antenatal classes and spirituality ~
an oxymoron or opportunity for transcendency?
lorna davies
A version of this article has now been published in The Practising Midwife.
We talk about ‘holistic care’ a great deal in midwifery practice and education.
Yet in reality, how much of what we offer is truly holistic, that is geared to optimise the emotional, psychological, social, and spiritual experience of the childbearing period for women and their families. Most midwifery practitioners would consider themselves to be skilled at identifying physical requirements of women. Some of us may even be fortunate to works in a team or group practice, where we get to know the women reasonably well and have some insight into who she really is, what factors are affecting her during this pregnancy, helping her to identify her social and psychological needs. The really thorny issue in the model of holistic care seems to be this matter of spirituality.
As a culture we are not very comfortable with the whole notion of spirituality. It is an abstract and complex entity that it is easier to slot into the box of ‘religion’, in neat little denominational boxes. That way it doesn’t interfere too much with the main thrust of provision in care within our reductionist pseudo-scientific system.
Jenny Hall in her book Midwifery, Mind and Spirit, rightly points out, that any discussion of spirituality is usually confined to the question of ‘what religion are you?’ at booking interview. This suggests that one’s spirituality is restricted to the a strict code of religious conformity, and ignores the manifold ways in which human beings utilise a spiritual plain as a form of self expression.
The spiritual dimension of our humanity is not necessarily defined by holiness or mysticism, though it may be. It may be encountered in acts of collective worship, but it may equally be a profoundly personal and private affair. It may focus on articles of faith, or be a statement of self, which may culminate in a transcendental experience.
I do not intend to undermine the significance of religious faith or practice , or the importance of acknowledging the individual denominational needs of our client group. But I feel that we must recognise that a tick box describing religious conviction or association may do little to inform us of the spiritual needs of women in their pregnancies, birth and postnatal period, and that we must be aware of this fact.
Pregnancy places a woman in a very special place, on a journey from one state of being (woman) to a new state of being (mother) Does this mean that such a journey has the potential to be transcendental? Is this a concept that we embrace within our current provision of care? Are fathers also on a spiritual journey, that will lead to the development of new elements of the self?
How can we as midwives best help new parents on this journey? I firmly believe that we have the capacity to provide such opportunities during the antenatal period both in an informal capacity on a one to one basis with the woman and on a slightly more formal level in parent education sessions in the antenatal and post natal period.
It would appear that the dominant consideration in antenatal classes in the NHS continues to be the preparation for the physical event. Although progress is slowly being made and the psychological and emotional needs of women are being more widely addressed, thanks to the work of antenatal educators such as Andrea Robertson, Judith Schott and Mary Nolan. The recognition that a woman’s emotional state may affect her physical state is now broadly recognised. However, the spiritual element continues to be shadowed, and if the model of holistic care is right then the harmony required for total well being may be held in disequilibrium.
We may argue that we facilitate client led sessions, where the group determine the agenda. Therefore if they request information on the menu of pain relief, then we are duty bound to provide that for them. I would argue that we frequently end up providing them with information that they do not necessarily require, information that they either already have, or have easy access to. I would equally argue that there is no reason why a spiritual dimension could not be included within a discussion on pain and its purpose in labour, instrumental delivery or any other subject considered essential in parent education. In her book ‘Birthing from Within’ Pam England emphasises that regardless of the mode of birth, the most significant factor is that the woman has experienced “birthing in awareness”.
Pregnancy itself may be considered by the woman to be a intensely spiritual experience. On a physical, psychosocial and spiritual level, it is a rite of passage. A correspondent on a midwifery Internet list recently described birth as the nearest a woman gets to reaching out and touching the face of God. It is not uncommon for a woman who has experienced labour to talk about an out of body or other psychic experience.
We know that encouraging a woman to communicate with her unborn child, may have some physical and psychological benefits, we may add to this a spiritual advantage.
Fergal Keys the BBC overseas correspondent published a series of letters that he wrote to his unborn son during spells away form his partner during her pregnancy. This simple act has left his son with a legacy that few people would fail to be touched by. Couples attending classes could be introduced to this idea. This may be something that they will eventually share with their child in years to come, or it may remain a private entity, but one that may help them to grow and develop as parents.
I actively encourage parents to keep a log of their experience of pregnancy in pretty much the same way that they would keep a ‘baby book’ once the baby has been born. This may include reflections on being pregnant or being with someone in their journey through pregnancy; photographs of the mother and father during this period; interesting news items and stories; entries from the grandparents. Women frequently become more aware of their creativity during this, the greatest act of creation, and it may prompt them to write poetry or paint or draw, and these could also be included.
Pam England introduced me to the idea of preparing a ‘birthing bundle’ for the baby. Couples are encouraged to bring along a number of items for their baby which they have wrapped in a bundle and, if they are comfortable, “show and tell” with the group. The items must include something that symbolises the life of one of the grandparents, something from the parents that represents who they (singly or jointly) are, and something that represents the baby itself. I have never ceased to be moved at the offerings that group members have made when I have used this activity in my sessions. Items such as poetry, pressed flowers, family bibles and patchwork quilts have been offered. The birthing bundle makes the group members consider connections with the past and the future and in doing so gives them a sense of their own place in the world. It also highlights the changing relationship with their own parents at this significant time and lastly it makes them consider the relationship that they want to have with their new baby, often beyond a material level.
Using a spiritual approach in sessions may mean developing an intuitive response in a woman and her partner. We believe that women are particularly intuitive during pregnancy and by helping to strengthen a woman’s belief in her intuitive responses we may enable her to achieve an enhanced belief in her ability as a mother. Intuitive responses are almost impossible to quantify and do not therefore sit comfortably within a medical model of care. Women may therefore be wary of sharing what they believe to be irrational responses which may sometimes supersede decisions based on medical information. Encouraging women to talk about their dreams, which are known to be ‘different’ during pregnancy may help to strengthen their trust in their own intuitive responses, and encourage them to disclose what they may perceive as unfounded knowledge.
Relaxation and visualisation may offer another means of establishing a intuitive bond between parents to be and their future offspring. A basic relaxation exercise can be used initially and when in a relaxed state, the group should be asked to imagine a special place where they would like to be. Get them to think about the surroundings, the sounds, the colours, the temperature. Ask them to consider why this place is so special to them, why is it significant. Then ask them to imagine taking their child to this place and sharing with them. When the group have come out of the relaxation, you can ask them how they feel and where they were and how it felt to share where they had been.
A further visualisation involves getting the group into a state of deep relaxation before getting them to visualise their unborn baby. A guided imagery can then be used to get them to see the watery world of the baby; to hear the muffled sounds and the growing familiarity of its parents voices; to imagine its ten tiny fingers and toes and the little toe and finger nails. I have found over the years that this particular relaxation exercise is extremely effective at getting parents to connect with their babies. If couples are doing it together, it is useful if the father sits behind the mother with his hands gently touching her ‘bump’. This enables him to make a connection with the baby too and may help to visualise their little one more clearly.
Birth is a rite of passage, as we have already acknowledged it embraces the transitional acts of woman to mother and man to father. This is a profound event and one that surely deserves due recognition. In other cultures, rituals and celebrations of birth abound. Sheila Kitzinger and Jaqueline Vincent-Priya highlight numerous accounts of such acts of ceremony in their work. However, in western industrialised society, we seem to have lost sight of the sacred value of birth and with it we have lost the sense of initiation that ritual brings to this rite of passage. Ironically we still recognise the importance of ritual in marriage and death, if not the sanctity, but in birth the nearest we get to a ritual is the commercialisation of the American baby shower or the fathers pub celebration in the early postnatal period.
I recently met a woman from California, who told me about a tribe of Native American Indians who take the pregnant women from their tribe when they are about 36 weeks pregnant, and involve them in an interesting ritual where they receive a ‘make-over’. Someone will massage them; someone else will brush and style their hair. They are adorned with new clothes and jewellery and emerge as a new person which serves as a metaphor for their new persona as mother. Most women that I know would welcome the thought of being pampered and luxuriated at a stage of pregnancy when one is often tired and weary. Most importantly is that this simple rewarding act actively acknowledges the woman’s changing status.
The newly revived trend of belly casting could provide a vehicle for exalting the passage to motherhood. This act, which involves creating a plaster cast of the woman’s pregnant abdomen followed by decoration of the impression, provides the opportunity for the woman to metaphorically step outside her pregnancy and create something beautiful and eternal from this special period in her life.
Pam England encourages the men who attend her classes to bring in a gift for their partner, without the knowledge of the women. They are then invited to perform a footbath (complete with floating rose petals and essential oils) on their partner, followed by a foot massage. At the end of the ceremony, the man dries the feet of the woman and then presents her with his gift. This is an act of love that is guaranteed to make any woman feel as though she is the most special person in the world, and serves as a wonderful act of initiation into motherhood.
Many of these activities may sound arcane and may leave the reader wondering how they could have any place in the antenatal classes that we are currently able (or willing) to provide. They may consider their clientele to be more interested in the facts, ‘spiritually bereft’ or simply unready for such an initiation. From personal experience I would suggest that they serve to fulfil those who are involved in a way that defies scepticism.
We know that from the work of many in this field that our current approach to parent education is not meeting the needs of parents to be. As we have already stated, it may well be that holistic needs are not being met . The idea of trying something so different may fill you with trepidation, but by feeling the fear and doing it anyway, you may be opening a window to the soul that has been denied within a strictly medical frame of reference. The benefits may be as great for the midwife/facilitator as they are for the women and their partners and may offer a new and strengthened belief in the less concrete elements of becoming a parent.
Pam England and Rob Horowitz (1991)
Birthing From Within
Pantheon Publishing.
Jennifer Hall (2001)
Midwifery Mind and Spirit
Books for Midwives Press.