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Before we discuss validation in labor and birth, I need to give some background on Maslow’s hierarchy of needs. In college I minored in psychology where we were taught Maslow’s hierarchy of needs. Abraham Maslow was a psychologist who was interested in figuring out how to attain what he called self actualization, or reaching one’s full potential. He came up with five needs that we have as humans that need to be fulfilled in order to reach our full potential.  These needs are outlined below:

1. Physiological Needs

The needs required to sustain life. These include such things as air, water, sleep, and nourishment.

2. Safety Needs

Safety needs include the need for structure or order. This means feeling free from threat of physical and emotional harm. It also involves feeling protected from injury or pain.

3. Social Needs

This has to do with our interactions with people. It involves our ability to give and receive love, as well as the need for friends and belonging.

4. Esteem

Esteem deals with our need to feel important. This includes our desire for self-respect and the feelings of achievement.

5. Self-Actualization

This is comprised of finally reaching our full potential. This is how we find meaning in our lives.

New Beginnings uses Maslow’s hierarchy of needs in the training course to help identify the needs of women in labor.  We have focused on the need of Esteem in the birthing room in many ways. One of the most important ways is manifested as validation during labor and birth; viewing and treating the woman as a person capable of making her own decisions.

While there has been big improvements in many of the other needs that have been mentioned in this model of care, such as physical and safety needs in the field of medicine, esteem is the one that seems to be neglected the most and is often pushed off as unimportant. In fact, providing choice to the woman is often downplayed during childbirth. In some instances, information that may provide women with more options is not given.  Many times the information given is based on protocols, not evidence-based care(Lothian, 2008).  Women who display a desire for options tend to be seen as high maintenance, rather than participants in their own safe birth experience.

Often, survival is seen as the end point of birth.  However, with the safety that modern technology and medicine has given us, we can now start to see survival as the beginning point, not the end, on which to build.  Because of the great job modern medicine has done, we are now able to do more than just survive, we can live.  A line from the movie, “WALL-E” says, “I don’t want to survive.  I want to live!”  The idea being that the most basic level we should achieve is survival, but to live means you appreciate and enjoy being alive.  It means more than just surviving.

Esteem, demonstrated through validation, is often the missing element found in stories of women who have had emotionally traumatic births. In fact, it is found that many women are made to feel belittled, unimportant, and disrespected. On the other hand, when women have felt that their opinion mattered, were given choices, and had those choices validated respectfully, they had better psychological outcomes after birth. (Green et al., 1990)

The most important component in all of this is choice.  By giving women choices, you are showing them that their opinion counts.  This also allows them to feel that they are the one in charge and achieving the goal, not the doctor, nurse, midwife, or doula. When a woman feels validated, she feels a sense of self-worth and achievement. This sense of self-worth can lead to healthier coping mechanisms.

Another important part is validating how a woman feels or thinks.  I read a story of a woman who was told that the contractions she was feeling at the moment were not really painful. She therefore got the sense that the midwife thought she was acting like a baby.  This had a huge impact on how she viewed her labor and birth and she felt very self conscious.  This also gave her the idea that she was failing in some way.  No matter how it looks to us on the outside, a woman’s view on what is going on should be viewed as important and should be validated.

Women also feel a sense of validation when they are given encouragement that they are capable of giving birth.  During one of my labors, I remember looking at my husband and telling him I could not do this anymore.  He just looked back at me and told me that I could, that I had already done it, and was capable of doing it again.  That validation gave me the esteem that I needed to continue with the labor.

Overall, the concept of esteem and validation should be a part of how we choose to help women during labor and we should acknowledge the impact it has on a how a woman subsequently assesses her labor and birth.

Additional Content You Might Be Interested In:

Green JM, Coupland VA, Kitzinger JV. (1990). Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women. Birth;17:15–24.

Lothian, J. A. (2008). Choice, Autonomy, and Childbirth Education. The Journal of Perinatal Education, 17(1), 35–38. http://doi.org/10.1624/105812408X266278

Maslow, A. (1943). A theory of human motivation. Psychological Review, 50, 370-396.

The Obstetrics and Gynecology Risk Research Group, Kukla, R., Kuppermann, M., Little, M., Lyerly, A. D., Mitchell, L. M., … Harris, L. (2009). Finding Autonomy in Birth. Bioethics, 23(1), 1–8. http://doi.org/10.1111/j.1467-8519.2008.00677.x

Follow Rachel Leavitt:

Rachel has worked as a register nurse (BSN from University of Utah) since 2004 with a work history in Labor and Delivery, NICU and Postpartum Care. She is also the founder of New Beginnings Doula Training which she organized in 2011. When she's not busy being a mother and grandmother, she can be found reading research papers related to some aspect of childbirth.

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