The experiences of Iranian women of pain during childbirth

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

Article in Women and Birth · June 2017

DOI: 10.1016/j.wombi.2017.04.010

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Original Research - Qualitative

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

Z. Taghizdeh

^a

, A. Ebadi

^b

, M. Dehghani

^c

, M. Gharacheh

^d

, P. Yadollahi

^e,

*

aDepartmentofReproductiveHealth,FacultyofNursingandMidwifery,TehranUniversityofMedicalScience,Tehran,Iran

bBehavioralSciencesResearchCenter,NursingFacultyofBaqiyatallah,UniversityofMedicalSciences,Tehran,Iran

cFamilyResearchInstitute,ShahidBeheshtiUniversity,G.C.,Tehran,Iran

dDepartmentofMidwifery,FacultyofNursingandMidwifery,AzadEslamicUniversity,GachsaranBrunch,Gachsaran,Iran

eDepartmentofReproductiveHealth,TehranUniversityofMedicalScience,Tehran,Iran

ARTICLE INFO

Articlehistory:

Received3April2016

Receivedinrevisedform15April2017 Accepted28April2017

Availableonlinexxx

Keywords:

Transcendence Laborpain Motherhood Psycho-spiritual Childbirth

ABSTRACT

Background:Thedescriptionofwomen’sexperiencesofchildbirthimprovesourunderstandingsofthe natureofchildbirth,women’ssufferingandpainduringchildbirth.

Aim:Thisstudyaimedtoexplorewomen’sexperiencesofpainduringchildbirth.

Method:Aqualitativestudywasconductedusingaconventionalcontentanalysismethodproposedby Graneheim andLundman(2004). In-depthfacetofacesemi-structuredinterviews wereheldwith 17womenwhometinclusioncriteriaforparticipationinthisstudy.

Findings:Thewomen’sexperiencesofpainduringchildbirthwasdescribedas‘atimeforpsycho-spiritual transcendence’.Categoriesdevelopedduringthedataanalysiswere‘conﬂictingemotionstowardspain’,

‘newinsighttowardslaborpain’,‘self-actualization’and‘spiritualdevelopment’.

Conclusion:Mostparticipantshadpositiveexperiencesandattitudestowardspainduringchildbirth inﬂuencedbycultural,contextandreligiousfactors.Accordingtothisstudy,‘transcendentalprogression’

wasaneminentfeelingthatcreatedpositiveinnerfeelingsalongwithself-actualizationinwomen.This providesanewinsightonlaborpainandhelpshealthcareprovidersunderstandtheeffectofpainduring childbirthonwomen’sspiritual,mentalandpsychologicalneeds.

Statementofsigniﬁcance

Problemorissue

Childbirth in Iran is considered an unpleasant painful condition.Iranianwomen have tocometo termwiththe medicalizationofchildbirth.Therefore,therateofcesarean sectionhasincreaseddramaticallyamongIranianwomen.

Whatisalreadyknown

Studies on women with different cultural and religious backgroundsshowedthatwomen’sreligiousbeliefsinﬂu- ence on the provision of care. According to the Islamic

doctrine, childbirth makes women closer to God and enhances their spirituality. However, a few studies are availableonIranianwomen’sexperiencesofchildbirth.

Whatthispaperadds

According to the Iranian ministry of health and medical education,therateofcesareansectionshouldbereduced.

Also,thereisaneedothepromotionofvaginalchildbirth with the consideration of religious and cultural back- grounds. The results ofthisstudy helppolicymakers and midwives for the provision of culturally appropriate and sensitivecaretowomenduringchildbirth.

1.Introduction

Labor pain is a subjective interaction between multiple physiological and psychological factors. Pregnancy for most women is associated with considerable enthusiasm, but labor painisastressfuleventandcandiminishthefeelingsofself-worth,

* Correspondingauthorat:FacultyofNursingandMidwifery,TehranUniversity ofMedicalSciences,NosratSt.,TohidSq.,1419733171,Tehran,Iran.

Fax:+982166941668.

E-mailaddress:[email protected](P.Yadollahi).

http://dx.doi.org/10.1016/j.wombi.2017.04.010

xxx–xxx ContentslistsavailableatScienceDirect

Women and Birth

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self-confidenceandself-aversion.¹ Women’sbeliefs, perceptions andattitudesduringchildbirthinfluenceontheirself-efficacyand satisfactionofpregnancy.²Laborpainreduceswomen’shappiness, strength,courageandthefeelingofmeaningandpurposeduring childbirth. It can also create a dissociation from individuals’ feelingsandreduceanabilitytofeeljoy,loveandconnectionwith the newborn.³ From a holistic perspective, an interaction between the mind, bodyand spirit is essential in childbirth.⁴ Therefore, women who consciously perceive the interaction betweenthemindandbodyinlaborpainareabletofacetheir innerreality,whichdevelopsapositivefeelinginlife.⁵Childbirth notonly isaffected bywoman’shealth conditionsand expect- ations,butalsoisconsiderablyinfluencedbythesocialcontext andcultural values.⁶ Women experience labor pain and their cultural, contextual and religious beliefs determine how they perceive, interpret and react to pain.1,8,9,10,11,12,13,14 Childbirth fromtheperspectives of African–Canadianwomenis a painful process and mixed with challenges. However, they consider childbirthaspiritualjourneyandtrytotakecontroloverit for gainingself-worthand hope.¹⁵ Nowadays,spirituality isrecog- nizedasanewpsychologicalreality,conceptandresearchtopic, whichcan be consistent in part with religiousnessor not.^16,17 Modern spirituality includes a reference to transcendence or sacredness, but God is defined within religious traditions. It emphasizesanindividualrealitywithaconnectiontotranscen- dence,others,andtheworldwithoutnecessarilyaconnectiontoa certainreligious institution orgroup.^18,19Also, evidenceshows thatindividualsvaluespiritualitymorethanreligion.Therefore, anincreasingnumberofindividualsdeclarethattheyarespiritual ratherthanreligious,whereasafewpeoplereporttheopposite.

Spiritualityisabroaderconceptthanreligiousnessandreﬂectsa dynamic ratherthan a static condition. Also, it is an emotion ratherthanabelief.²⁰

According to the Islam, the holy Qur’an and the Hadiths (sayings,deeds,oragreementsoftheProphet),thereisanoverlap betweenreligionandspirituality.IntheIslamiccontext,thereis no spirituality without religious thoughts and practices, but religionprovidesaspiritualpathinlife.²¹AccordingtotheIslamic doctrine,childbirthisanopportunitythatmakeswomencloserto God and makes spirituality more meaningful.¹⁰ Spirituality is quintessentialtochildbirth⁷andlaborpainisanidealcontextfor women’s transcendence and spiritual health.²² Despite the Islamic teachings regarding the sanctity of childbirth, vaginal childbirth has become an unpleasant and painful condition whereby women have to comply with the medicalization of childbirth.²³ In technocratic societies, women’s reproductive bodieshaveinherentfaultsandneedmedicalmanagement.²⁴In fact,medicalinterventionsinmostcases isnotessential²⁵ and even may increase therisk for losing individual’shumanity.²⁶ Giventhefactthatmidwiferycarehasaholisticnature,grounded intheunderstandingofthesocial,emotional,cultural,spiritual, psychologicalandphysicalexperiencesofwomen,²⁷understand- ingwomen’sbeliefs,values,andbehaviorswithdifferentcultures helps midwives provide a more culturally appropriate and sensitivecaretowomen.²⁸Afewstudieswereavailableonthe women’sexperiencesofchildbirthintheIranianculturalcontext.

Therefore,thisstudyaimedtoexplore women’sexperiencesof laborpain.

2.Method

An inductive qualitativemethodwas used,becauseit was a suitable methodfor exploring culturalphenomena in terms of meaningsthatparticipantsascribetothem.Therefore,giventhe requiredlevelofabstractionandexplorativedesignofthisstudy,a qualitative content analysis method was chosen. Qualitative

content analysis is a method for categorizing and coding data thataimstodescribeaphenomenon.Also,thismethodissuitable whenthereislimitedknowledge,theoryandresearchaboutthe study phenomenon. This technique provides knowledge, new insights,andin-depthdescriptionsofrealities.²⁹Therefore,given thesubjectivity of thewomen’sexperiences of laborpain, this methodwasusedforexploringtheexperiencesofIranianwomen oflaborpain.

2.1.Participantsandsetting

The participants wereselected using a purposeful sampling method.Also,maximumvariationinsamplingwasconsideredin termsofage,educationallevel,income,gravidity,participationin educationclassesbeforechildbirth,vaginalchildbirthwithoutand with medical interventions. The inclusion criterion for the selectionofthewomenwastheexperienceofvaginalchildbirth withoutcomplications.Theexclusioncriteriawerebeingunableto speak in Farsi, being diagnosed with mental disorders as documented in the woman’s health ﬁle, cesarean section for childbirth,havingthehighriskforpregnancyandthehistoryof infertilityandillicitdrugsabuse.

2.2.Procedure

ThedatacollectionwasperformedfromMaytoOctober2015.

In-depth,individual,face-to-facesemi-structuredinterviewswere heldwith17eligiblewomen.Atthebeginningofeachinterview session,theparticipantswereinformedabouttheaimofthestudy, conﬁdentiality of data collection and voluntary nature of participation in thestudy. Next, the written informed consent formwassignedbythosewomenwhowillinglyagreedtotakepart in this study. The interviews were guided by an open-ended question: “Will you describe your experiences of pain during childbirth?” Also, probing questions were asked to clarify the participants’descriptionsandimprovethedepthoftheinterviews.

Theinterviewswereheldinacalmenvironment,tape-recorded and lasted for 30–90min. The interviews were transcribed verbatim simultaneously afterthe data collection and analysed bytheresearchteam.TheMAXQDAsoftwarev.10wasusedfordata management.Theinterviewswerecontinueduntildatasaturation wasreached.

2.3.Dataanalysis

The conventional content analysis method proposed by Graneheim and Lundman (2004) was used for analysing the collecteddata.³⁰Aftertranscribingtheinterviews,theywereread carefully and manifest and latent contents were identiﬁed as meaningunits.Next,codeswereassignedtothemeaningunits.

Thecodeswereorganizedaccordingtotheirrelevance,similarities anddifferencesandcategoriesweredeveloped.Ultimately,themes asthelatentcontentofthedataweredeveloped. Theﬁrstand second authors carried out coding and categorizing and other authors supervised this process. In case of disagreements, the research team members held discussions to resolve disagreements.

2.4.Trustworthiness

LincolnandCuba’scriteriawereappliedtoassesstrustworthi- ness.³¹Memberchecking,peerdebrieﬁng,andaudittrailhelped with the credibility of the study process. Dependability was ensured using purposive sampling and maximum variation in sampling,Moreover,adetaileddescriptionoftheresearchprocess helpedwiththetransferabilityofourﬁndings.

2 Z.Taghizdehetal./WomenandBirthxxx(2017)xxx–xxx

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2.5.Ethicalconsiderations

The research and ethics committee afﬁliated with Tehran UniversityofMedicalSciences,Tehran,Iranapprovedthestudy’s protocol(decreenumber:IR.TUMS.REC.1394.1577).Allparticipants were informed of the aim of thestudy, and written informed consentformwassignedbytheparticipantswhowillinglyagreed to take part in this study. A permission to tape-record the interviews was obtained and a number was assigned to each participanttomaintaintheirconﬁdentiality.Theywereinformed thattheyhadtherighttowithdrawfromthisstudyatanytime withoutbeingpenalized.

2.6.Findings

Therangeoftheparticipants’agewas27–53yearswithamean of32.2years.Sevenwomen(41.2%)hadahighschooldiplomaor lowereducationallevel,andtenwomen(58.8%)hadabachelor’s degree or higher. Nine (52.9%) and eight (47.1%) women were primiparousandmultiparous,respectively.Threewomen(17.65%) hadvaginalchildbirth.Mostofthem(70.6%)reportedamiddleor highincome.Inthisstudy,theoverarchingthemedevelopedfrom the participants’ experiences was ‘a time for psycho-spiritual transcendence’,whichwasconsistedoffourcategoriesasfollows:

‘conﬂictingemotionstowardspain’,‘anewinsighttowardslabor pain’,‘self-actualization’and‘spiritualdevelopment’.Thethemeof

‘atimefortranscendence’referredtothewomen’sexperiencesof vaginal childbirth as a transformation process from conﬂicting emotions to spirituality. This meant that the women who experiencednegativeemotionstowardslaborpainhadnegative memoriesaboutchildbirth.Ontheotherhand,thosewomenwho hadpositivefeelingstowardpainduringchildbirthgainedpositive insightstowardsit,reachedself-actualizationanddevelopedtheir ownspirituality.

3.Conﬂictingemotionstowardspain

Conﬂictingemotionstowardspainreferredtodifferentpositive andnegativefeelingsexperiencedbytheparticipants.Thewomen describedreasonsfortheirnegativeemotionstowardschildbirth.

Theyexperiencedmorelaborpainthanwhatwasnarratedbyother women.Oneparticipantstated:“Ididnotknowthatit[childbirth]

wassopainful.ItwasmuchmorechallengingthanwhatIimagined.” (29yearsold,primiparous).Someotherparticipantsbelievedthat laborpainwasunprecedentedandtheworstpain.“Itledtosuch severe pain that I had never experienced before.” (35 years old, primiparous).Anotherparticipantsaid:“Itcouldbesaidthatitwas theworstpain;thereisnopainlikethat.”Therefore,abadmemory onpainwas formedin thewomen’smind sothat theydidnot recommendvaginalchildbirthtootherwomen.Forinstance,one participantsaid:“SinceIsufferedfrompain,Iencouragedothersto give birthvia the caesareansection. I donot recommendvaginal childbirth to anybody, because it is very painful.” (28 years old, multiparous).

Conversely,those womenwhohad positivefeelings towards laborpainhadanoppositeperspective.Oneparticipantbelievedin thegoodfeelingandtheconsciousexperiencesoflaborpain:“In myopinion,thepleasureofvaginalchildbirthwasrelatedtoitspain.

Someonemaynotfeellaborpaininthecaesareansection... Ithink it is much better to experience such pain.” (29 years old, primiparous).Someparticipantscomparedvaginalchildbirthwith thecesarean sectionand highlighted theadvantages ofvaginal childbirthdespitelaborpain. One participantstated: “Idid not wanttogivebirthviathecaesareansection,becauseIdidnotwantto beunconsciousduringchildbirth.Iwantedtoseewhatwasgoingon aroundme.Iwantedtobeawareofeverythingandseewhatothers

weredoingformeandhowothersweretreatingme.”(45yearsold, multiparous). Some participants achieved good feelings after reviewingtheprocessofchildbirth.Oneoftheparticipantsstated:

“Ididnothaveanynegativefeelingsaboutthat day.Igooverthat experience[childbirth]inmymind,momentbymoment.Itisvery fascinating.Everydaythatpasses,Ienjoyitmore.Iamveryhappy about it.” (27 years old, primiparous). Another participant also added:“Whenthebabywasborn,Ifeltrelaxed.Iamhappyandfeel comfortable.WhenIenduresuchpain,IfeelthatIambornagain.” (33years old,multiparous).Mostparticipantswerehappywith receiving the family attention. One participantsaid: “When my husband and my mother-in-law came to see me,I experienced a feelingof happiness.Ithinkthateveryone likesbeingcaredfor by others.”(45yearsold,multiparous)

4.Newinsighttowardslaborpain

Thoseparticipantswhohadgoodemotions,acquirednewand positive insights towards labor pain. They believed that the position of womenwas recognizedonly if women had vaginal childbirth.Oneparticipantstated:“Myoldersistertoldme:‘youwill understand the valueof beingamotheronlywhen youbecomea mother’.Ithinkthisistrue.AfterIexperiencedpainandbecamea mother, I found the meaning of being a mother.” (29 years old, primiparous). Another participant believed that a lack of pain experiencemeantbeingseparatedfromthenatureofcreation.“I didnotwantmychildbirthtobeentirelywithouttheexperienceof pain.Ididnotwanttoescapefromthenatureofthisprocess.Iwanted toexperiencelaborpainandhaveamemoryofchildbirthinmymind.

Anaturalfeelingofchildbirth.Icertainlywantedtoexperienceit.” (42yearsold,multiparous).Finally,theparticipantswithpositive insightsencouragedotherwomentoexperiencevaginalchildbirth.

Oneoftheparticipantssaid:“IfIamgoingtoexperiencechildbirth again,Iwillchoosetohavevaginalchildbirth.Istronglyrecommend everypregnantwomantoexperiencevaginalchildbirthanddonot undergothecaesareansection.”(29yearsold,primiparous).

5.Self-actualization

In this transitionperiod and internal revolution, thepartic- ipantswhohadpositiveinsightstowardslaborpainreachedself- actualization. They considered pain a powerful experience for understandingtheirownreality.Theyexpressedfeelingssuchas

‘developingasenseofhonorandprideandthesenseofvictoryand success. Oneparticipant stated:“Whenmy babywasborn,Ifelt triumphandpridefor vaginalchildbirth.” (29yearsold,primiparous).Anotherparticipantsaid:“Iwasgladtobeabletodosucha hard task and my self-conﬁdence was doubled.” (35 years old, primiparous).Thefeelingof greatnessand self-conﬁdencewere otheraspectsofthewomen’sexperiences.Oneparticipantsaid:“I feltthatIcoulddoanything.IamastrongwomanandIcandoit;Iam amothernow.IfoundsomuchstrengthinmyselfthatIcantakecare of my child by myself... this [experience] made me to grow.” (27yearsold,primiparous).Someparticipantsbelievedthatthe human-being’sbeliefisstrongerthanpain.Asoneparticipantsaid:

“Painisnotstrongerthan meandIamstrongerthanpain... so muchstronger.”(45yearsold,multiparous)

6.Spiritualdevelopment

Spiritualdevelopmentreferredtotheparticipants’perspectives thatspiritualityhelpedwithtoleratinglaborpain.Theybelieved thatvaginalchildbirthwasrewardedandtheenduranceofpainled totheforgivenessofsins.Oneparticipantsaid:“Godgavepainto women. if Iendurepain,my sinswillbeforgiven.”(30years old, multiparous).Also,anotherparticipantstated:“Ihaveheardfrom

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mymotherthatvaginalchildbirthhasagreatreward.Mymothersaid thatthesinsofwomenafterhavingvaginalchildbirthwillbeforgiven.

IwantedtobeconnectedtoGod.”(29yearsold,primiparous) Inaddition,someparticipantshadthefeelingofpurity,sacrifice andselflessness.Itwasfoundthatthewomenachievedspiritual insightsfollowingtheexperienceoflaborpain.Oneparticipant mentioned:“Inmyopinion,thereissuchafeelingforallwomenafter vaginalchildbirth;thisisafeelingofsacrificeandapositivefeeling.I feelthatIhavedevotedmyselftoanewcreature[thechild].Itgivesme asenseofpurity.”(42yearsold,multiparous).Someparticipants evenshowedtheirgratitudetoGodforgrantingpain.“IthankGod forgivingmesuchagift.ThankGod.Godblessedmeandhelpedmeto havevaginalchildbirth.”(27yearsold,primiparous).

7.Discussion

Thepresentstudyaimedtoexplorethewomen’sexperiencesof laborpain.Therewerestudiesonthisphenomenon,afewstudies consideredwomen’sexperiencesoflaborpain.Theresultsofthis studyillustratedthatthewomen’sexperienceswere‘conﬂicting emotionstowardspain’,‘anewinsighttowardslaborpain’,‘self- actualization’and‘spiritualdevelopment’.

Conﬂictingemotionstowardspainmeantthatlaborpainwas accompaniedbyamixtureofpositiveandnegativeemotions.The participantsexpressedpleasantfeelingssuchascomfort,tranquil- ityandhappinessafterchildbirth. Somewomeneven feltgood aboutreviewingwhathappenedinlaborpainanddescribeditas theexperienceofbeingbornandsweet.Painisnotalwaysabitter experienceandifaconsciousconnectionisdevelopedbetweenthe body and mind, positive emotions are developed after the experienceofpain.AccordingtoKarlströmetal.,womenattributed theirpositivebirthexperiencestobothinternalfactors(theirown ability and strength) and external (the trustful and respectful relationshipwiththemidwife)factorsandthefeelingsoftrustto andsupportbythehusband.Thewomen’sfeelingofsafetywas promotedbythe creationof a supportive environment. In this study,differentnarrativeswithregardtotheexperienceofpain wasavailable,butallwomendescribeditasafeelingofjoyand happiness.³²Inthepresentstudy,negativefeelingsandattitudes towardspainwereexpressedbysomeparticipantsasthepainwas moreseverethanwhatwasexpected.Therefore,theyhadnogood feelings regarding childbirth. The women experienced such negativefeelings because of unmet needsduring childbirth or unplannedpregnancy.Similarly,Ithasbeenreportedthatwomen’s showednegativeresponsessuchasanger,anxietyanddepression to childbirth.³³ It is believed that women’s concerns during childbirthmaybeexpressedbyambiguousfeelingsandthoughts.

Inaddition,thefearof childbirthisconsidereda strongfeeling towards something specific. Therefore, the expression of what influenceonwomen’sworriesandfearshelpwiththedevelop- ment of strategies for adjusting with pain during childbirth.³⁴ Lundgrenetal.describedchildbirthasanambivalent,bittersweet andtranscendentexperience. In otherwords,theexperience of childbirthcanstrengthenself-confidenceandtrustinothers.On thecontrary,it can resultin failure and mistrust.³⁵Etowa also indicatedthatchildbirthwasabittersweetparadox.¹⁵

Ourﬁndingsshowedthatdespitetheexperienceofseverepain duringchildbirth,mostwomenachievednewinsightstowardsit.

Otherstudiesshowedthattheindividual’sbodyandmind,family andcareprovidershaverolesinthecreationofsuchaninsight.

Therefore,mostwomenconsiderpainduringchildbirthacritical momentforprovingoneself.³⁶Thewomendescribedpainduring childbirthasrebirthandrecommendedotherwomentoexperi- enceit.Fromthewomen’sperspectives,childbirthwasanatural feeling of birth and an expression of individual’s reality. They believedthatpainwasrequiredforunderstandingthepositionof

themother,improvinghuman’sstrength,andobservethemoment ofbirth.

While many studies were conducted on labor pain, a few studiesfocusedonnewinsightstowardslaborpain.Womenmay liketochangetheirattitudestowardschildbirth,thenatureofthis process and the realization of self. Barnes emphasized the psychologicalaspectsofchildbirth,consideredittheringofﬁre and described it as follows: in a women’s journey through childbirth, she experiences the transition from unconscious, automaticmotherhoodtoconsciousanddeliberatemotherhood.

Also,shecrossestheboundaryfromphysicalnurturing,feeding, and creating the baby inside her to consciously protecting, nurturing, and breastfeeding the infant. In fact, labor pain for both the mother and baby means the transition to a new developmentalstage,whichisthethresholdforfulﬁllingtherole as a mother that ultimately leads to emotional, spiritual and psychological growth. This is based on the principle of the psychologicalwellbeingintegrationthatgiveswomenanultimate responsibilitysothattheirchoicesarerespectedandtheirdignity ispreserved.³Reedetal.consideredchildbirthariteofpassage consisting of separation phase: separating from the external world;liminal phase: intheirownworld;incorporation phase:

reintegrationwiththeexternalworld.Theseﬁndingsdemonstrate themultidimensionalandtransformativenatureofchildbirth.³⁷

Inthisstudy,thefeelingofself-actualizationwasaninternal beliefcommonlyfoundinmostparticipants.Self-actualizationis atthe topoftheMaslow’shierarchyof needs. Theaimof self- actualizationissimultaneouslyafinalgoal,atransitionalgoal,a riteofpassage,astepalongthepathwiththetranscendenceof identity. According toMaslow, self-actualization precedes self- transcendence.Itisnotedthatsomeindividualsgobeyondself- actualizationasasalientmotivationandarriveatthetopofanew hierarchy of motivation with a strong intention towards self- transcendence.³⁸ In this study, pain during childbirth was interpretedasthewinning ofan internalbattle, thefeelingsof pride, strength, triumph, greatness and self-confidence. The tolerationofpainensuredthewomenthattheywereempowered andwerecapableforachievinganythingintheirlife.Cheyneyalso suggeststhat celebrating and honoring a womanfor childbirth results in a postpartum phenomenon called ‘superwoman syndrome’meansthatthewomanfeelsthatshecandoanything.²⁴ Theempoweringandtransformativenatureofchildbirthalsohas been reported by previous studies.^37,39,40 Moreover, childbirth providesasenseofrebirth,perfection,strength,confidenceandan opportunityforenteringthenewroleofmotherhood.¹⁰Nilsson et al. explored the experiences and reflections of primiparous women regarding their childbirth, and identified primiparous mothers’empowermentasthechanceforhavingapositivebirth experiencewiththreecategoriesof‘trustingthebodyandfacing pain’,‘interactionbetweenthebodyandmindinchildbirth’and

‘theconsistencyofsupport’.Also,womenwantedtobeconﬁrmed as unique individuals by theirpartners and healthcare profes- sionals.Ifwomenweresupportedbytheprofessionals,theyhada positivebirthexperience,evenifchildbirthwasassociatedwith medicalcomplications.⁴¹Thewomenparticipatinginthestudyof Reedet al. didnotdescribe childbirthasthestage for internal physical changes. Instead, their experiences of childbirth was describedasamultifaceted,physical,emotional,andpsychological process,whichledtoasenseofempowerment.³⁷However,some womenmayhavenegativeemotionsduetopainandsufferingthat hindertheirpsychologicaldevelopment.Lastly,negativefeelings suchassadness,anxiety,depression,violence,andevenpsycho- logicaldisordersmayappearinwomenafterchildbirthinsteadof thefeelingsofjoy,gratitudeandself-sufﬁciency.³Also,Dixonetal.

foundthatwomen’sperspectives of childbirthdidnot resonate withtheirexperiences.⁴²

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Inthisstudy,painduringchildbirthhelpedwiththespiritual developmentofthewomen.Spiritualityhasverticalandhorizontal dimensions.Theformeristheindividual’srelationshipwiththe transcendentandthelateristherelationshipwithoneself,others and the nature.⁴³ Therefore, the transcendent experience is characterizedbyadeepexperienceofpleasuremostlydescribed as ecstatic, which occurs abruptly in response to an event or specific spiritualpractice.⁴⁴ In theIranian cultureand context, pregnancyisconsideredagiftfromGodandchildbirthisoneofthe most valuable duties of women, which deserves respect and reward.Also,mothershaveanimportantroleinthecreationofthe physical and spiritual characteristics of the human-being.⁴⁵ Despitethemedicalizationofchildbirthand women’sintention tothecesareansectioninIran,theparticipantsdescribedspiritual developmentasconnectednesstoahigherpowerthatincreased theirfaith and inner sublimation. Labor pain is as thewomen enteredintoaspiritualpathinwhichtheirsinsareforgivenand increasestheinnersensesofpurityandself-sacrifice.¹⁰Theroleof spiritualityinimprovingthequalityofbirthhasbeendescribedby previousstudies.Spiritualityisasignificantpartofchildbirthand thesacredjoyatthetimeofbirthisunique,evenwhenitisnotas hoped.Therefore,thesignificanceofforegroundingspiritualityin childbirthcanprovideaholisticperspectiveonantenataleduca- tion.⁴⁶Anotherstudyalsoshowedthatthemajorityofwomenwith variousculturalbackgroundslookatchildbirthviaaspirituallens.

Womendescribepainastherealizationoftheindividual’sreality, individual’sworth,individual’splaceintheuniverse.Also,women believethatthedivineprovidenceismainlyfocusedonbecominga special being rather than a simple transitionfrom girlhood to motherhood.¹⁰

Otherstudiesreportedthatwomen’sspiritualacceptancewas promotedduringpregnancy and childbirthparticularly in rural areas and middle social classes. Women pray to God when childbirthbeginsandﬁndadeeperfeelingoftheAfrican–Canadian womenintheEtowa’sstudythatdescribedchildbirthasaspiritual journey.¹⁵ In addition, according to Crowther, spirituality is a personalsearchformeaninginlifethatbringsfaith,hope,peace and empowermentand leadstojoy,forgiveness ofoneself and others,awarenessandacceptanceofhardshipandmortality.Itis also the ability to transcend the inﬁrmities of existence and enhancementofthefeelingofphysicalandemotionalwellbeing.⁷ Theexperiencesof Russianwomenoflaborpain indicatedthat childbirthwasaspiritualexperienceandthattheywereableto giveanewlife.¹⁰Also,Dutchwomenhadthesamefeelings.⁴⁷In contrast, some Australian women believed that they had no spiritualfeelingsduringchildbirthandchildbirthwasonlyawayof lifeforbeingconnectedtothechild.⁴⁸

8.Limitations

While this study improves our knowledge of women’s experiencesof laborpain, thetransferabilityof ﬁndings should bedone withcaution due tothe impactof social and cultural factorsonindividuals’experiences.Therefore,thedevelopmentof avalidandcomprehensiveinstrumentissuggestedtoinvestigate women’sexperiencesusingalargersamplesize.Giventhefactthat Iranisamulti-culturalandmulti-ethnicsociety,anethnographic studyisrequiredfortheexplorationofwomen’sexperienceswith variousculturesandcontexts.Furtherresearchalsoisneededto explorewhetherwomen’sperspectivesoflaborpainisdifferentin vaginalchildbirthcomparedwiththecesareansection.

9.Conclusion

The childbirth path highlights factors that inﬂuence on the experienceoflaborpain.Itisdescribedasthespiritualtransition

phaseinthenaturallifecycle,whichplaysasigniﬁcantroleinthe development ofwomen’semotional,spiritualandpsychological aspects.Sincethisprocessisstrictlyinternalandindividualistic, thewomanistheonlyonewhocanexperiencepainandutilizeitas apowerfultoolforspiritualgrowth.Fromsuchaperspective,pain during childbirth has the potential for internal and personal transformation.Theconsciousacceptationofpaincanbeobserved as a positive inherent and natural event.In fact, a shiftin the women’s perspective of labor pain can help describe her real identity. The results of this study increase the knowledge of midwivesand obstetriciansfor providing culturallyappropriate caretowomenandincreasetheirsatisfactionwithchildbirth.It canalsopromotethephysicalandpsychologicalhealthofwomen andtheirchildren.

Acknowledgments

Thisarticlewasonepartofthefirstauthor’sPhDdissertationin the field of reproductive health. The authors would like to acknowledgeTehranUniversityofMedicalSciencesforproviding financialsupport.Also,ourgratitudeshouldbeextendedtothe womenfortakingpartinthisstudy.

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