The different rite of passage- We need to reach every woman and newborn when they are most vulnerable – during labor and birth
Some 3 million deaths(women, newborn and stillbirths) can be attributed to childbirth each year, many due to “complications from delivery,” according to the World Health Organisation. (Source)
One of those “complications” is the fact that humans have a big brain encased in bone. The fetus performs a series of rotations to be able to navigate through the tight space.
Why does it matter?
During birth, a baby rotates while traveling through the canal, aligning the sides of the head and shoulders to the channel's contours.
Says Lia Betti, Senior Lecturer, Evolutionary Anthropology, University of Roehampton, London in the journal Proceedings of the Royal Society of London B: " A typical pelvic shape and typical childbirth pattern can differ among populations. An obstetrician's training is often based on a model of the pelvis that has been developed from European women... Especially in a multi-ethnic society, an update seems necessary. If a woman's birth canal is substantially different from the model described in textbooks, the movement of the baby will also deviate from the expected pattern.”
Betti, along with evolutionary ecologist Andrea Manica of the University of Cambridge in the United Kingdom, measured the pelvises of 348 female human skeletons from 24 different parts of the world. The birth canals were far from carbon copies of each other.
Debunking “Obstetrical Dilemma”
The shape of a mother’s birth canal is a tug-of-war between two opposing evolutionary forces: It needs to be wide enough to allow our big-brained babies to pass through, yet narrow enough to allow women to walk efficiently. The evolutionary compromise- commonly referred to as "Obstetrical Dilemma" is anything but close to the truth.
This, people thought, led to a twisted birth canal to make delivery easier.
“However, that was based – basically exclusively – on European women, who have a particularly twisted canal,” said Betti.
A newborn's route into the world is determined by the depth and width of the pelvic canal. Forcing births to conform to a single standard can be harmful to both mother and child.
World over, most medical training is based on Europeans. But unfortunately, just like fingerprints, humans from different races need to be treated based on their unique physiology. Most medical textbooks are based on European body type, and therefore there are inherent health risks in blindly going by these books.
How it is dangerous to base all assumptions on one birth canal size of one ethnicity
The pelvic canals of women from Sub-Saharan Africa differ from Asians, Northern Europeans, and Native Americans. The size and shape, which varies in both width and depth largely depend on the part of the world they live in.
Compounding factors like interpersonal and institutional racism, poverty, poor health care access, and environmental burdens disproportionately harm black mothers. These contribute to the risk of pregnancy-related deaths being three to four times higher for black women than for white women.
Remember the horrendous consequences of forceps deliveries in the early-to-mid 20th century? Most of the techniques used to rotate babies during delivery were based on erroneous/ limited assumptions about the shape of the pelvis.
Limited prescriptions of what constitutes a “normal” pelvis or birthing process might lead doctors to perform unnecessary interventions — like induced labor, cesarean sections or the use of forceps- in the past.
According to Betti, there are problems with standard textbooks, as they base their descriptions of the anatomy of the birth canal – and how a baby must rotate as it passes through – on European women.
“A different pattern of childbirth that is considered odd for European women and therefore seems to ring alarm bells could be perfectly normal for other populations,” said Betti.
Whatever may be the reason for the diversity in the internal architecture of female pelvis , the need of the hour is to update textbooks, create specific obstetric training programs and resources that take ethnicity of the pregnant mother into consideration and provide practical solutions to protect women and children from the most dangerous day of their lives – the day of birth.
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