Human Childbirth: An Obstetrical Dilemma or a Solo Act

Nicole L. Falk-Smith, M.A., Doctoral Student Department of Anthropology & College of Public Health University of South Florida

Introduction:

“In her account of a single !Kung woman, Shostak (1981) reported that her informant Nisa described her mother giving birth unaided...There is inadequate evidence to address this issue with confidence at present, yet if preagricultural populations did experience less of an obstetric dilemma than is typical of contemporary agricultural populations, the evolutionary significance of birth attendants...might also benefit from reappraisal” (Well et al. 2012: 64).

Results: 60%

Mothers reporting 'catching' her baby

This project seeks to contribute to the issue of the obstetrical dilemma through analysis of qualitative data gathered with ‘unassisted’ and ‘solo’ birth mothers. The data presented here are based on a preliminary and explorative survey.





q Unassisted child birth (a.k.a. q Solo birth is defined as giving

freebirth) is defined here as giving birth without the assistance of

birth without the presence of a birth another person, such as a partner,

professional (a physician or midwife).

mother, or friend.







The obstetrical dilemma, as coined by Washburn (1960), posits that through the evolution of bipedalism and encephalization, childbirth became more difficult for hominin females.



Due to this increased difficulty, complications are more likely to arise and women may require assistance during childbirth. Indeed, it is theorized that in response to the obstetrical dilemma the genus Homo adapted, in part, through obligate midwifery (Trevathan 1987).



The term obligate indicates that this particular function, midwifery, is required for life in the same way as an obligate aerobe requires oxygen to grow.



A growing number of women, who have access to biomedical or midwifery care, are choosing to give birth at home. For example, between 2004 and 2009 there was a 36% increase in home births among nonHispanic white women in the US (MacDorman, 2012). Within this home birthing population, which account for 1% of all births in the US, a small number are choosing to have unassisted or solo births.



50%

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u The survey received 226 respondents



BIRTH EXPERIENCES



•  84% had a midwife ‘catch’ the baby during at least one of her births



53% of these occurred in the home



•  34% had an OB ‘catch’ the baby during at least one of her births

•  22% had a friend, partner, or family member catch the baby



•  17% had caught their own baby

•  Of those women who reported catching the baby, 34% (n=13) gave narratives regarding the birth order of the baby(ies) they caught.

•  Three women stated the unassisted birth was unplanned.

Ultimate Research Questions: Do the data on unassisted and solo birth support the obstetrical dilemma and obligate midwifery as set forth by Trevathan (1987)?



Alternatively, is the modern notion that birthing mothers need assistance a historically rooted misconception as described by Walrath (2006)?



Further, is difficult and dangerous childbirth the result of ecological pressures among contemporary Homo sapiens and not associated with Pleistocene Homo as describe Wells et al. (2012)?

“I would argue that with the increase in encephalization at this time, there was a third behavioral transition, a point at which assistance at childbirth made a difference in mortality of Homo mothers and infants. Again not only was parturition more difficult, the genus became encumbered with a unique need of obligate midwifery”

(Trevathan 1987: 225).

“Movement away from the gendered obstetrical dilemma, a cultural-bound notion of inadequate female biology requiring cultural interventions to perform a distinctly female biological task, will improve not only the quality of scientific investigation but also the lives of women”

(Walrath 2006: 70).

“With regard to contemporary Homo sapiens, we suggest that the magnitude of the dilemma is sensitive to several ecological pressures including the thermal environment, dietary energy availability and glycemic load, and infectious disease burden. In turn, we suggest that these ecological stresses may each have become exacerbated during the transition to agriculture, acting on both maternal and fetal phenotype, such that the obstetric dilemma may have been worse in the last few thousand years than was the case for Pleistocene Homo.”

(Well et al. 2012: 64).

Methods:

Facebook (FB) is a major source for information and support for mothers and mothers to be. There is currently one main FB page that is a space for support, information, and mother-to-mother guidance on

unassisted birth. There are other pages that focus on home childbirth, but not specifically on unassisted birth.





a preliminary step into research with the unassisted birthing community, a survey was posted to three FB As pages. The surveys sought basic demographic data and childbirth scenarios that the respondents had

experienced.





After collecting basic demographic data, the participants were asked to choose the type of birth experiences

have had and finally, in an open-ended question, to describe their birth experiences.

they



The survey was disseminated and data was collected using SurveyMonkey.



After the survey, I used follow up emails to gain further clarification on the solo birth process.



RESPONDENT’S NARATIVES: We were also aiming for a waterbirth. However my son had different plans and I ended up catching him myself in the car on the freeway after only 45 minutes of labor! [Second birth]

My first 3 babies were hospital births with an OB.

My 4th & 5th babies were born at home with a midwife. My 6th baby was born at home (unassisted) caught by my husband. My 7th baby was born at home with only me there.

Sixth baby, born at home in the bathtub, unassisted, caught by mom, baby weighed 10 lbs. (2 hour labor)

I gave birth in a semi-standing, semi-squatting position in front of the toilet. After catching her, I woke my partner, he slept through the entire labor and birth! [Second birth]

One son born in the tub that I pulled up to my chest right after birth.

My next [fourth] child was born at home...40 minutes or so. Just me. Husband was out of town and the midwife arrived to catch the placenta.

I caught my second child, before the midwives arrived. Both births were completely normal and natural with no complications or interventions of any kind. I would also describe them as peaceful, private, gentle, ecstatic and empowering.

Discussion & Conclusions: It is widely accepted in biomedical and anthropological literature that there is a disjunction the neonatal head circumference and maternal pelvis size and that this disjunction is due to antagonistic demands for encephalization and bipedalism. However, this view is now under scrutiny (see previous quotes by Walrath 2006; Wells et al. 2012).

 

The data presented here are preliminary and explorative, but indicate that primiparous women are able to catch their own babies, when complications do not arise. The narratives also indicate that the occiput anterior presentation was not an obstetrical problem. For example, when probed about the baby’s presentation, one woman stated, “The baby naturally does a little turn to face the mama when coming out.”



The survey was posted to three Facebook pages that provide information

and social online support for women seeking unassisted childbirth.



Seventeen percent of the respondents indicated that they caught their

own baby. However, only three respondents experienced birth without the

presence of another person, known as solo birth.



Among a group of women seeking practical and social online support in

preparing for unassisted childbirth, having social and physical

support during labor and delivery from a midwife or other birthing

partner is almost universal.



These data suggest that the term obligate midwifery should be refined to better reflect a woman’s ability to birth unassisted, particularly after she has experienced her first birth.



Further research is needed to evaluate if current childbirth complications, specifically obstructed labor, is likely due to antagonistic selective pressures on neonatal encephalization and maternal bipedal locomotion that developed during the evolution of the genus Homo or if such complications have arisen more recently due to ecological pressures, especially dietary transitions.

My second child was born at home with a midwife in attendance. Baby was born at 37 weeks and labour started spontaneously and lasted 57 minutes. It was very manageable too. Baby was born in our home bath and I caught her. It was wonderful and the after care was great.

I had a lovely homebirth in 2005 attended by a midwife who watched me catch our daughter..

My Midwife did not catch my baby, she gave me the opportunity to reach down and grab her and pull her to me by myself.

My second birth, we planned to have a midwife but she didn't get there in time (our fault) but my husband and I caught our baby.

1st birth was in a public teaching hospital. I was uneducated and will NEVER make that choice again! 2nd birth was at home with a midwife, born in water. She helped me catch the baby. 3rd birth (a month ago today!) was an unassisted birth (& pregnancy) in water at home, birthed into my own hands:)

Works Cited: MacDorman, MF, TJ Mathews, and E. Declercq 2012 Home Births in the United States, 1990–2009. NCHS data brief no. 84.

Trevathan, W. 1987 Human Birth: An Evolutionary Perspective.

Walrath, D. 2006 Gender, Genes, and the Evolution of Human Birth. Feminist Anthropology: Past Present and Future:55–72.

Washburn, S. L., M. D. Sahlins, C. F. Hockett, W. W. Howells, R. J. Braidwood, E. S. Deevey Jr, and T. Dobzhansky 1960 The Human Species. Biodemography and Social Biology 7(4):217-225.

Wells, J. C., DeSilva, J. M., & Stock, J. T.

2012 The obstetric dilemma: An ancient game of Russian roulette, or a variable dilemma sensitive to ecology?. American journal of physical anthropology, 149(S55), 40-71.