From Issue No.97, Summer 2003
Nessa McHugh
The intention of this article is to focus on the spirituality of birth in an attempt to recognise how all the elements of birth can blend into a synergy of celebration that transcends the inadequacies of contemporary care systems.
For most women the main focus of birth is the physical reality that they anticipate. In the UK many of us may be familiar with the idea that birth is a psychophysiological drama that unfolds against the backdrop of technology, medicalisation and taboos.
The discourse of obstetrics now manages pregnancy and birth by institutionalising rigid time standards, carving procreative time up into increasingly more fragmented units, which are imbued with the potential for danger. (Simmonds 2002 p560)
Women and midwives negotiate their own expectations and hospital demands to enable good birth outcomes and experiences. When things go well we are successful in this negotiation but all too frequently women are left with feelings of dissonance, a sense that something somewhere is not quite right.
It just felt that something was missing, at first I was too preoccupied to notice but gradually it dawned on me that I should have felt more than this - I just felt empty. I was told that I had a mild depression, but I don't really think that I was depressed - I felt I'd allowed myself to be let down. (Sally talking about the birth of her first baby.)
Depression or distress following childbirth is now frequently recognised in Britain, although there are many differing views about the causes (Littlewood and McHugh, 1997). We have gradually changed from a society that was dominated by the church into a society that is dominated by medicine as a form of social control. Medicine operates as a powerful social force within western society, and medical terms and definitions are commonplace. When the outcome is traumatic, then the missing component is usually translated into a medical diagnosis. It could be argued that we are culturally conditioned to see any expression of negative emotion as pathological.
Mainstream religious traditions have focused on the cleansing and purity elements of birth through rituals such as churching. In contemporary Britain even such limited spiritual acknowledgment has faded away, and there is little recognition of the spirituality of birth. Where it does exist, spiritual expression remains most recognised only within a Christian context; there is little recognition of the needs of other religions and belief systems. Cultural customs such as sawa maheena are viewed as restrictive or women are left unsupported by midwives in the belief that their families will care for them. Many white British women in their move away from the Christian church have also moved away from any expression of spirituality. Other religious expressions of spirituality are not formalised or commonly recognised within the context of birth by many health care professionals. Contemporary Britain speaks the rhetoric of multi-cultural existence - but how does that translate into multicultural birthing practices?
Unless the flexibility that has been introduced as a result of the greater choice can accommodate the different choices that women from ethnic minorities may make, the whole process of childbirth will continue to be as rigid and alienating for them as it once was for all women. (Commission for Racial Equality, 1994, p9)
The clash between culture and medicine (and also of spiritual expression) occurs head on in the birthing room. Rites and rituals of obstetric practice overrule cultural, religious and spiritual expression. Women report feeling distanced from their spiritual selves by the processes of hospital care, this can leave women feeling alienated and vulnerable.
Midwives who themselves may have little sense of the spiritual have difficulty in recognising and supporting the spiritual needs of women from within their own culture. How well can they recognise the needs of women from different cultural backgrounds?
Do we now express spiritual dissonance as emotional distress? It would seem that in our persistent psycho-logisation of women's emotions we have chosen to use medical labels rather than recognise the potential loss of the sacred.
When looking at contemporary mainstream western birth experiences it is possible to reflect on the loss of spirituality as an aspect of the birthing experience. I tend to feel that, although outcomes are viewed as good, there is often something missing. We rarely acknowledge that adverse reactions to birth may partly be the result of spiritual depletion or suppression. We rarely recognise that the sense of the spiritual within our working environments can have profound effects on birthing experiences. Women who are attuned to the spiritual dimension of their lives find it very difficult to express themselves within most contemporary British hospitals where birth is highly technocratic and controlled.
I had heard that right after you give birth you are the closest possible to God because you brought life. I don't feel this. I feel alone. Everyone left me. There was so much excitement during the birth and then everybody's gone. (Starr Sered, 1994, p13)
The health literature on spirituality would indicate that spiritual recognition and well-being play huge roles in the people's life experiences. Qualities such as self transcendence - the ability to move beyond one's personal boundaries to gain a wider perspective and gain meaning and understanding from life's experiences are seen as crucial to health and well-being (Coward, 1996). Tanyi (2002) has indicated the importance of self transcendence, connectedness, inner strength and belief - arguably qualities that enable a woman to access the deeper levels of her consciousness in order to gain the total strength to give birth to her baby.
If the birthing environment has a profound impact on women's experiences how significant is that impact on the midwives who work there day in and day out? Perhaps there is a danger that when we become so stressed by the pressures of our working environment we too can forget that birth is a sacred experience and that something that is so commonplace is also truly extraordinary. The environment of birth leaves little space for a spiritual dimension. The atmosphere of a highly technological hospital with its competing energies can often deplete the spiritual surges that are present at birth. Women become disconnected from themselves and midwives become overburdened by the hellish demands of a vocation that does not fit NICEly in with CNST!
We already know that we should be taking a good look at the demands for birthing centres and home births - these are the real places where women can enter into birth with all its multi layered levels. This may also be one of the reasons why midwives are voting with their feet, birth centre managers do not appear to report issues with recruitment - more than can be said for many of the modern birth gulags passing themselves off as maternity hospitals.
When birth is removed from its social and cultural context women become reduced by the experience and birth is viewed as pathological until proven otherwise. The current attempts to repair the mind/body split centres on the recognition of birth as a psychosocial experience; it holds that the relationship between the mind and body is crucial for all outcomes of birth. However, I believe we need to extend this further and revitalise the jaded mantra of holistic care. Synergistic holism takes the move towards holistic care a stage further and embraces the creativity and growth potential of a true blend of the physical, emotional, social and spiritual. This means re-remembering the place of the spirit within the birth experience as a positive focus for the woman, her partner and for the baby. It also means acknowledging that midwives need the space to practise meaningful midwifery in environments that support them in supporting women.
REFERENCES
Commission for Racial Equality (1994). Race Relations Code of Practice in the Maternity Services, Caxton House Press Limited, London.
Coward, D (1996). 'Self transcendence and correlates in a healthy population', Nursing Research, 45, 116 - 121.
Littlewood J, McHugh, N (1997). Myth of the Madonna: Postnatal depression and maternal distress, MacMillan, Basingstoke.
Simmonds, W (2002). 'Watching the clock: keeping time during pregnancy, birth and postpartum experiences', Social Science and Medicine, 55, 559-570.
Starr Sered, S (1994). 'Childbirth as a Religious Experience?'. Journal of Feminist Studies in Religion, 7, 7-18.
Tanyi, J (2002). 'Towards clarification of the meaning of spirituality', Journal of Advanced Nursing, 39, 5, 500-509.
LW updated February 4, 2005