Spiritual Midwifery: Advancing Patient-Cantered Care Beyond the Biopsychosocial Model

Introduction

In a quiet side room of a busy maternity ward, a mother sits in silence after a miscarriage. Her pain is beyond physical, it’s existential. She is no longer asking questions about medication or recovery times, but now deeply human ones about what this experience means for her. However, in today’s NHS, such spiritual needs are often overlooked.

The biopsychosocial model was introduced by George Engel in 1977 and was revolutionary for modern medicine. It identified the fact that health involves not just the body, but also the mind and social context. ¹ And yet, even this framework lacks the vital concept of the realm of spiritual meaning. What is the difference between treating and healing patients, and is the NHS currently addressing symptoms without addressing suffering?

Spiritual care is the support of the non-physical aspects of a person’s wellbeing, be it their need for connection or hope, and it may be the final frontier of truly holistic healthcare. This essay argues that at life’s most profound thresholds, birth, death, and when people are forced to redefine who they are, clinicians must be trained not just as technicians, but as spiritual midwives: companions who help patients find meaning in moments where medicine alone cannot reach.

What is Spiritual Care?

Spiritual care is often misconstrued as being synonymous with religion, but in modern healthcare, its meaning is broader and more inclusive. It refers to the support of a person’s non-physical wellbeing in times of stress or illness where they may be searching for purpose, belonging or hope. Of course, this can include religious beliefs, but it also encompasses non-religious forms of spirituality: cultural identity, morality or deep personal questions like “Why is this happening to me?”

The World Health Organisation is increasingly recognising spirituality as a core dimension of health, alongside physical, mental, and social wellbeing. ² Yet, while physical symptoms are easily assessed, spiritual needs often go unspoken, partially due to staff discomfort, time pressures, or lack of training.

To fill this gap, clinicians must learn not just to give answers, but to accompany patients as they search for their own.

Why is Birth Spiritual?

Birth is sometimes viewed as a purely physiological event, yet for many women, it is one of the most spiritually and emotionally charged moments of their lives. It signifies more than just the arrival of a child, but a profound transformation of self – into motherhood, into vulnerability, or, for some, into grief. All reproductive experiences, from childbirth and miscarriage to infertility or abortion, frequently prompt existential questions: “Am I still whole?” “Why did this happen to me?” “Who am I now?”

For women who experience traumatic births or reproductive loss, the psychological wounds often run deeper than the physical. In a 2004 study, it was found that women described birth trauma not in clinical terms, but through emotional language. This ranged from descriptions of feeling invisible, powerless, or broken. ³ This very clearly demonstrates just how much the impact of birth extends far beyond the body.

In these moments, patients do not simply need procedures or pain relief. They need presence, compassion, and a sense that someone sees the full scope of their suffering, which is where spiritual midwifery begins.

Why is Death Spiritual?

Death is a profound existential moment where questions of meaning and identity can come to the forefront. Patients nearing the end of life often wrestle with fears and uncertainties which transcend physical symptoms. Yet, modern medicine tends to focus on managing physical discomfort, sometimes neglecting the deeper spiritual distress that Saunders described as “total pain”: the intertwined physical, emotional, social, and spiritual suffering experienced by dying patients. ⁴

While there are efforts within palliative care to integrate spiritual support through chaplaincy and psychosocial teams, these services are often fragmented and inaccessible to many. The healthcare system frequently medicalises death, sidelining the human need for meaningful presence and existential comfort. True healing at the end of life requires a spiritual midwife to accompany patients through this final transition with empathy, listening, and respect for their spiritual questions.

Illness, Diagnosis & Identity Loss

Illness and major life changes can alter a person’s identity and sense of purpose. Whether facing a life-altering diagnosis, chronic illness, or the demands of caregiving, patients can often have deeply spiritual crises. Viktor Frankl, a psychiatrist and Holocaust survivor, famously observed: “Those who have a why to live can bear almost any how.” ⁵ This reminds us that meaning making is central to human resilience and recovery. Yet, healthcare often focuses narrowly on symptoms and function, neglecting this existential dimension. In these “in-between” moments, when patients are caught between what was and what will be, spiritual midwives play a crucial role. By holding space for grief, hope, and self-redefinition, they help patients navigate their transformed realities with dignity and purpose.

The Role of a Spiritual Midwife

A spiritual midwife’s role is not to provide answers or solutions but to accompany patients through their journeys of loss and transformation. They create a safe, non-judgmental space where patients can express fears, hopes, and questions that may go unspoken in clinical contexts.

Examples include maternity staff supporting a woman grieving a miscarriage, palliative nurses helping patients create legacy projects, or chaplains who listen without preaching. These caregivers recognise that healing involves more than physical recovery and that it requires attending to the whole person, including their spiritual and emotional wellbeing.

Fitchett and Risk (2009)⁶ emphasise the importance of recognising and addressing spiritual struggle in clinical care through attentive screening and compassionate presence. Such approaches enable healthcare professionals, not just chaplains, to support patients’ spiritual needs, effectively acting as “spiritual midwives” who guide patients through life’s transitions.

Progress & Challenges with Spiritual Care in the NHS

The NHS has made important strides in recognising spiritual care, notably through chaplaincy services, palliative care teams, and the implementation of Schwartz Rounds, which provide safe spaces for staff to reflect on their emotional and ethical experiences⁷. However, these services remain unevenly distributed and under-resourced, leaving many patients without access to meaningful spiritual support.

Time pressures within the NHS, such as brief consultations and high patient volumes, often prevent clinicians from exploring patients’ spiritual needs. Additionally, many healthcare professionals report discomfort or lack of confidence in addressing spirituality, partly due to limited training during their education, despite its importance being recognised by the General Medical Council⁸. While holistic care is championed in policy documents like the NHS Long Term Plan, practical implementation remains challenging.

To close this gap, systemic change is required: embedding spiritual care training into curricula, fostering interdisciplinary collaboration, and creating protected time for reflective practice. Only then can the NHS evolve from treating illness to truly healing the whole person.

How the NHS Can Train Spiritual Midwives

To embed spiritual care into everyday NHS practice, education must evolve. The idea pf spiritual care as a healthcare dimension must be integrated into medical curricula. Furthermore, narrative medicine – the art of listening and interpreting patient stories – should be taught, to foster empathy and provide clinicians with an appreciation of the meaning and experience behind the symptoms.

Charon argues that attentive listening transforms patient care by uncovering the layers of a person’s experience beyond physical ailments⁹. This skill is crucial for spiritual midwifery, enabling clinicians to accompany patients through existential questions without judgment or rushing to fix.

Beyond education, interdisciplinary collaboration between clinicians, chaplains, psychologists, and social workers is vital. Together, they can create a supportive network that nurtures patients’ spiritual wellbeing. Protected time for reflection and training is also necessary to help staff build confidence in addressing spirituality, turning the vision of spiritual midwives into a sustainable reality.

Conclusion

Patients often face more than physical challenges when confronted with illness, grappling with questions of meaning, identity, and purpose. While the biopsychosocial model has broadened the scope of modern healthcare provision, it stops short of fully addressing the spiritual dimension of suffering.

Training healthcare professionals as spiritual midwives, i.e. companions who listen, support, and hold space for each patient’s spiritual journey, would fill this critical gap. The NHS has taken steps toward this vision, but much remains to be done to integrate spiritual care into everyday practice, education, and policy.

Ultimately, a distinction must be made between physical recovery and healing. Healing requires more than treating symptoms; it demands attending to the whole person. By embracing spiritual care as the final frontier, the NHS can become not only more compassionate but truly transformative, where every patient’s experience is witnessed, honoured, and held with dignity.

References

Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36. Available from: http://www.jstor.org/stable/1743658

Dhar N, Chaturvedi SK, Nandan D. Spiritual health, the fourth dimension: a public health perspective. WHO South-East Asia J Public Health. 2013;2:3–5. Available from: https://iris.who.int/bitstream/handle/10665/329763/seajphv2n1_p3.pdf?sequence

Beck CT. Birth trauma: In the eye of the beholder. Nurs Res. 2004;53(1):28–35. Available from: https://journals.lww.com/nursingresearchonline/abstract/2004/01000/birth_trauma__in_the_eye_of_the_beholder.5.aspx

Saunders C. The evolution of palliative care. Patient Educ Couns. 2000;41(1):7–13. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0738399100001105

Frankl V. Man’s Search for Meaning. Boston: Beacon Press; 2006.

Fitchett G, Risk JL. Screening for spiritual struggle. J Pastoral Care Counsel. 2009 Spring-Summer;63(1–2):4–12. PMID: 20196352.

Pepper JR, Jaggar SI, Mason MJ, Finney SJ, Dusmet M. Schwartz Rounds: reviving compassion in modern healthcare. J R Soc Med. 2012;105(3):94–95. doi:10.1258/jrsm.2011.110231

General Medical Council. Outcomes for Graduates. 2020. Available from: https://www.gmc-uk.org/-/media/documents/outcomes-for-graduates-2020_pdf-84622587.pdf

Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286(15):1897–1902. doi:10.1001/jama.286.15.1897