A time for psycho-spiritual transcendence: The experiences of Iranian women of pain during childbirth

Birthing consciousness and the flow experience during physiological childbirth

PROBLEM

It has been demonstrated that birth without medical intervention conveys significant physical and psychological benefits to the mother and her newborn baby. However, there is a need to include women's subjective experience of physiological birth to understand and promote it.

BACKGROUND

The theoretical concept of "birthing consciousness" hypothesizes that women during natural childbirth sometimes experience a specific altered state of consciousness, which is a positive peak experience that resembles "flow" in many aspects.

AIM

To investigate the underexplored connection between the physiological mode of childbirth and altered states of consciousness during childbirth.

METHODS

Israeli women with childbirth experience were recruited through social media (Facebook groups with a focus on childbirth and motherhood). Participants (n = 766) completed an online survey: the Flow State Scale (FSS) and a demographic questionnaire.

FINDINGS

Differences were found between modes of birth as to flow state, as women who experienced physiological childbirth (i.e., with no epidural anesthesia or instrumental interventions) had a higher flow state during birth.

DISCUSSION

This link empirically confirms the phenomenon of birthing consciousness. All nine dimensions of the mental state of flow apply to childbirth: challenge-skill balance, action-awareness merging, clear goals, unambiguous feedback, concentration on the task, sense of control, loss of self-consciousness, transformation of time, and autotelic experience.

CONCLUSION

Understanding a women's subjective experience during physiological birth can enhance clinical understanding of physiological birth thus promoting positive physiological birth experiences - which has crucial health benefits. We propose that more studies need to be done to promote experiencing flow during physiological birth.

Muslim and Christian Women's Perceptions of the Influence of Spirituality and Religious Beliefs on Motherhood and Child-Rearing: A Phenomenological Study

(1) Background: Spirituality is a factor that plays a role in decisions related to health and illness. When a woman becomes a mother, she undergoes physical, psychological, and social changes for which healthcare professionals must provide the necessary care. However, women may feel misunderstood and stigmatized when they carry out their religious practices and express their spirituality related to motherhood. The aim of this study was to describe the experiences of women with Muslim and Christian religious ideologies on the influence of spirituality and religious beliefs in motherhood and child-rearing. (2) Methods: A descriptive phenomenological qualitative study with two groups of women of Islamic and Christian ideology, respectively. Three focus groups and in-depth interviews were conducted, recorded, transcribed, and analyzed with ATLAS.ti 7.0. An inductive analysis was carried out according to the Moustakas model. (3) Results: Three themes were identified: religious and cultural aspects that determine child-rearing, the influence of spirituality and family on the mother's role, and the support received from healthcare personnel. (4) Conclusions: Spirituality and religious beliefs are manifested during motherhood and child-rearing in the form of infant feeding, the need for their protection, or the need for support from mothers. Healthcare personnel must be able to offer culturally competent and spiritually respectful care. Patients should not be judged based on their spirituality.

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.

Perceived Childbirth Self-Efficacy and Its Associated Factors Among Pregnant Women in South-Central Ethiopia

Background

Childbirth self-efficacy has been identified as a significant indicator of a positive childbirth experience. It is, however, the most neglected aspect of maternal care, and evidence in this regard was lacking in Ethiopia. Therefore, this study aimed to assess perceived childbirth self-efficacy and its associated factors among pregnant women in the Gurage zone, southern Ethiopia.

Methods

The current study was conducted from April to May 2022 using a facility-based cross-sectional study design. We used a systematic sampling technique and selected a total of 423 women. To collect the data, we utilized an interviewer-administered questionnaire containing a childbirth self-efficacy inventory scale. Multiple linear regression analysis was employed to discover the factors influencing a woman's self-efficacy during childbirth.

Results

The current study included 423 pregnant women in total. This study revealed that the overall mean score for perceived childbirth self-efficacy was 489.06 (SD = 65.77). Social support (β = 0.214, P< 0.001), psychological well-being (β = 0.254, P< 0.001), education status at the secondary level (β = 0.151, P< 0.001), no fundal pressure (β = 0.11, P = 0.010), and planned pregnancy (β = 0.10, P =0.013) were positively associated with childbirth self-efficacy. Fear of childbirth (β = 0.19, P< 0.001), Primipara women (β = 0.14, P< 0.001), women who had experienced discomfort during vaginal examination (β = 0.10, P = 0.009), and women who experienced the inability to push (β = 0.10, P = 0.013) were negatively associated with childbirth self-efficacy.

Conclusion

The overall mean score for the perceived childbirth self-efficacy was high when compared to the previous studies conducted in Australia. Healthcare professionals should create multifaceted strategies to support childbirth self-efficacy, such as relaxation techniques, prenatal psycho-education to reduce childbirth fear, enhance psychological well-being and encourage social support, particularly partner support during pregnancy and childbirth.

Transcending the self to transcend suffering

Suffering is inevitable in human life. Our perspective paper theorizes on precise mechanisms for how self-transcendence-the state in which an individual looks beyond the self and adopts a larger perspective including concern for others and the world-may help people endure the experience of suffering. From an examination of empirical literature ranging from social psychology to clinical research, we propose that self-transcendence may aid the endurance of suffering along three psychological levels: (1) On the level of affect, the unique profundity and positivity of self-transcendent experiences (e.g., awe, flow, compassion) may supersede and reduce the salience of negative affect arising from suffering (e.g., fear, despair, depressive mood). (2) On the level of cognition, the larger frame of reference provided by self-transcendent thinking may contextualize one's suffering as something comprehendible, thereby helping to resolve the challenges of making meaning from suffering (e.g., that one's existing meaning systems are unable to explain the suffering event). (3) On the level of motivation, the drive to fulfill one's need for self-transcendence may counterbalance the more hedonically-oriented motivations that can promote negative coping strategies in response to suffering (e.g., avoidance, substance abuse). All three mechanisms may also provoke downstream prosocial behaviors that help embed the individual into networks of social support. Altogether, by synthesizing specific mechanisms from affective, cognitive, and motivational self-transcendent processes, our paper establishes a theoretical framework for how self-transcendence may help people endure and transcend suffering, thereby elevating the conditions and experiences of our existence.

Developing a woman-centered, inclusive definition of positive childbirth experiences: A discussion paper

INTRODUCTION

A positive childbirth experience promotes women's health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research.

AIM

To formulate an inclusive woman-centered definition of a positive childbirth experience.

METHODS

A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women's feedback (n = 42).

RESULTS

The following definition was formulated: "A positive childbirth experience refers to a woman's experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman's psychosocial well-being."

CONCLUSIONS

This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.

Spiritual Interventions Used by Jewish Women to Facilitate the Family Continuum: A Qualitative Study

Introduction: Spiritual interventions (SI) are used by patients and their families as a means to promote health. The family continuum (FC), which includes finding a partner/spouse, getting married, becoming pregnant, and having a safe pregnancy/birth, is an important concept for the Jewish culture as well as other cultures that have a traditional family-centered approach. There is a dearth of professional literature pertaining to SI to promote the FC. Although patients may use SI, this information is not routinely collected in a health history. The purpose of the study was to describe the experience of Jewish women's use of SI to promote the FC. Methods: This ethnographic study included interviews of Jewish women pertaining to FC, a text review, and field study. Coding of the text, site visits, and interviews were performed and reviewed to identify categories and themes and were refined until saturation was achieved. Results: Fifty-three observant and non-observant Jewish women participated in the study. Women expressed that SI were the means for them playing an active role in fulfilling the FC, and included intermediaries to God, self-improvement, and folk/spiritual remedies. The examples of SI included: visits to holy sites and spiritual leaders for blessings and advice, prayers, psalms, doing good deeds, eating special foods, wearing amulets, and performing certain SI with predesignated repetitions. Women attributed these SI to attaining an FC. Women who achieved each FC milestone without difficulty tended to use less SI, whereas women's SI usage increased the longer a milestone was not achieved. Conclusions: Jewish women are using many SI to promote the FC. Health care should be delivered in a culturally competent manner, which includes the incorporation of safe cultural practices. Obtaining a cultural assessment as part of the medical history could assist the health care professional in integrating safe SI into patient care.

Relationship between Religious Coping, Pain Severity, and Childbirth Self-Efficacy in Iranian Primipara Women

Background. One of the important goals of midwifery support and care is to control labor pain and increase the ability to cope with pain. The use of religious coping may be effective in counteracting the stressors of labor, especially labor pain, as well as increasing the self-efficacy of labor. This study was conducted to determine the relationship between religious coping, pain severity, and childbirth self-efficacy in Iranian primipara women. Materials and Methods. This cross-sectional study was performed on 200 Iranian primiparous women referred to eight health centers in the capital of Hormozgan Province who were intending to have a normal vaginal delivery (NVD) in the Persian Gulf and Sharifi Hospitals. The sampling was multistage. Data were collected by demographic and fertility questionnaires, the Iranian Religious Coping Scale, the Childbirth Self-Efficacy Inventory, and the Visual Analog Scale for pain measurement. Results. Among the dimensions of religious coping, benevolent reappraisal had a significant direct relationship with pain severity, and negative religious coping had a significant inverse relationship with pain severity. In the case of childbirth self-efficacy subscales, the results showed dimensions of religious practices, benevolent reappraisal, and active religious coping had a significant direct relationship with outcome expectancy, and negative religious coping had a significant indirect relationship with outcome expectancy. Also, there was a significant direct relationship between religious practices and efficacy expectancy and a significant inverse relationship between negative and passive religious coping and efficacy expectancy. Conclusion. With increasing some dimensions of positive religious coping, the severity of labor pain and childbirth self-efficacy increases, and with increasing dimensions of negative and passive religious coping, childbirth self-efficacy decreases. These correlations were weak in all the mentioned results.

Prevalence and contributory factors of anxiety and depression among pregnant women in the post-pandemic era of COVID-19 in Shenzhen, China

BACKGROUND

Pregnant women are emotionally vulnerable and have suffered great psychological impacts. Following the coronavirus disease 2019 (COVID-19) outbreak, a study was undertaken of the prevalence of, and factors contributing to, symptoms of anxiety and depression among pregnant women in Shenzhen, China.

METHODS

A cross-sectional study on pregnant women was conducted from September to December 2020 in Shenzhen, using a random-recruit method. The General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) surveys were used to evaluate symptoms of anxiety and depression. A multivariate logistic regression model was developed to explore factors potentially associated with symptoms of anxiety and depression during pregnancy.

RESULTS

A total of 3,434 pregnant women aged 15 to 59 years were enrolled. Symptoms of anxiety and depression were present in 9.8% and 6.9%, respectively. Logistic regression analysis using a stepwise procedure revealed that an increased risk of symptoms of anxiety and depression was associated with unmarried/divorced/widowed, unemployed, received professional psychological counseling, family dysfunction, the first trimester of pregnancy, pregnancy complications and vaginal bleeding, unplanned pregnancy, decline in household income and disputes between partners caused by the COVID-19 pandemic, consumption of alcoholic drinks by women and their partners, smoking, lack of exercise and sedentary lifestyle. Women with education from junior high school through college were less likely to experience symptoms of prenatal depression.

CONCLUSIONS

Our study revealed factors associated with psychological symptoms among pregnant women in the post-COVID-19-pandemic era. These results should help to update guidance for psychological interventions for pregnant women during the period of COVID-19.

Relationship Between Fear of Childbirth and Psychological and Spiritual Well-Being in Pregnant Women

The aim of the study was to investigate the relationship between fear of childbirth (FOC) and psychological (PWB) and spiritual well-being (SWB) in pregnant women. Descriptive and relational study was conducted with 338 pregnant women in Turkey. Information form, Wijma Delivery Expectancy/Experience Questionnaire-A, Spiritual Well-Being Scale and Psychological Well-Being Scale were used for data collection. There was a negative correlation between SWB and PWB and FOC in pregnant women. SWB explained 18% of the variance related to FOC which increased to 24% with PWB. SWB was a partial mediating variable in PWB and FOC relationship. PWB and SWB of pregnant women should be evaluated in order to reduce FOC. PWB and SWB of pregnant women should be evaluated in order to reduce FOC.

'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.