#3 Childbirth - are our bodies designed for it?

FACT OF THE DAY: Walking and talking are the reasons why women risk their lives each time they give birth

It’s sometimes said that a picture can speak a thousand words. I think this is one of those pictures:

  DARK SOLID OVAL = size of baby’s head   
  WHITE OVAL = size of pelvic outlet

If I had to draw a picture of what labour felt like, I think it would look somethingvery like the circles on the far right. Ouch! 

I felt a moment of recognition when I saw this picture in Sarah Blaffer Hrdy's book about Mother Nature.

Just look at that large dark circle!

It seems that when people tell you that your body is designed for childbirth, they’re lying....

What our bodies are designed for is being intelligent and walking upright on two feet. The net result of this during childbirth is a large head full of brains, being pushed out of a small, tilted upright, pelvis.

In comparison, our great ape cousins who don’t have the smarts and walk on all fours, still have a small head that just slips out of a lovely large hole, as it were. They just grunt their babies out in the amount of time it takes us to make a cup of tea. Not that many Orangutans, Chimps or Gorillas have actually been observed giving birth in the wild or even in captivity – keepers often seem to miss the event despite checking regularly which shows how quick it must be. Compare this to our childbirth marathons which often last many painful hours, and without intervention can end in disaster.

It does seem a pretty major design flaw that women risk death each time they give birth. I hadn’t fully appreciated the mechanics of this before, and I'm surprised that our bodies are so badly designed for childbirth. It seems to go against evolution – surely killing off the creators of the next generation is not such a great adaptation. I suppose the overall benefit to our species of walking, running, hunting and being intelligent must make it worth it overall.

But talk about women bearing the brunt of human advances. While we nearly die in childbirth, what price do men pay for their large brains and walking bodies? They come along, have their fun and impregnate us, and then it’s up to us to endure the risk of childbirth to keep the human race going while they run off and do a bit of hunting. How can men and women ever be equal when our biology is so unequal.

I’m sure there is some sort of biblical analogy of Eve and women being punished for the sins of man. In fact I just looked it up in the bible, and in Genesis 3:16 God says to Eve after finding out about the apple "I will greatly multiply your pain in childbearing; in pain you shall ring forth children, yet your desire shall be for your husband, and he shall rule over you."  Nice.  Thinking about it, this probably reflects the painful birthing experiences of women at the time that Genesis was written, sometime 5000BC.

Anyway, I digress.

I have looked for some statistics to see if I am being melodramatic and actually childbirth is not that risky after all. It's not cheerful stuff.

In Western countries around 6 to 12 women die per 100,000 live births each year (to put that in context there are close to 700,000 births each year in England).

But in non-Western countries there is a huge variation in the ability to deal with the complications of labour.  In Africa the average risk is as high as 870 maternal deaths per 100,000 live births, but in some cultures such as the Hausa of Nigeria the risk is a staggering 1,050 maternal deaths per 100,000 live births because of the consequences of female genital mutilation and their horrendous childbirth practices. Countries at war have still worse outcomes, for example Sierra Leone (2100 maternal deaths per 100,000 live births), Afghanistan (1,800 maternal deaths per 100,000 live births) or Niger (1,800 maternal deaths per 100,000 live births).

The cumulative effect is worse – a Scandinavian woman has a lifetime risk of dying in childbirth of 1 in 25,000 compared to 1 in 8 for rural African women. And the awful fact is that in the non-Western world for every woman that dies, around 30 more end up with serious or humiliating birthing injuries that affect them for life. 

These statistics certainly make me question the advocates of natural, intervention-free childbirth. I’ll take the hospital birth with all the medicines I can lay my hands on thanks!

*  *  *

If you want to read more yourself, have a look at:

http://www.who.int/topics/maternal_health/en/

Blaffer Hrdy, S (1999) Mother Nature; A History of Mothers, Infants and Natural Selection  United States of America : Pantheon Books

Rosenberg, K and Trevathan, W (1006) Bipedalism and human birth: The obstetrical dilemma revisited Evolutionary Anthropology 4 (5): 161-168

Lindburg, DG and Lester Dessez Hazell (1972) Licking of the neonate and duration of labour in great apes and man American Anthropologist Vol74 p318-325

Wall, L (1998) Dead mothers and injured wives: The Social Context of Maternal Morbidity and Mortality Among the Hausa of Northern Nigeria Studies in Family Planning 29, 4 : 341-359