Spirituality is something of a taboo subject in health care. While there has been an increase in scientific research on spirituality, there have been few studies of spiritual care in enhancing midwifery practice. At a time when maternity services in the NHS are aspiring to deliver evidence-based care, it appears that we have a problem discussing anything that cannot be demonstrated through research. However, a study into how women perceive the caring role of the midwife indicates that women recognise the importance of the presence of many elements of spiritual care (Crowther and Hall, 2015). It seems that we may be failing to address issues of spirituality in the context of birth and midwifery practice.
For midwives in the UK, holistic care is written into the Standards for competence for registered midwives (Nursing and Midwifery Council, 2011) with the assumption that the midwife will assess and monitor each woman holistically, meeting her physical, emotional, social, spiritual and educational needs throughout the preconception, antenatal, intrapartum and postnatal periods. But what does spiritual care mean, and how is it incorporated into midwifery practice?
Studying the available literature reveals a lack of consistency in defining spirituality, owing to the multidimensional elements involved. Waugh (1992: 10) defines spirituality as
‘that element within man, from which originates: meaning, purpose and fulfillment in life; a will to live; belief and faith in self, others and God and which is essential to the attainment of and optimum state of well-being, health and quality of life.’
A more recent definition of spirituality presented by McSherry and Smith (2012: 118) suggests that
‘spirituality is universal, deeply personal and individual; it goes beyond formal notions of ritual or religious practice to encompass the unique capacity of each individual. It is at the core and essence of who we are, that spark which permeates the entire fabric of the person and demands that we are all worthy of dignity and respect. It transcends intellectual capability, elevating the status of all of humanity.’
However, if these complex concepts are placed in the context of midwifery, the indication is that the midwife should acknowledge the relationship of the mind, body and spirit to the changes taking place within the woman during pregnancy and the time around birth. Therefore, in order to provide spiritual care, the midwife must be able to assess and meet the woman's spiritual needs. Gaskin (2002: 271–2) states that
‘a midwife must constantly put out an effort to stay compassionate, open and clear in her vision, for love and compassion and spiritual vision are the most important tools in her trade… The spiritual midwife brings about states of consciousness in women that allow physical energy transformations of great power, great beauty and great utility.’
Other elements of spiritual care identified in the literature include recognising the value and acceptance of each person (Price et al, 1995), self-awareness, self-development, understanding, intuition and counselling skills (McSherry, 1996).
A study by Moloney and Gair (2015) showed that when midwives’ empathy and spiritual care were evident, women's birth experiences appeared enhanced, providing a solid foundation for confident mothering. Conversely, participants appeared to link a lack of caregiver spiritual care with more enduring consequences, birth trauma and difficulty bonding with their babies.
Spiritual care is as important as physical care in caring for women, both in hospital and the community. It is an area often overlooked and may result in practitioners being isolated by team members and management who do not hold the belief that spirituality is part of every human being. The lack of attention to spiritual topics in the midwifery literature indicates that there is a need for spiritual awareness to be addressed within midwifery education. A question remains as to whether spiritual care is something that can be taught or whether it is something that develops in the individual. However, training may help us to think about these issues and explore the concept of spirituality and its application to caring for women and their families.