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1343
Journal for Re Attach Therapy and Developmental Diversities
eISSN: 2589-7799
2023 August; 6 (10s2): 1343-1348
https://jrtdd.com
Spirituality and Psychological Wellbeing During Pregnancy and
Childbirth: A Review of the Literature
1Manar Abu-abbas, 2Ibrahim R. Ayasreh, 3Yasmeen Abu
Sumaqa,4Sajeda Alhamory, 5Tamador Raked Al Tarawneh,
6Mohammad Othman Abudari, 7Haitham Khatatbeh, 8Suad
Sadi Jakalat,
1Assistant professor, Faculty of Nursing, Jerash University, Jerash, Jordan.
manar.abuabbas@jpu.edu.jo, orcid ID: 0009-0008-7855-1546
2Assistant professor, Faculty of Nursing, Jerash University, Jerash, Jordan.
ibrahim.ayasrah@jpu.edu.jo
3Assistant professor, Faculty of Nursing, Zarqa University, Zarqa , Jordan.
yabusumaqa@zu.edu.jo, orcid ID: 0000-0003-2367-3569
4Assistant professor, Faculty of Nursing, Al-Zaytoonah University, Amman, Jordan.
5Clinical Instructor, Faculty of Nursing, University of Mutah , Alkarak , Jordan.
6Assistant professor, Arab Emirates, Fatima College of Health Science, Al Ain, United Arab
Emirates. M-abudari@yahoo.com
7Assistant professor, Faculty of Nursing, Jerash University, Jerash, Jordan.
Haitham.Khatatbeh@jpu.edu.jo
8Faculty of Nursing, Al-Balqa Applied University, Amman, Jordan.
Received: 19- June -2023
Revised: 02- July -2023
Accepted: 10- August -2023
Abstract
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.
Keywords: Psychological wellbeing, Spirituality, Pregnancy, Childbirth.
Introduction
Spirituality is a main domain need to be in consideration, it is more than an aesthetic part of human`s life, it is
considered a central part of human`s wellbeing and holistic care (Goyal et al., 2019; Hemmati et al., 2019; Hodapp
and Zwingmann, 2019; Mertha, 2020). Spirituality effect is obvious on several aspects of health; however,
highlighting spirituality effect during pregnancy is necessary. Recent literature witnessed a growing interest in the
spirituality during pregnancy and childbirth (Abu-abbas, Khalaf and Abu summaqa, 2022; Abu-abbas, Khalaf and
Al-Shraydeh; 2022).
Several studies found spirituality a critical source for coping with illnesses, an integral part of quality of life and
a source of better mental wellbeing (Burlacu et al., 2019; Hemmati et al., 2019; Piccinini et al., 2021;
Rathakrishnan et al., 2022). In addition, spirituality was considered a central factor in palliative care during
chronic and terminal diseases, and was found an effective factor resulted in better prognosis and positive outcomes
(Dinapoli et al., 2022; Goyal et al., 2019; Mertha, 2020; Sharif and Ong, 2019; Ozveren and Kırca, 2019).
Specifically, the importance of spirituality among childbearing women is valued and it was considered an
important component of perinatal health (Callister and Khalaf, 2010; Rathakrishnan et al., 2022; WHO, 2018).
Several complications such as caesarian section, the use of intrapartum analgesia and assistive procedures and the
incidence of post-partum depression could be minimized when providing spiritual support (Abdollahpour and
khosravi; 2018; OBoyle et al., 2017).
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Journal for Re Attach Therapy and Developmental Diversities
eISSN: 2589-7799
2023 August; 6 (10s2): 1343-1348
https://jrtdd.com
Recently, there is a global trend toward the use of spirituality as a complementary non-medical and alternative
management factor to maintain psychological wellbeing perinatally (Chehrazi et al., 2021; Haghighat et al., 2018;
Kamali et al., 2018; Nourimand et al., 2020). Yet there is still little research focusing on spirituality and its effect
on pregnancy, and little is known about the indicators that maintain maternal mental wellbeing (Field, 2017).
Spirituality during pregnancy and childbirth
Pregnancy and childbirth are critical phases that childbearing women encounter. Considering the multiple physical
and psychological changes of pregnancy, sever health problems could occur if this period is not managed properly
(WHO, 2018). Antenatal care is a holistic approach of care; including the physical, psychological, social and
spiritual care (Australian government, Department of health, 2019; Mitchell, 2014; OBoyle et al., 2017; WHO,
2018).
Specifically, spiritual midwifing is an overarching theme that emerged from an international cooperative inquiry
and reflected the existential significance and meaningfulness of childbirth (Crowther et al., 2020). Wojujutari
(2018) discussed the issue of ritualizing pregnancy and childbirth as a spiritual experience in secular societies
including the five dimensions of spirituality; moral, majestic, mysterious, questions of meaning and unifying with
the other or something outside of self. OBoyle et al. (2017) found that providing spiritual support during childbirth
decreases caesarian section incidence and the use of intrapartum analgesia and prevents several complications and
assistive procedures.
During Covid-19 pandemic, Nodoushan et al. (2020) investigated spiritual health among 560 pregnant women;
study findings revealed that the majority of pregnant women had high levels of stress and low levels of spiritual
and psychological well-beings, which leads to an increase in the risk of preterm delivery and unhealthy births.
Collectively, most of the evidences showed the inverse correlation between spirituality and stress during
pregnancy, which adds to the body of knowledge spirituality importance in maternal stress management.
Specifically in a multidimensional study in Brazil, Piccinini et al. (2021) conducted 160 pregnant women to
investigate the effect of religious and spiritual beliefs on several indicators; it was found that negative religious
and spiritual coping were associated with higher levels of depressive, anxious and stress symptoms and worse
physical and psychological quality of life. On the other hand, Athan et al. (2015) studied spiritual beliefs of
mothers who had distressing pregnancies. Authors found that women who held attributions of God as loving,
knowable and residing within the self, witnessed lower levels of anxiety, depression and perceived stress and
higher levels of social support, these meanings represented in spirituality as a more general concept opposing
considering God as a supreme being who was judging (Athan et al., 2015).
Spiritual intelligence is another concept associated with spirituality; Wojujutari et al. (2018) studied it in Nigeria
by collecting data from 348 pregnant women using the spiritual intelligence self-report inventory that include
human capacity to ask questions about the ultimate meaning in life. Results of the study showed the significant
moderation role of the spiritual intelligence on the relationship between psychological well-being and maternal
psychosocial adjustment (Wojujutari et al., 2018). Moreover, another study in Iran conducted pregnant women
using the spiritual well-being and DASS (Depression, Anxiety, Stress) questionnaires, Nourimand et al. (2020)
considered spirituality an integral part of the quality of life and a central factor during pregnancy for mental health
(Nourimand et al., 2020). The study used a general measurement instrument regarding anxiety rather than a
specific prenatal anxiety scale.
Using multi-stage sampling technique among 200 pregnant women, the relationship between maternal-fetal
attachment and spiritual well-being showed a positive correlation (Zahrani et al., 2020). Moreover, Dokuhaki and
Ghodrati (2019) conducted a unique study among primiparous women and their infants; maternal religious
attitudes affect fetal mental health by using specific newborns mental health indicators.
Spirituality was considered as one of the associated factors which decreases the incidence of postpartum
depression (Abdollahpour and khosravi; 2018; Clements et al., 2016; Cheadle and Schetter, 2018). Specifically,
Cheadle and Schetter (2018) conducted 2399 women who had symptoms of post-partum depression to participate
in interviews at three time points over 15 months. Cheadle and Schetter (2018) found that higher levels of
spirituality lead to better maternal mental health and emotional wellbeing after childbirth; psychosocial resources
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Journal for Re Attach Therapy and Developmental Diversities
eISSN: 2589-7799
2023 August; 6 (10s2): 1343-1348
https://jrtdd.com
of mastery, self-esteem, and optimism were the mechanisms linking religiousness and spirituality with the
symptoms of postpartum depression (Cheadle and Schetter, 2018). Consistently, Clements et al (2016), in another
similar study, found that social support and religious commitment predict depressive symptoms during pregnancy
and after childbirth; Clements et al. (2016) measured social support using Prenatal Psychosocial Profile while
religious commitment was measured using Religious Surrender and Attendance Scale. Consequently, it is strongly
evident the effect of spirituality on maternal mental wellbeing during pregnancy and in the postpartum period;
studies revealed the significant association between spirituality and several variables related to psychological
wellbeing by using various measurement methods.
Psychological wellbeing during pregnancy and childbirth
Stress during pregnancy affects women`s physical and psychological wellbeing, therefore, stress management
strategies is essential to promote maternal health, one of the protective and adaptive coping strategies is spirituality
which provides pregnant women with the ability to mitigate stress and its consequences and adapt well during
difficulties (Jenna et al., 2021). In their structural model, Dolatian et al. (2017) and his colleagues, found that there
was a significant effect for spirituality and psychological well-being in reducing pregnancy-specific stress.
Additionally, Dilgony et al. (2016) studied same correlation previously in 2016 in Iran among 450 pregnant
women and they confirmed same results. Furthermore, Foruzandeh et al. (2019) found the predictive role of
spiritual well-being for the pregnancy-specific stress. Contradictory, in a cross sectional study which was done in
the USA among Hispanic pregnant and postpartum women, it was found that religiousness and spirituality was
associated with increased perceived stress (Mann et al., 2010).
Spirituality and psychological wellbeing is highly correlated; according to a qualitative study in Iran, women
described their experiences of pain during childbirth as a time for psycho-spiritual transcendence reflecting the
need for engaging spirituality in maternity care (Taghizdeha et al., 2017). In addition, Mutmainnah and Afiyanti
(2019) investigated the experience of spirituality among Muslim pregnant women in Indonesia. The main themes
of the study were; submission to God makes it easier to overcome pregnancy and childbirth, spiritual stories
enhances confidence and motivation, remembrance of God is a way of self-control and overcoming anxiety and
labor pain and, finally, faith raises self-confidence during labor and help to overcome the challenge of pregnancy
and childbirth (Mutmainnah and Afiyanti, 2019). Study themes reflect the strong power that women have when
they increase their level of spirituality.
On the other hand, life satisfaction is a health related concept that was studied with spiritual wellbeing by Niaghiha
et al. (2019), cluster-sampling technique was used to select 160 pregnant women from the health care centers in
Iran. Scales of: Diener Life Satisfaction, Vaux Social Protection and Dehshiri Spiritual Well-being were used for
data collection, and the study results showed the positive strong correlations between life satisfaction, social
support, and spiritual well-being, taking into account the mediating role of social support (Niaghiha et al., 2019).
Researchers investigated spirituality during pregnancy using randomized clinical trials as a strong research
method to explore its effect on other variables. Haghighat et al. (2018) found a significant effect of spiritual
counseling on stress and anxiety among 112 pregnant women. Kamali et al. (2018) found a significant effect of
spiritual care education on postpartum stress disorder among 72 women with preeclampsia. Moradi et al. (2022)
found that the integration of spirituality into prenatal care using group counseling which include spiritual contents,
improve sleep quality and reduce insomnia severity during pregnancy.
Adanikin et al. (2014) found that 75.8% of the pregnant women reported the need for spiritual integration during
pregnancy and childbirth. Even though, Crowther and Hall (2015) in their investigation found that the introduction
of spiritual care guidelines into pregnancy and childbirth health care practice do not address spiritual meaningful
significance of childbirth. Collectively, there is an evidence-based recommendation, indicating the importance of
providing spiritual care during antenatal care to maintain maternal psychological wellbeing (Chehrazi et al., 2021;
Foruzandeh et al., 2019; Nourimand et al., 2020). Health care professionals are responsible to engage spirituality,
provide consultation about its benefits and to implement effective spiritual strategies and educational training for
pregnant women at the clinical settings (Chehrazi et al., 2021; Nourimand et al., 2020).
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eISSN: 2589-7799
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References
[1] Abdollahpour and khosravi (2018). Relationship between Spiritual Intelligence with Happiness and Fear of
Childbirth in Iranian Pregnant Women. Iran Journal Nursing Midwifery Research; 23(1): 45–50. doi:
10.4103/ijnmr.IJNMR_39_16.
[2] Abu-abbas, Khalaf and Abu-Summaqa (2022). Psychological Aspects of Health during Pregnancy: a
Comparative Critical Review, Before, During and After Covid-19 Pandemic. Journal of Positive School
Psychology, 6(9), 1984-1994
[3] Abu-abbas, Khalaf and Al-Shraideh (2022). The Effect of Spiritual Interventions on the psychological
aspects, stress and quality of life during pregnancy: a Systematic Review of Randomized Clinical Trials.
Turkish Journal of Physiotherapy and Rehabilitation; 32(3), 2651-4451
[4] Adanikin, Onwudiegwu and Akintayo (2014). Reshaping maternal services in Nigeria: any need for spiritual
care?. Pregnancy and Childbirth; 14:196 http://www.biomedcentral.com/1471-2393/14/196
[5] Athan, A., Chung, S. and Sawyer Cohen, J. (2015). Spiritual beliefs of mothers with potentially distressing
pregnancies. Spirituality in Clinical Practice, 2(3), 216–232. https://doi.org/10.1037/scp0000069
[6] Australian government, Department of health (2019). Clinical practice guidelines; Pregnancy Care. Canberra
[7] Burlacu, Artene, Nistor, Buju, Jugrin, Mavrichi and Covic (2019). Religiosity, spirituality and quality of life
of dialysis patients: a systematic review. International Urology and Nephrology; 51(5):839–850 doi:
10.1007/s11255-019-02129-x.Caton (2021). The impact of spirituality, social support, and self-esteem on
the resilience of Haitian nurses: Implications for nursing education. Archives of Psychiatric Nursing; 35,
206-212. https://doi.org/10.1016/j.apnu.2020.08.006
[8] Callister, L. C. and Khalaf, I. (2010). Spirituality in childbearing women. The Journal of perinatal
education, 19(2), 16-24 doi: 10.1624/105812410X495514
[9] Cheadle & Schetter ( 2018). Mastery, self-esteem, and optimism mediate the link between religiousness and
spirituality and postpartum depression. Journal of Behavioral Medicine, 41:711–721
https://doi.org/10.1007/s10865-018-9941-8
[10] Chehrazi, Faramarzi, Abdollahi, Esfandiari and Shafie (2021). Health promotion behaviours of pregnant
women and spiritual well-being: Mediatory role of pregnancy stress, anxiety and coping ways. Nursing open;
8 (6), 3558-3565
[11] Clements , Fletcher, Childress, Montgomery and Bailey (2016). Social support, religious commitment, and
depressive symptoms in pregnant and postpartum women. Journal of Reproductive and Infant Psychology;
34 (3), 247–259 http://dx.doi.org/10.1080/02646838.2016.1152626
[12] Crowther, Stephen &Hall (2020) Association of psychosocial–spiritual experiences around childbirth and
subsequent perinatal mental health outcomes: an integrated review, Journal of Reproductive and Infant
Psychology, 38:1, 60-85, DOI: 10.1080/02646838.2019.1616680
[13] Dilgony, Dolatian, Shams, Zayeri and Mahmoodi (2016). Correlation of spirituality and psychological well-
being with pregnancy-specific stress. Journal of Reaserch on Religion & Health; 2(4), 35- 43
[14] Dinapoli et al. (2022). Resilience, spirituality and survival outcome in glioblastoma patients after
radiotherapy. Radiotherapy and oncology; 170 (1), 203 https://doi.org/10.1016/S0167-8140(22)02796-7
[15] Dokuhaki and Ghodrati (2019). Investigation of Relationship Between Maternal Religious Attitude and
Mental Health of Infant at Birth. Women Health Bull, 6(3):e93292. doi: 10.5812/whb.93292
[16] Dolatian, Mahmoodi, Dilgony, Shams and Zaeri (2017). The Structural Model of Spirituality and
Psychological Well-Being for Pregnancy-Specific Stress. Journal of Religion and Health; 56:2267–2275
DOI 10.1007/s10943-017-0395-z
[17] Field (2017). Prenatal anxiety effects: A review. Infant Behavior and Development. 49, 120-128.
http://dx.doi.org/10.1016/j.infbeh.2017.08.008
[18] Foruzandeh, Foruzandeh, Darakhshandeh, Deris, Jalaly, Jaafary and Delaram (2019). The Role of Spiritual
Well-being in Predicting Pregnancy-Specific Stress. Journal of Health and Care; 20 (4), 292-300 DOI:
10.29252/jhc.20.4.292
[19] Goyal, Lp, Salsman and Avis. (2019). Spirituality and physical health status: a longitudinal examination of
reciprocal effects in breast cancer survivors. Supportive Care in Cancer, 27(6):2229–2235 doi:
10.1007/s00520-018-4494-5.
1347
Journal for Re Attach Therapy and Developmental Diversities
eISSN: 2589-7799
2023 August; 6 (10s2): 1343-1348
https://jrtdd.com
[20] Haghighat et al. (2018). The Effect of Spiritual Counseling on Stress and Anxiety in Pregnancy: A
Randomized Controlled Clinical Trial. Iran Red Crescent Medical Journal, 20(4). doi: 10.5812/ircmj.64094
[21] Hemmati et al. (2019). Religion, Spirituality and Risk of Coronary Heart Disease: A Matched Case–Control
Study and Meta-Analysis. Journal of Religion and Health, 58(4):1203–1216 doi: 10.1007/s10943-018-0722-
z.
[22] Hodapp and Zwingmann (2019). Religiosity/Spirituality and Mental Health: A Meta-analysis of Studies
from the German-Speaking Area. Journal of Religion and Health, 58(6), 1970–1998 doi: 10.1007/s10943-
019-00759-0.
[23] Kamali Z, Tafazoli M, Ebrahimi M, Hosseini M, Saki A, Fayyazi-Bordbar et al. (2018). Effect of spiritual
care education on postpartum stress disorder in women with preeclampsia. Journal of Education and Health
Promotion; 7 (73). DOI: 10.4103/jehp.jehp_170_17
[24] Kamali Z, Tafazoli M, Ebrahimi M, Hosseini M, Saki A, Fayyazi-Bordbar et al. (2018). Effect of spiritual
care education on postpartum stress disorder in women with preeclampsia. Journal of Education and Health
Promotion; 7 (73). DOI: 10.4103/jehp.jehp_170_17
[25] Mann, McKeown, Bacon, Vesselinov and Bush (2008). Religiosity, spirituality and antenatal anxiety in
Southern U.S. women. Archives of Womens` Mental Health; 11: 19–26 DOI 10.1007/s00737-008-0218-z
[26] Mertha, Palmer Kelly, Hyer, Mehta, Agne, Deans, Fischer and Pawlik (2020). Patient perceptions about the
role of religion and spirituality during cancer care. Journal of religion and health; 59 (4), 1933-194
[27] Mitchell (2014). Women’s use of complementary and alternative medicine in pregnancy: A search for
holistic wellbeing. Women and Birth; 27: 276–280 http://dx.doi.org/10.1016/j.wombi.2014.06.011 1
[28] Moradi, Maleki and Zenoozian (2022). The Efficacy of Integrating Spirituality into Prenatal Care on
Pregnant Women’s Sleep: A Randomized Controlled Trial. BioMedical Research International, 4295761,
https://doi.org/10.1155/2022/4295761
[29] Mutmainnah and Afiyanti (2019). The experiences of spirituality during pregnancy and child birth in
Indonesian muslim women. The Second International Nursing Scholar Congress; 29(2), 495-499
DOI: 10.1016/j.enfcli.2019.04.074
[30] Niaghiha, Baglooei, Mafi and Taherpour (2019). Spiritual well-being and life satisfaction in pregnant
women: The mediating role of social support. Social and Health Behaviors; 2, 83-88. DOI:
10.4103/SHB.SHB Taghizdeha, Ebadib, Dehghanic, Gharachehd and Yadollahi (2017). A time for psycho-
spiritual transcendence: The experiences of Iranian women of pain during childbirth. Women and Birth; 491-
496 http://dx.doi.org/10.1016/j.wombi.2017.04.010_11_19
[31] Nourimand et al. ( 2020). Studying the Correlation between Spiritual Well-Being and Religious Attitude
with Mental Health and Quality of Life in Pregnant Women. Public journal of medical health, 14(1),681-
684
[32] Oboyle, Brady and Timmins (2017). Making space for spirituality in childbirth. Journal of clinical nursing,
2823-2825, https://doi.org/10.1111/jocn.13795
[33] Ozveren and Kırca (2019). Influence of Palliative Care Training on Last-Year Nursing Department Students’
Perception on Regarding Spirituality and Spiritual Care: A Single-Group Pretest–Posttest Intervention
Study. Journal of Religion and Health; 58(3):860-869. doi: 10.1007/s10943-018-0701-4.
[34] Piccinini, Almeida, Ezequiel, Fajardo, Lucchetti and Lucchetti (2021). Religiosity/Spirituality and Mental
Health and Quality of Life of Early Pregnant Women. Journal of Religion and Health; 60, 1908–1923
https://doi.org/10.1007/s10943-020-01124-2 doi: 10.1007/s10943-019-00907-6.
[35] Rathakrishnan B, Singh S.B, Yahaya A, Kamaluddin M.R and Aziz S.A (2022). The Relationship Among
Spirituality, Fear, and Mental Health on COVID-19 Among Adults: An Exploratory Research. Frontiers in
Psychology 12:815332. doi: 10.3389/fpsyg.2021.815332
[36] Sharif and Ong (2019). Education Moderates the Relationship Between Spirituality with Quality of Life and
Stress Among Malay Muslim Women with Breast Cancer. Journal of religious health; 58, 1060-
1071 https://doi.org/10.1007/s10943-018-0587-1
[37] WHO (2018). WHO recommendations on antenatal care for a positive pregnancy experience. World Health
Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
[38] Wojujutari, Alabi, Emmanuel and Olugbenga (2018). Spiritual Intelligence and Mindfulness as Moderators
of Relationship between Psychological Well-Being and Psychosocial Adjustment of Pregnant Women.
1348
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2023 August; 6 (10s2): 1343-1348
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Journal of Women's Health Care; 7(3) DOI: 10.4172/2167-0420.1000435
[39] Zahrani, Rafiei, Hajian, Majd and Izadi (2020). The Correlation between Spiritual Health and Maternal-Fetal
Attachment Behaviors in Pregnant Women Referring to the Health Centers in Qazvin, Iran. International
journal of community based nursing and midwifery ;8(1), 84-91. doi: 10.30476/IJCBNM.2019.81668.0.
