Vaginal Birth vs. C-sections and Evolution

Factual Questions
1

I’m just a guy but… My wife and I have a couple of kids and I delivered the last one personally (well, with her of course, she’s a CHAMP!). All of our kids were born with the time honored method that got humanity through most of history to the 1900’s. Thus, whenever I see discussion of vaginal birth vs. C-section I read to see what the consensus is of those involved. I know that the numbers of C-sections in the US andCanada are much higher than the rest of the developed world who enjoy equally our low ‘birth complication leading to demise of the child’ rates. Even the WHO says that C-section rates above 10-15% are unhealthy.

It just occurred to me yesterday though… Why when more than 50% of American’s seem to believe in the validity of evolution getting humanity through all the trials of early homoerectus etc. life to become the overwhelmingly dominate species on earth don’t they think that the most crucial point in life (the birth process being able to kill both mom and child) is so flawed that it must be solved with a knife and a C-section? Now my SIL has had 2 back to back C-sections when the health of the child was in grave danger; thank goodness we have figured out a way to ensure the health of the child/mom in extreme cases. But yikes! Look at the numbers of C-sections in Sweden (10-14% I believe) etc. compared to our numbers.

Some Docs seem to think that obesity could cause the rise in the US. This sure seems like it could be true, I’m no expert, but we know obesity leads generally to more health problems, less healing ability, etc. So maybe that explains it, we’re just fat. However I think there is more phsych to it. In the ‘families with young children’ crowds we hang out with the ‘gee I’m glad I didn’t have to birth him/her vaginally’ mentality rises more than I would really expect. I’m just a dumb guy who stands by holding a hand and saying ‘come on Honey, you can do it!’ during a birth and even I know the list of advantages for the mother and child of a vaginal birth are long and significant. The [disadvantages of C-section are many](http://www.childbirthconnection.org/docs/modebirthreviewpoints.ppt#292,25,Results Overall (cont)) (the cite has 7 slides full), while there are about 4 disadvantages of spontaneous vaginal birth and three of them are: perineal pain (for sure, but I always provide perineal support for my wife and it really seems to help), urinary and bowel incontinence (which is very true and can be worse than a bad time after ‘chili night,’ but only temporary).

I guess I am just stunned by the apparent hypocrisy, if evolution is so able to ‘refine’ us to earthly dominance why didn’t it come up with a good system for birth. I mean, come on, a babe can actually move and get itself to the breast after the birth. You know what else? Breast feeding after the birth helps the uterus to contract and stop the bleeding of a hemmoraging mom. The babe can actually provide first aid to his/her own mother. Pretty awesome, right? Well if this all seems so cool why don’t we American’s care to push for the advantages (the birth fluids being pressed out of the babe’s nose etc. as the babe passes through the birth canal empowering the nose for the all important breathing process is just one of MANY advantages) of a vaginal birth?

Please don’t get this sent to the pit, k?

2

There’s a couple of issues, here. First of all, evolution and “nature” don’t give a squat about individuals. If it works well enough for enough individuals to keep propagating the species, who cares if it kills off even 20% of the breeding population?

Second: there are way too many doctors rushing into c-sections, IMHO. Reading Ina Mae Gaskin’s books on midwifery, one reads about 24, 30, 48 hour labors as routine. Very few doctors in the US will let a woman labor that long. It may be that a large percentage of c-sections would have been successful vaginal deliveries if let be.

Third: we don’t live “natural” lives. A cavewoman would be exceedingly fit by today’s standards, just because she’d be doing hard manual labor, lots of bending and digging and walking and skinning and curing hides and grinding seeds and just generally working hard for at least 5-10 hours a week. Most women don’t work out an hour a day, everyday. Our bodies are simply weaker and not in shape. Added to this is the age at which we like to have children - 30 is far older than nature “intended” for a first pregnancy. Even hospitals acknowledge that women this “old” have harder pregnancies, labor and deliveries than a 20 year old.

We’ve removed ourselves so far from nature that we can’t really expect nature to take care of us anymore.

3

I think you’ve been given a good answer. What I don’t understand is why if you think we were intelligently designed (That is, if you do. You don’t say so, but the wording here seems to imply it). we weren’t intelligenlty designed with a good system for birth. The argument you give seems more against intelligent design than evolution since evolution only has to satisfice, but intellignet design should come closer to optimizing.

4

I’ll grant you your point on increased age affecting things but the above statement I’m not so sure about. Well yes I suppose cavewomen would have worked more cleaning their granite counter tops and stone wear dishes and the gathering/fending for their lives stuff but…
What about the Vit. D deficiencies? They may have worked more but let’s not assume they had healthy/adequate diets.

First off I’ll make it clear, I think we have a wonderful method for reproducing. The mating that has through history tied a man and a woman together (and thus help to ensure the survival of offspring), the incredible formation of a placental system that protects the babe against mom’s diseases, and the steps in the birth process that allow the mom and babe to help one another out (like the breast feeding/uterous connection mentioned above).

Yes, evolution only HAS TO ensure enough of the population reaches reproductive age to get enough propogation to ensure survival, but humans have for centuries or more been used better than 20% odds of reaching reproductive age. (or have we? Now that I think about it I recall that life expectancy went up A LOT for a child, in Europe of ole, if he/she reached the age of three. But how that applies here exactly…)

I guess my main point is that if even the WHO thinks 90% of pregnancies are well able to go without c-section, then the ‘natural’ birth process must be pretty good, or actually from what we know now it must be very excellent. Many Americans believe evolution did the work. We believe, from today’s data, eveolution did a very excellent job at that work. We also think that the system is so refined so as to be 90% successful with no help other than that being provided by mid-wives for millenia. Then why don’t we trust it? Why are almost a third of the births in America by c-section? It is not just mom’s who want to scheduale the birthdate. Is it Doc’s who don’t seem to know what they are doing as well as mid-wives in days of yore?

5

Well, sure, but neither do a lot of modern women! :smiley: Between crazy diets and junk food, I’m not sure we’re a whole lot better off sometimes. But that is a valid point. I guess the only answer I have is that labor and delivery is about muscle power and endurance, things which they had in abundance.

Also, and I think this cannot be underestimated though I didn’t mention it before - women used to see birth a lot. We’d watch our mothers, our aunts, our sisters giving birth. We knew what to expect and how it all worked. A 10 week birthing class cannot make up for sitting with women in labor for two decades before doing it yourself. The efficiency of a calm labor cannot be underestimated.

And a minor point: before chairs, people spent more time in squating and tailor (“Indian”) sitting positions - both good positions to labor in if your thighs are strong enough.

I agree that the c-section rate in the US is way, way too high. I’ve ranted about it in length in other threads. I’m sure if you do a search for c-section and my username, you’ll find more than you ever desired. In short, I think that hospitals are driving OB’s c-section rates up for monetary reasons, and that OB’s are driving the c-section rate up to avoid malpractice suits. The last thing a doctor wants if something has gone wrong is the suggestion that he should have done “something - anything!” that could have prevented it.

As for why women and their partners put up with it, they’re in a very vulnerable and frightening position, being told by the “experts” that a c-section has to be done. They don’t know or believe they can say no. They are afraid to say no, because what if something does go wrong? See again: fear.

6

Evolution is all about “good enough”, not “good”. But the human birthing process is an amazing feat-- there are many, many changes that needed to be made to the basic ape birthing process to get us where we are today. Don’t underestimate the incredible piece of evoultionary “design” that it is.

You’re kids are extremely prcocious if they were able to do that. I don’t think any other newly born infants in the world are capable of that feat.

7

It’s a balance. A birthing system that kills off a percentage of the mothers and newborns is counterbalanced by the large brain size at birth and enormous growth potential. The overall result is success, so evolution doesn’t care about the details.

8

Well I was shown a vid of a babe doing just that in the Bradley class we took prior to our first kid.

These are good points, I have to get on my wife to drink enough water. But yes on your point on fear. Here I am a father of two, we did the last delivery practicly unaided and am confident we could do it again when the time comes. But the ‘buts’ start cropping up. I don’t know how I would look at myself in the mirror if a child died during birth 'cause I didn’t force my wife to the hospital from the beginning. My wife and I agree the hospital sucks, but that white building of hope blindly wipes away all fears of complications somehow…

9

A couple of points: first, in the past century we’ve started giving birth to much heavier babies, on the whole. We eat more, or something. So as a primitive human, I would not have been trying to give birth to the 10-pound whopper I wound up with as a modern, over-fed woman.

Second, this whole difficult birth system is largely evolution’s fault anyway. The price of upright carriage is a pelvis that doesn’t give birth as easily–apes have a much easier time–and the price of intelligence is big heads that are difficult to push through the difficult pelvis. That’s why our babies are born only half-cooked and so dependent compared to other animals; any more growth in the womb and it would be impossible to give birth at all. It’s a delicately balanced system of compromises, design-wise.

10

As other have said, it;'s all about risk. Nature may be happy with a 90% survival rate, but my neighbors want 99.999% survival rates. C-sections & other modern care can & do make up that difference.

Coincidentally, my SIL gave birth last week. It was planned as a vaginal birth, but as is always done in the USA today, preparations were made for a C-section if needed.

As best I understand the story, the labor was to the point where baby was about to emerge when the cord got draped across the head, potentially blocking the birth canal. That is apparently a random event that significantly raises the risk level.

So they switched gears & did a C-section. Result: immediate risk reduced, healthy child out a few minutes later & Mom recovering from moderately invasive surgery in modern surroundings.

i’m not competent to second guess the decision making in this case, but I can certainly understand the motivation. Surgery is not risk free, but dead or oxygen-starved brain-damaged new borns are a VERY bad thing to be strenuously avoided.
Turning back to statistics. …

The difference between 90% and 99.999% is not around 10%.

It is changing 10,000 failures per hundred thousand to one failure per hundred thousand. The failures are reduced by a factor of ten thousand. 9,999 people don’t have tragedies. That’s what doing C-sections in the event of problems does.

Are there many people who get them to simplify scheduling the arrival date of the baby? Sure. Are many done in reaction to a perception of risk that is greater than reality? Almost certainly; my SIL’s may well have been one. But is any of that bad, or wrong in some sense? Not that I can see.

It may be unneccessary, but so was the dessert I had yesterday. People spend resources on unnecessary things all the time. And my dessert wasn’t risk free either; it’s one more brick in the path I’m slowly building towards obesity & heart disease in later life.

Another point to ponder. Europe & Canada have largely government-provided health care, where providers have an incentive to minimiie care provided in borderline cases. The US system has the opposite incentive: when the patient & the staff both gain for doing more, more gets done in borderline cases.

So while the discrepancy in C-section rates between, say, the US & Germany are interesting, perhaps the German rate is as much too low as the US rate is too high.
Ultimately, decisions about risk are made with a significant emotional content. They are, almost by definition, not 100% rational. In my industry (US commercial airlines) we take safety far more seriously than a strictly rational economic analysis would dictate.

As long as 300 people dying in car crashes each and every day passes unnoticed, while 300 dying in a plane crash once every couple years is seen as a disaster of nation-wide import whose aftermath will reverberate for months if not years in the national psyche, … well … that over-investment in safety will continue.

11

Another point to consider is that not all c-sections are done for medical reasons.

“Reasons for c-sections range from life-threatening emergencies to simple convenience to threats of malpractice. Doctors agree that c-sections can save lives, and in the face of patients who demand the procedure and threaten malpractice suits if a vaginal birth goes wrong, the surgery may also save them time with their lawyers.”
-source

The term “too posh to push” comes to mind.