Spirituality in Birth: Creating
Sacred Space within the Medical Model
By Jennifer N. Ayers-Gould, BA LPN ICCE
International Journal of Childbirth Education, March 2000
As our culture has taken leaps and bounds in the arena of technology, we have distanced ourselves from the ancient treasures of humanity. The warm embraces and meaningful gazes, shared songs and stories, and handwritten letters and love poems have all been replaced--advanced some would say--toward the age of modernization. The activities which once were a demonstration and reminder of our humanity have been replaced with the new tools of "communication": fax, e-mail, cellular phones, pagers, and computer-generated greetings. The warmth of human touch has been replaced by the cold, inanimate presence of electronic media. The very traits which define our humanity have been left behind for what we have been led to believe is the faster, better, more modern approach to living. In the absence of human interaction, person-to-person contact, we lose that which by its very nature makes us human and find ourselves looking for something to fill this void in our soul.
The greatest act of humanity is the birth of a child. Yet even that has become the victim of technology. The medical model has taken upon itself to dehumanize the sacred act of birth. Pregnant women are treated as though they have a "medical condition" which requires "treatment." From the very beginning of their pregnancy, they are socialized to believe that the blessed event of birth cannot be done in the absence of medical care, that birth can only safely be accomplished within the walls of the hospital. Childbirth education classes stress the technical aspects of birth, analyzing and defining each week of pregnancy and each stage of labor, and of course, going into detail about all the medical interventions the woman may undergo once she arrives in the hospital. But, then again, these are the things women want and expect to hear at childbirth preparation classes. We also cannot neglect to mention the most important aspect of our duties as educators: we must teach the women how to breathe.
The only way to change women's expectations of the birth experience is to change the societal influences which instill these expectations and beliefs. We can do this through education. We need to stop perpetuating the myths. We must not continue to profess medical truths which have no basis in research. We cannot convey an opinion as fact. We must be a light on the path, guiding pregnant women not to where they think they should go, but to the way they must go. We must teach not what is part of the hospital's agenda, nor the doctor's possible outdated practices, we must teach truth.
It has been clearly demonstrated that human beings have three distinct levels, all of which need to be equally addressed by health care professionals. This is the holistic approach: acknowledging and caring for the mind, body, and spirit. If one of these aspects is deficient, the whole being suffers. The traditional and long-practiced medical model seems to put almost its entire emphasis on the physical aspect of being. It may address the mind and spirit from the viewpoint of psychiatric concerns and disorders, but it fails to recognize and nurture the healthy, real presence of mind and spirit. By viewing pregnancy as a disease and birth as an illness, it is implying that something is "wrong" with the body that needs to be "fixed." This "problem" with the body is the main focus of prenatal care and birth. The body is emphasized almost completely, leaving the mind-spirit aspect unbalanced, unaddressed, and uncared for. The body is separated from the whole entity and, by doing so, becomes dehumanized.
How exactly should we address the holistic view, and how does it apply to pregnancy and birth? First let us look at the mind: the center of cognitive thought, conscious decision-making, and the acquisition of factual information. Each person has a different capacity and method for using mental energy. Variations must be considered. Those with learning disabilities or educational deficits, as well as those individuals with higher than average intellect, must be accommodated appropriately. Care must be taken to not insult anyone's intelligence, regardless of their level of mental capacity. The "mind" portion of holism includes the areas of psychology, intelligence, and the ability to receive and utilize informed consent regarding their care.
Secondly, let us acknowledge the body: the physical, tangible vehicle of the soul. We are familiar with the anatomy, physiology, biology, and pathology of the physical body. We are taught to assess, diagnose, treat, and evaluate based on objective physical signs. The deviations from the "normal" body are emphasized as part of the medical model. Neglected are the needs of the physical body for human interaction which includes the utilization of the senses in the experience of living. We need touch, human tenderness, and warmth--a hand to hold. Our bodies crave sensory stimulation via sight, sound, taste, and smell. This is how we perceive our environment and create meaning in our lives. The cold touch of a stethoscope and the sterile white walls of a private hospital room are not what our bodies need to be nurtured and truly cared for.
Thirdly, let us examine perhaps the most elusive and difficult to define, not to mention the most neglected member of the holistic model, the spirit. The spiritual aspect of our being encompasses emotion, intuition, faith, life-force, our eternal being, and immortality. It acknowledges that we are magnanimous beyond which is readily apparent, that there is a greater force outside of ourselves which is also within ourselves. It is intrinsically unique to each person. Its presence is validated through faith, the belief in that which cannot be seen. The medical model operates on exactly the opposite viewpoint and will not begin to accept the spiritual aspect of humanity until it can own the concept of faith and treat people placing as much emphasis on the tangible, provable physical as on the abstract, theoretical properties of mind and spirit. Only then will there be balance--acknowledgment and treatment of the human being as a whole.
Part of what makes up our humanity and gives each of us individuality is our social, cultural, and religious beliefs. These are the experiences we share in community with our family and friends which give meaning to our existence. We share in symbolic traditions and rituals. The health care professional must not only be tolerant of these unique and sometimes "strange" behaviors, but we must also be understanding of the purpose behind them. Specific areas where cultural variations must be addressed and accepted are dietary concerns, social customs, language barriers, family structure, superstitions and beliefs, the use of amulets, charms, or other sacred/symbolic objects, and prevailing attitudes toward the Western medical model of care. We must nurture the practice of social, cultural, and religious practices in the birth setting. Culture is not just about ethnicity, but about regional social practices. Generalizations about specific ethnic groups do not serve to show appreciation for diversity within these groups. It is advisable to gain applicable knowledge about the larger populations of culturally distinct groups, such as their widely-held beliefs and practices. If in doubt, ask. Show an interest in learning about a person's specific beliefs. Show them you care about them as an individual and strive to meet the needs of each individual for who they are.
The birth of a child is a great rite of passage in many cultures. The act of birth is a role transformation for the entire family. It creates mothers, fathers, brothers and sisters, grandparents, aunts, uncles, and cousins. It is celebrated in many diverse ways. There can be formal religious ceremonies, spontaneous songs, prayers, rituals, or other customary practices. There may be superstitious beliefs about what the mother should eat, what she should wear, and/or how the mother and baby should be cared for. As long as these practices are not harmful to mother or baby, there should be no opposition in catering to the cultural needs of the birthing family. By understanding these needs and supporting their practice, we validate the birthing family's importance. We celebrate their humanity and their spirit.
This transition into parenthood and the celebration of a new life is not a medical event, but a spiritual event. What makes birth spiritual? It is the transcendence of a hope and a dream into a real, living being. It is the creation of life. The origin and source of life are a scientific mystery. It cannot be artificially created or controlled. The existence of a soul cannot be contrived. It is the significance of one being created from the physical, spiritual, and mental union of two. The physical act of birth requires great strength and stamina. The intense demands on the entirety of the laboring woman's being bring forth the reward of life. The pain she feels is not that of stubbing a toe or twisting an ankle. This pain is not a warning sign to the brain that something is "wrong." This is pain with a purpose. This pain is empowering and life-giving. This pain is transforming. It ultimately strengthens the woman and brings her the wisdom that has been passed down from woman to woman throughout all time. Birth is ancient and new. Its spiritual significance is beyond that which the medical community is even beginning to recognize, yet it is undeniable.
The meaning of birth is unique to each woman. It is personal. It is an "owned" experience which is dependent on past experiences and current life situations with which the woman is faced. Influences which create the meaning of birth and its implications include meaningful relationships (both positive and negative), previous birth experiences, previous encounters with the medical model, cultural/ethnic/religious beliefs, socioeconomic status, educational level, psychological integrity, physical characteristics and limitations, personality type, and the sum of all other external environmental influences. As part of prenatal care and history-taking, these influences and expectations regarding the birth experience must be acknowledged. Care must be taken to adapt the woman's care to her specific needs.
How do we educate about the spiritual impact of birth? By following the holistic model of care, it is imperative that the spiritual aspect is addressed. Otherwise, we are neglecting one-third of the human experience. We are only reaching one or two-thirds of the whole being. We can educate on the spiritual level when we recognize cultural/ethnic/ religious concerns. We need to provide knowledge of how to bring personal meaning to the birth experience. We must address and encourage emotional expression as a natural part of the birth process. We have to validate the abstract ideas of spirituality and treat them with the same matter-of-fact approach as the concrete ideas we teach.
In order to convey the spiritual nature of birth and encourage our birthing families to experience it, we must provide families with specific ways of bringing spirituality to life in the process of birth. As with any type of learning, we begin with preparation. The preparation in this case begins as soon as the couple is even thinking about conceiving. While that is not always possible, it is important to begin the process of incorporating spiritual practices as early in the pregnancy as possible. in order to connect to the spiritual part of our being, we have to create specific goals which will allow us to do so. This includes making time and space for this to happen; making it a priority and having the self-discipline to put these practices into action on a regular basis. Ways of preparing and connecting include meditation, yoga, prayer, reading/reflecting, keeping a journal, individual and community worship, and communicating with the unborn baby.
Once the woman has learned to connect to her spiritual self, she will more easily be able to make that connection during the birthing process. It is imperative to have an environment conducive to nurturing this spiritual connection. Since we are specifically concerning ourselves with birth as it occurs within the medical model, we will concentrate on the environment that most women will find themselves in: the hospital. There are wide variations of hospital rooms in which the woman will give birth. it could be a sterile, instrument-filled delivery room, complete with stirrups. It may be a semi-private standard hospital room, separating laboring women by a curtain. It may be a labor room, a small room with or without a bathroom, the central focus being a labor bed in which the woman is expected to lie while attached to a fetal monitor and then after the birth be transferred to a postpartum room. It could be the labor-delivery-recovery-postpartum (LDRP) room, in which the woman labors, births, and recovers, a room made to look more like a hotel, yet having all the same underlying medicalization as the delivery room. Women want to birth in an environment which is most like home. Unfortunately, homebirth is not mainstream enough to afford all women that privilege. So, the LDRP has become the next best thing, albeit a long shot. The key factor here is comfort. The cozy wallpaper, lights with dimmer switches, rocking chairs, sofas, tables, and full-size beds make it less intimidating and more comfortable. If the woman is fortunate enough to remain in one room keeping with the concept of single-room maternity care (SRMC), instead of being admitted to a labor room, transferred to a delivery room, and then shipped off to a recovery room, she will reap the most benefit. Borrowing an idea from Celeste Phillips, look at how an animal gives birth: the mother cat finds a comfortable corner of the house, lies there, labors there, gives birth (without an epidural, I might add!), nurses her kittens immediately, waits patiently for the delivery of the placenta, cares for her kittens, and remains with them for several hours. She does not move from place to place for each stage of her labor, nor does she find a separate place for recovery or postpartum. She will only relocate if she feels threatened or fears for the safety of her kittens. The point being, it is inherent in nature that the birthing mother create a comfortable place and nest there as she brings forth the life that is within her. Let's stop defying our instincts and start listening to them.
There are many ways we can enhance and personalize the birth environment. The limitations, of course, being what is acceptable under hospital policy. Creating an environment means controlling what the senses perceive--the senses being the gateway between our environment and our mind, which leads to our spirit. Aromatherapy such as potpourri, candles, incense, essential oils, lotions, or perfumes stimulate the olfactory center, evoking pleasant and soothing sensations. Music, in the form of cassettes, CDs, a radio, or records permeates our auditory center, bringing peace and harmony to our being. Physical touch can be invigorating, healing, soothing, or even irritating, but just holding a hand may be enough to build the bond of human contact. Ways to recognize the sense of touch include massage, counterpressure, heat/cold application, position changes, freedom of movement, hydrotherapy (shower/ bath), comfortable clothing, and encouraging the woman's right to refuse any unnecessary medical procedures (for example, enema, shave, continuous or internal electronic fetal monitoring, amniotomy, episiotomy, narcotics, induction/augmentation). Controlling the amount of lighting may bring a calm in the midst of what may seem like a raging storm inside the woman's body. Familiar objects and pictures may give visual cues which promote relaxation. Objects the woman may want to surround herself with can include familiar pictures, posters, stuffed animals, pillows, blankets, favorite clothes, trinkets, figurines, or religious articles. Providing the woman with food and drink of her choice is a way to nourish her body as well as her soul.
Another option which the birthing woman may want to consider is who will be accompanying her during the labor and birth experience. Most hospitals have specific policies as to the number of people who may be present and may limit those people to only immediate family members. Ideally, there should be no limit on whom the woman could choose to surround her during this life-changing, miraculous event. She should have the right to be accompanied by the support people of her choice which may include a doula, spouse, parent, and/or child. Conversely, she may simply request to be left alone with no support outside of the medical staff. The environment created for birth is significantly influenced by the dynamics of human interaction.
How can hospitals incorporate spirituality into birth? First of all, stress the normalcy of birth. Separate the treatment of pregnant and birthing women from the treatment of medical-surgical patients. Unless the pregnant woman has a medical condition which must be addressed, birth itself should never be seen as an illness which requires medical treatment. The medical establishment is present to offer support and to prevent and treat complications which may arise. The hospital must provide education devoted to the emotional and spiritual aspects of birth as part of the standard prepared childbirth education program. The psychospiritual realm of birth must be seen as equally valid as the biological aspect. It is real. Pregnant women must be fully informed as to all their options for birth. They must be informed of the opportunity to participate in homebirth or utilize a birth center, if available and applicable, employ the use of midwives for low-risk pregnancies as opposed to obstetricians, and explore the possibility of water birth. They should be encouraged to use many position changes to promote a more physiologically appropriate second stage of labor. Health care organizations must provide truly family-centered maternity care. This includes single-room maternity care, keeping mothers and babies together at all times whenever possible, and policies which give birthing women more autonomy, control, and personalization over their birth environment.
The LDRP/SRMC should ideally include components which allow the widest variety of options to address the physical. mental, and spiritual elements of labor and birth. These may include a large bathroom with a shower and Jacuzzi tub, a stereo system which provides the ability to play cassettes, compact discs, and radio, TV and VCR, a bed for the support person(s) such as a convertible sofa, dining table and chairs, full-size bed for the laboring woman, dimmer control for lighting, blinds for windows, table lamp(s), temperature control, rocking chair, birth ball, small refrigerator with freezer, microwave, sink, coffee maker, soundproof walls, and a telephone. While not all these options may be feasible nor fiscally probable, it should be the goal of family-centered maternity care to provide the most comfortable and homelike atmosphere for the process of birth. This includes not only the external appearance of the facility, but the attitudes and actions of staff as well.
The ultimate goal in embracing the spirituality of birth is respecting the needs of each individual who comes to the hospital to give birth. The woman enters the institution and becomes a patient, yet she is still the consumer who is paying for the services rendered on her behalf. She must be fully educated and all her needs met. There must be a conscious effort to individualize care rather than generalize it. It is time to break routine and provide holistic care on every level. especially for the process which continues to mesmerize and amaze us, the miracle of birth. Let us honor it for all it is worth.
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