"A Heritage of Healing: Traditional Song and Its Anxiety-Mitigating Effects During Pregnancy"
Phase: NA
Conditions: Anxiety
Sponsor: Health Polytechnic of Palangka Raya

 
  
 
Health Polytechnic of Palangka Raya 
A Heritage of 
Healing: 
Traditional Song 
and its Anxiety-
Mitigating Effects 
During Pregnancy 
 
Erina Eka Hatini  
Yesika Putri Pratama 
Vissia Didin Ardiyani 
 
7-12-2025 
 

A Heritage of Healing: Traditional Song and its Anxiety-Mitigating Effects 
During Pregnancy 
 
Erina Eka Hatini 1*, Yesika Putri Pratama1, Vissia Didin Ardiyani2 
1 Midwifery Department, Health Polytechnic of Palangka Raya—Indonesia Ministry of Health, Indonesia 
2 Nursing Department, Health Polytechnic of Palangka Raya—Indonesia Ministry of Health, Indonesia 
 
*Correspondence: vissia.ardiyani@polkesraya.ac.id 
 
Abstract 
Introduction: Pregnancy is a period of profound physiological and emotional transformation, 
often leading to heightened anxiety due to hormonal shifts, body image changes, and the 
anticipation of motherhood. This anxiety can significantly impact both maternal and fetal well-
being. Recognizing the need for effective interventions, non-pharmacological approaches like 
music therapy are gaining traction due to their low risk of side effects. This study highlights 
the historical use of music for relaxation and its ability to influence physiological responses, 
such as hormone release. Specifically, it introduces the Sape' Dayak, a traditional Indonesian 
instrument known for its calming qualities, as a potential therapeutic tool. While Sape' music 
has cultural significance, its specific efficacy in reducing anxiety in pregnant women remains 
under-researched. 
Objectives: This study attempts to address the gap by investigating whether Sape' Dayak music 
can reduce anxiety levels in pregnant mothers as successfully as traditional lullabies, therefore 
promoting holistic health practices and maintaining cultural heritage. 
Methods: Thirty-two pregnant women will be recruited from midwifery clinics. A total of 16 
pregnant women will receive the traditional Sape’ Dayak music, while another 16 pregnant 
women will undergo the lullaby music therapy. Following a non-randomized design, we will 
collect data on an anxiety assessment using the PASS before and after the music intervention. 
Data will be analysed using the linear mixed model. 
Keywords: anxiety, pregnancy, music therapy, lullabies, traditional music, mental health 
 
 
 
 
 

1. Introduction 
A woman's life undergoes significant transformation during the gestational period, which is 
characterized by a symphony of physiological and emotional adaptations designed to support 
the growing fetus (1). These substantial changes could have far-reaching effects, affecting not 
only the woman's physical health but also her emotional and psychological stability (2). The 
increase of hormones, the changing perceptions of body image, and the expectation of 
motherhood together create a unique emotional environment, resulting in pregnant women 
possibly being more susceptible to increased levels of anxiety (3). This sensitivity is worsened 
by worries about the pregnancy, the fetus's health, and the labor and delivery process. Anxiety 
during pregnancy is a common experience, frequently arising from the numerous uncertainties 
and challenges associated with this phase of life, and it can have significant repercussions, 
affecting both the mother and the developing child (4). The occurrence of anxiety disorders 
during pregnancy highlights the necessity for effective intervention strategies, particularly 
considering the potential long-term effects on both maternal and offspring well-being (5). 
Diverse therapeutic approaches have emerged in response to the urgent need for successful 
solutions, including psychosocial support, alternative therapies, and pharmacological 
interventions. There is an increasing interest in non-pharmacological interventions, like music 
therapy, which have shown effectiveness in alleviating anxiety and fostering relaxation during 
pregnancy (6). Non-pharmacological interventions are especially attractive because they carry 
a low risk of negative side effects for both the mother and the developing fetus. Music therapy 
has become acknowledged as a gentle and approachable method that can successfully reduce 
anxiety and promote relaxation during pregnancy. Mindfulness-based approaches are preferred 
for managing stress and improving well-being during pregnancy (7). Relaxation techniques are 
essential for minimizing or preventing the potential negative impacts of maternal stress (8). In 
addition to standard therapeutic methods, there is increasing acknowledgement of the 
advantages of traditional cultural practices, including lullabies and traditional songs, for 
improving maternal well-being during pregnancy. 
According to Ni Gusti Made Ayu Agung Budhi and Sasnitiari (9), music therapy is a non-
pharmacological method that can help with pain relief, stress reduction, and anxiety reduction, 
particularly during childbirth. This is true regardless of the mother's age, education level, 
religion, socioeconomic status, number of children, or social support. Music has been utilized 
as a means of relaxation since ancient times, with historical evidence indicating its presence 

across various cultures. It is known to generate positive sensory stimuli that can trigger 
endorphin release (10). Music influences the parasympathetic nerve and autonomic nervous 
system, either directly or indirectly (10). Listening to music exerts a soothing and uplifting 
effect on individuals and positively influences unborn babies. The beneficial sound from music 
facilitates prenatal stimulation, aiding pregnant mothers in bonding with their unborn children 
(11). Music can influence hormone release, as relaxing music has been shown to reduce cortisol 
levels and may also affect other hormones associated with stress and well-being. Research 
indicates that family-centered music therapy positively impacts the well-being of parents and 
infants in neonatal intensive care units (12). Music during labor correlates with reduced pain 
and anxiety levels, along with lower postpartum analgesic needs (13). 
With its origins in cultural history, traditional music contains unique rhythmic patterns and 
aural structures that may influence both mental and physical states, making it a desirable choice 
for treating anxiety. Traditional music serves as a tool for alleviating anxiety symptoms and 
promoting relaxation through the integration of culturally relevant sounds in therapeutic 
environments (14). Known for its gentle, contemplative sounds, the Sape is a traditional Dayak 
musical instrument from East Kalimantan, Indonesia. The Sape' has historically been integral 
to Dayak healing rituals, spiritual offerings, and community entertainment. It conveys family 
history and cultural values as a sign of Dayak identity. With its delicate tones and repeating 
rhythms, the Sape' creates pentatonic melodies that promote healing and relaxation while 
fostering a calm, reflective, and emotionally calming environment. The cultural significance is 
well-established, and there is increasing acknowledgment of its potential therapeutic benefits, 
particularly in reducing anxiety. Because pregnancy frequently causes increased anxiety, 
research into non-pharmacological techniques like music therapy—like those utilizing the 
Sape'—is essential for the well-being of expectant mothers. Thus, examining the potential of 
Sape' Dayak to reduce anxiety in expectant mothers advances the study of holistic health 
therapies as well as the preservation of cultural heritage. 
Discussions on the Sape' Dayak in academia and culture today mostly center on its cultural 
value, gender roles in its performance, and its changing position in modern society. A 
significant gap remains in the research on the therapeutic applications of Sape' music. 
Particularly, there is a scarcity of research that investigates the potential of traditional Dayak 
music, including the Sape', to enhance mental health, particularly in the context of maternal 
health, by reducing anxiety. This gap signifies an overlooked opportunity to integrate cultural 

heritage with modern healthcare practices. While Nadia Anjani, Amir Razak (15) propose that 
Sape' music possesses anxiety-reducing properties, this claim necessitates additional empirical 
investigation, particularly in specific populations such as expectant women. 
This study seeks to examine the efficacy of Sape' Dayak music in alleviating anxiety among 
pregnant women. The primary goals are to ascertain whether the anxiety levels of expectant 
women are similarly influenced by exposure to Sape's Dayak music as they are by conventional 
lullaby instruments. 
2. Materials and Methods 
2.1. Study design 
This study is a quasi-experiment with a control group and is conducted in alignment with the 
JBI standard, published in 2020 (16). Pre- and post-tests are conducted to assess the effects of 
the music therapy.  
2.2. Study participants 
This study will involve 32 pregnant women who will receive standard antenatal care (ANC). 
All of them are ANC visitors at midwifery clinics between 1 February and 30 April 2025. A 
total of 16 pregnant women will receive the traditional Sape’ Dayak music, while another 16 
pregnant women will undergo the lullaby music therapy.  
Participants will be recruited during their third trimester of pregnancy (28-40 weeks). They 
will be eligible if they are 1) at least 18 years old, 2) having a score on the Pittsburgh Sleep 
Quality Index (PSQI) > 5, which indicates poor sleep quality, and 3) primiparous. Exclusion 
criteria included women who 1) are beyond the 40th week of pregnancy; 2) have mental illness 
that causes hallucinations or altered perception of reality; or 5) have a twin pregnancy. 
Sample size is estimated by applying these parameters as follows: The effect size is considered 
to be 0.52 (17), with a power of 0.8 and a 0.05 level of significance. Sample size calculations 
for comparing the two independent means (18) indicates each group requires 14 participants. 
For dropout anticipation, we add an extra 10% of participants. Two participants are 
withdrawing due to preterm delivery (n=2). The test power is maintained by recruiting new 
participants.  

2.3. Procedures 
During the study period, trained assistants will approach potential pregnant women who attend 
midwifery clinics, and the 32 women are assessed for eligibility for the study by the research 
assistant. Firstly, women who will meet the inclusion criteria will be informed of the aim and 
content of the study, and their written informed consent will be obtained prior to the 
experiment. After inclusion in the study, participants (n = 32) will be purposefully allocated, 
with the rules that those who visit midwifery clinic A will be grouped in the intervention group 
(IG) (n = 16), while the control group (CG) (n = 16) will be made up of those who visit 
midwifery clinic B. The distance between clinics is 15 km, which minimizes interactions 
between participants in the two groups. The IG will listen to Sape’ Dayak while gently 
massaging their abdomens and imagining their infants. The lullaby of Brahms will be played 
for the CG, who will also touch gently on the tummy and remind of their unborn children. Each 
piece of music will be performed for 20 minutes. Respondents will be instructed to wear 
earphones to listen to the music. The experiment will be conducted between 08:00 and 11:00 
post-breakfast, during which no medical care, diagnostic assessments, or normal follow-ups 
are performed. Throughout the experiment, they will maintain standard care and treatments. 
The main investigator at the clinic will manage all practices that could potentially influence the 
study. 
The participants will not interact with the researchers administering the intervention unless 
they receive important information about the experiment to minimize confounding effects on 
the research outcomes. The intervention will be conducted by the same assistant. The assistants 
and participants will not be blinded to the research given the characteristics of the music 
intervention. To avoid patient interaction between the two groups, the intervention will be 
carried out in each pregnant woman's home while she is comfortably seated in a chair in her 
room. 
2.4. Lullaby intervention 
The Sape’ Dayak recital consists of only one song, which will be played for a duration of 20 
minutes. This traditional Dayaknese song creates melodies with a pentatonic subtlety, a five-
note scale popular in traditional Asian music, particularly the Indonesian archipelago. This 
musical scale leaves a simple yet profound effect, fostering a serene, contemplative, and 
emotionally relaxing environment. Sape's music has a contemplative quality due to its mild 

sound and repeating beat, making it ideal for relaxation and healing, as well as anxiety relief 
(15). 
While the Sape Dayak song is a traditional instrument, the lullaby recital is a popular 
instrument in the world. The lullaby recital consists of 1 song composed by Johannes Brahms, 
which will be played for a duration of 20 minutes. The lullabies preselected by the researcher 
are among the best-known ones. The lyrics of this lullaby typically revolve around themes of 
love and affection, which express mothers’ love and tenderness for their fetus. To provide a 
homogeneous intervention and to avoid bias, the personal lullaby preferences of the pregnant 
women will be ignored. However, we will report the mothers’ habit of listening to other music. 
For three consecutive days, the IG will utilize a music device to listen to the Sape' Dayak for 
20 minutes each day. The Sape' Dayak has a slow rhythm (the beat fluctuates from 80 to 85 
beats per minute, measured by a metronome), which corresponds to the normal heart rate. Each 
participant will receive an earphone. Evidence has shown that listening to music for relaxation 
therapy can last practically from 10 to 60 minutes (19-23). In accordance with the findings of 
the study, a length of 20 minutes will be established. Respondents will be directed to compile 
a personal preference playlist for relaxation, which will be subsequently saved on the paid 
Spotify platform. Participants will be instructed to listen to the lullaby while reflecting on their 
babies and engaging in physical connection by touching their abdomen. The intervention will 
be conducted in the participants' homes, at times when they will be available and feel prepared. 
The door and windows of the room will be closed to ensure the participants' privacy. 
Participants will be instructed to have an empty bladder, turn off their cell phones, and refrain 
from receiving medical treatment during the intervention. Respondents in the CG will be 
directed to listen to Brahms' lullaby following the same procedure. 
To ensure participants compliance, the Trackify music tracking app will be used, and research 
assistants will collect the time of playing from the app upon completion of the session.  
2.5. Outcome Measurements 
The assessment of participants’ characteristics (i.e., age, gestational age, parity, abortus history, 
health insurance, income per month, pregnancy complication, hospital admission history, 
smoker presence, and listening to music) will be measured at baseline. The level of anxiety will 
be assessed by using the Perinatal Anxiety Screening Scale (PASS) adapted from Somerville, 
Dedman K Fau - Hagan (24). It will be created to identify a wide variety of anxiety symptoms 

that are particularly significant to perinatal women and comprises four assessment subscales, 
including acute anxiety and adjustment; general concern and specific fears; perfectionism, 
control, and trauma; and social anxiety. Furthermore, thirty-one items will be applied to assess 
the subjective anxiety, rated with the Likert scale ranging from 0 to 3 (0 refers to not at all, 1 = 
little, 2 = moderately, and 3 = very much). The application of the PASS has been evident to be 
valid and reliable both in the English version (25) and the Bahasa version (26). The score 
system will be assessed based on the sum of the individual item scores, with 26 as the cut-off 
score, which indicates clinically significant anxiety (25). From the scores, they will be 
categorized into minimal anxiety (0-20), mild-moderate anxiety (21-26), and severe anxiety 
(>26). The PASS in this current study will be evaluated before and after intervention.  
2.6. Data analysis 
All statistical analyses will be conducted employing the IBM SPSS v.26 statistics software 
(SPSS Inc., Chicago, USA). The alpha level will be set up at p < 0.05 (two-tailed). A descriptive 
analysis of the major study variables will be conducted. For the quantitative numeric, the 
means, standard deviations, and confidence intervals will be computed. The Shapiro-Wilk test 
will be employed to assess data normality. The student's t-test will be employed to analyze 
differences between groups for anthropometric and confounding variables. The medians, 
maxima, and minima will be applied when the distribution is non-normal. In addition, the chi-
square test or Fisher’s exact test will be used for categorical variables. Multivariate analysis 
will be carried out with a linear mixed model for additional analysis.  
2.7. Ethics approval 
Our research was approved by the Research Committee of the Health Polytechnic of Palangka 
Raya (Polkesraya), number 470/II/KE.PE/2025. All participants will give signed informed 
consent prior to taking part in the study.  
 
 
 
 

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Informed Consent Form for Participation in a 
Research Study 
Study Title: A Heritage of Healing: Traditional Song and its Anxiety-Mitigating Effects During 
Pregnancy 
Version Date: July 12, 2025 
Introduction and Purpose of the Study 
You are invited to participate in a research study aimed at understanding how traditional music can help 
reduce anxiety during pregnancy. Pregnancy is a special time, but it can also bring feelings of worry. 
This study explores whether listening to certain types of music, specifically traditional Dayak Sape' 
music or traditional lullabies, can help pregnant women feel less anxious. 
Your participation is entirely voluntary. Before you decide, please read this form carefully. It explains 
why we are doing this study, what will happen if you take part, what the possible benefits and risks are, 
and your rights as a participant. Please ask the study team any questions you have. 
What will happen if I participate? 
If you agree to participate, you will be part of a study involving 32 pregnant women. We will first assess 
your anxiety levels using a questionnaire called the Perinatal Anxiety Screening Scale (PASS). This 
scale has 31 questions asking about your feelings and worries. 
You will then be assigned to one of two study groups: 
1. Group 1: Traditional Sape' Dayak Music Listening 
o 
You will listen to one traditional Dayak Sape' song through earphones for 20 minutes 
each day. 
o 
This will happen for three consecutive days. 
o 
While listening, you will be asked to gently massage your abdomen and imagine your 
baby. 
o 
The music has a slow, calming rhythm (80-85 beats per minute). 
2. Group 2: Brahms' Lullaby Music Therapy 
o 
You will listen to one preselected Brahms' Lullaby song through earphones for 20 
minutes each day. 
o 
This will also happen for three consecutive days. 
o 
While listening, you will be asked to gently touch your tummy and reflect on your 
unborn child. 
All music sessions will take place in your home, in a private and comfortable setting, between 8:00 AM 
and 11:00 AM after breakfast. We will ask you to turn off your cell phone and ensure no medical 
treatments or other distractions occur during the session. 
After the three-day music intervention, we will again assess your anxiety levels using the same PASS 
questionnaire. This post-intervention assessment will be conducted approximately 20 minutes after your 
last music session. 

How long will I be in the study? 
Your active participation in the study, including the pre-assessment, three days of music listening, and 
the post-assessment, will last approximately three days, with about 20 minutes of active participation 
per day. 
Risks and Discomforts 
We do not anticipate any significant risks or major discomforts from participating in this study. 
• 
Mild Discomfort: You might experience mild boredom or discomfort from listening to the 
music if it's not to your personal preference, or from sitting for 20 minutes. 
• 
Emotional Responses: Music can sometimes evoke emotions. While the selected music is 
intended to be calming, it is possible, though unlikely, that it might trigger unexpected 
emotional responses in some individuals. If you feel any distress, you are free to stop at any 
time. 
• 
Confidentiality Risk: As with any research, there is a minimal risk of a breach of 
confidentiality, although we will take extensive measures to protect your privacy. 
Benefits of Participation 
You may not directly benefit from participating in this study. However, information gained from this 
study may help us better understand how traditional music and lullabies can help pregnant women 
manage anxiety. This understanding could lead to better non-pharmacological interventions for future 
pregnant women and contribute to the preservation of cultural health practices. 
Confidentiality 
Your privacy and the confidentiality of your data will be strictly protected. 
• 
All information collected during this study will be kept confidential and will be identified only 
by a unique study code, not by your name. 
• 
Any personal identifying information will be removed from your data as soon as possible. 
• 
Study data will be stored securely on password-protected computers and in locked cabinets. 
• 
The anonymized individual participant data (IPD) from this study may be shared with other 
qualified researchers in the future to further scientific discovery. This sharing will occur after 
the study's main results are published, and only under strict data use agreements that ensure 
your privacy is protected through de-identification and anonymization methods, as outlined in 
our study's data sharing plan. No information that could identify you will ever be shared. 
Voluntary Participation and Right to Withdraw 
Your decision to participate in this study is entirely voluntary. You are free to refuse to participate or to 
withdraw your consent and discontinue participation at any time, for any reason, without penalty or loss 
of benefits to which you are otherwise entitled. If you choose to withdraw, your decision will not affect 
your standard antenatal care. 
Costs 
There are no costs to you for participating in this study. 
Who to Contact for Questions or Problems 
If you have any questions about this research study, please feel free to contact the lead researcher: 

Erina Eka Hatini 
Midwifery Department, Health Polytechnic of Palangkaraya  
Phone: +62812-5456-4640 
 
If you have any questions about your rights as a research participant, or if you have concerns or 
complaints about the study, you may contact: 
Research Committee of the Health Polytechnic of Palangka Raya (Polkesraya)  
Yeni Lucin (Ethics Committee Coordinator)  
+62 812-5087-359; Email: lucinyeni@polkesraya.ac.id 
as per approval number 470/II/KE.PE/2025 
 
--------------------------------------------------------------------------------------------------------------------------- 
Statement of Consent 
I have read and understood the information provided in this consent form. I have had the opportunity to 
ask questions, and my questions have been answered to my satisfaction. I understand that my 
participation is voluntary and that I may withdraw at any time without penalty. 
By signing below, I freely and voluntarily agree to participate in this research study. 
Participant's Name: _________________________ 
Participant's Signature: _________________________ 
Date: _________________________ 
Person Obtaining Consent Name: _________________________ 
Person Obtaining Consent Signature: _________________________ 
Date: _________________________