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Making Space for Spirituality in Childbirth
Abstract
In this editorial we consider the relationship between spirituality and childbirth and highlight potential gaps in both national and international understandings and research in the field of maternity care. We believe, as many do, that childbirth is a deeply spiritual experience (Bélanger-Lévesque et al. 2016). To desire to be pregnant, to give birth and to become a mother (or parent) reflects the very essence of what it is to be human and to want to derive meaning from the human experience through recreation. In childbirth, women may encounter a sense of awe and personal transcendence at having created new life (Hall 2007). This article is protected by copyright. All rights reserved.
... Interventions, such as pain relief medications, anesthesia, or cesarean delivery, attempt to control and minimize pain during the childbirth process (American College of Obstetricians and Gynecologists, 2019). Thus, considering and celebrating childbirth as a spiritual event could be inhibited by a reductionist view of health and humanity that perpetuated the medicalized, technocratic, and biomedical model (Crowther et al., 2021;OBoyle et al., 2017;Thomson & Downe, 2013;Timmins & Caldeira, 2019). However, childbirth is a choice, and women may seek medicalization to alleviate pain. ...
... The experiences of pregnancy, birth, and new motherhood may be considered so transformative that the meaning given to them is profoundly spiritual (Callister & Khalaf, 2010;Crowther & Hall, 2015;Crowther et al., 2021;Gaskin, 1978;Linhares, 2012;OBoyle et al., 2017;Timmins & Caldeira, 2019). ...
... Although the woman is responsible for this rite of passage and her choices, regardless of the type of birth, birth care professionals can help enable, protect, and preserve the sacredness of childbirth. Previous studies have reported a correlation between healthcare professionals' spiritual health and women's childbirth satisfaction (Chiang et al., 2016;Ghalaychi et al., 2019;OBoyle et al., 2017). ...
This study aimed to understand the significance of spirituality to Portuguese women who had a water birth. In-depth interviews, using a semi-structured questionnaire, were conducted with 24 women who experienced water birth at the hospital or home. Results were analyzed from a narrative interpretation perspective. Three spirituality-related categories emerged: (1) Beliefs and connections with the body; (2) Spirituality: integration of being a woman and transformation during birth; and (3) Spirituality as wisdom, intuition, or the sixth sense. Spirituality was perceived in women's faith and beliefs in a superior being that helped them manage the unpredictability and uncontrollability of giving birth.
... We believe our findings applies to all birthing people. Addressing existential and spiritual considerations could be included in maternity care services in recognition of how the transition to motherhood may change life at a profoundly existential level ( Boyle et al., 2017 ;Crowther and Hall, 2017 ;Prinds et al., 2021 ). Moreover, if existential meaning-making considerations and practices are important components of good mental health, there should be a focus on further research and clinical practice ( Health, 2016 ;Koushede, 2015 ). ...
Background
The emergence of the COVID-19 pandemic and the derived changes in maternity care have created stress and anxiety among pregnant women in different parts of the world. In times of stress and crisis, spirituality, including spiritual and religious practices, may increase.
Objective
To describe if the COVID-19 pandemic influenced pregnant women's considerations and practises of existential meaning-making and to investigate such considerations and practices during the early pandemic in a large nationwide sample.
Methods
We used survey data from a nationwide cross-sectional study sent to all registered pregnant women in Denmark during April and May 2020. We used questions from four core items on prayer and meditation practices.
Results
A total of 30,995 women were invited, of whom 16,380 participated (53%). Among respondents, we found that 44% considered themselves believers, 29% confirmed a specific form of prayer, and 18% confirmed a specific form of meditation. In addition, most respondents (88%) reported that the COVID-19 pandemic had not influenced their responses.
Conclusion
In a nationwide Danish cohort of pregnant women, existential meaning-making considerations and practices were not changed due to the COVID-19 pandemic. Nearly one in two study participants described themselves as believers, and many practised prayer and/or meditation.
... According to a holistic approach, an individual is a total physical, mental, emotional, socio-cultural and spiritual dimension and each of these dimensions is interrelated and interdependent with one another [2]. For health workers, paying attention to spirituality and religiosity, (in addition to one's emotional, physical and psychological dimensions) is important [3]. Spirituality is a broad concept with various dimensions and perspectives characterized by a feeling of attachment (connection) to something bigger than ourselves, which is accompanied by a search for meaning in life or can be described as an experience that is universal and touching [4]. ...
... Becoming a parent is an event with many expectations. Pregnancy and childbirth can trigger existential self-awareness and can be a deep spiritual experience ( OBoyle et al., 2017 ). However, some parents experience severe disease during pregnancy or labour threatening both the mother's and infant's lives. ...
Objectives: To elucidate and develop the comprehension deepen the understanding of parents’ existential challenges and experiences when having a premature infant due to the mother's pre-eclampsia severe illness.
Design: Two empirical studies based on reflective lifeworld research (RLR), were conducted to investigate parents’ experiences of having a premature infant due to mother's pre-eclampsia. A further abstraction was possible. The two essences were synthesised into a general structure. Then, a philosophical examination of the existential issues was done using Karl Jaspers' concept of limit situation and health theory outlined by Dahlberg and Segesten.
Setting: Maternity ward and neonatal intensive care unit.
Participants: Nine mothers and six fathers.
Findings: The findings revealed the experiences of a vulnerable group of parents in the maternity ward and in the neonatal intensive care unit (NICU). The parents faced a paradoxical experience. They experienced mothers' severe illness and in some cases accompanied by the possibility of death, at the same time they experienced the joy of becoming parents. The premature birth and the mother's severe symptoms revealed the intertwinement of biological and existential features. Preeclampsia restricted the mothers from fulfilling the major project in their lives: to become real mothers.These experiences were elucidated by the concept of limit situations as suffering, struggle, death, and paradoxes of life as well as the health theory with its biological and existential dimensions.
Key conclusion: Some parents experienced closeness to death and the beginning of life as almost intertwined. These two fundamental facets of life are connected to existential features and challenges. The study also underlined the antinomies of life; suffering and facing severe illness that could cost both the mother's and infant's lives, and at the same time feeling the happiness of becoming parents.
Implications for practice: Health professionals should know how these experiences affect parents. They should be sensitive when approaching mothers and fathers in such situations. The families’ vulnerability must be considered within the physical space of health services. If the parents needs to talk, time and staff should be available to meet their needs.
... There ID:p0080 is a spiritual dimension of childbirth which holds the potential to facilitate significant personal transformation and may also serve as a protective resource against problems such as depressive symptoms, or high risk pregnancy issues (Budin, 2001;Cheadle et al., 2015;Jacinto & Buckey, 2013;Nogueira, 2013a;O'Boyle, Brady, & Timmins, 2017). The environment for childbirth appears to influence the extent spirituality and transformative experiences manifest. ...
PURPOSE
The purpose of this study was to examine the how different aspects of the birthing environment were associated with a parturient's states of consciousness, spirituality, and satisfaction with the childbirth experience.
DESIGN
The study utilized a convergent mixed methods research design involving both quantitative and qualitative components with convenience sampling. In total, 276 Brazilian postpartum women completed a states of consciousness mini-test and the Expressions of Spirituality Inventory—Revised. A small subsample of women who gave birth in different settings were also interviewed. Quantitative data were examined using descriptive statistics, bivariate correlations, and analysis of variance and covariance. Qualitative interview data were thematically analyzed.
MAJOR FINDINGS
Home birth and the absence of a physician were associated with a higher occurrence of favorable non-ordinary states and satisfaction with childbirth. Spiritually-inclusive birth preparation was found to be associated with most spirituality and states of consciousness variables and more than childbirth satisfaction.
MAIN CONCLUSION
Non-ordinary states emerged from a parturient's sense of security with their surroundings and from preparation for childbirth. Spiritual experiences were related to pre-existing spiritual beliefs and practices.
Globally, there is a growing interest in the spiritual care; neglecting spirituality during health care provision may negatively affect psychological, emotional and physical well-beings. Specifically, providing spiritual care during pregnancy and childbirth affects health outcomes and decreases the risk for complications. Current literature review explains the main spiritual attributes in maternal psychological health. In addition, the review help healthcare providers decide upon suitable strategies to overcome the negative consequences of the psychological difficulties during pregnancy and childbirth.
Globally, there is a growing interest in the spiritual care; neglecting spirituality during health care provision may negatively affect psychological, emotional and physical well-beings. Specifically, providing spiritual care during pregnancy and childbirth affects health outcomes and decreases the risk for complications. Current literature review explains the main spiritual attributes in maternal psychological health. In addition, the review help healthcare providers decide upon suitable strategies to overcome the negative consequences of the psychological difficulties during pregnancy and childbirth.
Pregnancy is a critical period in women`s lives, maternal psychological wellbeing during this period is a core component of health. Physiological changes during pregnancy affect women`s mental status and may lead to negative consequences, if not managed properly. Recently, Covid-19 pandemic resulted in additional consequences on pregnant women`s mental wellbeing along with psychological effects of the pregnancy itself. Therefore, it is crucial to prevent the negative consequences of the psychological changes during pregnancy to overcome it without complications. Current literature review explains the associated main psychological attributes among pregnant women before, during and after Covid-19 pandemic; including fear of childbirth and prenatal anxiety. Understanding the impact of Covid-19 pandemic on the psychological aspects during pregnancy will help healthcare professionals decide upon suitable strategies to assist pregnant women to overcome the negative consequences of the psychological difficulties.
Spirituality with its impact on health outcomes continues to emerge in the medical literature. This article discusses the role of spirituality in pregnancy, childbirth, and postpartum. It highlights the importance of more fully integrating this concept into births traditionally attended by physicians and midwives in the hospital setting. This discussion covers birthing practices ingrained with culture and spirituality. The article concludes with strategies to elicit and integrate spirituality into routine practice to provide improved health care to patients and to find more fulfillment in the role as birth attendant.
Background
While spirituality is well described in end-of-life care literature, research on its place in the delivery room remains largely limited to mother-oriented qualitative studies focusing on life-threatening situations (e.g., high-risk pregnancies). Our aim was to compare mothers’ and fathers’ spirituality during childbirth.
Methods
A mixed methods questionnaire was developed from our childbirth-related spirituality categorization and distributed to all parents of newborns, 12–24 h postpartum, over 45 consecutive days. Paired-sample t-tests and qualitative thematic analysis were used to compare mothers and fathers. Multiple linear regressions identified factors associated with their respective global scores (vaginal and cesarean deliveries separately).
Results
The global scores for mothers (38.6/50) and fathers (37.2/50) were similarly high (N = 197; p = 0.001). Highest-ranked (“respect”, “moral responsibility”, “beauty of life”, “gratitude”) and lowest-ranked spiritual themes (“prayer”, “greater than self”) were in agreement. Fathers scored higher on “fragility of life” (p = 0.006) and mothers on “self-accomplishment” (p‹0.001), “letting go” (p‹0.001), and “meaningfulness” (p = 0.003). “Admission of baby in neonatal unit” was associated with higher global score for both mothers and fathers. Other factors also increased fathers’ (witnessing a severe tear) and mothers’ scores (birthplace outside Canada; for vaginal deliveries, religious belonging and longer pushing stage).
Conclusion
These first quantitative data on the prevalence of spirituality during childbirth highlight a high score for both parents, among a non-selected public hospital population. Spirituality emerges not only from unordinary situations but from any childbirth as an “intensification of the human experience”. Significant differences for some spiritual themes indicate the need to consider the spirituality of both parents.
Background:
Emerging evidence points to childbirth as a spiritually felt meaningful occasion. Although growing literature and development of guidelines charge the midwife to provide spiritual care felt spiritual experiences are not addressed. There is need to revisit contemporary approaches to spiritual care in midwifery lest something of significance becomes lost in policy rhetoric.
Aim:
The aim of this discussion paper is to bring to the surface what is meant by spiritual care and spiritual experiences, to increase awareness about spirituality in childbirth and midwifery and move beyond the constraints of structured defined protocols.
Methods:
The authors' own studies and other's research that focuses on the complex contextual experiences of childbirth related to spirituality are discussed in relation to the growing interest in spiritual care assessments and guidelines.
Findings:
There is a growing presence in the literature about how spirituality is a concern to the wellbeing of human beings. Although spirituality remains on the peripheral of current discourse about childbirth. Spiritual care guidelines are now being developed. However spiritual care guidelines do not appear to acknowledge the lived-experience of childbirth as spiritually meaningful.
Conclusion:
Introduction of spiritual care guidelines into midwifery practice do not address the spiritual meaningful significance of childbirth. If childbirth spirituality is relegated to a spiritual care tick box culture this would be a travesty. The depth of spirituality that inheres uniquely in the experience of childbirth would remain silenced and hidden. Spiritual experiences are felt and beckon sensitive and tactful practice beyond words and formulaic questions.
to provide a thematic overview of the existing literature on existential meaning-making related to transition to motherhood among mothers of full term born babies in Western oriented countries and to discuss the themes from a existential psychology perspective.
the review follows the approach of a scoping review. Systematic searches in the electronic databases PubMed, CINAHL and PsycINFO were combined with manual and electronic searches for related references. Studies published between 1990 and 2010 examining dimensions of existential meaning-making in transition to motherhood were selected. Eleven papers were included in the synthesis, all using qualitative interviews. The following data were extracted from each study: (a) author(s), year of publication, study location, (b) aims of the study, (c) participants, (d) research design, (e) data collection method, (f) outcome measures, and (g) results.
the studies were synthesised in a thematisation on the basis of the existential psychotherapist and philosopher Emmy van Deurzen's concepts of four interwoven life dimensions, through which we experience, interpret, and act in the world: Umwelt, Mitwelt, Eigenwelt, and Überwelt.
the findings in this review suggest that transition to motherhood is considered a pivotal and paradoxical life event. Through the lens of existential psychology it can be interpreted as an existentially changing event, reorganising values and what makes life worth living, and to some women also being interpreted as a spiritual experience. However, in present maternity services there is a predominant focus on biomedical issues, which sets the arena for motherhood transition, and the issues related to potentially existentially changing experiences, are not considered important. Without an integrative approach, where personal meaning-making issues are discussed, the potential for growth during existential authenticity is not utilised. Transition to motherhood raises existential questions about mortality and meaning of life, and we should explore this field in research and in clinical work.
Objective:
the aim of the present study was to gain a deeper understanding of how relational continuity in the childbearing process may influence the woman's birth experience. RESEARCH DESIGN/SETTING: a Q-methodological approach was chosen, as it allows the researcher to systematically assess subjectivity. 23 women were invited to sort a sample of 48 statements regarding their subjective view of birth experience after having participated in a pilot project in Norway, where six midwifery students provided continuity of care to 58 women throughout the childbearing process. The sorting patterns were subsequently factor-analysed, using the statistical software 'PQ' which reveals one strong and one weaker factor. The consensus statements and the defining statements for the two factors were later interpreted.
Findings:
both factors seemed to represent experiences of psychological trust and a feeling of team work along with the midwifery student. Both factors indicated the importance of quality in the relation. Factor one represented experiences of presence and emotional support in the relationship. It also represented a feeling of personal growth for the women. Factor two was defined by experiences of predictability in the relation and process, as well as the feeling of interdependency in the relation. According to quality in the relation, women defining factor two experienced that the content, not only the continuity in the relation, was important for the birth experience.
Key conclusions:
relational continuity is a key concept in the context of a positive birth experience. Quality in the relation gives the woman a possibility to experience positivity during the childbearing process. Continuity in care and personal growth related to birth promote empowerment for both the woman and her partner. Relational continuity gives an opportunity for midwives to provide care in a more holistic manner.
The aim of this article is to clarify the concept of spirituality for future nursing research.
Previous concept analyses of spirituality have mostly reviewed the conceptual literature with little consideration of the empirical literature. The literature reviewed in prior concept analyses extends from 1972 to 2005, with no analysis conducted in the past 9 years.
Rodgers' evolutionary framework was used to review both the theoretical and empirical literature pertaining to spirituality. Evolutionary concept analysis is a formal method of philosophical inquiry, in which papers are analyzed to identify attributes, antecedents, and consequences of the concept.
Empirical and conceptual literature.
Three defining attributes of spirituality were identified: connectedness, transcendence, and meaning in life. A conceptual definition of spirituality was proposed based on the findings. Also, four antecedents and five primary consequences of spirituality were identified.
Spirituality is a complex concept. This concept analysis adds some clarification by proposing a definition of spirituality that is underpinned by both conceptual and empirical research. Furthermore, exemplars of spirituality, based on prior qualitative research, are presented to support the findings. Hence, the findings of this analysis could guide future nursing research on spirituality.
© 2015 Wiley Periodicals, Inc.
This paper presents the preliminary descriptive findings from an online survey commissioned by the Royal College of Nursing to ascertain members' perceptions of spirituality and spiritual care.
There is a professional requirement for nurses to achieve competence in the delivery of spiritual care and to assess and meet the spiritual needs of their patients. Recently, the area of spirituality has come under criticism bringing into question the role of the nurse with regard to the provision of spiritual care.
A descriptive online survey was conducted with all Royal College of Nursing members to obtain their perceptions of spirituality and spiritual care in an attempt to identify what action they feel is required with regard to this aspect of nursing practice.
An online survey consisting of a five-part questionnaire was developed incorporating the Spirituality and Spiritual Care Rating Scale. Members were asked to complete the survey during a three-week period in March 2010.
Overall, 4054 Royal College of Nursing members responded, making this probably the largest UK survey ascertaining nurses' perceptions of spirituality and spiritual care. Descriptive statistics, frequencies and percentages were used to identify key findings. A Cronbach's alpha of 0·80 was obtained for the Spirituality and Spiritual Care Rating Scale. The preliminary analysis confirms that nurses across the full health economy in the United Kingdom consider spirituality to be a fundamental aspect of nursing.
The findings indicate that nurses recognise that attending to the spiritual needs of patients enhances the overall quality of nursing care. However, despite all the attention given to the spiritual dimension, the majority of nurses still feel that they require more guidance and support from governing bodies to enable them to support and effectively meet their patients' spiritual needs.
Why do so many American women allow themselves to become enmeshed in the standardized routines of technocratic childbirth—routines that can be insensitive, unnecessary, and even unhealthy? This book is a second edition of the text. The new preface in this edition makes it clear that the issues surrounding childbirth remain as controversial as ever. The book analyzes the technocratic method of birth, its cultural variations and alternatives, and obstetric training and women's experiences in Western culture. It covers ritual and how it is used in obstetrics, and compares the technocratic and holistic paradigms of childbirth. The book demonstrates the linkages between American core values concerning technology and expertise, and prevailing obstetrical practices.
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