These words, taken from a prayer read during the High Holy Day services at my synagogue, have special meaning for me. As I reflect on the journey that my life's work has taken me, I am struck by a powerful link between giving birth, facing death, and awakening spirituality.

I began my professional career as a nurse working in labor and delivery. I was drawn to this area of nursing partly by the awe I experienced when, during my student days, I first witnessed a birth. Seeing a woman give birth brought up emotions for which I had no words, back then. I only knew that I had been moved beyond all reason and that there was no other specialty in nursing for me. As I look back on that experience, I realize that it was more than just witnessing the miracle of a new life beginning. What inspired me was how this unmedicated woman could integrate the power of birthing energy with the strength of her own being and accept the sacred work of creation. When each of my three daughters was born years later, I understood how the awesome act of giving birth can have a profound effect on a woman's life.

Although working with childbearing women has remained my passion over the years, more recently my professional practice has evolved to helping women deal with the events associated with the diagnosis and treatment of breast cancer. Women with this potentially life-threatening illness are often forced to confront their own mortality. I have noticed that many women faced with a diagnosis of breast cancer develop a greater appreciation for life. Coward (1990, 1991) and Tylor (1983) report that, in some women, the experience of a life-threatening illness leads to self-transcendence and greater emotional well-being. Reed (1991) defines self-transcendence as the experience of extending self-boundaries inwardly, outwardly, and temporally to take on broader life perspectives, activities, and purposes. Although giving birth in modern times is rarely considered a life-threatening illness, I believe that for some women the experience of giving birth can also provide an opportunity for self-transcendence.

Recently, while participating in a Catholic studies seminar at Seton Hall University, titled “Divine Madness and the Intellectual Life: Exercises in Appreciation,” I began to reflect on birth and death—two very diverse yet somehow similar life-altering experiences. Giving birth and facing death both have the potential to awaken spirituality and, thus, open the individual to a greater appreciation for meaningful life. This commentary focuses on the idea that giving birth provides an opportunity for self-transcendence.

Why is it that for some women the process of giving birth takes on a spiritual dimension and for others it is approached with fear and dread and avoided at all costs? In her book Birthing Normally: A Personal Approach to Childbirth, Peterson (1981) points out that most women labor in the same way they live. Labor is a crisis situation for most women. They approach it the way they approach any crisis: Some believe they are powerless, while others try to assume control. Many women choose not to experience a natural labor and birth; instead, they choose to “control” the experience of the process with the use of technology and pain-obliterating anesthesia. Today, too many women approach labor with the wish (stated or unstated), “Take care of this inconvenience, please. I don't want to feel a thing—just hand me the baby when it's over!” Instead, what women need most in labor is encouragement and loving support for their abilities to birth normally. Women's confidence and ability to give birth are either enhanced or diminished by the care provider, place of birth, and the amount of input laboring women can add to decisions about their own care. Sadly and too often, women do not get the encouragement they need because many doctors and nurses hold the same attitudes about labor as they do about any medical crisis or inconvenience—in their role as experts, they feel they must cure it as soon as possible. Thus, most women today opt for routine use of epidural anesthesia. In doing so, they are deprived of the opportunity to truly experience an event that has the potential to help them grow to greater spiritual and psychological fullness.

Our spiritual selves are an intrinsic part of us, but we spend less time focusing on this part of our lives than we do on just about anything else. For the most part, we go through our lives believing that if we learn as much as we can about the material world—our bodies, our education, our jobs, etc.—we will be in control and able to contend with life's challenges. Traditional childbirth education classes emphasize the need to learn everything there is to know about the process of labor. Coping strategies are discussed, as well as the technology that will be there to help, if necessary. Couples expect that, if they attend classes and practice their breathing and relaxation exercises, they will be prepared to cope with the challenges of labor. One thing that is often absent in childbirth classes is a discussion of the spiritual aspect of this life-affirming experience—the recognition of God's presence in the miracle of life.

When I propose to my undergraduate nursing students the notion that giving birth naturally can be a spiritual experience, they often look at me as if I am “mad.” Why, they ask me, would anyone want to “suffer” when modern medicine can provide anesthesia to take away all the pain? Why bother to experience a natural birth? Why not plan to feel as little as possible? This often leads to a philosophical discussion on birth. I want them to appreciate birth as normal, natural, and healthy. We hear a great deal about the pain of childbirth, but very little about the joy and pleasure of feeling the contractions, bearing down as the baby pushes into the world, and experiencing harmony with the rhythms of one's body as it does the incredible work of birth. I try to help students recognize that the experience of birth profoundly affects women and their families, that women's inner wisdom can guide them through birth. My contention is that, in order to be transformed by birth, one must truly experience it. Some students accept this philosophy; however, others continue to question why anyone should needlessly have to or want to endure pain. This leads to ongoing intellectual dialogue. Jerome Miller writes:

Perhaps this argument explains the benefit to women in being challenged and confronting potential suffering in labor. Jiménez (1996) describes a comfort continuum for exploring issues of pain and comfort. She places suffering at the far end of the continuum. Jiménez further notes that culture, ethnicity, and religion strongly influence pain beliefs and practices. She notes that some religions teach that the acceptance of one's own pain and suffering is a means to spiritual perfection and growth. As Miller (1992) writes, “Suffering, Aeschylus says in Agamemnon, is the greatest spiritual teacher. It is through suffering that one learns whether God exists” (p. 23). Miller (1992) also argues that “…suffering is the exact opposite of being in control. It means opening oneself to what is horrifying, instead of recoiling from it” (p.27). In trying to manage or control pain in labor, one takes away its capacity to challenge the core of one's being. When allowed, suffering in labor can turn everything upside down and lead one to become an appreciative participant in the mystery of birth. As Miller (1992) writes, “When the very center of the self is deeply affected, one's whole way of thinking about the world, as well as one's whole way of feeling it, is profoundly and permanently altered” (p. 21). The person one was before has, to some degree, ceased to exist—and so has the world in which one used to live.

When a woman is able to give up the notion of controlling her normal labor process and, instead, open her heart to the dread, horror, wonder, awe, and mystery of the process, she allows for an altered view of her existence. In the book Birthing from Within, England (1998) beautifully articulates this process:

The mounting intensity of labor forced complete surrender of this woman's body and will, dissolving her ego, ideas, and familiar sense of self. There was no fear of dying because there was no “self” left to resist and fear. At that transcendent moment she had become birth itself. Perhaps, this represents the spiritual birth of woman into mother.

How can health care providers help women achieve this kind of self-transcendence during birth? First, it must be acknowledged that the work of normal labor is painful. Seeking pleasure and avoiding pain are natural pursuits. For survival's sake, it is essential to avoid or fix pain that is life-threatening. When we touch something hot, our response is to remove our hand; in doing so, we protect ourselves from serious injury. But normal labor pain does not need to be fixed. It is a healthy sensation that provides direction for women moving through the maze of labor. In her article, Really Teaching Lamaze: The Power of Pain, Lothian (1999) explains:

Well-supported women who trust their bodies' ability to give birth seem to have an intuitive sense that guides them. The challenge of giving birth today is to develop confidence, trust inner wisdom, and allow nature to do its thing. Women who are able to labor and give birth relaxed, confident, and with loving support experience an inner harmony that brings with it strength and endurance. The pain that is a natural part of childbirth becomes manageable. Experiencing, not obliterating, labor and birth allows women to feel the interweaving of the joy and pain, work very hard, and delight in their incredible accomplishment.

When this is accomplished, a woman's body is often permeated and nourished by spiritual energy and guidance. Having faith and trust in this reality is an important part of creating healthy childbirth. When a woman has faith in something greater than her intellect or her present circumstances, she is in touch with her inner source of power. Learning to connect with this inner wisdom—or spirituality—is not difficult, but neither our intellect nor our ego can control either the connection or the results. Often, this spiritual awakening and greater appreciation for life does not occur until someone is faced with death. Why not open the door so that giving birth long before experiencing death can help guide women through this significant journey with insights, wisdom, and reassurance that will heighten their spiritual awareness and create a more meaningful life?

Imagine what might happen if the majority of women emerged from their labor beds with a renewed sense of the strength and power of their bodies and an enhanced spirituality through giving birth. When enough women realize that birth is a time of great opportunity to get in touch with their true power, when they are willing to assume responsibility for this, we will reclaim the power of birth as an opportunity for self-transcendence and come to realize the miraculous gift of being.