Sunday, April 18, 2010

Maslow's Hierarchy of (Birth) Needs

At a church meeting I attended recently, a speaker brought up psychologist Abraham Maslow's Hierarchy of Needs to make a point about serving others. It had been years since I thought about Maslow's Heirarchy, but I was familiar with it from the AP Psychology class I took in high school and I think it was also covered in the Child Development course I took as a requirement for my Bachelor degree in Early Childhood Education. This course was actually where, as a college freshman, I first learned that placentas come out. I don't know what I thought happened to it before--guess I figured it was just a permanent part of the mother's anatomy or something. Perhaps public high school curricula are a little lacking on the subject of childbirth?

In my high school psychology class, we discussed the different theories of psychology--Freud's psychoanalytic theory, behaviorism, etc. We divided into groups, each representing a theory. I chose to join the Humanist group. Basically, the theory of Humanism is that people are like seeds with the potential to grow into something great if all of their needs are met. For plants, the needs are soil, water, sunlight, etc. Maslow attempted to explain what human beings need with his Hierarchy of Needs, usually depicted as a pyramid like this:
Maslow arranged the needs this way because he believed that certain types of needs must be met before other needs manifest. In other words, if more pressing needs like needs for food, sleep, and safety are unmet, then the person can't be very concerned with higher needs, like belonging and confidence.

Here is an explanation of each level of needs, quoted from this site.

Physiological Needs
These are biological needs. They consist of needs for oxygen, food, water, and a relatively constant body temperature. They are the strongest needs because if a person were deprived of all needs, the physiological ones would come first in the person's search for satisfaction.

Safety Needs
When all physiological needs are satisfied and are no longer controlling thoughts and behaviors, the needs for security can become active. Adults have little awareness of their security needs except in times of emergency or periods of disorganization in the social structure (such as widespread rioting). Children often display the signs of insecurity and the need to be safe.

Needs of Love, Affection and Belongingness
When the needs for safety and for physiological well-being are satisfied, the next class of needs for love, affection and belongingness can emerge. Maslow states that people seek to overcome feelings of loneliness and alienation. This involves both giving and receiving love, affection and the sense of belonging.

Needs for Esteem
When the first three classes of needs are satisfied, the needs for esteem can become dominant. These involve needs for both self-esteem and for the esteem a person gets from others. Humans have a need for a stable, firmly based, high level of self-respect, and respect from others. When these needs are satisfied, the person feels self-confident and valuable as a person in the world. When these needs are frustrated, the person feels inferior, weak, helpless and worthless.

Needs for Self-Actualization
When all of the foregoing needs are satisfied, then and only then are the needs for self-actualization activated. Maslow describes self-actualization as a person's need to be and do that which the person was "born to do." "A musician must make music, an artist must paint, and a poet must write." These needs make themselves felt in signs of restlessness. The person feels on edge, tense, lacking something, in short, restless. If a person is hungry, unsafe, not loved or accepted, or lacking self-esteem, it is very easy to know what the person is restless about. It is not always clear what a person wants when there is a need for self-actualization.

Now, I've heard that birth is psychological. There are many examples of birth stories in Ina May's Guide to Childbirth where the woman couldn't give birth until she solved some issue with her partner or voiced a fear or something like that. I also have read a lot about the mind-body connection and how a woman feels during birthing can affect the physical process of birth (a explanation of this is in Better Birth: The Ultimate Guide to Childbirth from Home Birth to Hospitals by Denise Spatafora). I've also heard explanations from an evolutionary standpoint, that humans, like animals, have to feel comfortable in our surroundings to give birth.

However, I've never heard the psychology of birth explained in terms of unmet needs before. If we assume that meeting the needs on Maslow's Hierarchy is essential to a woman's emotional well-being, and hence, important for both the physical progress and the woman's experience of birth, then it's easy to see why some births go smoother and are better experiences than others. A lot of what is common in birth in America actually denies women of their needs.

In the average hospital birth, women are usually denied food and sometimes denied drink (physiological needs) and given an intravenous drip and ice chips instead. Women can't feel safe (safety needs) in the hospital if they fear strangers, unfamiliar places, needles, or bodily injury from episiotomy or cesarean. Traumatic birth stories sometimes mention the woman feeling alone, deserted, or unloved (social needs) when she was taken away from loved ones to be preped for surgery or left to be "watched" by a fetal monitor. Sometimes women are disrespected (esteem needs) by being ordered around, spoken to demeaningly (you can find a lot of examples of these two at, or not being free to move. With so much frustration of women's needs, no wonder there are so many unsatisfying birth experiences.

If you were to look at my birth plan from my son's birth (unmedicated hospital birth), you would find evidence of my needs to be able to drink, to feel safe, and to be respected. Perhaps social needs explain the results the various doula studies. Wanting a birth environment that allows these needs to be met certainly explains why some women choose out-of-hospital births.

Emjaybee, in a post at the Unnecessarean, recently asked so what does "good" look like? I think that the ideal birth environment would be one that supports the fulfillment of women's needs. This means one with unrestricted access to food and drink, one that is non-threatening in both appearance and practice, where women who want continuous emotional support can have it and there is no restriction on the presence of family members, and where caregivers are religiously respectful of the woman's autonomy, decisions, space, and person--where thy ask permission instead of stating their intentions and they avoid any unnecessary disruptions or interventions.

For women who are able to have all their needs met at birth, it can be a highly satisfying event, maybe even, I suggest, a self-actualizing experience.


  1. You are SO right. This fits perfectly.

  2. Great post! I hadn't ever thought to apply Maslow's hierarchy to childbirth, but it totally works! I linked over from

  3. Thank you so much for this. It made me cry. It really hit all the right spots of where I was failed. I appreciate you writing this!