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The spirituality of presence in midwifery care

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DOI: 10.1016/j.midw.2006.10.004 · Source: PubMed

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 Author's personal copy
ARTICLE IN PRESS
Midwifery (2008) 24, 321–327

www.elsevier.com/midw

The spirituality of presence in midwifery care

Neil F. Pembroke, Ph.D (Senior Lecturer)a,, Janelle J. Pembroke, RN, RM (Registered Midwife)b

a
School of History, Philosophy, Religion, and Classics, Forgan Smith Building,
University of Queensland, St. Lucia, 4072, Australia
b
Womans’ and Childrens’ Hospital, Brisbane, Australia
Corresponding author. E-mail address: n.pembroke@uq.edu.au (N.F. Pembroke).

Received 3 April 2006; received in revised form 13 September 2006; accepted 19 October 2006

Abstract The quality of the relationship between the midwife and the woman is widely acknowledged to be of vital
importance in pregnancy and childbirth. The authors argue that presence is the spiritual strength that enables midwives
to fully actualise their relational capacity. Presence describes a special way of being there or being with the other
person. In order to develop its meaning fully, reference is made to the concepts of responsibility (Martin Buber) and
availability (Gabriel Marcel). Responsibility indicates a deep capacity to respond to the needs people have to be heard,
understood, respected, and, when it is required, helped and supported. Availability refers to the willingness of a person
to give of herself for the sake of others. The aim of this paper is to offer a fresh perspective on the nature of caring
midwifery through the use of these unique perspectives on genuine presence. The research method used is an
integration of the philosophical reflections with relevant personal reports from women. These reports have been
gathered from the research of others.
& 2006 Elsevier Ltd. All rights reserved.

Keywords Midwife-woman relationship; Presence; Spirituality; Midwifery led care; Availability; Responsibility; Women-centred care

Introduction long-term positive or negative effects on the

Women in labour value midwives who are honest,
respectful, ready to listen, sensitive and who treat
them as individuals (Berg et al., 1996; Walsh, 1999;
Green and Baston, 2003; Fenwick et al., 2005).
When the midwife expresses these attitudes and
behavioural traits, she makes a significant con-
tribution to a positive birth experience. Conversely,
when they are absent or lacking, the woman lacks
trust in the midwife, feels insecure, and is less
satisfied with the birth experience (Berg et al.,
1996).
In addition, the effects of the birth experience
reach into the future; they have the potential for
woman, her relationship partner, and their children
(Halldorsdottir and Karlsdottir, 1996a). Childbirth,
beyond the physical act of giving birth, constitutes
a pivotal moment in the transition into parenthood;
the woman is changed forever by it (Beech and
Phipps, 2004). The power of the birth experience
builds the inner strength, belief in self, and self-
confidence that are such important assets in
parenting. Given what is at stake for the woman
and those close to her, it is very important that
midwives reflect deeply on what it means to be
helpfully present to women.
A number of terms are used to describe a
relational presence. The caring midwife is a

0266-6138/$ - see front matter & 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.midw.2006.10.004
 Author's personal copy
ARTICLE IN PRESS
322
companion (Berg et al., 1996; Walsh, 1999;
Lundgren, 2004), a professional friend (Walsh,
1999; Pairman, 2000), and a partner (Seibold
et al., 1999; Fleming, 2000; Pairman, 2000; Free-
man et al., 2004). It will be argued here that
presence is the spiritual capacity that enables a
midwife to be a companion, a friend, to the
woman. A caring presence is variously described
in the nursing and midwifery literature. That it
involves a personal connection is emphasised.
Presence describes a special way of being there or
being with the other person (Nelms, 1996; Hunter,
2002). It involves a capacity for self-communication
(Pembroke, 2004). That is, presence means sharing
one’s humanity (Hunter, 2002, p.653) and putting
oneself ‘in contact’ with the woman who is ‘the
centre of the relationship’ (Siddiqui, 1999, p.112).
Presence involves an offering of self (Scotto,
2003). In being present to the other, one generously
makes available one’s personal resources. To be
present as a midwife is to be open, available and
receptive to the needs and preferences of the
woman (Berg et al., 1996; Lundgren, 2004).
A caring presence involves creating an environ-
ment of trust and security. Some authors find the
image of ‘mother’ to be evocative in this context
(Campbell, 1984; Odent, 2002). The caregiver is
like a mother in that she creates a warm presence
amidst the frightening realities that the patient or
labouring woman must face.
These brief descriptions of presence are very
helpful. To date, however, little has been provided
in the way of a comprehensive analysis of the term.
In seeking to develop an in-depth understanding of
personal presence, the penetrating discussions
offered by the dialogical philosophers Martin Buber
and Gabriel Marcel will be presented. Buber and
Marcel are part of a small group of philosophers
who have given extensive consideration to the
factors involved in constructive and meaningful
interpersonal relations. Both men were committed
to a religious tradition—Buber to Judaism and
Marcel to Roman Catholicism; however, they
intentionally developed their spiritualities of pre-
sence in general terms. Their approaches do not
require a religious commitment in order to be
appreciated and embraced. Attention will be given
to two of their central concepts: ‘responsibility’
and ‘availability’. These concepts have been
chosen because the way in which Buber and Marcel
develop them has something quite unique to
contribute to our understanding of genuine pre-
sence in a midwifery context. The aim of the paper,
therefore, is to view the spirituality of midwifery
care from two new angles: responsibility and
availability.
N.F. Pembroke, J.J. Pembroke
The words ‘spiritual’ and ‘spirituality’ have been
used a number of times above. Before moving to
the central discussion, we discuss exactly what is
meant by these terms.
Defining the term, ‘spirituality’
The role of spirituality in the health-care profes-
sions is being assigned an increasingly higher
importance. In discussions on spirituality in
health-care settings, it is common for the author
to distinguish between religion and spirituality
(Herbert et al., 2001; Scheurich, 2003; Hall and
Taylor, 2004). She or he usually makes it clear that
her or his interest is in a non-religious spirituality.
We need to ask, first, what is religion? Religion is a
social and cultural structure or construct. Religions
embrace a myth that seeks to explain where
humanity came from, what the purpose of human
life is, the moral duties that we must embrace and
what our destiny is (Young, 2005). The myth is
embodied in symbolic practices or rituals that
sustain it over time and provide spiritual nourish-
ment and guidance for believers. Religions normally
identify a sacred sphere, in contrast to which the
remainder of life is defined as profane.
Spirituality involves the quest for meaning,
purpose and edifying values; it also involves a
commitment to transcendence of the ego (Swinton,
2001). The spiritual person identifies making mean-
ing out of one’s existence on earth as a central
human task. The journey into meaning usually
involves self-transcendence. To be spiritual is to
break through the confining and limiting grip of
egoism. Egoistic persons are locked up inside
themselves; they have little or no capacity to
reach out to others and to the world around them.
Overcoming selfish tendencies in order to help
others is central in an authentic spirituality. It is
very significant for the spirituality of presence that
is being developed here.
Spirituality has both an immanent and a trans-
cendent form. An immanent spirituality refers to an
orientation in which people believe that all the
resources they need to find meaning and value can
be found within the self. Within the monotheistic
religions (Christianity, Judaism and Islam), how-
ever, the centre for spirituality is located in God.
God takes the initiative in the divine–human
relationship. Spirituality is the quest for a deeper
relationship with God.
In describing the importance of responsibility and
availability in the midwife–woman relationship, we
are working within the framework of an immanent
spirituality. The terms and ideas that we use do not
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The spirituality of presence in midwifery care
require a religious orientation in order to be
embraced; they are intended to speak to secular
and religious people alike.
‘Responsibility’ in midwifery
At the outset, it needs to be made clear that Buber
uses the term ‘responsibility’ in a particular way.
He is talking about ‘responsiveness’, about the
ability to respond to the other person and her needs
and aspirations. For Buber, responsibility is a deep
capacity to respond to the claims others make
on us. It requires an acute awareness of the
other through which she becomes present in her
wholeness and uniqueness. Buber (1947, pp.8–10)
contrasts this awareness with two other perceptual
modes, namely ‘observing’ and ‘looking on’.
The observer operates with a quasi-scientific mind-
set. She is interested in a careful, analytical
study of the other. Her aim is to compile a
comprehensive list of traits. For the purposes of
observation, the other person is nothing but a
bundle of characteristics.
The onlooker is not at all interested in traits.
Focusing on traits, she thinks, leads one away
from one’s real purpose. Looking on—the artistic
perspective—involves trusting one’s intuitive
powers. That which is really significant about the
other will show itself if only one is attentive and
receptive.
Neither in observing nor in looking on, however,
do we find the possibility of being addressed
directly by the other. The observer perceives a
bundle of traits, the onlooker an existence, but the
one who is ‘aware’ perceives a call to action, feels
the weight of destiny falling on him or her:
[I]n a receptive hour of my personal life a man
meets me about whom there is something, which
I cannot grasp in any objective way at all, that
‘says something’ to me. That does not mean,
says to me what manner of man this is, what is
going on in him, and the like. But it means, says
something to me, addresses something to me,
speaks something that enters my own life.
(Buber, 1947, p.9)
In becoming aware that I have been addressed, I
have a moral obligation to respond:
Responsibility presupposes one who addresses
me primarily, that is, from a realm independent
of myself, and to whom I am answerable. He
addresses me about something that he has
entrusted to me and that I am bound to take
care of loyally (Buber, 1947, p.45).
323
Women in labour address their birth attendants
with certain claims. That is, they ask something of
their midwives. They want them to be ready to
listen, to be honest, respectful and sensitive, and
to treat them as individuals (Berg et al., 1996;
Walsh, 1999; Green and Baston, 2003; Fenwick
et al., 2005). Reports from women indicate their
deep appreciation when their needs are met:
This was the first time I felt someone listened to
me and not just baby’s heartbeat (Berg et al.,
1996, p.13).
In order to be genuinely responsive to a woman,
it is necessary to include oneself in her inner world.
That is, one must discover precisely what it is that
she needs and values. Women ask to be sensitively
listened to. Further, they ask that the midwife
approach them with a respect for their uniqueness.
For Buber (1957), to enter into a relation with a
person, it is necessary to become aware of the
other as ‘a whole, as a unity, and as unique’
(p.109). When I am aware of her in this way she
becomes present to me. I have managed to grasp
something of ‘the dynamic center which stamps
[her] every utterance, action, and attitude with
the recognizable sign of uniqueness’ (Buber, 1957,
p.109). The labouring woman wants to be treated
as an individual. She does not want to feel as if she
is just another client in a long list that the midwife
has dealt with (Carlton et al., 2005; Fenwick et al.,
2005). To be fully present to the woman, the
midwife needs to make contact with her ‘dynamic
centre’, with that part of her that is expressive of
her unique personhood. This is expressed beauti-
fully in this extract of a report to a researcher:
[The midwife’s] attention was first and foremost
on me. It was as if she positioned herself by my
side and tried to figure out how I perceived
things. (Halldorsdottir and Karlsdottir, 1996a,
p.53).
Perhaps the most important claim that women
make on their birth attendants is to be allowed to
play an active part in the decision-making related
to the birth process. Control over the management
of the labour is a desideratum that is frequently
articulated by women (Green et al., 1990; Green
and Baston, 2003; Baker et al., 2005; Carlton et al.,
2005; Fenwick et al., 2005). The moral responsi-
bility that birth attendants have is particularly
acute because a significant power asymmetry is
present (Leap, 2000; Baker et al., 2005). The
woman is in a compromised and vulnerable position
in relation to her caregivers. She is extremely tired,
in intense pain, and worried about her own health
and that of her baby. Further, she does not have the
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knowledge and skills that the attendants do; nor
does she understand the institutional systems and
bureaucracy (Baker et al., 2005). Responsibility in
the relationship with labouring women requires
reciprocity and sharing of power through providing
accurate information that is as neutrally framed as
possible. Every communicative act involves a
personal bias. In relating to another person, it is
not possible to completely bracket out all of one’s
values, preferences, and presuppositions. If our
commitment, though, is to reciprocity and sharing
power, we will aim for neutrality in presenting the
information. That is, we will avoid the temptation
to frame the options in a way that leads the woman
towards our particular preferences. In this way, we
demonstrate a commitment to supporting the
woman’s personal autonomy.
Therefore, to be fully present as one human
subject meeting another requires a midwife to be
responsive in the face of the moral claims the
woman makes. This capacity to respond loyally and
authentically to the woman is at the heart of a
spirituality of midwifery care. It requires a will-
ingness to dispose of oneself for the other. To
describe this spiritual capacity, Gabriel Marcel uses
the word, ‘disponibilité’. It has a financial con-
notation and is linked to the notion of disposable
assets. The available person is the one who is
prepared to put all of her assets at the disposal of
the other.
Availability in midwifery
Marcel (1964a) interprets ‘disponibilité’ in terms of
receptivity. He develops the link between the two
terms in an essay in Creative Fidelity entitled
‘Phenomenological Notes on Being in a Situation’.
To exist with others, he observes, is to be exposed
to influences. It is not possible to be human without
to some extent being permeable to those influ-
ences. Permeability, in its broadest sense, is
associated with a certain lack of cohesion or
density. Thus, the fact of being exposed to external
influences is linked with a kind of ‘in-cohesion’.
I am ‘porous’, open to a reality which seeks
to communicate with me. Marcel (1964a) puts it
this way:
I must somehow make room for the other in
myself; if I am completely absorbed in myself,
concentrated on my sensations, feelings, anxi-
eties, it will obviously be impossible for me to
receive, to incorporate in myself, the message of
the other. What I called incohesion a moment
ago here assumes the form of disposability...
(Marcel, 1964a, p.88).
N.F. Pembroke, J.J. Pembroke
Disposability, then, is closely associated with
receptivity. Receptivity involves a readiness to
open oneself to the other. It involves getting
beyond one’s own interests and preoccupations in
order to be receptive to the ideas, needs, hopes
and fears of the other person. In essence, it is about
making available one’s personal centre. We receive
others in a room, in a house, or in a garden, but not
on unknown ground or in the woods. Receptivity
means that I invite the other ‘chez soi’ (Marcel,
1950, p.118). That is, I invite her to ‘be at home’
with me. A home receives the imprint of one’s
personality; something of myself is infused into the
way my home-space is constructed. Contrast this
with ‘the nameless sadness’ associated with a hotel
room; this is no-one’s home. To share one’s home-
space is disposability or availability because ‘[t]o
provide hospitality is truly to communicate some-
thing of oneself to the other’ (Marcel, 1950, p.91).
A good host respects the individuality of her
guests. To offer others genuine hospitality is to
provide an empty space for them to fill with their
own unique personalities, needs and desires:
The paradox of hospitality is that it wants to
create emptiness, not a fearful emptiness, but a
friendly emptiness where strangers can enter
and discover themselves as created free; free to
sing their own songs, speak their own languages,
dance their own dances...Hospitality is not a
subtle invitation to adopt the life style of the
host, but the gift of a chance for the guest to
find his own. (Nouwen, 1975, p.51)
Walsh (2006), in examining the style of care
provided at a Free Standing Birth Centre, points to
the nature of hospitality in midwifery very well. He
observes that the emphasis is on being rather than
on doing. For example, postnatal observations are
set within a context of simply talking and chatting
with women. That is, in sharing the same space as
the woman, the observations are done quite
naturally. The appreciation of the women for this
informal, natural engagement is evident in this
report:
At 10 o’clock at night we’d put the babies down
and get around the telly and have lots of like
cocoa and it was so relaxed. And like the
midwife came down and joined us and often
brought us drinks and Kenco biscuits. She was
like chit chatting, just being a friend. (Walsh
2006, p.1334)
Hospitality plays a vitally important role in
engaging on a personal, friendly level with women.
We need to ask, however, whether or not it is
appropriate to refer to a midwife as a host. Many
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The spirituality of presence in midwifery care
would rather have it that the midwife is the invited
guest (Leap, 2000; Kennedy, 2003). The primary
actor in the birthing experience is the woman. She
invites others to be with her as she gives birth.
There is a still a place, we contend, for the
appellation ‘host’ in relation to the midwife’s role.
It is clearly wrong to refer to him or her as host of
the birthing process. To speak of him or her as host
in the context of the relationship he or she shares
with the woman is, however, not only appropriate
but also illuminating. It is illuminating because it
reminds us that the midwife is called upon to
mentally establish an open space that will be filled
by the woman’s needs and preferences. To be
available to the woman involves listening to her
and following her lead through the process of
childbirth (Lundgren, 2004). Midwives need a
certain ‘incohesion’ in order to be truly receptive.
If they fill their internal spaces with their own
commitments and preferences, there is no place
for the woman to make contact.
The person who shuts herself up like this is
described by Marcel (1964b, p.50) as suffering from
an ‘inner inertia’ or ‘spiritual asthenia’. That is,
there is little or no spiritual energy to take her out
of herself, little or no power to identify and meet
the needs of the other person. The only way to
break out of this ‘self-obsession’, according to
Marcel (1964b), is by ‘submerging oneself suddenly
in the life of another person and being forced to see
things through his eyes’ (p.51). One cannot break
out of this ‘inner inertia’ on one’s own; it is through
the presence of another person that this ‘miracle’
is accomplished. The miracle does not, of course,
happen automatically; one must be open and
responsive to the appeal of the other.
Some midwives find it difficult to draw close to
women and to respond to them sensitively and
warmly (Halldorsdottir and Karlsdottir, 1996b;
Hunter, 2002). These are the midwives who ‘keep
their distance’. McCrea et al. (1998), for example,
refer to a midwife who responds to a woman using
the coping mechanism of shouting in this way:
‘Don’t shout, you are wasting your energy’ (p.177).
She did not sit with the woman, but rather spent a
great deal of time checking machines and monitors
and recording the output. Women who feel a lack of
confidence in the midwife fail to engage with him
or her:
I felt that we didn’t talk, we were not on the
same wavelength. We had no direct communica-
tion (Berg et al., 1996, p.13)
This brings us to the following questions posed by
Marcel: why am I non-responsive to the commu-
nication of the other? Why do I feel opaque, non-
325
permeable? Marcel believes that non-availability is
associated with the tendency to see one’s existence
in terms of possession. I will treat myself as
indisposable ‘just so far as I construe my life or
being as a having which is somehow quantifiable,
hence as something capable of being wasted,
exhausted or dissipated’ (Marcel, 1964b, p.54). In
this attitude, I become like a person who knows
that his small sum of money must last a very long
time. I become afflicted with an anxiety and a
concern which discourage self-giving. These nega-
tive affects are ‘reabsorbed into a state of inner
inertia’ (Marcel, 1964b, p.54).
Inner inertia prevents a midwife from opening
him- or herself to the needs and desires of the
woman. What is required is a generosity of spirit
that opens the self to the women in one’s care.
Midwifery is a spiritual practice because it requires
disposing of the self for the other. This self-
transcendence is expressed through a willingness
to support, care for and encourage. McCrea et al.
(1998) illustrate quite beautifully in their research
this commitment to giving of self for women:
She sat near them, holding their hands or
massaging their back and speaking words of
comfort and encouragement in a gentle tone of
voice. She made the women feel special with
statements such as ‘I am here for you’. The
women seemed to depend on them more than
their partners in a number of cases, and asked
that ‘she stay close to them’ (McCrea et al.,
p.178)
Being respectful and sensitive in midwifery
involves creating an open space in the relationship
with the woman. This open space is not unbounded,
however. This paradoxical way of framing the
situation is designed to indicate that, although
midwifery involves a genuine openness to the
preferences of the woman, it also sets appropriate
boundaries. After all, the gracious host does not
offer absolute freedom to her guests. There are
limits on her hospitality. She wants her guests to
express themselves freely, but she will intervene if
they exceed the bounds of good behaviour. The
limits in relation to the birthing process are
established around both the woman’s ability and
the midwife’s professional responsibility (Lundgren
and Dahlberg, 2002; Lundgren, 2004). The mid-
wife’s role is to support the woman in her desire for
a normal birth. However, he or she must recognise
deviations from the normal process and respond
appropriately by instigating medical involvement.
We have identified the capacity for genuine
dialogue as central in midwifery practice. The
mode of interpersonal communication necessarily
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326
changes, however, during labour. At certain points,
a woman goes into a state of intense introversion.
For a time, the woman cuts herself off from our
world and does a sort of ‘inner trip’ (Odent, 1996,
p.304). One woman described the experience as a
‘hiding in the self’:
You go into yourself, I don’t know how to explain
it, but hide in yourself, and that you know that
this is going to end. (Lungren and Dahlberg,
1998, p.107).
Receptivity to the woman’s state when she is
introverted is focused on her somatic communica-
tion (Lundgren and Dahlberg, 2002). The eyes
produce very important signals. Attending to them
indicates whether the woman is feeling in control
or is being taken over by fear and distress. The face
is also an important communicative site. Informa-
tion about the mental and physical state of the
woman can be gleaned from observing her breath-
ing and the general expression of the face. The
body as a whole is also expressive of the woman’s
condition. Her general posture and the level of her
perspiration speak to the attentive midwife.
Availability in midwifery is also expressed
through offering a ‘calm presence’ (Berg et al.,
1996, p.14). Midwifery can appropriately be
thought of as ‘the art of doing nothing well’
(Hunter, 2002, p.652; Kennedy, 2002, p.1759).
Paradoxically, the less midwives do, the more they
give (Leap, 2000). What is required is reflecting ‘a
quiet and spaciousness’ amidst all the intense
emotion and physicality of the childbirth process
(Kennedy, 2002, p.1760). Odent (1996) tells the
story of a unique woman, Gisèle, and her capacity
to create an environment of ‘quiet and spacious-
ness’. She was educated as a midwife in the 1940s.
When Gisèle looked after a laboring woman, one
could often find this typical scenario: no one was
in the small, dimly lighted room other than the
mother to be and Gisèle, who sat in a corner,
knitting. She could spend hours and hours
knitting. Her technique and speed were impress-
ive! And it was usually unremarkable when a first
baby was born in three or four hours.
In a very small number of cases, not exceeding
2% of the births, Gisèle was in a position to
decide that a technique other than silent
knitting was needed. (Odent, 1996, p.304)
Gisèle manifests an instinctive, intuitive attune-
ment to the birthing process. In a remarkable way,
she set herself at a slight distance from the
labouring woman and yet at the same time was
able to communicate a total involvement in her
(the woman’s) experience.
N.F. Pembroke, J.J. Pembroke
Presence as availability in midwifery care has two
main components. It refers, first, to openness and
receptivity to the woman, and, second, to provid-
ing a calm, reassuring presence.
Conclusion
The aim of this paper was to approach the
spirituality of midwifery care through a considera-
tion of the concepts of responsibility and avail-
ability. The discussion has been set in the context
of spirituality because a commitment to a respect-
ful, sensitive and supportive engagement with
women expresses a desire for meaning, self-
transcendence and edifying values. At the outset,
we noted that this desire is at the centre of a
spiritual life.
Responsibility is Buber’s term for a deep capacity
to respond to what others ask of us. Women in
labour want certain things from their birth atten-
dants. They want them to be honest, respectful,
ready to listen, sensitive, and to treat them as
individuals. To be fully present to women requires a
positive response to these claims.
Another important claim that women make on
their midwives is to be given control in the
management of their labour. Given the power
asymmetry that exists in the woman–midwife
relationship, responsibility to the woman requires
reciprocity and sharing of power through providing
accurate information that is as neutrally framed as
possible.
Availability is Marcel’s term for receptivity to the
other. Receptivity in midwifery care involves play-
ing the role of the host. Midwives certainly do not
host the birth experience, but they should never-
theless see themselves as host in the relationship
they share with the woman. That is, hospitality is a
relational metaphor in midwifery practice. The
midwife creates an open space for the woman to fill
with her particular needs and preferences.
The other central metaphor in our discussion
was ‘calm presence’. In the midst of the emotional
and physical frenzy, the midwife offers calm
reassurance.
The burden of this paper has been to demon-
strate that a spirituality of presence in midwifery
requires a commitment to an ongoing movement
towards higher levels of responsibility and personal
availability. This involves a commitment to self-
transcendence. Self-transcendence in the context
of midwifery is expressed through a desire to go out
of self in order to respond sensitively, respectfully
and generously to the values and needs of labouring
women.
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The spirituality of presence in midwifery care
References
Baker, S.R., Choi, P.Y.L., Henshaw, C.A., Tree, J., 2005. ‘‘I felt as
though I’d been in jail’’: Women’s experiences of maternity
care during labour, delivery and the immediate postpartum.
Feminism and Psychology 15, 315–342.
Beech, B.L., Phipps, B., 2004. ‘Normal birth: women’s stories’.
In: Downe, S. (Ed.), Normal Childbirth: Evidence and Debate.
Churchill Livingstone, London.
Berg, M., Lundgren, I., Hermansson, E., Wahlberg, V., 1996.
Women’s experience of the encounter with the midwife
during childbirth. Midwifery 12, 11–15.
Buber, M., 1947. Between Man and Man. Translated by R. Gregor
Smith. Routledge & Kegan Paul, London.
Buber, M., 1957. Elements of the interhuman. Psychiatry 20,
105–113.
Campbell, A., 1984. Moderated Love: A Theology of Professional
Care. SPCK Press, London.
Carlton, T., Callister, L.C., Stoneman, E., 2005. Decision making
in laboring women: Ethical issues for perinatal nurses.
Journal of Perinatal and Neonatal Nursing 19, 145–154.
Fenwick, J., Hauck, Y., Downie, J., Butt, J., 2005. The childbirth
expectations of a self-selected cohort of West Australian
women. Midwifery 21, 23–35.
Fleming, V., 2000. The midwifery partnership in New Zealand:
past history or a new way forward? In: Kirkham, M. (Ed.), The
Midwife–Mother Relationship. Macmillan Press, Basingstoke.
Freeman, L.M., Timperley, H., Adair, V., 2004. Partnership in
midwifery care in New Zealand, 2004. Midwifery 20, 2–14.
Green, J., Coupland, V., Kitzinger, J., 1990. Expectations,
experiences, and psychological outcomes of childbirth: a
prospective study of 825 women. Birth 17, 15–23.
Green, J.M., Baston, H.A., 2003. Feeling in control during labor:
concepts, correlates, and consequences. Birth 30, 235–247.
Hall, J., Taylor, M., 2004. ‘Birth and spirituality’. In: Downe, S.
(Ed.), Normal Childbirth: Evidence and Debate. Churchill
Livingstone, London.
Halldorsdottir, S., Karlsdottir, S.I., 1996a. Journeying through
labour and delivery: perceptions of women who have given
birth. Midwifery 14, 174–180.
Halldorsdottir, S., Karlsdottir, S.I., 1996b. Empowerment or
discouragement: women’s experiences of caring and uncaring
encounters during childbirth. Health Care for Women Inter-
national 17, 361–379.
Herbert, R.S., Jenckes, M.W., Ford, D.E., O’Connor, D.R.,
Cooper, L.A., 2001. Patient perspectives on spirituality and
the patient–physician relationship. Journal of General Inter-
nal Medicine 16, 685–692.
Hunter, L.P., 2002. Being with woman: a guiding concept for the
care of laboring women. Journal of Obstetric, Gynecologi-
c,and Neonatal Nursing 31, 650–657.
Kennedy, H.P., 2002. The midwife as an ‘‘instrument of care’’.
American Journal of Public Health 92, 1759–1760.
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Leap, N., 2000. The less we do, the more we give. In: Kirkham,
M. (Ed.), The Midwife–Mother Relationship. Macmillan Press,
Basingstoke.
Lundgren, I., 2004. Releasing and relieving encounters: experi-
ences of pregnancy and childbirth. Scandinavian Journal of
Caring Science 18, 368–375.
Lundgren, I., Dahlberg, K., 1998. Women’s experience of pain
during childbirth. Midwifery 14, 105–110.
Lundgren, I., Dahlberg, K., 2002. Midwives’ experience of the
encounter with women and their pain during childbirth.
Midwifery 18, 155–164.
McCrea, H., Wright, M., Murphy-Balck, T., 1998. Differences in
midwives’ approaches to pain relief in labour. Midwifery 14,
174–180.
Marcel, G., 1950. The Mystery of Being, vol. I. The Harvill Press,
London.
Marcel, G., 1964a. Phenomenological notes on being in a situation.
In: His Creative Fidelity. The Noonday Press, New York.
Marcel, G., 1964b. Belonging and disposability. In: His Creative
Fidelity. The Noonday Press, New York.
Nelms, T.P., 1996. Living a caring presence in nursing: a
Heideggerian hermeneutical analysis. Journal of Advanced
Nursing 24, 368–374.
Nouwen, H., 1975. Reaching Out. Doubleday Press, New York.
Odent, M., 1996. Knitting needles, cameras, and electronic fetal
monitors. MIDIRS Midwifery Digest 6, 304–306.
Odent, M., 2002. The farmer and the obstetrician. Tree
Association Books, London.
Pairman, S., 2000. Women-centred midwifery: partnerships or
professional friendships. In: Kirkham, M. (Ed.), The Midwife–
Mother Relationship. Macmillan Press, Basingstoke.
Pembroke, N., 2004. Working Relationships: Spirituality in
Human Service and Organisational Life. Jessica Kingsley
Publishers, London.
Scheurich, N., 2003. Reconsidering spirituality and medicine.
Academic Medicine 78, 356–360.
Scotto, C., 2003. A new view of caring. Journal of Nursing
Education 42, 289–291.
Seibold, C., Miller, M., Hall, J., 1999. Midwives and women in
partnership: The ideal and the real. Australian Journal of
Advanced Nursing 17, 21–27.
Siddiqui, J., 1999. The therapeutic relationship in midwifery.
British Journal of Midwifery 7, 111–114.
Swinton, J., 2001. Spirituality and mental health care. Jessica
Kingsley, London.
Walsh, D., 1999. An ethnographic study of women’s experience
of partnership caseload midwifery practice: the professional
as friend. Midwifery 15, 165–176.
Walsh, D., 2006. Subverting the assembly-line: childbirth in a
free-standing birth centre. Social Science and Medicine 62,
1330–1340.
Young, W.A., 2005. The world’s religions: worldviews and con-
temporary issues. Pearson Prentice Hall, Upper Saddle River.