OBJECTIVE: To evaluate the effects of music played preoperatively in women undergoing elective cesarean delivery. METHODS: Sixty women undergoing elective cesarean delivery were randomized to a study group or a control group. Those in the study group listened to music for 30 minutes before surgery. All women underwent heart rate variability analysis and scored their anxiety and pain levels using the Self-Rating Anxiety Scale and a visual analog pain scale. RESULTS: In the study group the mean HRV, as measured by the low frequency power (LF) value and the LF to high frequency power (LF/HF) ratio during Holter assessment, was significantly less after the music intervention but was not significantly changed in the control group. Moreover, the mean HF value was significantly increased and the mean anxiety score was significantly decreased after the music intervention but not in the control group. Finally, the mean pain score obtained 6 hours after surgery was significantly lower in the study than in the control group. CONCLUSION: A preoperative music intervention can reduce anxiety and pain in women undergoing cesarean delivery.