Spirituality in Birth: Creating
Sacred Space within the Medical Model By Jennifer N. Ayers-Gould, BA LPN ICCE
International Journal of Childbirth Education,
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 The warmth of human touch has been
replaced by the cold, inanimate presence of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
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
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
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
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.
Balaskas, J. 1992. Active birth:
The new approach to giving birth naturally.
Boston: The Harvard Common Press.
Balaskas, J. 1994. Preparing
for birth with yoga. Rockport, MA: Element,
Capacchione, L., and
S. Bardsley. 1994. Creating a joyful birth
experience. New York: Fireside.
Gaskin, I. 1990. Spiritual
midwifery, third edition. Summertown, TN: The
Book Publishing Company.
Goer, H. 1995. Obstetric
myth versus research realities: A guide to
the medical literature. Westport, CT: Bergin
Harper, B. 1994. Gentle
birth choices: A guide to making informed decisions
about birthing centers, birth attendants, water
birth, home birth, hospital birth. Rochester,
VT: Healing Arts Press.
Hopkins, J. 1999. Welcoming
the soul of a child. New York: Kensington Publishing
Sears, W., and M. Sears.
1994. The birth book: Everything you need to
know to have a safe and satisfying birth. Boston:
Little, Brown, and Company.
Wagner, M. 1994. Pursuing
the birth machine. Campersdown, NSW, Australia:
ACE Graphics .