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Foregrounding spirituality and joy at birth in antenatal education.

Foregrounding spirituality and joy at birth in antenatal education is essential in lessening fear and allowing meaningful holistic experiences to emerge. To foreground is to make something stand out from the taken for granted everyday experience (Heidegger, 1927/1962). This paper, drawn from a phenomenological study, reveals spiritual shared human experiences that are taken for granted within maternity services. These experiences prevail despite increasingly secular and biomedical approaches that inform contemporary birth care. Dominance of scientism appears to preclude contextual understanding of human experience leaving much unspoken (Gadamer, 1976). This paper contends that the distinctive vocabulary or language now dominating many antenatal education classes are in peril of becoming discourses of risk aversion and medicalisation. The voice of hope and joy needs to be heard more explicitly.

Fuller understanding of the moment of birth and how it is spiritually meaningful may have important implications for how education in and around childbirth is organised and provided. There may be unknown consequences of denying spiritual meaning in and around childbirth. Concern that something of experiential significance is being lost at birth has been voiced by childbirth and midwifery researchers (Crowther, 2012; Fenwick, Staff, & Gamble, 2010; McAra-Couper, Jones, & Smythe, 2010). Women want to be healthy and safe but also desire positive life-enhancing birth experiences (Renfrew et al., June 2014). Odent (2011) argues that the fundamental ecology of birth is now in jeopardy. It is probable that the effects of not addressing spiritual meaning in and around childbirth in antenatal preparation leaves the wholeness and potential of what birth "is" silenced.

Maternity services have become increasingly technocratic, structured and standardised in order to improve certain outcomes. It appears that the natural cadence of birth has been replaced by timings and structured labours and births (Downe & Dykes, 2009). The unborn baby has increasingly been the focus in modern maternity care giving way to an evolution of how we attend or attune to birth (Crowther, 2014). The specialness of birth has become hidden in pursuit of the scientifically managed birth. Spirituality at birth seems to have no place in a world focused on risk aversion and fear. Some reproach the evolution of technological birth. Lamaze (1956), Gaskin (1977), Leboyer (1991) as well as others persistently acknowledge the magic and mystery of birth as more than biomedical, hinting at birth's inherent spiritual 'specialness.'

Ongoing polemic discourses of abnormal/pathological versus normal/natural fuel a culture of risk management and mistrust in the physiological process. For example physiological third stage versus active management of the third stage, birth with or without epidural analgesia and hospital births versus out of hospital births tell us little of the wholeness of the childbirth experience. Selin and Stone (2009) argue that birth culture has become so entangled with risk avoidance strategies that it is in jeopardy of being reduced to a "sterile, safe, vacant experience" (p. xv). The true risk appears to be that advances in technology have threatened the spiritual experience at birth by stripping it of spiritual meaning. Yet condemnation of technology is unwarranted, for it can afford assistance so that spiritual experience can awaken. There is no evidence to support that certain births are more joyful and spiritual than others. Some highly technologically focused births may be less joyful in those immediate moments as other concerns take priority, yet a baby is born and this occasion is equally significant (Crowther, 2014). Dichotomous interpretations belie the holistic worldview. The purpose of this paper is to expand findings on the spiritual experience at births for all those involved in childbirth and offer a message of hope for those who find themselves positioned either by choice or circumstance in a technological birth. This an important subject that needs conveying in antenatal education.

Spirituality involves a quest for life's purpose, connection and meaning

Literature Review

Antenatal education classes are repeatedly found to be important in disseminating and exploring information as part of preparation for birth (Hardie, Horsburgh, & Key, 2014). Yet there continues to be conflicting evidence on the effectiveness of antenatal education and a paucity of holistic and spiritual content in many classes.

Spirituality involves a quest for life's purpose, connection and meaning. Spiritual and joyous experiences are personal and often occur in unexpected and surprising ways. The moment of birth confronts and connects those at birth with something profoundly meaningful and often inexplicable. Spirituality and sacredness in childbirth continue to be revealed in research (Crowther, 2013; Doherty, 2010; Fahy & Hastie, 2008; Hall, 2012; Lahood, 2007). However, there by Susan Crowther, PhD MSc BSc(Hon) Registered Midwife RN appears to be little or no educational content that addresses spirituality of the birth experience in most antenatal classes. The notion of spirituality perhaps appears unnecessary in antenatal educational content when juxtaposed to other seemingly crucial topics (Davies, 2002).

Twenty-first century birth metanarratives point to universal beliefs and values based on concepts of fear, safety and need for protection from interventions. Perhaps these perspectives only confuse and conceal what birth means and how it is experienced in its wholeness (Crowther, Smythe, & Spence, 2014a). Although reduction in anxiety has been found by attendance at antenatal education programmes (Ferguson, Davis, & Browne, 2013), caution is required so that antenatal education does not echo dominating metanarratives and intensify fear (Serceku & Mete, 2010).

Providing information in classes that is solely safety driven and risk averse oriented leaves much unsaid. At the same time it is essential to acknowledge that safety means different things to different people (Smythe, 2010). Women usually prioritize the outcome of emerging unharmed with a healthy baby but also seek unique peak and meaningful experiences central to the birth itself (Fahy & Hastie, 2008; Hall, 2010; Parratt, 2010; Thomson, 2011). The experience of giving birth and being at birth is more than about being safe; it is experientially meaningful to birthing mothers and those with them. Some women welcome technology at their birth (McAra-Couper et al., 2010), however, exploration of meanings within sociocultural, historical and linguistic contexts results in deeper and more relevant understanding.

Birth holds differing meanings in different cultures. It is interpreted according to different ethnic cosmologies, creation theories, religious and spiritual understandings that provide a sense of purpose and meaning of life. The need to appreciate others different from oneself in maternity is essential (Farry & Crowther, 2014). The concern is that sacred significance and spiritual meanings at birth remain unspoken and thus forgotten. These attributes of birth experiences are not easy to articulate. Antenatal education is an opportune time for talking together, learning and sharing (Svensson, Barclay, & Cooke, 2008). Perhaps the antenatal education class is an opportunity for dialogue about spirituality that could ignite and drive change towards a more holistic family centred birth culture.

Methodology

This study is an interpretive phenomenological study underpinned by the philosophies of Heidegger and Gadame (Gadamer, 1960/1975; Heidegger, 1927/1962). Following ethical approval from AUTEC (AUT University Ethics Committee) 14 participants were recruited for their interest and willingness to participate (see Crowther, 2014, pp. 111-114). Stories of being at birth were collected from mothers, birth partners, obstetricians and midwives. Interviews used a conversational style and provided nuanced detail of the experienced phenomenon. Phenomenology is reflection on the taken-for-granted and backgrounded pre-reflective lived experience. Hermeneutic analysis was used to surface the inter-relational meanings from the wholeness of the rich contextual narratives provided by phenomenological enquiry Thus hermeneutic phenomenology is "less a determinate code of inquiry than the inceptual search for meaning of prereflective experience"--it is an examination of the "experiences as we live through them." (van Manen, 2014, p. 27).

In hermeneutics the researcher is acknowledged as being an integral part of the whole. Therefore the pronoun 'I' is used, as research of this nature is irretrievably personal. It is not possible to be objective or step outside of one's own presuppositions nor is it necessary (Gadamer, 1960/1975). This is a strength of the methodology. I am already in the world of birth and from within that world the concern and questions arose initiating this study. Who I am, and why and how I came to this research, are explicitly stated. I have been a midwife for more than two decades working across various cultures, regions, and practise in primary and hospital settings, education and research. I experience and understand birth to be more than biomedical in nature and feel the spiritual specialness at birth in ways that I am unable to articulate. Any interpretation is mine and open to further interpretation. What is presented here are the most plausible interpretations and conclusions.

Hermeneutics does not privilege a final answer or polemic assumptions but gestures towards the 'beingness' of experiences, providing deeper knowing, thinking and an ongoing dialogue. Hermeneutic analysis is performed by keeping close to the phenomenon of interest by cycles of writing and re-writing, reading and re-reading, and paying attention as meaning surfaces that leads to plausible meaningful understandings (Smythe, 2011). This is a continual crafting process not shaped by organised qualitative thematic analysis but a constant openness to new possibilities. This is a process of seeing relationships of the parts and the whole that reveal common and essential meanings often left hidden in the background of lived-experience. A previous publication by Crowther, Smythe, and Spence (2014b) provides more comprehensive description of the philosophical underpinnings, method and how interpretive analysis of this study unfolded.

Findings

The study reveals that birth is experienced as significant and joyous across professional groups, different types of births and locations with or without technological interventions (home, hospital, forceps and Ventouse, premature birth, transfer from home to hospital due to slow progress, epidural birth, induction and augmentation of labour). Joy at birth was revealed as a shared embodied, spatial and essentially gathering experience.

Amy (mother), following a forceps birth that she described as dreadful, goes on to speak about the actual moment at birth:

   I had an immediate sense of empowerment. The emotion
   was love--a pretty whole-body experience. I'm like
   "Wow", it's happened, a wow moment.


This sudden change of mood in the moment is expressed by Brenda (obstetrician) at caesarean section as she described an embodied joy:

   To be honest when you get that rush of emotion from
   the parents I get the little tears well up and I sort of have
   to sniff them back and focus on doing the stitches and
   medical things! I sometimes feel myself overcome and fight
   back the tears as I have a job to do.


Karl (father) had an embodied experience seeing his son born in front of him at home:

   I remember feeling soft waves of tearfulness


This embodied joy reaches out and fills the space in and around birth:

When the baby was here, the elation and the relief and the joy flooded in and it didn't matter who's there, or if the lights are on, it didn't matter. The mood suddenly changed in the whole room around the birthing pool as the baby just emerged (Simone--midwife)

This experience of being flooded with joy can be felt as overwhelmingly intoxicating:

That joy and that feeling of love is like you're absolutely intoxicated! This is the highest feeling. (Tui--grandmother)

Something special and sacred about being at birth is uncovered in these stories. A profound experience at birth that invites and attunes participants. To be at birth was also to find oneself in a joyful gathering, a being-with others in new ways:

That was a special moment when he just 'flew out'; especially seeing him on [wife]. It was peace, relief and love; we've got a baby, pfoof! He's alive; we've made a human being! (John--father)

This speaks of tenderness and an overflowing joy and connection in that moment. The labour had been induced and it had been a long process ending in an instrumental birth, yet something extraordinary and gathering occurs at birth. There is a power at birth that brings people together:

Whoever is there at birth, including me, gets realigned with their own sense of the occasion. Initially I and others may have not been taken on how significant it was and then when we realise how it's affecting everyone around you I realise how it is still a big deal. (Steve--obstetrician)

In that moment of birth there is often the desire to reach out and bring others into the specialness:

I called my dad as he really wanted to know right away when the baby was born. I left a message on his phone and I felt myself welling-up telling him he is a grandfather [begins to weep] I didn't know where the tears were coming from. (Pat--mother)

As Karl (father) says:

   There is a special feeling around birth--it is joy, everybody
   is so happy. When you tell people you've had a baby
   people are instantly happy and joyful about it. They are so
   happy and want to contact you and want to come round,
   they just want to be around 'it.'


This feeling of coming together reveals something extraordinary that lies in the background familiarity of birth. It is a reminder of how we live and share a world with others. Birth is a significant once in a lifetime event rich in togetherness that stands out more pressingly than other concerns in that moment. For the time at birth is special, not clock or cyclic time, but more than these:

It was a timeless preciousness that touched me to my core that I will not get back; it's never going to happen again. (Amy--mother)

It is Kairos' time, a time that touches participants profoundly across and beyond time bringing forth deeper knowing and feeling of connectedness to holy "otherness":

The joy comes from generations and generations that have gone before. Time folding in and out of past and future, all that past, thousands of ancestors, their energy focused to make that child, the moment calling them. Where does it come from? I've got no idea, it is connection beyond the world and God, whatever God is. (Tui--Grandmother)

These excerpts reveal how the time at birth is a sacred moment. An overwhelming joy erupts suddenly at birth unexpectedly. An experience that assails them coming from everywhere and nowhere akin to Heidegger's (1927/1962) notion of attunement. Heidegger claims that how we attune determines how we come to understand the situations we find ourselves living through and in. Each participant had a unique experience made intelligible to them by how they tuned into the moment of birth. To tune into something is to attune and be in a certain mood. Heidegger suggests that we are always in some mood or other.

Joy at birth is a spiritual experience that gives purpose to life, opens possibilities, and fosters relational connectedness. The joy at birth serves as a reminder of our shared natality, potential of new tomorrows, exciting possibilities yet unknown, and connections across time stretching back through ancestors and reaching forward to our inheritors.

Discussion and Implications

Joy at birth cannot be forced for it arrives at the optimum moment. The apogee of a good birth remains unclear. There are times when birth is experienced as horror and sorrow yet I would argue that the mystery and wonder of birth is not diminished. This research has shown that in times of breakdown the spiritual meaning gifted by joy at birth remains despite potential for being hidden or turned away from (Crowther, Smythe, & Spence, 2014b). The stories presented in this paper gesture to something profoundly significant and inspiring about many types of interventional births beyond that commonly articulated. This is not to claim that all births are experienced as spiritual--for there is always more remaining unknown and concealed about childbirth. However this study is a message of hope for parents who find themselves wrapped in technology and/or trauma who may feel robbed of meaningful experiences.

Childbirth interventions can avert tragedy and therefore allow joy to awaken at birth when judiciously used. Yet technology should not be allowed to define what birth 'is.' Modern maternity systems focus on morbidity and mortality, often overshadowing the celebratory and spiritual nature at birth. This study begins revealing how joy at birth conceals profound spiritual meanings and understandings. This encourages further thinking about how antenatal educators can be attuned to the wholeness of childbirth. This is a call to prenatal educators to examine the relationship with technology at birth, not the technology itself. Advances in technology could threaten society's experience of the sacredness of birth by stripping it of meaning. Even in the high risk situation when joy is delayed, it can be anticipated and welcomed. There is a need to attend to the wholeness of birth in antenatal classes so that deeply meaningful experiences do not become buried under technological culture. This, I argue, would be a perversion of birth's unfolding possibilities for everyone.

McIntosh (2012) argues that how a society interprets birth is fundamental to how a society functions. Cultural awareness and willingness to listen to the silenced voices that beckon sacredness at birth can be heard in human history. Phenomenology gives voice to all experiences without privileging one worldview. However some voices were absent in this study, for example those there at stillbirths or births of unwanted or severely unwell babies. I would maintain that these births are no less spiritually significant despite joy's retreat into shadow. This is a challenge for everyone involved in antenatal education. Antenatal teachers need to be amazed by birth and not limit how and what birth 'is' to technocratic interpretations. Those teaching antenatal classes need to be open and sensitive.

This paper is a remembrance that childbirth may be far more than our present knowing. Joyful experiences at childbirth are revealed as shared temporal lived-experiences gesturing spiritual meaning involving felt purpose to life and interconnectedness. Birth is a moment to pause, share and savour. Many know that those precious moments at birth are precious and meaningful. This is not a time for idle chatter, clearing equipment, people coming in and out or texting and using mobile phones. This simple guidance and shift in awareness can be enculturated at antenatal classes. It requires classes to attune to the miracle at birth. Natality according to Arendt (1958) lays bare our nature which continually unfolds into ever new beginnings revealing our capacity to always conceive new futures. Is this honoured at the time of many births? How would our antenatal preparation classes be attuned differently if this were the foundation of our class plans?

To bring future parents into a space of existential wonder about birth would awaken a deeper yearning for profound knowing. This paper offers a challenge to the lists of choices and options presented to prospective parents in a menu format that are decontextualized and secularised. This study is a call to revisit what birth means collectively and re-position what birth 'is' in terms of its shared spiritual uniqueness. This has implications for all those involved in the childbearing year and perhaps for society as a whole (see table 1). This can be conveyed to families in their antenatal preparation.

Limitations

This study took place in New Zealand. The interpreted data thus represents perspectives from within one maternity system. Technocracy and medicalization of birth is now a global phenomenon throughout developed countries. Generalisation of this study can be challenged, yet arguably transferability to other regions is possible given the universal experience of natality. The numbers of participants would be unsatisfactorily low in other methodologies but this study was not about testing hypotheses or formulating theories. This was an ontological project, examination of "being" at birth. It was concerned with understanding experiences at birth as lived in and lived through and uncovering commonalities. This was an ontological project, an examination of "being" at birth.

Future Research

An exploratory examination through focus groups of prenatal education content is required. This would provide understanding of cultural differences, uncover community meanings connected with birth and provide opportunity to examine congruence or otherwise with maternity service provision. How birth is experienced and meaningful to parents, antenatal educators and society has implications for developing people-centred holistic antenatal education. Inclusion of spiritual content into antenatal education may encourage those that choose not to attend to feel 'seen.' This needs examination.

Conclusion

This paper is a reminder that the time of birth is always significant, "something almost intangible is inherent in the world of birth ... a sense that those there at birth can be gathered by such a mood and swept away" (Crowther et al., 2014b, p. 25). Birth is a moment in human life that needs acknowledging and honouring. It deserves a willingness to engage openly with the whole rather than to examine birth preparation in decontextualized objectified parts. The language for articulating spiritual birth experiences are essentially silenced until permission is given to speak about them. It is in the speaking that the phenomenon of sacred joy at birth becomes manifest and the spirituality of birth is made visible.

For all of us teaching antenatal education, what is hidden remains always ineffable. Yet it is the joy at birth which authenticates us, brings us home, and reminds us of life's mystery that brings hope of new tomorrows. It is essential that joy at birth is foregrounded, spoken and explored in our antenatal education so that fear does not overwhelm breaking connection to birth's mystery. Attuning joyfully at the moment of birth reveals spiritual qualities that are uniting, freeing and empowering. Safeguarding this vulnerable yet potent 'feeling' at birth is to foreground, protect and remember something spiritually significant. To attune to joy in antenatal education in a way that does not deny or negate that birth at times can be difficult can help change the fear dominated birth culture and bring holistic focus to educational content.

Acknowledgements

Thanks to Professor Liz Smythe (AUT University Auckland, New Zealand) for her expertise and generosity of spirit who has proofread and assisted in the conceptualization of this article.

The principle study was self-funded other than an awarded writing scholarship from AUT University Auckland, New Zealand in 2013.

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Susan is a senior lecturer in midwifery at AUT University Auckland, New Zealand. She has extensive experience working across primary and secondary maternity services as caseload self-employed midwife, educator, researcher and manager in several countries and continues to provide locum rural caseload midwifery services. She is on the editorial boards for The Practising Midwife and New Zealand College of Midwives journal and a member of the International Confederation of Midwives' Research Advisory Network.

Table 1: Implications for Prenatal Educators

* Birth is always significant in all circumstances for everyone.

* Spiritual and joyful experiences at birth are part of all births
although at times these experiences can be delaye

* Technology and medical intervention do not preclude existential
meaningful experiences at birth.

* Sensitivity and awareness to cultural difference provides
openness to exploration of how birth is uniquely meaning

* Foregrounding spirituality and joy at birth in antenatal
education can diminish anxiety and fear related to birth.

* Antenatal educators need courage to explore spirituality and
meaning in antenatal classes.

* Foregrounding spirituality in antenatal educational content
provides an opportunity to reaffirm the shared sacred
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Title Annotation:Primary Research
Author:Crowther, Susan
Publication:International Journal of Childbirth Education
Article Type:Report
Date:Oct 1, 2014
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