Body & Mind

Spirituality in Childbearing Women

Lynn Clark Callister, RN, PhD, FAAN

Inaam Khalaf, RN, PhD

ABSTRACT

Childbearing is the ideal context within which to enrich spirituality. The purpose of this study was to

generate themes regarding spirituality and religiosity among culturally diverse childbearing women. A

secondary analysis was performed, using existing narrative data from cross-cultural studies of child-

bearing women. The following themes emerged from the data: childbirth as a time to grow closer to

God, the use of religious beliefs and rituals as powerful coping mechanisms, childbirth as a time to

make religiosity more meaningful, the significance of a Higher Power in influencing birth outcomes,

and childbirth as a spiritually transforming experience. In clinical settings, understanding the spiritual

dimensions of childbirth is essential. Assessments of childbearing women may include the question,

‘‘Do you have any spiritual beliefs that will help us better care for you?’’

The Journal of Perinatal Education, 19(2), 16–24, doi: 10.1624/105812410X495514

Keywords: spirituality, childbirth, birth experiences

Spirituality and religiosity are recognized as impor-

tant components of health and well-being. Women

have used prayer and other spiritual practices for

their own and others’ health concerns for thousands

of years (National Center for Complementary and

Alternative Medicine, 2005). Most current literature

focuses on the spiritual health of individuals living

with chronic illnesses and those who are terminally

ill, whereas there is relatively little focus on spiritu-

ality or religiosity during the childbearing year.

However, a recent study documented the relation-

ship between religious involvement and health risk

behaviors in childbearing women, concluding that

such involvement was significantly correlated with

less-risk health behaviors (Page, Ellison, & Lee,

2009). Although spirituality and religiosity may

be related, women may be spiritual without being

religious, and more research on this association is

recommended.

Childbearing and motherhood may be ideal con-

texts in which to enrich spirituality. Moloney (2007)

asserts that ‘‘cross-culturally and throughout his-

tory, pregnancy and childbirth have been perceived

as spiritual events because of the miraculous pro-

cesses involved’’ (p. 1). Birth narratives provide in-

sights into the connection between childbearing and

spirituality and present significant information

(Callister, 2004b; Rosato et al., 2006). ‘‘Birth stories

actually offer a powerful and rich source of data.

Greater emphasis needs to be accorded to a valuing

of women’s stories as data’’ (Carolan, 2006, p. 66),

which are typically collected for research using focus

groups referred to as ‘‘talking circles’’ and inter-

views called ‘‘woman to woman listening’’ (Oakley,

16 The Journal of Perinatal Education | Spring 2010, Volume 19, Number 2

2005, p. 225). Attending to women’s spiritual expe-

riences during childbearing is an important way to

enhance care.

The purpose of the current study was to generate

themes related to spirituality and childbirth by

performing a secondary analysis of two decades

of cross-cultural studies regarding the meaning of

birth to diverse childbearing women. Because child-

birth is a life experience endowed with rich personal

meaning, defined as ‘‘the work of the spirit’’ (Trice,

1990, p. 248), it cannot be described adequately by

quantitative means alone. Qualitative research hu-

manizes health care, including childbirth education,

and can be used to develop effective interventions

(Zuzelo, 2007).

REVIEW OF THE LITERATURE

Themes related to spirituality in nursing and health

science literature include spirituality as religion, spir-

ituality as the meaning and purpose of life events,

spirituality as connectedness to others and/or

a Higher Power, spirituality as nonreligious values,

spirituality as holism, and spirituality as self-tran-

scendence (Cowling, 2008; Lemmer, 2005; Miller,

1995; Padela, 2007; Sessanna, Finnell, & Jezewski,

2007). Spirituality has been studied in Appalachian

women (Burkhardt, 1994); battered women (Gillum,

Sullivan, & Bybee, 2006; Humphreys, 2000); em-

powered women (Keene & Jenson, 1997); HIV-

positive women (Sowell et al., 2000); older women

(Learn, 1995); Hispanic women (Rojas, 1996);

women with breast cancer (Chiu, 2000; Manning-

Walsh, 2005); and women with end-stage renal

disease (Tanyi & Werner, 2008).

An early ethnographic study focused on the sacred

dimensions of childbearing (Balin, 1988). Nearly two

decades ago, Sered (1991) asked, ‘‘Is childbirth

a [spiritual]-religious experience?’’ (p. 7). Spirituality

and religiosity have also been studied in childbearing

women, including women living with HIV/AIDS

who had faith that God would protect their child

from becoming infected (Polzer Casarez & Miles,

2008; Siegel & Schrimshaw, 2001); Ghanaian women

(Agovi, 2003; Farnes, Callister, Beckstrand, &

Carlton, in press); Mormon women (Ashurst-McGee,

1997); and women experiencing a high-risk preg-

nancy (Breen, Price, & Lake, 2006). Religiosity is

associated with attendance at religious services, con-

gregational social support, religious coping prac-

tices, and belief systems; furthermore, religiosity

may be distinct from women’s levels of spirituality,

which may not be formalized.

Perinatal bereavement and spiritual issues have

been described (Cunningham, 1997). Dailey and

Stewart (2007) focused on childbearing African-

American women, including those who were coping

with grief after an involuntary pregnancy loss, and

found spirituality was a powerful ameliorating cop-

ing strategy. In a similar investigation, one study

participant said, ‘‘We’re taught that the only thing

you need to do is get on your knees to pray and

you’ll be okay’’ (Van & Meleis, 2003, p. 32).

The effects of Islam and traditional practices on

Turkish women’s reproductive health have been de-

scribed, with God seen as the ‘‘ultimate healer’’

(Bahar et al., 2005). A woman said when she was

in labor, ‘‘I have ritual ablution, pray to God,

[and] worship God when I leave home to go to

the hospital’’ (p. 559).

In a study of 130 urban, low-income, expectant

mothers, themes were generated related to the

meaning of spirituality or faith during pregnancy

(Jesse, Schoenboom, & Blanchard, 2007). The

themes included having guidance and support from

a Higher Power, receiving protection or blessing or

reward for sacrificing to bear children, communi-

cating with God, feeling a sense of strength and con-

fidence in approaching birth, experiencing a sense

of help with difficult moral choices, and having

a generalized sense of well-being and peace.

Authors who conducted reviews of research re-

garding spirituality during pregnancy concluded

powerful spiritual relationships exist between child-

bearing women and their unborn children (Hall,

2006; Hall & Taylor, 2004). The spiritual develop-

ment of women experiencing their first pregnancy

has been described: ‘‘I can imagine no time in adult

life when the definition of one’s self, one’s worth,

one’s place in the universe and in God’s creative

providence is more focused toward becoming

a new and special being than that which changes

a girl into becoming a mother’’ (Baumiller, 2007,

p. 7).

METHODS

For the present study, we performed a secondary

analysis of published and unpublished descriptive

narrative data from cross-cultural phenomenologi-

cal studies that we conducted over the past 20 years

with childbearing women espousing Christian, Jew-

ish, and Islamic religious traditions and with child-

bearing women from countries in a variety of global

regions (Australia; Europe; Middle East; North,

Central, and South America; Southwest Pacific;

Spirituality in Childbearing Women | Callister & Khalaf 17

Western, Northern, and Eastern Asia; and Western

and Southern Africa). Trustworthiness of the data

was established by performing member checks with

study participants, reviewing field notes made

when the interviews were conducted, and verifying

the findings with a team of qualitative nurse re-

searchers.

RESULTS

The majority of women in our study regarded

childbearing as a spiritual experience. Neverthe-

less, one Australian woman did not view childbirth

as a spiritual experience. She stated, ‘‘What’s so

spiritual about it? I just see it as a normal way

of life. To me, spiritual is where you go to church

and listen to the minister’’ (Callister, 2008). An Or-

thodox Jewish woman, however, said that child-

birth would be a spiritual experience for her

because, ‘‘We take spirituality and we infuse it into

every aspect of our daily life’’ (Callister, Semenic, &

Foster, 1999, p. 288). Though not all women in our

study had a similarly spiritual outlook on their

daily lives, most women resonated with the idea

that childbirth is a time when spirituality was en-

hanced.

The themes we identified in all of the reviewed

data included childbirth as a time to grow closer

to God, the use of religious beliefs and rituals as

powerful coping mechanisms, and childbirth as

a time to make religiosity more meaningful. Other

themes included the significance of a Higher Power

in providing blessings and influencing birth out-

comes, and childbirth as a spiritually transforming

experience.

Childbirth as a Time to Grow Closer to God

Several women were specific in their articulation

that childbirth was a time of powerful connection

to their God. For example, a Mormon woman de-

scribed her birth experience in the following way:

The nurse had been so loud, like, ‘‘You can do

it!’’—cheering me on. And then right as she [the

baby] was born, the nurse got quiet and the doctor

got quiet and my husband got quiet. It felt honestly

like a moment frozen, and the room was bright. It

was one of those moments when the Spirit is there.

(Callister, 1992a)

A Guatemalan mother shared a similar experience.

She stated, ‘‘Giving birth I felt closer to God. I thank

God for allowing me to have a baby. While the baby

was in the womb, I realized how great God is’’

(Callister & Vega, 1998, p. 292).

Another Mormon woman expressed a heightened

sense of holiness experienced during childbirth:

When the baby was born, I felt the Spirit of the Lord

touch my heart, and I realized that this little inno-

cent human soul came from my Heavenly Father. I

felt so close to Him and thanked Him for the bless-

ing I have of being a woman, of being able to assist

in the creation of a child, and help him come from

heaven to earth. (Callister, 1992a)

A Canadian Orthodox Jewish mother, for whom

bearing a child was the highest mitzvah or good

deed according to Rabbinical law, said, ‘‘You feel

God’s presence most tangibly when you have gone

through [childbirth]’’ (Callister, 1994). Similarly,

according to the religion of Islam and its adherents

(Muslims), life experiences prove the oneness

(tawhid) of Allah, or God. The deep spirituality

of women who espouse the Islamic faith make

the birth experience sacred. For example, an Arabic

Muslim woman expressed the sense that she was one

with God during labor and birth:

During childbirth the woman is in the hands of

God. Every night during my pregnancy I read from

the Holy Qur’an to the child. When I was in labor I

was reading a special paragraph from the Holy

Qur’an about protection. The nurses were crying

when they heard what I was reading. I felt like

a miracle might happen—that there was some-

thing holy around me, protecting me, something

beyond the ordinary, a feeling, a spirit about being

part of God’s creation of a child. (Khalaf & Callister,

1997, p. 383)

A new Guatemalan mother also remarked on an al-

most tangible holiness:

[Giving birth] I felt closer to God. I thanked God

for allowing me to have a baby. Well, I don’t say

she [the baby] is mine but that He let me borrow

her. While the baby was in my womb I realized how

great God is. Only God watches over the children

that are yet in the womb because only He could do

that. (Callister & Vega, 1998, p. 292)

Although the sense of God’s presence and a feel-

ing of closeness to God’s power was a reality for

many women during childbirth, some of the women

18 The Journal of Perinatal Education | Spring 2010, Volume 19, Number 2

identified the spiritual dimensions of childbirth

while not espousing a specific religious faith (Cal-

lister et al., 2007; Kartchner & Callister, 2003).

While some of these women said birth was not spir-

itual per se, they associated their emotions with

a sense of transcendence. For example, a Chinese

woman said, ‘‘It really isn’t easy at all. Every mother

experiences pain, but I do believe it is sacred’’ (Cal-

lister, 2007). A Finnish woman suggested that her

birth experience was far more than physical, and

that being centered and balanced gives women

strength to negotiate childbirth. She advised, ‘‘Each

mother should listen to herself, to her own body. Be

calm and receptive, willing to take whatever comes’’

(Callister, Vehvilainen-Julkunen, & Lauri, 2001, p.

31).

The Use of Religious Beliefs and Rituals as

Powerful Coping Mechanisms

The women described how their religious beliefs

and accompanying rituals, such as prayer, served

as helpful coping mechanisms during labor and

childbirth. For example, a Tongan woman

explained how her faith sustained her when giving

birth:

When it got to the worst part of the pain that’s

when you look up to heaven for God’s help. Some-

times during the labor I would cry out in pain and

say, ‘‘Jesus, help me.’’ I felt like God was saving me

as I gave birth. Whenever I need help I call on Jesus

for help. (Callister, Khalaf, Semenic, Kartchner, &

Vehvilainen-Julkunen, 2003, p. 149)

Similarly, a 26-year-old Ecuadorian mother of

five said that during labor and birth, ‘‘I always give

myself to God [in prayer]. I asked God to give me

strength!’’ (Callister, 2009). Several Ecuador-

ian women spoke of praying to Narcisa de Jesús

Martillo Morán, a Roman Catholic saint from Ecua-

dor. One of the women said, ‘‘I asked God and the

virgin [Narcisa de Jesús Martillo Morán] that every-

thing would turn out good, and yes they helped. The

virgin, I even saw her at my side’’ (Callister, 2009).

Childbirth as a Time to Make Religiosity More

Meaningful

Women described how their religiosity was

strengthened during pregnancy and childbirth.

For example, a Tongan woman described how

her religious faith became more meaningful as

she was expecting a child: ‘‘During pregnancy was

a good time to say a prayer and give thanks to

the Lord. Tongan women believe that, during preg-

nancy, it is a good time to have spiritual experiences

so that the baby will be created with a good body’’

(Callister, 2001). An evangelical Christian woman

who had five children reported the importance of

saying a prayer of thanksgiving after giving birth:

‘‘The Spirit of the Lord helped me a lot to give birth

to each baby. It is important to the Tongan lady that

the first thing they do after they give birth is to give

thanks to the Lord’’ (Callister, 2001).

The Significance of a Higher Power in Providing

Blessings and Influencing Birth Outcomes

Most of the women believed God can and will in-

fluence the outcomes of their pregnancy and birth.

Many women reported relying on God for help to

ensure positive birth outcomes. This theme was es-

pecially common among women living in develop-

ing countries where maternal and infant mortality

rates were high. A Ghanaian woman explained that

‘‘this junction of life and death’’ is dangerous for

both mother and child (Wilkinson & Callister,

2010). A Mexican immigrant mother described

her reliance on the Lord for positive outcomes

for herself and her child:

I would always ask God that He would take care of

me and of my baby. The baby was born alive and

healthy. I think it was because He was always help-

ing me. My belief is that the baby was born healthy

because I asked God and He listened. (Callister &

Birkhead, 2007, p. 189)

One Guatemalan woman articulated her fears re-

lated to high infant and maternal mortality rates

and the need to rely on God: ‘‘Having a lot of chil-

dren is very difficult. It is a miracle that one comes

out alive. Only God can save your life at that time

[of birth]. It’s hard. Many women die’’ (Callister &

Vega, 1998, p. 292). A Tongan mother said, ‘‘I trust

in the Lord. Sometimes I don’t get support from my

husband, but I trust in Heavenly Father to give me

strength. I rely on the Lord to give me support when

it comes to childbirth’’ (Callister, 2001). Another

Tongan woman expressed her sense that ‘‘the most

difficult part were the contractions. I could barely

handle them. You need the help of the Spirit.

The fruits of labor are the baby, who is a gift from

God’’ (Callister, 2001).

A Ghanaian woman who gave birth to twins after

a previous perinatal loss said, ‘‘I was not afraid. I left

Spirituality in Childbearing Women | Callister & Khalaf 19

everything to God. As for me, I was not afraid be-

cause I knew God was in control’’ (Wilkinson &

Callister, 2010). Another Ghanaian woman

reported:

That period [of pregnancy] is the period of death

and life and anything can happen. Some [women]

go for delivery and they never come back. It is the

time that I need spiritual protection from God, so I

will pray to God so that God will be with me until I

deliver and have a live baby and come home alive.

(Callister, 2007)

Childbearing as a Spiritually Transforming

Experience

Several women reported that childbirth was a pow-

erful and spiritually transforming experience. A

Finnish woman expressed the sense that giving birth

to her first child was in many respects a rebirth, an

opportunity for her to give birth to herself as

a woman entering the new role of motherhood (Cal-

lister et al., 2001). Some women described a ‘‘con-

nected’’ experience or feeling the power of creation

when they gave birth. Dutch women described birth

as a holistic experience characterized by judicious

use of technology and nonpharmacological pain

management. One Dutch woman said, ‘‘I felt so

in touch with myself’’ (Johnson, Callister, Freeborn,

Beckstrand, & Huender, 2007, p. 175). An Austra-

lian mother said:

I didn’t think about childbirth being a spiritual ex-

perience at the time, but looking back I do. I think it’s

just the way you can connect with your baby in a way

you’ve probably never connected with anything. It

gives you a whole different perspective on your spir-

itual side. (Callister, Holt, & Kuhre, in press)

On the other hand, a South African mother

reported an immediate sensation of spiritual trans-

formation. When she gave birth, she felt the same

way she felt in church, ‘‘because the baby is also

coming from Heaven’’ (Callister, 1998). A Muslim

woman said, ‘‘This pregnancy reminded me of

God’s ability to create a child. My faith increased’’

(Khalaf & Callister, 1997, p. 383). An Armenian

mother reported:

I do think that birth is a spiritual experience. When

you know where this child is coming from and that

he is from God, it is more special. We are all spirits.

Sometimes I feel that the child is not only mine but

is a child of God. (Amoros, Callister, & Sarkisyan,

2010)

A Mormon woman described the spiritual trans-

formation she experienced during pregnancy and

birth: ‘‘The spirit of God’s love just enveloped

the whole situation. It was all through the whole

pregnancy. It just felt good and right’’ (Callister,

1992a). A Russian mother articulated, ‘‘Labor and

birth are spiritual experiences. Just the feeling that

I did it—that I was able to give new life. That means

a lot’’ (Callister, 2005). An Armenian woman de-

scribed her birth experience in this way: ‘‘I think

giving birth is a spiritual experience. Nothing hap-

pens without God. When the baby is born, it is like

a light in the family’’ (Callister, 2004a).

A Mormon woman spoke of the awe she was pre-

pared to experience during childbirth, and the

transformation that she did ultimately have:

It’s almost like a spiritual experience in a way. I

had a feeling like I had done something right.

[My mother told me] what a beautiful thing it

was and how exciting that it was. . .[so] I concen-

trated on the positive side—that it was going to be

a really neat spiritual experience. I can’t believe I

was blessed with a wonderful baby. I think it’s

made me really appreciate more of the spiritual

side, the love that Heavenly Father has shown

us. (Callister, 1992b, p. 55)

Being part of the creation of a child was viewed as

spiritually transforming and very meaningful. A

Mayan woman from Guatemala said, ‘‘There is no

word to express the experience of giving birth. . .

it is a gift and a privilege that God gives to women’’

(Callister & Vega, 1998, p. 293). A Mormon woman

spoke of insights that came to her at the moment

of birth:

I knew that God was happy with me for doing this,

and that He wanted me to be the mother of this

child. Not just a child, but this child. It was almost

overpowering that this is one of God’s children and

He trusts me to take care of him. (Callister, 1992a)

These women shared a similar sense of personal

transformation as a result of childbearing. Most of

the women tied that transformation to a sense of

spirituality or a Higher Power.

Some women described a “connected” experience or feeling the

power of creation when they gave birth.

20 The Journal of Perinatal Education | Spring 2010, Volume 19, Number 2

DISCUSSION AND IMPLICATIONS FOR

CLINICAL PRACTICE AND RESEARCH

The study’s results affirm the work of King (1989),

who concluded, ‘‘Motherhood is a rich and widely

ramified concept linked to biological birth, to cul-

turally learned patterns of mothering and to expres-

sions of. . .spiritual insights of human experience’’

(p. 79). One cannot truly assess a childbearing

woman without assessing her spirituality (Tanyi,

2006). Meraviglia (1999) suggested that ‘‘the spiri-

tual dimension is thought to integrate all human

dimensions: Mind, body, and spirit, for a sense of

wholeness and well-being’’ (p. 19). Hispanic women

often speak in terms of a person’s soul or spirit

(alma or espiritu) when referring to one’s inner

qualities and relationship with a Higher Power,

which Sellers and Haag (1998) suggested is ‘‘the

center or core of humanness’’ (p. 339). For many

women who participated in our studies, childbirth

was a sacred event.

Listening to the voices of culturally diverse child-

bearing women is an important spiritual interven-

tion (Callister, 2004b), because sharing birth stories

can be a significant experience for childbearing

women. Hall and Taylor (2004) concluded, ‘‘When

women tell their birth stories, they often do so in the

language and framework of a spiritual experience,

and they use terms such as ‘holiness’ and ‘miracu-

lous’’’ (p. 45). Women share their storied experi-

ences, and the ‘‘experience is enhanced by the

telling of it. . ., [and] forming narratives also allows

the teller to own the experience’’ (Ashurst-McGee,

1997, pp. 138, 142). Sered (1991) suggested, ‘‘For

some women childbirth ‘feels’ spiritual and a num-

ber of women reported a heightened sense of holi-

ness after birth. However, women lack the language

to express that feeling. Even those who had a spiri-

tual experience couldn’t find language for it’’ (p.

16).

It would be valuable for childbirth educators to

have a class reunion where new mothers can share

their experiences. Another approach is to invite new

mothers to submit a written narrative about their

birth experiences to the childbirth educator.

Spiritual care includes presence, actively listen-

ing, helping women articulate their feelings about

their birth experience, and sharing that experience

by connecting (Eldridge, 2007). Researchers sug-

gested, ‘‘Listening to women offers the best way

to find common ground between what we as health

professionals think is best and what women want

[and need]’’ (Brems & Griffiths, 1993, p. 256). As

Gardner (2008) noted, ‘‘Numbers are nice, but

stories matter’’ (p. 108).

The Joint Commission, which accredits and cer-

tifies health-care organizations in the United States,

includes spiritual assessment and care as part of its

standards (The Joint Commission, 2008). It is es-

sential for childbirth educators to recognize that

spiritual care is significant (Dunn, 2009). Childbirth

educators are encouraged to remember that spiritu-

ality is more than affiliation with a specific religious

tradition and, as Adams and Bianchi (2008) sug-

gested, ‘‘The laboring woman’s spirituality or faith

may serve as a source of inner strength and comfort

during labor’’ (p. 109). The need has been identified

to enrich the vision of spirituality in the provision of

health care (McSherry, Cash, & Ross, 2004). Reed

(2008) asserted that ‘‘spiritual care requires per-

sonal and practice-based knowledge beyond the

forms of knowledge typically promoted in evi-

dence-based practice. . .. Spiritual [care] is already

inherently a process. . .of relating, trusting, connect-

ing, listening, supporting, respecting’’ (p. 16).

Understanding the spiritual dimensions of

childbirth helps childbirth educators provide holis-

tic health care (Lauver, 2000), which has been de-

scribed by Corrine, Bailey, Valentin, Morantus,

and Shirley (1992). Assessment of childbearing

women may include the question, ‘‘Do you have

any spiritual beliefs [or religious practices] that will

help us provide better care for you during your

pregnancy and birth?’’ (Jesse et al., 2007, p. 158).

Tending to childbearing women’s spiritual needs

in this way may improve their health care

(Eldridge, 2007). After a woman gives birth, simply

asking, ‘‘What was your experience like?’’ allows

the woman to express tender feelings about the

spiritual dimensions of her birth experience rather

than just focusing on ‘‘the facts’’ of her birth

(Callister, 2004b).

Curricula for childbirth education and nurses

may include a focus on spirituality and childbirth

(Callister, Bond, Matsumura, & Mangum, 2004;

Mitchell, Bennett, & Manfrin-Ledet, 2006). Further

exploration is recommended of the relationship be-

tween spirituality, religiosity, holistic health, and

well-being in childbearing women (Dunn, 2009).

When women tell their birth stories, they often do so in the language

and framework of a spiritual experience, and they use terms such as

“holiness” and “miraculous.”

Spirituality in Childbearing Women | Callister & Khalaf 21

Childbirth and motherhood are ideal contexts in

which to acknowledge the spiritual dimension of

women’s lives. Birth narratives can provide insights

into the connection between childbearing and spir-

ituality, and can be utilized as an effective interven-

tion for childbirth educators.

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LYNN CLARK CALLISTER is a professor of nursing at the Brig-

ham Young University College of Nursing in Provo, Utah, and

a fellow in the American Academy of Nursing. She has conducted

cross-cultural studies of childbearing women for over two decades.

INAAM KHALAF is the dean and a professor of nursing at the

University of Jordan Faculty of Nursing in Amman, Jordan. She

has conducted research with childbearing families as study par-

ticipants for more than 20 years.

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