Spirituality and spiritual care in and around childbirth

The Relationship Between the Sense of Professional Belonging and Perceptions of Spirituality and Spiritual Care Among Turkish Midwifery Students

This study examined the relationship between the sense of professional belonging and perceptions of spirituality and spiritual care among midwifery students. This cross-sectional study's sample included 194 third- and fourth-year midwifery students associated with the Faculty of Health Sciences at two universities in western Turkey. Data were collected using web-based surveys. The results indicate a positive relationship between total scores on the Midwifery Belonging Scale and scores on the Spirituality and Spiritual Care Rating Scale. As the students' spirituality and spiritual care perceptions increased, their feelings of professional belonging as midwives also increased. Therefore, including the concepts of spirituality and belonging in the midwifery curriculum can increase students' spiritual perceptions and sense of professional belonging, thereby enhancing the quality of the care they ultimately provide.

The REBOOT First Responders Program: Insights of U.S. Graduates

The REBOOT First Responders program offers spiritual care for occupational stress. Although prior work suggests benefits to the program, no research has considered attendees' experiences in an open-ended way. The aim of this study was to document first responders' thoughts about the effectiveness, evaluation, and effects of the course in their own words. Interviews with 36 graduates living in the U.S. indicated favorable perceptions of the course. Reasons for success included the program's tangible benefits, community atmosphere, and faith-based approach (RQ1). Strengths involved helping first responders realize they are not alone and educating them about trauma; recommended upgrades involved customizing to specific occupations and offering ongoing support (RQ2). Effects included more self-acceptance, enhanced spirituality, better relationships, a more constructive view of trauma, and greater optimism about the future (RQ3). These results have implications for improving spiritual care for first responders.

Evaluation of Midwives' Perceptions of Spirituality and Spiritual Care in Aydın, Turkey

Spirituality is an integral part of holistic care, but studies have revealed that the spiritual dimension of care is largely neglected in healthcare settings. This study evaluated midwives' perceptions of spirituality and spiritual care. The study is a cross-sectional design and was conducted from April 1 to June 30, 2018 in Aydın, Turkey. The research sample of the study contacted 101 midwives. The Spirituality and Spiritual Care Rating Scale were used to collect data. It was found that the midwives' perceptions of spirituality and spiritual care were affected by age, having children, family type, and working unit (p < 0.05).

Spiritual Experiences of Portuguese Women Who had a Water Birth

This study aimed to understand the significance of spirituality to Portuguese women who had a water birth. In-depth interviews, using a semi-structured questionnaire, were conducted with 24 women who experienced water birth at the hospital or home. Results were analyzed from a narrative interpretation perspective. Three spirituality-related categories emerged: (1) Beliefs and connections with the body; (2) Spirituality: integration of being a woman and transformation during birth; and (3) Spirituality as wisdom, intuition, or the sixth sense. Spirituality was perceived in women's faith and beliefs in a superior being that helped them manage the unpredictability and uncontrollability of giving birth.

Experiences of women who have planned unassisted home births in high-resource countries: a qualitative systematic review

OBJECTIVE

The aim of this review was to identify, appraise, and synthesize the qualitative evidence about the experiences of women in high-resource countries who have planned unassisted home births.

INTRODUCTION

Unassisted birth occurs when a woman chooses to give birth without the assistance of health care providers. These births are planned and usually occur in a woman's home. It is difficult to know the prevalence of unassisted birth because it occurs at the margins of health care systems, making data difficult to collect. Based on its lack of visibility in society, we assume that unassisted birth is not a common birth choice. Women who choose planned unassisted birth may face stigma for their decision and their experience of birth, which challenge accepted norms. Synthesizing qualitative evidence about women's experiences of planned unassisted birth can improve our understanding about women's birthing values and provide important clues about aspects of birthing care that may be missing in mainstream birthing services.

INCLUSION CRITERIA

Studies that explored the experiences of women who had planned unassisted home births without the support of health care providers in high-resource countries were included. Unassisted home births were defined as those that were planned not to be assisted by health care professionals. Study designs that focused on qualitative data were eligible for inclusion.

METHODS

MEDLINE (Ovid), Embase, CINAHL (EBSCO), Scopus, Web of Science, Sociological Abstracts (ProQuest), ProQuest Dissertations and Theses (ProQuest), and Nursing and Allied Health Database (ProQuest) were searched in 2022. Studies published in English since the databases' inception were considered for inclusion. A search of relevant websites for unpublished and gray literature was also undertaken in 2022. Two independent reviewers assessed the methodological quality of papers identified for inclusion. Qualitative research findings were extracted from papers that met the inclusion criteria and critical appraisal standard. Findings were extracted and categorized based on similarity of meaning. The categories were synthesized to create 2 synthesized findings, and the ConQul approach was used to grade the findings to establish confidence in the synthesized findings.

RESULTS

Six studies were included in the review. All the studies used interviews for data collection; other methods included surveys, email correspondence, posts on internet discussion boards and forums, and websites. The total sample size for interviews was 103 participants. Total survey sample size for surveys was 87 participants. Total sample size for email correspondence was 5. Internet data sources included more than 100,000 individual and forum posts and 127 birth stories. A total of 17 findings were extracted and grouped into 4 categories. The 4 categories were then synthesized into 2 synthesized findings: i) navigating tensions within self, and between self and systems, and ii) integrating and transcending physical experiences of birth.

CONCLUSIONS

More research is needed to better understand the experiences of women who have planned unassisted births. Improving understanding and increasing the awareness of planned unassisted birth are necessary steps for promoting inclusive, relational, and person-centered birthing experiences for everyone. Reflection about the differences between planned unassisted births and mainstream births may support needed reorientations of perinatal services.

REVIEW REGISTRATION

PROSPERO CRD42019125242.

SUPPLEMENTAL DIGITAL CONTENT

A French-language version of the abstract of this review is available [ http://links.lww.com/SRX/A9 ].

Women’s lived experiences of induction of labour in late- and post-term pregnancy within the Swedish post-term induction study – a phenomenological study

Purpose

There is a trend worldwide to induce pregnant women earlier. However, few studies have focused on women’s experiences. The aim was to gain a deeper understanding of women’s lived experiences of induction of labour in late- and post-term pregnancy.

Methods

Phenomenology with a reflective lifeworld approach was chosen as the method. Twelve women participating in a larger study in which women were randomized to either induction of labour in week 41 or to expectant management until week 42, were interviewed one to three months after giving birth.

Results

The essence is described as follows: labour becomes another journey than the intended one. The women adapted to this new journey by seeing the advantages and handing themselves over to the healthcare system, but at the same time something about giving birth could be lost. The result is further described by its four constituents: planning the unplannable, being a guest at the labour ward, someone else controlling the labour, and overshadowed by how it turned out.

Conclusion

Induced labour presents a challenge to maternity personnel to support the birthing woman’s normal progress, not to rush her through labour, and to involve her in the process.

Meaning of the spiritual aspects of health care in pregnancy and childbirth

OBJECTIVE

to know the importance of the spiritual aspects of health care during pregnancy and childbirth, in the light of complexity thinking.

METHOD

qualitative research, based on complexity thinking. Twenty-seven postpartum women with children between one month and six months old participated in the study. The data were collected between August and November 2021, based on individual interviews with guiding questions. Thematic analysis was used for data analysis.

RESULTS

three themes were obtained: The inseparability of spiritual care and emotional care; Connection between spirituality and the uterus - sacred temple; Alternative techniques for spiritual health care.

CONCLUSION

the spiritual aspect of health care during pregnancy and childbirth can be considered an essential resource in the support of autonomy, security, and comfort. In addition, it can enable favorable outcomes in childbirth by strengthening the maternal-fetal attachment.

Significado da dimensão espiritual do cuidado em saúde na gestação e no parto

Resumo Objetivo: conhecer o significado da dimensão espiritual do cuidado em saúde na gestação e no parto, à luz do pensamento da complexidade. Método: pesquisa qualitativa, fundamentada no pensamento da complexidade. Participaram 27 puérperas com filhos entre um mês e seis meses de idade. Os dados foram coletados, entre agosto e novembro de 2021, a partir de entrevistas individuais, com questões norteadoras. Utilizou-se para a análise dos dados a Análise Temática. Resultados: obtiveram-se três temáticas: A indissociabilidade entre cuidado espiritual e cuidado emocional; Conexão entre dimensão espiritual e útero - templo sagrado; Técnicas alternativas e complementares de cuidado espiritual em saúde. Conclusão: a dimensão espiritual do cuidado em saúde na gestação e no parto pode ser considerada recurso essencial no despertar da autonomia, da segurança e do conforto, além de possibilitar desfechos favoráveis no parto pelo fortalecimento do vínculo materno-fetal.

Significado de la dimensión espiritual de la atención en la salud en el embarazo y en el parto

Resumen Objetivo: conocer el significado de la dimensión espiritual de la atención en la salud durante el embarazo y el parto, a la luz del pensamiento de la complejidad. Método: investigación cualitativa, basada en el pensamiento de la complejidad. Participaron 27 puérperas con hijos entre un mes y seis meses. Los datos fueron recolectados entre agosto y noviembre de 2021, a partir de entrevistas individuales, con preguntas orientadoras. Para el análisis de los datos se utilizó el Análisis Temático. Resultados: se obtuvieron tres temas: La inseparabilidad entre el cuidado espiritual y el cuidado emocional; Conexión entre dimensión espiritual y útero - templo sagrado; Técnicas alternativas y complementarias del cuidado de la salud espiritual. Conclusión: la dimensión espiritual de la atención en la salud durante el embarazo y el parto puede ser considerada un recurso esencial en el despertar de la autonomía, la seguridad y el confort, además de posibilitar resultados favorables en el parto al fortalecer el vínculo materno-fetal.

The Process of Spiritual Care

The aim of this article is to illustrate and outline an understanding of spiritual care as a process involving a number of organically linked phases: (1) the identification of spiritual needs and resources, (2) understanding the patient's specific needs, (3) developing the individual spiritual care treatment plan, hereunder involving the relevant healthcare/spiritual care professionals, (4) the provision of spiritual care, and (5) evaluating the spiritual care provided. The focus on spiritual care in healthcare research has increased throughout the past decades, showing that existential, spiritual, and/or religious considerations and needs increase with life-threatening illness, that these needs intensify with the severity of disease and with the prospect of death. Furthermore, research has shown that spiritual care increases quality of life, but also that failing to provide spiritual care leads to increased chance of depression and lowered health conditions. The World Health Organization accordingly emphasizes that providing spiritual care is vital for enhancing quality-of-life. Looking at spiritual care as a process suggests that working within a defined conceptual framework for providing spiritual care, is a recommendable default position for any institution where spiritual care is part of the daily work and routines. This so, especially because looking at spiritual care as a process highlights that moving from identifying spiritual needs in a patient to the actual provision of spiritual care, involves deliberate and considered actions and interventions that take into account the specific cultural and ontological grounding of the patient as well as the appropriate persons to provide the spiritual care. By presenting spiritual care as a process, we hope to inspire and to contribute to the international development of spiritual care, by enabling sharing experiences and best-practices internationally and cross-culturally. This so to better approach the practical and daily dimensions of spiritual care, to better address and consider the individual patient's specific spiritual needs, be they secular, spiritual and/or religious. In the final instance, spiritual care has only one ambition; to help the individual human being through crisis.

Development of the Woman-Centred Care Scale- Midwife Self Report (WCCS-MSR)

Background

Woman-centred care is recognised as a fundamental construct of midwifery practice yet to date, there has been no validated tool available to measure it. This study aims to develop and test a self-report tool to measure woman-centred care in midwives.

Methods

A staged approach was used for tool development including deductive methods to generate items, testing content validity with a group of experts, and psychometrically testing the instrument with a sample drawn from the target audience. The draft 58 item tool was distributed in an online survey using professional networks in Australia and New Zealand. Testing included item analysis, principal components analysis with direct oblimin rotation and subscale analysis, and internal consistency reliability.

Results

In total, 319 surveys were returned. Analysis revealed five factors explaining 47.6% of variance. Items were reduced to 40. Internal consistency (.92) was high but varied across factors. Factors reflected the extent to which a midwife meets the woman’s unique needs; balances the woman’s needs within the context of the maternity service; ensures midwifery philosophy underpins practice; uses evidence to inform collaborative practice; and works in partnership with the woman.

Conclusion

The Woman-Centred Care Scale-Midwife Self Report is the first step in developing a valid and reliable tool to enable midwives to self-assess their woman-centredness. Further research in alternate populations and refinement is warranted.

Health Care Providers' Perceptions of Quality of Childbirth and Its Associated Risks in Poland

OBJECTIVE

To describe Polish maternity care providers' cognitive frames of quality of childbirth and how they relate to providers' perceptions of childbirth using Baranowska's model of quality of care.

DESIGN

Mixed-methods, cross-sectional.

SETTING

Twenty-four hospitals and outpatient clinics that provide maternity care located in two central districts of Poland.

PARTICIPANTS

Obstetricians or resident physicians in obstetrics (n = 50) and midwives (n = 676) who were actively engaged in the provision of maternity care.

METHODS

Participants completed a survey that included two tasks. The first was a sentence completion technique that we used as a projective method to investigate participants' preconceived attitudes about quality of childbirth. Depending on the number of perspectives (as in Baranowska's model) included in the statements, participants' perceptions were categorized as strongly narrowed (zero perspectives), narrow (one perspective), intermediate (two perspectives), or holistic (three perspectives). In the second task, we asked participants to choose one statement out of three that best represented their beliefs about childbirth.

RESULTS

Participants had mostly intermediate (n = 436, 60%) or narrow (n = 183, 25%) perceptions of quality of childbirth. Those with less work experience tended to have more encompassing perspectives. More than half of the participants perceived childbirth as a physiologic process requiring no medical interventions (n = 385, 53%). Only 9% (n = 65) of the participants reported that childbirth is always associated with great risk. There was a main effect of work experience on the number of perspectives included in the definition of quality of childbirth with F(2, 720) = 5.532, p = .004. Participants with less work experience included more perspectives in their statements. There were no statistically significant differences in the perception of quality of childbirth between obstetricians and midwives, with F(1, 724) = .000, p = 0.991, or between participants from different workplaces, with F(3, 719) = 1.742, p = .157.

CONCLUSION

Only a small share of participants had holistic perceptions of quality of childbirth consistent with Baranowska's model. This may not only contribute to the medicalization of maternity care in Poland, but it also contrasts with participants' declarations that childbirth is a physiologic process with no need for medical interventions. Considering the greater rates of medical interventions in maternity care in Poland, the latter finding requires further research.

Determinants, reasons for choice and willingness to recommend birthing facility among mothers in public and private health facilities in Ebonyi, Nigeria

Introduction

facility-based births remain low in Nigeria despite the enormous benefits on maternal and neonatal health. We compared the determinants, reasons for choice and willingness to recommend public and private birthing facilities among mothers in Ebonyi, Nigeria.

Methods

this was a cross-sectional survey among 620 women whose childbirth occurred in public (teaching) and private-for-profit mission hospitals in Ebonyi, Nigeria. Semi-structured, interviewer-administered questionnaires were used for data collection.

Results

the mean age of the respondents was 29.86±4.4. Most had post-secondary education (71.0%), more than 4 antenatal visits (83.4%) and vaginal births (77.7%). Respondents with high economic status [adjusted odds ratio (aOR) 2.88; Confidence Interval (CI) 1.98-4.18], post-secondary education (aOR 1.73; CI 1.13-2.64) and urban residence (aOR 3.51; CI 2.19-5.61) were more likely to utilize public birthing facilities. In the private hospital, religion (78.4%) was the commonest reason for utilization while poor quality of services (61.9%) was the major cause of dissatisfaction. In the public hospital, the main reason for patronage was insurance enrolment (73.2%) while negative provider attitude (66.7%) led to dissatisfaction. In both facilities, majority (92%) were willing to recommend their birth facility to others.

Conclusion

regardless of facility type, respondents were willing to recommend or reuse the health facility for subsequent obstetric care. Religion and insurance enrolment were the major reasons for choosing the private and public hospital respectively. Residence, educational and income status influenced birthing facility type used. We recommend improved quality of services in private hospitals and provision of insurance with improved provider attitude in public health facilities.

How Giving Birth Makes Sense: A Questionnaire Study on Existential Meaning-Making Among Mothers Giving Birth Preterm or at Term

BACKGROUND

Women's reflections on existential meaning-making in relation to giving birth may seem indistinct in maternity services and have not been thoroughly explored in secular contexts. However, research suggests that childbirth accentuates spiritual and existential considerations and needs even in secular contexts highlighting the importance of care for such needs in maternity care practices. The objectives of this study were two-fold: Firstly, to explore how first-time mothers, living in a secular context, experience their first birth in relation to existential meaning-making. Secondly, to describe the relationship between existential meaning-making reflections and gestational week at birth.

METHODS

A nationwide cross-sectional study in Denmark based on the questionnaire "Faith, existence and motherhood" was conducted in 2011. Eight core items related to birth experience informed this study. The cohort was sampled from the Danish Medical Birth Registry and consisted of 913 mothers having given birth 6-18 months previously. Twenty-eight per cent had given birth preterm (PT) and 72% had given birth at full-term (FT). A total of 517 mothers responded.

RESULTS

In relation to the birth of their first child, both FT and PT mothers answered, that they had existential meaning-making reflections. The consent to the 8 items ranged from 17 to 73% among FT mothers and from 19 to 58% among PT mothers. Mothers who gave birth preterm mainly identified the negative aspects of birth, whereas mothers, who gave birth at full-term, to a higher degree identified positive aspects.

CONCLUSIONS

Findings suggest that not only traumatic birth events accentuate existential reflections, but that even normal childbirth to most mothers is an existential event. However, the quality of existential reflections differs when comparing normal and traumatic birth. The study points towards change in education and organization of maternity care to better care for existential needs and reflections specific to every new mother and birthing woman.

Midwives holding the space for women undergoing termination of pregnancy: A qualitative inquiry

PROBLEM

Hospital midwives are the main care givers for women undergoing termination of pregnancy after 20 weeks. Midwives' role and potential impact of regular involvement in termination of pregnancy (TOP) are poorly understood.

SETTING

New Zealand.

BACKGROUND

TOP after 20 weeks may be performed to save a woman's life or preserve her physical and mental health. Throughout the process midwives play a key role in supporting women's complex psychological and clinical needs.

OBJECTIVE

To gain a deeper understanding of the role of midwives in TOP care after 20 weeks, including the support they might need and the impacts caring for women who are having a TOP may have on them.

METHODS

Eight midwives from two District Health Boards were interviewed about their experiences of caring for women having a TOP after 20 weeks. Transcripts were analysed by applying a hermeneutic-phenomenological lens.

FINDINGS

Three themes emerged: "A different kind of midwife", "Staying true to oneself" and "Melting an Iceberg". TOP care is a different role within midwifery as midwives facilitate death in the space of birth. Immersing themselves in women's emotional space they create meaningful connections to support their complex needs and provide a positive birth experience. Yet, midwives are unprepared for the emotional effects of repeatedly caring for women undergoing TOP. Lacking appropriate support they can experience increasing, lasting grief.

CONCLUSION

Midwives' experiences of providing TOP care are complex, intense and have lifelong impact. Their role in the context of TOP is highly specialised and must be valued and supported.

Ritualizing Pregnancy and Childbirth in Secular Societies: Exploring Embodied Spirituality at the Start of Life

Birth is the beginning of a new life and therefore a unique life event. In this paper, I want to study birth as a fundamental human transition in relation to existential and spiritual questions. Birth takes place within a social and cultural context. A new member of society is entering the community, which also leads to feelings of ambiguity and uncertainty. Rituals are traditionally ways of giving structure to important life events, but in contemporary Western, secular contexts, traditional birth rituals have been decreasing. In this article, I will theoretically explore the meaning of birth from the perspectives of philosophy, religious and ritual studies. New ritual fields will serve as concrete examples. What kind of meanings and notions of spirituality can be discovered in emerging rituals, such as mother’s blessings or humanist naming ceremonies? Ritualizing pregnancy and birth in contemporary, secular society shows that the coming of a new life is related to embodied, social and cultural negotiations of meaning making. More attention is needed in the study of ritualizing pregnancy and birth as they reveal pluralistic spiritualities within secular contexts, as well as deeper cultural issues surrounding these strategies of meaning making.

Expressions of Spirituality and States of Consciousness in Brazilian Postpartum Mothers: A Convergent Mixed-Methods Study

PURPOSE

The purpose of this study was to examine the how different aspects of the birthing environment were associated with a parturient's states of consciousness, spirituality, and satisfaction with the childbirth experience.

DESIGN

The study utilized a convergent mixed methods research design involving both quantitative and qualitative components with convenience sampling. In total, 276 Brazilian postpartum women completed a states of consciousness mini-test and the Expressions of Spirituality Inventory—Revised. A small subsample of women who gave birth in different settings were also interviewed. Quantitative data were examined using descriptive statistics, bivariate correlations, and analysis of variance and covariance. Qualitative interview data were thematically analyzed.

MAJOR FINDINGS

Home birth and the absence of a physician were associated with a higher occurrence of favorable non-ordinary states and satisfaction with childbirth. Spiritually-inclusive birth preparation was found to be associated with most spirituality and states of consciousness variables and more than childbirth satisfaction.

MAIN CONCLUSION

Non-ordinary states emerged from a parturient's sense of security with their surroundings and from preparation for childbirth. Spiritual experiences were related to pre-existing spiritual beliefs and practices.

Development and validation of the Spirituality Instrument-27© (SpI-27©) in individuals with chronic illness

AIM

To develop and validate the Spirituality Instrument 27 (SpI-27©) in individuals with chronic illness (n = 249).

BACKGROUND

A need for a rigorously developed spirituality instrument that can be used with people who are religious and non-religious was identified.

METHODS

The initial 46-item instrument was developed from a concept analysis, a review of theoretical and empirical literature, and an appraisal of instruments measuring spirituality. Content validity was established with user focus groups and an expert panel review. A pilot study evaluated the online mode of administration and a descriptive correlational design assessed the reliability and validity of the instrument.

RESULTS

Results of exploratory factor analysis concluded a five-factor solution with 27 items: Connectedness with Others, Self-Transcendence, Self-Cognisance, Conservationism, and Connectedness with a Higher Power. Cronbach's alpha coefficients ranged from 0.823 to 0.911 for the five factors, and 0.904 for the overall scale. Paired t-tests, intra-class correlations, and weighted kappa values supported the temporal stability of the instrument. A significant and positive correlation was found between the SpI-27© and the Spirituality Index of Well-Being (p < 0.01), supporting convergent validity.

CONCLUSIONS

Findings support the validity and reliability of the SpI-27©, which was developed with patient input and is underpinned by theoretical and empirical literature. The SpI-27© should be validated for use with other samples. The conceptual framework that guided the study can be used to enhance healthcare professionals' understanding of spirituality and its core dimensions.

Exploring factors influencing adverse birth outcomes in a regional hospital setting in Ghana: A configuration theoretical perspective

BACKGROUND

Understanding the complexity of factors that influence adverse childbirth outcomes at health facilities can be enhanced by the theoretical articulation of the interplay between external socio-structural and internal technical dynamics of the birthplace in context. Guided by configuration theory, this study explored the factors that influence adverse birth outcomes at a regional hospital setting in Ghana.

METHODS

Qualitative data were collected from the Upper West regional hospital in Ghana. In-depth interviews were administered to 30 purposively selected respondents comprising 20 postpartum mothers and 10 midwives. The data was electronically audio-recorded, transcribed and analysed using thematic analysis.

FINDINGS

The study revealed three key dimensions of socio-technical configurations shaping adverse birth outcomes within the hospital setting. These are mother-midwife personality and behavioral dynamics including personality clashes and poor communication; birth process dynamics consisting of diverse paradigms of safe birthing process and socio-technical conflicts on caesarean section; and birthplace context, comprising nature of the birthing environment, confidence in the safety of the birthplace and national health policy implementation challenges. These socio-technical interactions result in late reporting at facilities by mothers and delay in care delivery by midwives, contributing to adverse birth outcomes.

CONCLUSION

In line with configuration theory, our study positions the influences of adverse birth outcomes in hospital settings in alignment with a subtle and iterative interplay of socio-technical factors. To comprehensively address adverse birth outcomes in hospital settings, health policymakers and practitioners need to understand and contextualise the socio-technical interactions that shape notable outcomes at specific hospital settings.

Understanding the spirituality of parents following stillbirth: A qualitative meta-synthesis

This meta-synthesis aims to synthesize qualitative evidence from primary studies to better understand the experience of the spirituality of parents and its relationship to adapting following stillbirth. Five electronic databases were systematically searched and the quality of 21 eligible studies was critically appraised. A thematic synthesis revealed two analytical themes: (1) Spiritual suffering following stillbirth; (2) Moving through spirituality to adapt to the loss, each encompassing four descriptive themes. The findings can inform a more culturally and spiritually sensitive approach to care, taking into account the parents' beliefs, folk customs, religion, values, and spiritual needs.

Developing a spiritual care competency framework for pre-registration nurses and midwives

This paper identifies competencies in spiritual care from an in-depth literature review and develops a theoretical framework for competencies in spiritual care. It forms part of a larger modified Delphi study which recruited international nursing/midwifery experts. Using Braun and Clark (2006) adapted six-phase content thematic analysis, 7 domains and 116 competency items were generated from an in-depth literature review in three areas; spirituality and spiritual care, spiritual care education, and spiritual care curricular contents.

Inner Voice of Pregnant Women: A Qualitative Study

BACKGROUND

Spirituality becomes more significant and evident during crises like pregnancy; therefore, it is crucial for healthcare providers to be supportive during pregnancy through exploring and understanding the meaning of spirituality for pregnant women. This study aimed to discover the experiences of Iranian pregnant women regarding spirituality.

MATERIALS AND METHODS

This qualitative, inductive, content analysis study was performed in 11 pregnant women (28-36 weeks' gestation) who attended the healthcare centers of Karaj, Iran. The subjects were selected by purposive sampling and invited to participate in the study. The data were collected through semi-structured, face-to-face, and in-depth interviews and were analyzed using the inductive content analysis approach.

RESULTS

Three major themes emerged during data analysis: "permeable transcendence," including "spiritual awareness of mother," "spiritual light of baby," and "personal transformation and improvement." "Doubled responsibility" comprised two subthemes of "spiritual nourishment for mother" and "spiritual nourishment for child," and "spiritual circumstance" consisted of two subthemes of "religious background" and "spirituality of healthcare provider."

CONCLUSIONS

Considering the importance of spirituality and religion in gestational health promotion, the results of this study can assist healthcare providers in recognizing the women's spiritual needs and valuing the protective role of religious/spiritual well-being during pregnancy.

Effect of Nursing Intervention Integrating an Islamic Praying Program on Labor Pain and Pain Behaviors in Primiparous Muslim Women

BACKGROUND

Labor pain has always been a priority issue for primiparous women. Pain behaviors appear as a response to labor pain. This study aimed at examining the effect of nursing interventions integrating an Islamic praying (NIIIP) program on labor pain and pain behavior.

MATERIALS AND METHODS

In this experimental design, 42 women in the control group received the usual care; 41 in the experimental group received the usual care and an NIIIP program from the 32nd week of pregnancy. This was done by providing childbirth education which they then practiced at home every day until they entered the labor room in the Bhinneka Bhakti Husada Hospital and Community Health Center Pamulang, Indonesia. They conducted 30 min of reciting from the Quran, stroking, positioning during their inter contractions, just breathing during contractions at the 1st, 2nd, 3rd h after cervical dilation of 3-4 cm. The visual analogue scale (VAS) and pain behaviors observation scale (PBOS) were used to measure pain and pain behaviors. Repeated measures of the ANOVA and t test were used to analyze the data.

RESULTS

There were significant differences in experience of labor pain ([F = 113.07, df (1, 81), p < 0.001] and pain behavior ([F = 147,49 df (1, 81), p < 0.001] between the control and experimental groups. There were significant statistical differences of over four times at the points of pain [F = 82.84, df (2, 182), p < 0.001] and pain behaviors [F = 165.55, df = (2, 189), p < 0.001].

CONCLUSIONS

The program effectively resulted in lower pain and increased pain behaviors.

'I felt like I could do anything!' Writing the phenomenon of 'transcendent birth' through autoethnography

OBJECTIVE

To discuss the concept of 'transcendent birth', an as yet poorly articulated and under recognised psychosocial wellness phenomenon of childbirth.

DESIGN

an auto-ethnographical examination of the primary authors' journaled experiences as a student midwife and childbearing woman.

SETTING

three maternity care units in South Eastern Australia as well as the home of the primary author.

FINDINGS

The phenomenon of transcendent birth is linked with physiologic birth. Maternity care can hinder or facilitate physiologic birth, and therefore transcendent birth.

KEY CONCLUSIONS

Transcendent birth is more likely in maternity care models which value the childbearing woman and physiologic birth.

IMPLICATIONS FOR PRACTICE

Women's access to transcendent birth is demarcated by women's position in society, cultural knowledge of transcendent birth and the valuing of transcendent birth as a maternity care outcome.

Developing a Training Course for Spiritual Counselors in Health Care: Evidence from Iran

Background:

Spiritual health can cause mental health promotion and well-being of the people's lives but it is still neglected in practice so that there is no trace of spiritual training in medical education in Iran. This study was conducted to develop a training course for spiritual counselors in the Iranian health-care system.

Methods:

In this qualitative study, senior managers of the Ministry of Health (MOH) and experts in the related fields were purposively selected as the participants. Semi-structured interviews and focused group discussions (FGDs) were conducted to collect the data. After transcription of the interviews and FGDs, the data were analyzed using content analysis.

Results:

In this package, community-based spiritual health services are offered in three forms of spiritual lifestyle education, introducing social facilities, and collaborating with the related organizations. Hospital services are offered in four forms of assessment of the spiritual status and referral, spiritual care, spiritual counseling, and providing a spiritual environment in the hospital.

Conclusion:

According to the results of the study, it is suggested that a strategic committee be established at the MOH level for establishment of these training courses as well as another strategic committee for evaluation, review, and service package promotion, and its training courses should be formed. In addition, a set of skills for spiritual assessment of patients and the related interventions should be designed for clinical skill centers of the country in the form of skill training packages.

"That was intense!" Spirituality during childbirth: a mixed-method comparative study of mothers' and fathers' experiences in a public hospital

BACKGROUND

While spirituality is well described in end-of-life care literature, research on its place in the delivery room remains largely limited to mother-oriented qualitative studies focusing on life-threatening situations (e.g., high-risk pregnancies). Our aim was to compare mothers' and fathers' spirituality during childbirth.

METHODS

A mixed methods questionnaire was developed from our childbirth-related spirituality categorization and distributed to all parents of newborns, 12-24 h postpartum, over 45 consecutive days. Paired-sample t-tests and qualitative thematic analysis were used to compare mothers and fathers. Multiple linear regressions identified factors associated with their respective global scores (vaginal and cesarean deliveries separately).

RESULTS

The global scores for mothers (38.6/50) and fathers (37.2/50) were similarly high (N = 197; p = 0.001). Highest-ranked ("respect", "moral responsibility", "beauty of life", "gratitude") and lowest-ranked spiritual themes ("prayer", "greater than self") were in agreement. Fathers scored higher on "fragility of life" (p = 0.006) and mothers on "self-accomplishment" (p‹0.001), "letting go" (p‹0.001), and "meaningfulness" (p = 0.003). "Admission of baby in neonatal unit" was associated with higher global score for both mothers and fathers. Other factors also increased fathers' (witnessing a severe tear) and mothers' scores (birthplace outside Canada; for vaginal deliveries, religious belonging and longer pushing stage).

CONCLUSION

These first quantitative data on the prevalence of spirituality during childbirth highlight a high score for both parents, among a non-selected public hospital population. Spirituality emerges not only from unordinary situations but from any childbirth as an "intensification of the human experience". Significant differences for some spiritual themes indicate the need to consider the spirituality of both parents.

Religious beliefs and practices in pregnancy and labour: an inductive qualitative study among post-partum women in Ghana

BACKGROUND

Religiosity in health care delivery has attracted some attention in contemporary literature. The religious beliefs and practices of patients play an important role in the recovery of the patient. Pregnant women and women in labour exhibit their faith and use religious artefacts. This phenomenon is poorly understood in Ghana. The study sought to investigate the religious beliefs and practices of post-partum Ghanaian women.

METHODS

A descriptive phenomenological study was conducted inductively involving 13 women who were sampled purposively. Individual in-depth interviews were conducted in English, Ga, Twi and Ewe. The interviews were audio-taped and transcribed. Concurrent analysis was done employing the principles of content analysis. Ethical approval was obtained for the study and anonymity and confidentiality were ensured.

RESULTS

Themes generated revealed religious beliefs and practices such as prayer, singing, thanksgiving at church, fellowship and emotional support. Pastors' spiritual interventions in pregnancy included prayer and revelations, reversing negative dreams, laying of hands and anointing women. Also, traditional beliefs and practices were food and water restrictions and tribal rituals. Religious artefacts used in pregnancy and labour were anointing oil, blessed water, sticker, blessed white handkerchief, blessed sand, Bible and Rosary. Family influence and secrecy were associated with the use of artefacts.

CONCLUSIONS

Religiosity should be a key component of training health care professionals so that they can understand the religious needs of their clients and provide holistic care. We concluded that pregnant women and women in labour should be supported to exercise their religious beliefs and practices.

Midwifery practice during birth: Ritual companionship

BACKGROUND

There is an expectation that midwifery practice is woman centred and promotes physiology. In addition, midwives must assess the wellbeing of mother and baby, and monitor the progress of labour. It is important to understand how midwifery actions and interactions influence the birth experience for women.

AIM

The aim of this study was to explore midwifery practice during physiological birth from the perspective of both midwives and mothers.

METHOD

A narrative inquiry involving face-to-face in-depth interviews was used to gather data. The participants were 10 midwives and 10 women who had recently attended or experienced an uncomplicated physiological birth. Data was analysed to identify themes occurring across the narratives.

FINDINGS

Two types of midwifery practice were identified from the data: rites of passage and rites of protection. Rites of passage were synergistic with women's needs during birth and involved managing distractions and reflecting internal wisdom. Rites of protection involved performing clinical assessments to determine wellbeing and labour progress. These practices could contradict the rites of passage by disrupting aloneness and reinforcing external wisdom.

CONCLUSION

Midwives performed two types of practices which intersected with women's experience of birth in differing and contested ways. Conceptualising the role of the midwife as a 'ritual companion' and actions and words as rituals enables a deeper exploration of the values transmitted and reflected by midwifery practice. This study contributes to a discourse about midwifery practice during birth, women's experience of birth, and the influence of the institution on the nature of mother-midwife relationship.