU environment and discussion with Dr. Pratt and the doctors had led us to include only three factors of assessment: the heart rate, oxygen saturation, and behavioral changes. These other things I noticed contained in each individual baby's records helped us gain even more of the "hard core" evidence we were needing to make the study good.

Scientists tend to put numbers to everything they do, so any changes physiologically in the babies was more of the bulls-eye issue than the anecdotal, or subjective assessments by me. So, while it was important to look at the behavior changes in the babies and put numbers to those, in order for the research to be taken seriously, I had to find ways to measure something more substantial. Adding the caloric intake, weight gain, and length of time in the unit information just completed the study in this regard.

To Be a Child Again/Here’s Looking at You, Kid

When all of these things were set in order and it finally came time to determine if a baby could receive the music, I saw that some infants were great candidates while others I had to pass up. They were either too young or too sickly to be included. This was always difficult as I truly wanted to expose every baby I saw to the possible healing effects of the music. Plus, it always worried me a bit when I couldn’t use a certain baby how I was going to be able to get a large sample we needed in ample time. It was always exciting, though, when an infant fit the criteria we had set with the doctors. This certain fixed criteria included weight, response tests, ability to hear, and gestation age. Each infant had to be between 25.5 and 34.5 gestation age, able to hear, be above a certain weight, and have a 5 minute APGAR score of 7 or higher. I had to check thoroughly the record of each baby I was considering testing in order to insure proper eligibility. As soon as I determined if a baby fit the criteria for the study, I left a consent form by the crib or isolette for the parents to read. This consent form described what the study was about, what the procedure was, and assured confidentiality of the data. Once it was read, I answered carefully any questions or concerns the parents might have about the study and what it was I was doing. We offered each family a tape of either female or male singing of the lullabies and told them about the possible benefits of the study.

Sometimes, if I were lucky, I would walk in and find a parent already there holding or rocking their baby. I would quickly gather my courage and approach them saying,"Hi, I'm doing research with music on the babies for my master's research project. Would you mind reading this consent form to see if you would like your baby to be included in my study?"

Looking down to read and then looking up again, "Wow, sounds neat. What exactly are you doing?" Most of the parents glanced over the form quickly. I sometimes wondered if they even read it.

"I'm testing to see if music can have a positive effect on these babies." While most parents liked the idea of having their infants listening to the music, some were reluctant at first to have someone they did not know administer it. Most of the parents trusted me, though, right away and welcomed the music for their babies enthusiastically. A few others, however, required reassurance from Dr. Stoddard, and he was always gracious to give it, lending a helping hand whenever needed.

First Rejections/You Can’t Win Them All

More than halfway through the study I thought every parent was going extend their acceptance, but then it happened one night.

"I was all set to let you go ahead and do your study on our baby, but then I talked with my wife. We've decided not to sign the consent form." I got my first rejection! I was crushed – more from having my perfect record spoiled than even having them not accept the musical gift we were offering. Because this particular couple had initially expressed interest I was surprised they changed their minds. I later ran into Dr. Stoddard who asked me how things were going. I told him what had happened and he immediately stepped in and got involved. Like a miracle worker, he talked with the couple quieting every concern and fear the parents had, turning things around and calming them right into consenting. "We are hopeful about the music aiding and benefiting these babies," he would say. “I think you will find the music to be a positive factor, not a negative one.” My record still stood and by the end of the study I had 100 percent parental approval. It was amazing even though I knew that what I was giving these babies and their parents was a gift, a very special gift. Even still today I have an occasional parent ask for a copy of the videotape of that small portion of time their baby was in the hospital. After all of this time they want those precious memories of their premature infant who is no longer struggling, but a growing, thriving child.

Ding! Round 1 . . . the NICU Scrubbing Table/A One Woman Band/Juggling Act

My heart was filled with excitement and anticipation as I juggled myself and all of my equipment into the NICU. I was finally ready to start seeing if the music made a difference. All of the preparations were in place, I had parental consent, and we had even made it through all of the school and hospital IRB’s (review boards)! I put everything down in the corner, hung up my coat and walked immediately over to the wash-basin to begin the sanitation process. Before ever officially entering the NICU I would have to begin a ritual of scrubbing my arms and hands, between my fingers and under my fingernails. I had to be so thorough because exposing these vulnerable infants to any outside germs could potentially cause unwanted illness on top of the many physical challenges which they are already overcoming by being born early. I grabbed a fine-combed brush and tapped a pile of foamy soap into my hands from the foot prompt on the floor. Then I hit the metal device with my knee that turned on the water to rinse my hands. Finally, I grabbed a paper towel and dried off my arms and hands really well. At first it was awkward coordinating all of this at once, but I soon learned the art of becoming a "one (wo)man band" at the NICU scrubbing table! This squeaky clean and presentable process usually took a good five to ten minutes to complete every night before beginning a long night of collecting data. I had to do it, though, every time I walked into the NICU and be precise about it. Even a slight sneeze and sniffle which caught a nurse's attention would send me right back to the sink to re-wash.

Ding! Round 2 . . . Step Right up!

As soon as this first obstacle for the night was through, I then entered the second round of events, the NICU! The study was definitely underway and I could hardly wait to get started and see the first infant’s reactions. I picked up my things, marched straight up to the counter and greeted the nurse sitting busy at her computer and answering phones.

"Hello, I'm here to do music research on the babies!" I exclaimed triumphantly.

"Oh yes, we've heard about you. How wonderful it is what you are doing! I bet it will really help the babies."

"We hope so."

" We've seen great things here in playing music for the babies already. Some of the parents even bring their own recordings for their infants, and sit and sing to their babies as they rock them." I looked over and sure enough there was a couple holding their infant and rocking him/her gently to sleep.

"That's great to know music is being played or sung to the infants already," I said anticipating my first infant’s reactions.

Then the nurse asked wondering, "What are you doing this for . . . school, your master's?"

"I'm doing this for my thesis project in a new field called MusicMedicine."

"MusicMedicine . . . I've never heard of that. Sounds interesting. So which babies are you doing tonight? Have you received permission from the parents already?" she questioned.

"Yes. I have a signed consent form for the [made up name] baby tonight, but I actually need a printout of some of the other babies who's parents I can contact for next week," I would tell her.

"Oh, certainly." There were printouts available every time I needed to select a new baby and contact his/her parents to read and sign the consent form. "You can go visit with the head nurse and she will direct you concerning the feeding schedule of the babies you are doing tonight."

Carefully Planned Agendas/Planning Ahead/Making Plans/Where’s My Planner?

I trained myself to look at the typed and hand-written agendas every night for each baby. Some of the nurses were more than happy to involve themselves with my research and help me. Others seemed nervous to have me there, wondering who this strange visitor was who interrupted their well-planned schedules for the evening. I learned to do as much as I could on my own without asking too many questions or getting in the way of the nurses' tasks.

I also learned real quick/by default to report regularly with the head-nurse, or the nurses in charge of each baby I was assigned to do, before beginning my research as it seemed there was always something that posed a challenge to my own carefully planned-out agenda for the evening. The feeding schedules, for one thing, fluctuated from day to day and according to the nurses' time as they were in charge of the care of a several babies each night. Parents would drop by unannounced just as I was ready to begin my study and want to hold their baby. Even family visitors, or friends of the baby, would be there, coming at odd hours during the night. So, I soon began to expect the unexpected and became flexible in working around the incidental pop-in visits, changes in different nurse's feeding schedules, and other problematic delays that postponed my research from time to time.

First Things First/Getting Ready

At last ready to record some real data. I put my things down next to the isolette of the infant I had scheduled and gazed upon its sweet, tiny body. I did not want to disturb him or her when I carefully opened the lid of the isolette (if it was closed) and placed the sound equipment at the back behind the baby’s head. The first item of business was to find out exactly what state the baby was in when I first got there/arrived. Was he or she awake, on its side, asleep, crying, etc? I grabbed my tripod, unscrewed the legs, and moved the heart rate and oxygen saturation monitors into the view of the camera while trying not to disturb the baby. I did not turn on the camera to record at this time, I merely set the equipment all in place so it was ready to go. I positioned the camcorder so that it had all of the information from the machines in good view. I then began taking what is called a baseline. I got out my chart and assessed carefully by number just where the babies were at, compared to when they would have the music. This minute-by-minute assessment took 10 minutes. Would their initial state change as they received the music? This is what we had to determine.

The oxygen saturation machine sent out digital readings that were fairly constant but the heart rate monitor flashed out changes rapidly in large skips sometimes, such as (flash) 156 . . . (flash) 172 . . . (flash) 169, depending on if the baby was fussing or moving around a lot. It would often do this within seconds, so I eventually decided on taking three readings per minute instead of one of the heart rate. This would help me avoid getting an inaccurate reading, and I could later average everything out with the statisticians.

Meanwhile, in between minutes I prepared the first audiotape. I unzipped my backpack and sifted through my tapes until I found the one specifically prepared for that evening. Before I left for the hospital every night I would check the randomized chart Dr. Abel had printed off his computer. This told me which voice was to be played each night to the baby. I would circle the next number on the sheet and jot down which singer was to be heard. I checked to see if it were the speaking or singing side of the tape, and, of course, record which one came first. It was a different experience each time I did this because the order of male or female voice, speaking or singing was entirely by chance, just like pulling names out of a hat. I never knew until I reviewed the chart which voices the baby would get to listen to that night, and whether it would be singing or speaking. In order to save my batteries I would rewind the tapes at home. I could then easily slip them into the tape recorder at the right time in the hospital.

Beep . . . beep . . . beep . . .

Once the baseline period of 10 minutes was passed, and I had written the
information about the infant's state when I was first got there, I carefully moved the isolette of the baby into the view of the camera for an even clearer picture. Some of my recordings look rather amusing b/c I stacked the equipment one on top of the other to get the best view. The babies' isolette would be within small ratio of the heart rate monitor and I would set the oxygen saturation machine on top of that. Sometimes I even set the oxygen saturation machine set right on top of the isolette so I would not miss a number. I then moved the tripod in a certain position and placed the camera in the best angle to avoid glare of the overhead lights or windows. As soon as I could see the best picture, which I tried to achieve in a rapid, quiet manner between the baseline and the first part of the intervention, I carefully placed the My First Sony at the back of the isolette. I turned on the minispeakers and taperecorder, and watched as the infant enjoyed its first exposure to twenty minutes of either singing or speaking.

Zooming in/Everybody Wants to be in Pictures/Smile for the Camera/Lights, Camera, Action

As the camera steadily recorded the infant's responses to the sound from
the player, I watched intensely for 20 minutes, writing down all of the numbers. After all the preparation and work in launching the study, I was at last seeing a real baby respond
to the music we had prepared so carefully. I realized that, more than any numbers
or statistics, the most important reason for doing the study was right inside
that isolette in the person of a very tiny infant whom I very much wanted to help. Oh, how I hoped the music would affect the infants for good, but I was just as anxious to see if they would respond equally to the male and female voices.

I held my breath for the first few infants I recorded. I secretly cheered inside whenever I saw fidgeting and heart rate fluctuations during the spoken portion of the lullabies. Conversely, every slight movement, raise of the heart beat, or dip in the oxygen saturation monitor during the music only made me tense. But, the more I observed the more I could see how the music at times really worked to calm these infants, especially when compared with the spoken lyrics or NICU noise in between. The transformation was like magic actually. I would watch as the infants' faces began to relax as they were listening to something soothing and beautiful for the first time. It was as if they were taking in new information and wanting to listen intently to all of it! I remember one mother just stood there amazed as her infant changed to the music. His body just relaxed into the padded bedding, his breathing got deeper, and he slept. I was fascinated to see infants like him react this way in comparison to squirming and moving around a lot to the talking, almost as if they were trying to get away from it.

Hunger Pains/Where’s My Binkie?

The sung lullabies did not always pacify the infant during the entire 20 minutes, though. At these times I worried what the ultimate results of my study would be. An infant would appear to be doing fine, but then suddenly cry at the end of the 20 minutes of the music. When other needs, such as hunger or for want of a pacifier caused the fussiness or crying, I knew that the music helped but did not supply the infants with all their needs. I wondered if 10 or 15 minutes at a time might not be a more appropriate amount for the infants instead of 20 minutes. This crying spell was rare, though, and most infants relaxed into a quiet, restful state where they did not move much but lay still. They certainly moved around a lot more while the speaking was played. That seemed to excite the infants into activity, and they would move their heads around as if looking for the source of it.

Meanwhile, as I continued writing down numbers minute by minute, first checking the heart rate monitor beeping . . . (flash) 152 . . . (flash) 156 . . . (flash) 161, etc., then the oxygen saturation machine, if the infant was hooked up to one. Not all of the infants were, and so we took readings from the ones who were receiving oxygen. Usually the monitors for those were steady while the heart rate numbers, as already mentioned, fluctuated incessantly. It was always a bit startling when the machines beeped if the babies moved around too much or jerked suddenly in their isolettes. The heart rate monitor would really shoot up high during those episodes. This happened at random periods during intervention, but appeared less frequently during the music.

Sleepy Time/Beddie-Bye Time

I watched carefully to make sure every movement was accurately recorded. I jotted down a number to the movements I observed according to a chart of numbers used for behavior assessment. A jerk of the hand, a lift of the arm, a squint of the eye, a flittering of their fingers, toes, or hands all had a number assigned that I wrote down instantaneously/as they happened. These infants seemed to love the sound of the beautiful voices singing. You could see their tiny bodies melt and move less when the music was playing. What was really exciting was seeing the heart rates go down and the oxygen saturation steadily raise simultaneously with less movement from the infant. Their little faces would become untight and they would take in breaths more deeply and rhythmically while they slept in their isolettes. When I turned to that one young mother who stood in amazement at seeing her baby respond so positively in this way, I was filled with joy. When parents and nurses witnessed this, too, I really became excited about what was happening as a result of the music. Limbs would stop moving or jerking so much, and if they were awake their eyes would gaze intelligently as if they were truly taking in the sound and wanted to know from where it was coming. The babies looked as if they were soaking in the soothing sounds and were intently listening. They seemed so interested in what was being played, reacting with wonder like they had found a new toy if they were awake while listening. It was truly gratifying after all this hard work, seeing these babies respond in this way while being introduced to sweet sounds for the first time in their young, little lives.

Who Turned the Sound Up?/Hey, What’s all the Racket?/Let's Make Like a Baby and Head Out

The infants instantly noticed when the tape was over. Soon after the music stopped the babies would start moving around again, especially their heads. They would begin waking up to the loud, undesirable NICU noises. Sometimes the babies would be so sound asleep they would continue in this pattern and not be affected once the music stopped, but eventually they would be disturbed and awakened by their everyday environment. It was not hard to notice the NICU becoming it's loudest; the babies' giving their biggest clue with a raising of their heart rates and increased movement. It was as if they suddenly were now more aware of the sounds around them and had increased sensitivity to it from listening to the music. The crescendo of beeps and talking seemed to rise well above that of the 65 decibel level "safe range" and the babies definitely responded to it by waking up and moving more.

Show Time!/Show Stopper

Lights, camera, action . . . 20 more minutes of a certain male or female singer or speaker would pass as I continued to write down numbers and assess behaviors. I was not certain just what the results would be concerning which voice type the infants preferred. From an observer’s standpoint I knew the music was having a decent effect, but when it came to which voice gender the infants responded to better it was clearly a toss up. I would sometimes call Dr. Pratt from the hospital after a reading all excited thinking the infants were responding well to the male voice. Then, a few weeks later I would call her confident it was the female voice that was having more of the effect we wanted. By the time I finished the study, I was calling her saying I could not decide which one it was!

When the last 20 minutes was up at the end of four consecutive days of observation, I would stop the tape-recorder, turn off the video camera, and breathe. I had finished another baby! After working closely with Jill’s and Kristin’s studies, I knew how important and oftentimes what a difficult task it was to finish a complete set of data before I had ever started collecting data for mine. I had to make certain I recorded data each day without missing a day in between of those four days total. This was not always possible, and unfortunately I didn’t always get all of the data that I wanted. I would come in all ready to finish the fourth day only to discover the baby I had been working with was either having an unexpected surgery or was leaving the unit earlier than anticipated. I always secretly wondered if the music helped in those cases when an infant left early.

Night after Night

As the minutes ticked by late at night I could feel myself turning very sleepy. Sometimes I would get my research going at 8:30 P.M. in the evening when I was lucky enough to get an early start, but there were nights when I would not even begin recording data until around 11:00 P.M. or midnight and be finished at 3:00 A.M. in the morning! Occasionally, I would do up to 3 babies at a time. One night I groaned as I walked into the unit at 11:00 P.M. and saw all three of the babies I was supposed to do being held by either a parent or another relative. I left and got Chinese food from a place nearby, rested, and came back to record at 1:00 A.M. That was a long night, but so well worth it when we later received the end results. I somehow managed to stay awake for the entire data collection of over five months worth of 33 babies, just slightly over the amount needed to meet my goal for a large sample, statistically speaking.

"Hi ho, hi ho, it's off to work we go," and so it was that the real work began when Dr. Pratt, Dr. Abel, and I sat down to the enormous task of carefully matching controls to the experimental group. We congregated around Dr. Pratt's big kitchen table and got out sheet after sheet of huge computer read-outs from the hospital for all of the babies born that year. As I looked I though, “Where in the world was I to begin?” It was like doing a jigsaw puzzle matching up all of those babies to their controls. We had to assign them as closely as possible to the babies who heard music, so we mapped out what the most important characteristics the babies possessed for this process. We agreed that weight, gender, and age were the three most important factors that would set them apart.

Yawn . . . Where’s My Blankie?/Awaiting Final Results

Hour drew upon hour as we sifted through these huge, large sheets, but I was determined to match them all up and well. Excitedly I would think I had the right match only to discover that a certain infant was better suited to another particular baby. This would change everything I just did and I'd have to start all over again. For instance, I could see that baby number 5 was 100 ounces closer in weight to infant number 11 than baby number 17, but the age of baby 17 was closer in gestational age to baby #5, etc. At times it became rather tedious and complicated to figure all of this out, but finally we were able to pair up a control with each experimental group baby to our liking. Once we got to this point, we were then ready to turn over to Dr. Abel the task of analyzing the results of caloric intake, weight gain, and length of time in the unit.

With bated breath, Dr. Pratt and I sat as Dr. Abel calculated the data on his laptop. It seemed endless as we awaited the preliminary results of months and months worth of important data collection. Being the skeptic that he was, Dr. Abel was not convinced the music would really have the affect we were anticipating. This never dampened Dr. Pratt's and my hopes, though. As we sat up late that night after matching the babies so carefully, waiting anxiously to see if what we hoped really happened, Dr. Abel finally finished the calculations. The change on his face told me everything. With results in hand, Dr. Abel humbly reported the music had produced our desired results, brightening our prospects about the remainder of our findings. Caloric intake was better, weight gain had occurred, and the infants did indeed leave the unit nearly three days earlier than the controls because of music listening. But this was just the tip of the iceberg. We still had the heart rate, oxygen saturation, and behavior observation responses ahead of us to analyze.

Last, But Not Least

With months of still more waiting time ahead of us, the time eventually came that we were able to review the remainder of the data with several BYU statisticians. When it came to this point I really became excited. Finally I received the call I had been waiting for. “Hello, is Jackie Coleman there?”

“Yes, this is she . . . how can I help you?”

“This is the BYU stats office with the results of your data.” My heart started racing when I heard the excitement and optimism in his voice. “I’d like you to come down and see the charts for yourself. When would be a good time for you?”

“Right now!”

I raced to the office. All of the numbers on the charts and graphs were clear. Every single aspect, the heart rates, oxygen saturation, and behaviors, were positively affected by the music! There it was before me in black and white. Not only that, but the infants preferred both voices and made no distinction between the two. I finally had something of significance scientifically to encourage males and females to unite more as a team in this great effort through music. What more could an infant want but beautiful, soothing music to sleep by and loving parents who both work together in equally important ways to comfort and care for this infant; parents who are willing to lose their inhibitions and sing to their baby without feeling afraid to be heard? Since doing the research people often now ask me, "Which is it? Which voice do the infants like better?" Most automatically assume it is the female voice the infants liked. It is always a pleasant surprise to them when I say, " They're equal!" Their eyes all light up and they repeat to themselves chuckling, "They're equal."

In short, all of our physiological and behavioral measuring tools turned out the way we wanted towards music. Singing of either male or female significantly lowered heart rates, raised oxygen intake levels and helped babies move less and relax into a more quiet, restful behavior. Because of the music, formula feeding was better, babies were gaining weight, and best of all the length of time in the unit was shortened by almost 3 days. What’s more, the recited lyrics had the complete opposite effect on the babies. Spoken lullabies only raised the heart rates and decreased the babies' ability to take in more oxygen, while exciting their behaviors to arousal. Not surprisingly, NICU noises dramatically heightened these undesirable results, and the baseline (or the babies' initial state before the music was administered) were somewhat mainstream. The music definitely made a difference and had a calming, soothing effect on the babies.

In the Public’s Eye/Being Noticed Makes a Difference

What a wonderfully energizing experience it was when I wrote and defended my thesis later that year! In the presence of my committee members, music faculty from BYU, we discussed the possibilities of where this research could go and how more studies could be done on this topic. Other research we decided might look at children's voices, the actual parent's voices verses trained singers, the idea of combining massage with the music, and testing brainwave patterns that occur during music listening. It would be interesting to see if there were a way to connect brainwave patterns with an infant's developing reasoning capacities and learning to music. Perhaps good music could aid in the infant's ability to take in more of the information around them.

Shortly after I graduated, I had the opportunity of presenting my thesis, "The Effects of the Male and Female Singing Voices, on Selected Physiologi,, cal and Behavioral Measures of Premature Infants in an Intensive Care Unit," at the VI Symposium of The International Society for Music in Medicine (ISMM), October, 1995. Two years later , I co-authored the , data in The Inter, national Journal of Arts Medicine, 5(2), 4-11 with Dr. Pratt and the other doctors. In 1998, the research results were reported internationally at VII Conferen, c, , e, of the International Society for Music in Medicine, University of Melbourne, Australia when Dr. Pratt presented the material to a large audience. In addition, the results have been televised through Channel 2 and 4 News of Utah and The Walstreet Journal, and have been printed in the Deseret News, Daily Herald, L.D.S. Church News, BYU's Daily Universe, Salt Lake Tribune, The Utah Co,, unty Journal, Parents Magazine, and American Baby.

A Change of Scenery/Atmosphere/Moving Things Around

Even with this important news coverage, changes do take time and the implementation of them takes a great deal of effort, . I would like to see every hospital in the United States playing music in their NICU’s to infants. I presented a hard copy of my thesis to the to the doctors at the hospital where I conducted the study and have since learned that a completely new sound protection system was adopted in part as a consequence of the findings when the building underwent extensive remodeling last year. The babies were more spread apart, the rooms were made larger, and the walls were specifically designed to be more soundproof. These and other changes are beginning to take effect, slowly but surely. And I’m pleased to see it happening.

Creating Happy Endings/Happily Ever After/Everyone Likes a Happy Ending

Today, I continue to publicize the research as Director of Creative Projects with the Music Health Institute collaborating with my advisor, Dr. Pratt, my singing, musical brother, Quinn Coleman, and Grammy Award Winning producer, Michael Lloyd. Together we have produced "MusicBabies," a CD, audiotape and booklet, based on the findings from the thesis research study. The CD contains 12 of the same lullabies that were used in the study, but with light instrumental accompaniment. Six of the lullabies are sung by a male and the other six are sung by a female, with the unsung accompaniments at the end for those who wish to pull out their karaoke machines and sing to their heart's content with the music. We hope to encourage all caregivers, including most importantly the parents and immediate family members, to sing to the infants in their lives and help create more family unity through the wonderful gift of music.

Dr. Pratt still recalls the lovely memories of her grandmother singing to her as a child. The important thing is not the quality of the singing, but the singing itself. Love and security is expressed through a sweet song that carries with it traditions that last a lifetime. If this research increases empathy towards parents who experience the trauma of prematurity, lessens abuse in the home acted out through stress, lowers hospital and insurance costs, and increases sound awareness levels in NICU’s throughout the country, then I will have contributed something indeed of worth. All of humanity is affected greatly when families stay together in a common goal of loving and nurturing their tender, tiny infants. Music, particularly of the male and female voices of parents and all caregivers alike, can be a wondrous means of helping this come about.