Spirituality in Childbearing Women

Abstract

Childbearing is the ideal context within which to enrich spirituality. The purpose of this study was to generate themes regarding spirituality and religiosity among culturally diverse childbearing women. A secondary analysis was performed, using existing narrative data from cross-cultural studies of childbearing women. The following themes emerged from the data: childbirth as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, childbirth as a time to make religiosity more meaningful, the significance of a Higher Power in influencing birth outcomes, and childbirth as a spiritually transforming experience. In clinical settings, understanding the spiritual dimensions of childbirth is essential. Assessments of childbearing women may include the question, “Do you have any spiritual beliefs that will help us better care for you?”

Spirituality and religiosity are recognized as important components of health and well-being. Women have used prayer and other spiritual practices for their own and others’ health concerns for thousands of years (National Center for Complementary and Alternative Medicine, 2005). Most current literature focuses on the spiritual health of individuals living with chronic illnesses and those who are terminally ill, whereas there is relatively little focus on spirituality or religiosity during the childbearing year. However, a recent study documented the relationship between religious involvement and health risk behaviors in childbearing women, concluding that such involvement was significantly correlated with less-risk health behaviors (Page, Ellison, & Lee, 2009). Although spirituality and religiosity may be related, women may be spiritual without being religious, and more research on this association is recommended.

Childbearing and motherhood may be ideal contexts in which to enrich spirituality. Moloney (2007) asserts that “cross-culturally and throughout history, pregnancy and childbirth have been perceived as spiritual events because of the miraculous processes involved” (p. 1). Birth narratives provide insights into the connection between childbearing and spirituality and present significant information (Callister, 2004b; Rosato et al., 2006). “Birth stories actually offer a powerful and rich source of data. Greater emphasis needs to be accorded to a valuing of women's stories as data” (Carolan, 2006, p. 66), which are typically collected for research using focus groups referred to as “talking circles” and interviews called “woman to woman listening” (Oakley, 2005, p. 225). Attending to women's spiritual experiences during childbearing is an important way to enhance care.

The purpose of the current study was to generate themes related to spirituality and childbirth by performing a secondary analysis of two decades of cross-cultural studies regarding the meaning of birth to diverse childbearing women. Because childbirth is a life experience endowed with rich personal meaning, defined as “the work of the spirit” (Trice, 1990, p. 248), it cannot be described adequately by quantitative means alone. Qualitative research humanizes health care, including childbirth education, and can be used to develop effective interventions (Zuzelo, 2007).

REVIEW OF THE LITERATURE

Themes related to spirituality in nursing and health science literature include spirituality as religion, spirituality as the meaning and purpose of life events, spirituality as connectedness to others and/or a Higher Power, spirituality as nonreligious values, spirituality as holism, and spirituality as self-transcendence (Cowling, 2008; Lemmer, 2005; Miller, 1995; Padela, 2007; Sessanna, Finnell, & Jezewski, 2007). Spirituality has been studied in Appalachian women (Burkhardt, 1994); battered women (Gillum, Sullivan, & Bybee, 2006; Humphreys, 2000); empowered women (Keene & Jenson, 1997); HIV-positive women (Sowell et al., 2000); older women (Learn, 1995); Hispanic women (Rojas, 1996); women with breast cancer (Chiu, 2000; Manning-Walsh, 2005); and women with end-stage renal disease (Tanyi & Werner, 2008).

An early ethnographic study focused on the sacred dimensions of childbearing (Balin, 1988). Nearly two decades ago, Sered (1991) asked, “Is childbirth a [spiritual]-religious experience?” (p. 7). Spirituality and religiosity have also been studied in childbearing women, including women living with HIV/AIDS who had faith that God would protect their child from becoming infected (Polzer Casarez & Miles, 2008; Siegel & Schrimshaw, 2001); Ghanaian women (Agovi, 2003; Farnes, Callister, Beckstrand, & Carlton, in press); Mormon women (Ashurst-McGee, 1997); and women experiencing a high-risk pregnancy (Breen, Price, & Lake, 2006). Religiosity is associated with attendance at religious services, congregational social support, religious coping practices, and belief systems; furthermore, religiosity may be distinct from women's levels of spirituality, which may not be formalized.

Perinatal bereavement and spiritual issues have been described (Cunningham, 1997). Dailey and Stewart (2007) focused on childbearing African-American women, including those who were coping with grief after an involuntary pregnancy loss, and found spirituality was a powerful ameliorating coping strategy. In a similar investigation, one study participant said, “We're taught that the only thing you need to do is get on your knees to pray and you'll be okay” (Van & Meleis, 2003, p. 32).

The effects of Islam and traditional practices on Turkish women's reproductive health have been described, with God seen as the “ultimate healer” (Bahar et al., 2005). A woman said when she was in labor, “I have ritual ablution, pray to God, [and] worship God when I leave home to go to the hospital” (p. 559).

In a study of 130 urban, low-income, expectant mothers, themes were generated related to the meaning of spirituality or faith during pregnancy (Jesse, Schoenboom, & Blanchard, 2007). The themes included having guidance and support from a Higher Power, receiving protection or blessing or reward for sacrificing to bear children, communicating with God, feeling a sense of strength and confidence in approaching birth, experiencing a sense of help with difficult moral choices, and having a generalized sense of well-being and peace.

Authors who conducted reviews of research regarding spirituality during pregnancy concluded powerful spiritual relationships exist between childbearing women and their unborn children (Hall, 2006; Hall & Taylor, 2004). The spiritual development of women experiencing their first pregnancy has been described: “I can imagine no time in adult life when the definition of one's self, one's worth, one's place in the universe and in God's creative providence is more focused toward becoming a new and special being than that which changes a girl into becoming a mother” (Baumiller, 2007, p. 7).

METHODS

For the present study, we performed a secondary analysis of published and unpublished descriptive narrative data from cross-cultural phenomenological studies that we conducted over the past 20 years with childbearing women espousing Christian, Jewish, and Islamic religious traditions and with childbearing women from countries in a variety of global regions (Australia; Europe; Middle East; North, Central, and South America; Southwest Pacific; Western, Northern, and Eastern Asia; and Western and Southern Africa). Trustworthiness of the data was established by performing member checks with study participants, reviewing field notes made when the interviews were conducted, and verifying the findings with a team of qualitative nurse researchers.

RESULTS

The majority of women in our study regarded childbearing as a spiritual experience. Nevertheless, one Australian woman did not view childbirth as a spiritual experience. She stated, “What's so spiritual about it? I just see it as a normal way of life. To me, spiritual is where you go to church and listen to the minister” (Callister, 2008). An Orthodox Jewish woman, however, said that childbirth would be a spiritual experience for her because, “We take spirituality and we infuse it into every aspect of our daily life” (Callister, Semenic, & Foster, 1999, p. 288). Though not all women in our study had a similarly spiritual outlook on their daily lives, most women resonated with the idea that childbirth is a time when spirituality was enhanced.

The themes we identified in all of the reviewed data included childbirth as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, and childbirth as a time to make religiosity more meaningful. Other themes included the significance of a Higher Power in providing blessings and influencing birth outcomes, and childbirth as a spiritually transforming experience.

Childbirth as a Time to Grow Closer to God

Several women were specific in their articulation that childbirth was a time of powerful connection to their God. For example, a Mormon woman described her birth experience in the following way:

The nurse had been so loud, like, “You can do it!”—cheering me on. And then right as she [the baby] was born, the nurse got quiet and the doctor got quiet and my husband got quiet. It felt honestly like a moment frozen, and the room was bright. It was one of those moments when the Spirit is there. (Callister, 1992a)

A Guatemalan mother shared a similar experience. She stated, “Giving birth I felt closer to God. I thank God for allowing me to have a baby. While the baby was in the womb, I realized how great God is” (Callister & Vega, 1998, p. 292).

Another Mormon woman expressed a heightened sense of holiness experienced during childbirth:

When the baby was born, I felt the Spirit of the Lord touch my heart, and I realized that this little innocent human soul came from my Heavenly Father. I felt so close to Him and thanked Him for the blessing I have of being a woman, of being able to assist in the creation of a child, and help him come from heaven to earth. (Callister, 1992a)

A Canadian Orthodox Jewish mother, for whom bearing a child was the highest mitzvah or good deed according to Rabbinical law, said, “You feel God's presence most tangibly when you have gone through [childbirth]” (Callister, 1994). Similarly, according to the religion of Islam and its adherents (Muslims), life experiences prove the oneness (tawhid) of Allah, or God. The deep spirituality of women who espouse the Islamic faith make the birth experience sacred. For example, an Arabic Muslim woman expressed the sense that she was one with God during labor and birth:

During childbirth the woman is in the hands of God. Every night during my pregnancy I read from the Holy Qur'an to the child. When I was in labor I was reading a special paragraph from the Holy Qur'an about protection. The nurses were crying when they heard what I was reading. I felt like a miracle might happen—that there was something holy around me, protecting me, something beyond the ordinary, a feeling, a spirit about being part of God's creation of a child. (Khalaf & Callister, 1997, p. 383)

A new Guatemalan mother also remarked on an almost tangible holiness:

[Giving birth] I felt closer to God. I thanked God for allowing me to have a baby. Well, I don't say she [the baby] is mine but that He let me borrow her. While the baby was in my womb I realized how great God is. Only God watches over the children that are yet in the womb because only He could do that. (Callister & Vega, 1998, p. 292)

Although the sense of God's presence and a feeling of closeness to God's power was a reality for many women during childbirth, some of the women identified the spiritual dimensions of childbirth while not espousing a specific religious faith (Callister et al., 2007; Kartchner & Callister, 2003). While some of these women said birth was not spiritual per se, they associated their emotions with a sense of transcendence. For example, a Chinese woman said, “It really isn't easy at all. Every mother experiences pain, but I do believe it is sacred” (Callister, 2007). A Finnish woman suggested that her birth experience was far more than physical, and that being centered and balanced gives women strength to negotiate childbirth. She advised, “Each mother should listen to herself, to her own body. Be calm and receptive, willing to take whatever comes” (Callister, Vehvilainen-Julkunen, & Lauri, 2001, p. 31).

The Use of Religious Beliefs and Rituals as Powerful Coping Mechanisms

The women described how their religious beliefs and accompanying rituals, such as prayer, served as helpful coping mechanisms during labor and childbirth. For example, a Tongan woman explained how her faith sustained her when giving birth:

When it got to the worst part of the pain that's when you look up to heaven for God's help. Sometimes during the labor I would cry out in pain and say, “Jesus, help me.” I felt like God was saving me as I gave birth. Whenever I need help I call on Jesus for help. (Callister, Khalaf, Semenic, Kartchner, & Vehvilainen-Julkunen, 2003, p. 149)

Similarly, a 26-year-old Ecuadorian mother of five said that during labor and birth, “I always give myself to God [in prayer]. I asked God to give me strength!” (Callister, 2009). Several Ecuadorian women spoke of praying to Narcisa de Jesús Martillo Morán, a Roman Catholic saint from Ecuador. One of the women said, “I asked God and the virgin [Narcisa de Jesús Martillo Morán] that everything would turn out good, and yes they helped. The virgin, I even saw her at my side” (Callister, 2009).

Childbirth as a Time to Make Religiosity More Meaningful

Women described how their religiosity was strengthened during pregnancy and childbirth. For example, a Tongan woman described how her religious faith became more meaningful as she was expecting a child: “During pregnancy was a good time to say a prayer and give thanks to the Lord. Tongan women believe that, during pregnancy, it is a good time to have spiritual experiences so that the baby will be created with a good body” (Callister, 2001). An evangelical Christian woman who had five children reported the importance of saying a prayer of thanksgiving after giving birth: “The Spirit of the Lord helped me a lot to give birth to each baby. It is important to the Tongan lady that the first thing they do after they give birth is to give thanks to the Lord” (Callister, 2001).

The Significance of a Higher Power in Providing Blessings and Influencing Birth Outcomes

Most of the women believed God can and will influence the outcomes of their pregnancy and birth. Many women reported relying on God for help to ensure positive birth outcomes. This theme was especially common among women living in developing countries where maternal and infant mortality rates were high. A Ghanaian woman explained that “this junction of life and death” is dangerous for both mother and child (Wilkinson & Callister, 2010). A Mexican immigrant mother described her reliance on the Lord for positive outcomes for herself and her child:

I would always ask God that He would take care of me and of my baby. The baby was born alive and healthy. I think it was because He was always helping me. My belief is that the baby was born healthy because I asked God and He listened. (Callister & Birkhead, 2007, p. 189)

One Guatemalan woman articulated her fears related to high infant and maternal mortality rates and the need to rely on God: “Having a lot of children is very difficult. It is a miracle that one comes out alive. Only God can save your life at that time [of birth]. It's hard. Many women die” (Callister & Vega, 1998, p. 292). A Tongan mother said, “I trust in the Lord. Sometimes I don't get support from my husband, but I trust in Heavenly Father to give me strength. I rely on the Lord to give me support when it comes to childbirth” (Callister, 2001). Another Tongan woman expressed her sense that “the most difficult part were the contractions. I could barely handle them. You need the help of the Spirit. The fruits of labor are the baby, who is a gift from God” (Callister, 2001).

A Ghanaian woman who gave birth to twins after a previous perinatal loss said, “I was not afraid. I left everything to God. As for me, I was not afraid because I knew God was in control” (Wilkinson & Callister, 2010). Another Ghanaian woman reported:

That period [of pregnancy] is the period of death and life and anything can happen. Some [women] go for delivery and they never come back. It is the time that I need spiritual protection from God, so I will pray to God so that God will be with me until I deliver and have a live baby and come home alive. (Callister, 2007)

Childbearing as a Spiritually Transforming Experience

Several women reported that childbirth was a powerful and spiritually transforming experience. A Finnish woman expressed the sense that giving birth to her first child was in many respects a rebirth, an opportunity for her to give birth to herself as a woman entering the new role of motherhood (Callister et al., 2001). Some women described a “connected” experience or feeling the power of creation when they gave birth. Dutch women described birth as a holistic experience characterized by judicious use of technology and nonpharmacological pain management. One Dutch woman said, “I felt so in touch with myself” (Johnson, Callister, Freeborn, Beckstrand, & Huender, 2007, p. 175). An Australian mother said:

I didn't think about childbirth being a spiritual experience at the time, but looking back I do. I think it's just the way you can connect with your baby in a way you've probably never connected with anything. It gives you a whole different perspective on your spiritual side. (Callister, Holt, & Kuhre, in press)

On the other hand, a South African mother reported an immediate sensation of spiritual transformation. When she gave birth, she felt the same way she felt in church, “because the baby is also coming from Heaven” (Callister, 1998). A Muslim woman said, “This pregnancy reminded me of God's ability to create a child. My faith increased” (Khalaf & Callister, 1997, p. 383). An Armenian mother reported:

I do think that birth is a spiritual experience. When you know where this child is coming from and that he is from God, it is more special. We are all spirits. Sometimes I feel that the child is not only mine but is a child of God. (Amoros, Callister, & Sarkisyan, 2010)

A Mormon woman described the spiritual transformation she experienced during pregnancy and birth: “The spirit of God's love just enveloped the whole situation. It was all through the whole pregnancy. It just felt good and right” (Callister, 1992a). A Russian mother articulated, “Labor and birth are spiritual experiences. Just the feeling that I did it—that I was able to give new life. That means a lot” (Callister, 2005). An Armenian woman described her birth experience in this way: “I think giving birth is a spiritual experience. Nothing happens without God. When the baby is born, it is like a light in the family” (Callister, 2004a).

A Mormon woman spoke of the awe she was prepared to experience during childbirth, and the transformation that she did ultimately have:

It's almost like a spiritual experience in a way. I had a feeling like I had done something right. [My mother told me] what a beautiful thing it was and how exciting that it was…[so] I concentrated on the positive side—that it was going to be a really neat spiritual experience. I can't believe I was blessed with a wonderful baby. I think it's made me really appreciate more of the spiritual side, the love that Heavenly Father has shown us. (Callister, 1992b, p. 55)

Being part of the creation of a child was viewed as spiritually transforming and very meaningful. A Mayan woman from Guatemala said, “There is no word to express the experience of giving birth…it is a gift and a privilege that God gives to women” (Callister & Vega, 1998, p. 293). A Mormon woman spoke of insights that came to her at the moment of birth:

I knew that God was happy with me for doing this, and that He wanted me to be the mother of this child. Not just a child, but this child. It was almost overpowering that this is one of God's children and He trusts me to take care of him. (Callister, 1992a)

These women shared a similar sense of personal transformation as a result of childbearing. Most of the women tied that transformation to a sense of spirituality or a Higher Power.

DISCUSSION AND IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH

The study's results affirm the work of King (1989), who concluded, “Motherhood is a rich and widely ramified concept linked to biological birth, to culturally learned patterns of mothering and to expressions of…spiritual insights of human experience” (p. 79). One cannot truly assess a childbearing woman without assessing her spirituality (Tanyi, 2006). Meraviglia (1999) suggested that “the spiritual dimension is thought to integrate all human dimensions: Mind, body, and spirit, for a sense of wholeness and well-being” (p. 19). Hispanic women often speak in terms of a person's soul or spirit (alma or espiritu) when referring to one's inner qualities and relationship with a Higher Power, which Sellers and Haag (1998) suggested is “the center or core of humanness” (p. 339). For many women who participated in our studies, childbirth was a sacred event.

Listening to the voices of culturally diverse childbearing women is an important spiritual intervention (Callister, 2004b), because sharing birth stories can be a significant experience for childbearing women. Hall and Taylor (2004) concluded, “When women tell their birth stories, they often do so in the language and framework of a spiritual experience, and they use terms such as ‘holiness’ and ‘miraculous’” (p. 45). Women share their storied experiences, and the “experience is enhanced by the telling of it…, [and] forming narratives also allows the teller to own the experience” (Ashurst-McGee, 1997, pp. 138, 142). Sered (1991) suggested, “For some women childbirth ‘feels’ spiritual and a number of women reported a heightened sense of holiness after birth. However, women lack the language to express that feeling. Even those who had a spiritual experience couldn't find language for it” (p. 16).

It would be valuable for childbirth educators to have a class reunion where new mothers can share their experiences. Another approach is to invite new mothers to submit a written narrative about their birth experiences to the childbirth educator.

Spiritual care includes presence, actively listening, helping women articulate their feelings about their birth experience, and sharing that experience by connecting (Eldridge, 2007). Researchers suggested, “Listening to women offers the best way to find common ground between what we as health professionals think is best and what women want [and need]” (Brems & Griffiths, 1993, p. 256). As Gardner (2008) noted, “Numbers are nice, but stories matter” (p. 108).

The Joint Commission, which accredits and certifies health-care organizations in the United States, includes spiritual assessment and care as part of its standards (The Joint Commission, 2008). It is essential for childbirth educators to recognize that spiritual care is significant (Dunn, 2009). Childbirth educators are encouraged to remember that spirituality is more than affiliation with a specific religious tradition and, as Adams and Bianchi (2008) suggested, “The laboring woman's spirituality or faith may serve as a source of inner strength and comfort during labor” (p. 109). The need has been identified to enrich the vision of spirituality in the provision of health care (McSherry, Cash, & Ross, 2004). Reed (2008) asserted that “spiritual care requires personal and practice-based knowledge beyond the forms of knowledge typically promoted in evidence-based practice…. Spiritual [care] is already inherently a process…of relating, trusting, connecting, listening, supporting, respecting” (p. 16).

Understanding the spiritual dimensions of childbirth helps childbirth educators provide holistic health care (Lauver, 2000), which has been described by Corrine, Bailey, Valentin, Morantus, and Shirley (1992). Assessment of childbearing women may include the question, “Do you have any spiritual beliefs [or religious practices] that will help us provide better care for you during your pregnancy and birth?” (Jesse et al., 2007, p. 158). Tending to childbearing women's spiritual needs in this way may improve their health care (Eldridge, 2007). After a woman gives birth, simply asking, “What was your experience like?” allows the woman to express tender feelings about the spiritual dimensions of her birth experience rather than just focusing on “the facts” of her birth (Callister, 2004b).

Curricula for childbirth education and nurses may include a focus on spirituality and childbirth (Callister, Bond, Matsumura, & Mangum, 2004; Mitchell, Bennett, & Manfrin-Ledet, 2006). Further exploration is recommended of the relationship between spirituality, religiosity, holistic health, and well-being in childbearing women (Dunn, 2009).

Childbirth and motherhood are ideal contexts in which to acknowledge the spiritual dimension of women's lives. Birth narratives can provide insights into the connection between childbearing and spirituality, and can be utilized as an effective intervention for childbirth educators.