Nature thinks babies are expendable

image

Two of the central conceits of the natural childbirth and homebirth industries is that women are “perfectly designed to give birth,” and “babies know how to be born.”

They are conceits not merely because they are untrue, but also because advocates imagine human beings as somehow immune to the forces and exigencies that rule birth among all other animals. The truth is that Nature thinks babies are expendable, and, to a lesser extent, mothers are expendable, too.

One of the main characteristics of reproduction in the animal kingdom (and the plant kingdom) is massive wastage. The chance of any individual organism surviving to adulthood is very small; therefore, massive amounts of offspring must be produced, because most of them are naturally going to die.

Think about how many seeds are produced by an individual plant. Think about how many larvae are produced by one insect. Think about how many eggs are produced by an individual fish. Then think about how many of those survive to become the adult form: only a vanishingly small proportion.

The classic example is the thousands of baby turtles who all hatch on a single night and immediately begin clambering across the beach to safety in the sea. Along the way they must travel a gaunlet of predators and most will not survive.

Of course plants, insects, fish and turtles don’t generally care for their offspring. Their investment in the next generation ends with birth, or even before.

How about those animals that invest time in brooding or gestating their young? For them, parental energy expenditure is much greater and the the proportion of offspring that are lost before adulthood is consequently much lower. It is still relatively high, which is why most animals reproduce every year or every other year.

Not surprisingly, there appears to be a correlation between the amount of parental time and energy invested in offsrpring and the proportion of those offspring that survive. Even when the parental contribution is enormous, however, such as in larger animals, death rates are extraordinarily high. For example, it is estimated that one out of two lion cubs will not survive its first year.

Human beings devote the most time and energy to raising the next generation. Pregnancy is 9 months long, infancy is nearly 2 years, and childhood lasts for up to 18 years. This intensive investment ensures that a high proportion of babies will survive to adulthood, but it is entirely compatible with losing 10%, 20% or even more children.

When you take the long view, the proportion of survivors is even smaller. Human females are born with millions of eggs, and human males produce billions of sperm. Most will never even be used in reproduction. Even when sperm meets egg, fertilization can fail; cell division can fail; uterine implantation can fail. For successfully established human pregnancies, the miscarriage rate is one in five (20%). These are all natural occurrences. How can anyone claim that women are perfectly designed (or evolved) to give birth when they can’t even sustain 20% of all pregnancies?

Obviously, they are not perfectly designed (or evolved). That’s not surprising since nature doesn’t “do” perfect; it only does good enough. In every generation, only the fittest survive. That means that the less fit will die.

This applies to childbirth as to any other aspect of human existence. Only the fittest babies will survive childbirth and only the fittest mothers. Fittest in this sense does not mean physically fit; it means having the characteristics that are most suitable in the specific setting. Hence very big babies are in danger of dying (and killing their mothers) during childbirth. They may be robust and strapping, but if their heads are too large to negotiate the maternal pelvis, they will die and their mothers will die, too. They weren’t fittest for the particular environment in which they existed.

Nature thinks that human babies and human mothers are expendable, subject to the exact same natural forces that kill babies of other species. The difference between humans and all other animals is NOT that humans are perfectly designed for nearly 100% survival in birth. The difference is that we can change our environment in ways that ensure that babies who would otherwise die will live instead.

Technology is our secret weapon.

Consider that human beings have come to inhabit nearly every climate on the globe. We have been successful in frigid climates NOT because the air got warmer, but because of our technology: clothes, houses, and heating. No one would suggest that we are “overusing” or should give up any of those technologies in order to return to our paleolithic past. Nor would anyone suggest that since were were “meant” to live in Africa, we should all return there so that clothes, houses and heating would no longer be necessary.

Technology also allows the same baby whose head is too big to fit through his mother’s pelvis to be delivered instead through a C-section incision. The baby will survive and the mother will survive, too. Neither will be compromised in the slightest by the surgery. Yet natural childbirth and homebirth advocates insist that we are overusing technology in childbirth and that we should give it up. The babies who die without access to that technology are dismissed as “meant” to die.

The facts of reproduction are no different for human beings than for any other animals. Women are NOT designed to give birth perfectly and babies are NOT designed to survive birth. The difference between human beings and all other animals is this: Our technology is perfectly designed to help women give birth safely. Our technology is perfectly designed to help every baby possible survive birth.

Natural childbirth and homebirth advocates who prattle that women are perfectly designed to give birth and babies are perfectly designed to be born suffer from the conceit that humans aren’t subject to the same natural forces as all other animals. They live in a fantasy world made possible by the liberal use of the technologies that they deplore. Childbirth isn’t safe; it only appears that way because technology is used.

That fantasy world shatters in the face of the reality of childbirth: it is dangerous and many mothers and babies aren’t perfectly designed to survive it. Fortunately, most women are smart enough and astute enough to avail themselves of the technology that allows them to survive despite imperfection.

  • Mariana

    Honest question, I swear. Are, as humans, having an impact on evolution because we can now save babies that would have died “in nature”? The very premature, the ones that can’t fit through the pelvis, the ones whose pregnancy extends beyond 42 weeks, the transverse lie, etc.? Will we have a bigger incidence of these things in the future? The same goes with infertility. Couples who could not conceive a few decades ago, now can. Will this make infertility more common in the future? I am not asking if it is morally good or bad, that is not the point, I’m asking if all of these “interventions” could affect our genetic make up for future generations.

    Just out of curiosity. As a non-scientist. I’m not trying to start a comment war.

    Just for the record. I needed fertility treatment with my first, formula for both and csections (one for being 41 weeks and the other for being transverse). In “nature” I probably wouldn’t have passed me genes to the next generations. I’m glad for all these “interventions” for giving me my two children.

    • Alex

      That is a hard to answer question. The answer is most likely yes, modern medicine is making people survive would otherwise be dead, however, it’s probably not as dramatic as one would think.
      Every mother or child that dies or should have dies without medicine was not necessarily ‘unfit’ to live or give birth. Most times, whatever it is that caused problems in the first place is just a freak accident and is not directly genetic or heritable. Most of the people who are born ‘unnaturally’ are capable of having children ‘naturally’ later in life.
      Maybe, over dozens of generation, we will have allowed some people less fit to reproduce have more offspring…..but considering how bad nature is at birth anyway, does is really matter? It would be really stupid to let all those baby die just so we don’t get slightly worst at giving birth…especially since we have the technology to compensate for this ‘slightly worst’
      The same case could be made of people with all kind of diseases suck as cancer, heart problems, mental problems, severe allergies or respiratory problems. Letting those people live and reproduce is probably harming our genes more than c-sections. But it would be ridiculous to suggest that everyone who is sick should not be allowed to have kids. Letting them reproduce will maybe make some of those diseases slightly more prevalent. But not near prevalent enough to destroy us as a specie.
      As was pointed in another post, we have evolved to a point where we no longer change to fit the environment, we are changing the environment with our technology. We don’t need ‘survival of the fittest’ anymore.

      • Mariana

        I’m in no way suggesting we let people die because they are “unfit”. I just posed a question that has been in my mind for a while, and I believed this is a forum where people are smart enough to talk about it and understand it is just curiosity.

      • StephanieA

        Just responding to part of your comment that I found interesting. My mom gave birth to me via c section, and we both would have most definitely died 100 years ago in the same situation. I had a wooey OB instructor in nursing school who told our class that if we were born vaginally, we came from a long line of ‘successful birthing women.’ It kind of scared me because it made me think, am I not supposed to be here? Will I have trouble giving birth because my mother wasn’t successful at having me vaginally?

        As you stated can happen, it was a freak incident. My mom went on to have two vaginal deliveries after me, and I had my son in an uneventful vaginal birth. I for one am extremely thankful for modern medicine, my mother, sisters and I wouldn’t be here without it.

    • KarenJJ

      I suspect it would, but I also don’t particularly care. A goal would be for all women to access good maternity care, not be denied care (eg due to lack of resources) or some sort of perceived “test for fitness”. The “fitness” of a woman or baby in modern society is a lot more than the size of her pelvis.

    • Ardea

      The proportion of children born to infertile couples is low compared to those born to fertile couples. Over 7 billion people, the interventions you received in order to have and cherish your two children will really not affect the genetic make-up of the population as a whole.

  • Jessica Sipos

    Thank you for this! We anthropologists (most of us) say, “culture is the human adaptation to the environment.” Culture includes everything we do to mediate nature, including technology, food processing, agriculture…it’s all under the same umbrella, so the rationality of picking and choosing which technologies are morally acceptable and which are not is dubious. Do people give birth in the winter without central heating (or using an ax (tool technology) to cut down a tree to burn in a fire (one of the most important technologies humanity ever came up with)? Surely not good for the cold little newborn….

  • Amazed

    OT: Let’s see what Nature whispers to naturopaths, shall we?

    http://www.naturopathicdiaries.com/

    I find this blog fascinating. The blogger is a former naturopath and it’s jawdropping. The woman is now disillusioned and in a quarter million in debt over education she now recognizes as dangerous and so, inapplicable.

    • Daleth

      A quarter million? Omg a QUARTER MILLION? That’s more than most MD’s!

      • Amazed

        That’s ’cause Nature is far superior to Big Pharma and Her priests and priestess should sacrifice more to serve Her.

        • Daleth

          It actually adds fuel to that blogger’s argument that naturopathic medicine schools have disturbingly low standards for what students they will accept. I doubt it takes much beyond sixth grade math to notice that a $250,000 debt that has to be paid off, with interest, in only 10-20 years will be overwhelming to a person whose new profession’s average salary is less than $58,000 a year. Who would do that math and still conclude that an ND degree was a good idea?

          At least MD’s make salaries that permit them to pay back their loans.

          • KarenJJ

            “Who would do that math and still conclude that an ND degree was a good idea?”

            People who don’t understand much beyond 6th grade maths?

  • Mattie

    OT: I want to thank many of the regular commenters who spent time discussing things with me on this site, you helped me learn a lot, and move away from some ideas that ranged from just crazy wrong, to just naive, you were patient and polite and took the time to teach rather than just dismiss. I wish more online spaces were so willing to listen and educate, and I wish you guys were treated with the same level of respect you show in other spheres of the childbirth community.

    Now, this post, I like it. If we let nature take its course babies and mothers would die, that is natural selection. But natural selection is not always the best way forward, and it is not the premise on which healthcare is based. It should not be the premise on which birth attendants should base their practice either.

    • moto_librarian

      Mattie, I think your heart and head are in the right place. As someone who was very happy with the care that I received from hospital-based nurse-midwives in the States, I feel very disturbed by the attitudes coming from the leadership for midwifery, both here and in the UK. The changes that I have noticed in the practice that delivered my own children bothers me to the point that I am unsure about recommending them. The midwife who saved my life after my first birth has left the profession because she simply could not deal with the unrealistic expectations surrounding birth that were leaving women who did not have umedicated vaginal births feeling broken. I hope that people like you, Medwife, and CrownedMedwife can help to get the profession away from ideology and back to safety.

      • Mattie

        I am not a good person to be a midwife, my stint in midwifery school showed me that. I couldn’t do it, I admire the people that do. But maybe I can help in other ways, if I do my best to listen to those that know better, and to those in the profession that feel things need to change. For example, If I could start an alternative to the RCM in the UK that would be awesome, because part of the reason they are so visible and influential is that there isn’t another option for the midwives that disagree with them.

        • Sarah

          Yes. And I know from personal experience that there are some truly fantastic midwives in the UK. I don’t believe they’re rare either: despite having experienced epidural denial that will haunt me til the day I die, I’ve still encountered lots more good than bad. It seems they could do with somewhere to go.

          • Mattie

            No, I don’t think they’re rare, but there’s a lot of factors that influence the reasons for them appearing rare. This is opinion although it’s based on personal experience as well as experience of my friends, people I know and other students in forums etc…

            1. Many student midwives will work where they train, if they can. So the ethos/feel of a maternity unit, or the maternity services in a particular area is especially influences by the quality of teaching at surrounding institutions. The teaching is done by midwives from the local are and it becomes a cycle of bad ideology and bad practice centring in one area. This often ends up with cases such as Morecambe or Mid Staffs, and can go on for many years unchallenged because things get covered up.

            2. There is 1 professional union for midwives and they offer a lot of tempting benefits to members, they then use their position to spout ideological rubbish. Because of their standing as the only union solely for midwives they are often invited in to universities and usually have at least one rep on every maternity unit in the UK, this can be problematic when the rep is also a senior member of staff who blurs the professional lines of those roles.

            3. There is a lot, and when I say a lot it is probably more than you are thinking, of bullying in midwifery as a profession. I was bullied, as were most of my course-mates and have heard it repeatedly from other students as well as newly-qualified and experienced staff. The bullying can be so bad that people have been forced to leave the course or profession, or even taken their own lives due to depression. This climate makes it incredibly difficult to ‘be different’ and also to complain or cause a fuss, mostly due to the first two points.

            I think if we can fix the first two issues, the third issue will be vastly improved, as well as improving reporting to third parties to attempt to avoid the backlash commonly seen in a lot of areas.

          • KarenJJ

            One of my cousins encountered bullying in nursing while training. It was awful.

          • Mattie

            It’s definitely not a problem unique to midwifery, although for some reason midwifery seems to have more than its fair share of bullies, and people who are just as happy to bully women as other members of staff.

    • The Bofa on the Sofa

      I think what you’ve realized, Mattie, is that in the end, you realize that, once you understand what the folks here are talking about, you actually agree. In fact, I think that happens a lot, it’s just that so many people get so defensive that they miss the fact that they agree with us. If you agree that there are midwives that do things that are, um…., unwise, and that we need to do something about them, then we are all on the same side. Pissing contests about how common it is or isn’t are beside the point – the people doing these things need to stop, and we need to get them to stop.

      As a regular here for many years, it’s always interesting to watch the interactions with new participants. If people are actually engaging you (as has been done), it’s actually a pretty good sign of respect, and it shows that they think you warrant discussion. Because it’s also very common to see “discussions” fall apart very quickly into little more than mocking, which is basically what happens when someone is so far over the top that it’s clear they are not amenable to anything meaningful.

      I’ll say one thing, you’ve been thoughtful and responsive, and never once complained about people being mean or the tone, or got overly defensive. And, consequently, the discussion continued. That’s actually fairly uncommon. I’m glad you’ve joined the conversation. Stick around and keep participating.

      • Mattie

        Thank you, I agree that often discussions are not really discussions because there’s no listening to the other side, or trying to understand, or even just admitting when you’re wrong. I’ll definitely stick around, I’ve been reading the posts for ages and will continue because they’re interesting and make me think 🙂

  • The Computer Ate My Nym

    Technology is our secret weapon.

    I have some bad, bad news about the “secret” part…

  • KarenJJ

    Humans, with their larger brains, complex language, opposable thumbs and dextrous fingers, are perfectly designed to utilise technology to assist the more vulnerable people in society during life events such as childbirth.

    • Sue

      Yep – and using our brains to solve problems and reduce maternal and neonatal mortality must therefore be a different kind of “nacheral”.

    • Sarah

      Exactly. Modern obstetrics and indeed properly practiced midwifery= evolution in action.

  • mom of (almost) 3

    If we were perfectly designed for birth, you’d think we’d have a mechanism for oxygen delivery more reliable than a flimsy cord. A cord that can be compressed, can prolapse, get knots in it, or tangle around the baby enough that they can’t descend. The risks of those things happening can’t be mitigated with any kind of lifestyle choice, and they aren’t genetic, they just happen. Not a very good “design.”

    • Cobalt

      Gills? That would be a neat feature.

      • My first husband often checked me for gills. I was a heck of a swimmer. His current wife drownproofed him. I thanked her, of course. Pretty sure I wasn’t issued gills at birth.

    • Wait.

      We weren’t meant to be jettisoned into hot poop water (soup?) so that youtube can praise our floppiness and urge us to refrain from gnawing off the cord until it starts to putrify?

      I need to reevaluate some things.

      • araikwao

        Poop soup. Tee hee!

    • Mariana

      Is it really possible for the baby to be so wrapped in the cord he or she can’t descend? My ob said this could have happened to my first, and I always wondered if this could really happen.

  • yugaya

    MANA also thinks that babies are expendable:

    http://www.babymed.com/blogs/lana-muniz/homebirth-midwives-and-art-of-letting-go

    “That is to say, a woman may be least traumatized by having a
    Cesarean and a live baby, when a spontaneous vaginal birth is not
    possible. We let go of that goal to achieve the possibility of a healthy
    baby.”

    Quote is from Illysa Foster , regular speaker at MANA conferences on the subject of ethics in midwifery, and what she is saying is that sacrificing babies for the possibility of “achieving” a vaginal birth is what they consider a more preferable outcome than a live baby born via c-section.

    And don’t even get me started on the implied travesty that a baby which does not exit through a vagina is according to them not “a healthy baby”.

    • Nick Sanders

      Maybe I’m misreading or missing something, but it seems that the statement is the other way around, that they let go of the goal of vaginal birth to achieve a healthy baby. Whether they practice what they preach, is probably another matter, though.

      • Therese

        That is how I read it too!

      • yugaya

        You are definitely misreading, check the first sentence, the “goal” that they let go of is a Cesarean and a live baby:

        “We let go of THAT goal to achieve THE POSSIBILITY of a healthy baby”

        • Paula

          I agree with Nick and Therese, “that goal” is referring to “a spontaneous vaginal birth”.

          • lawyer jane

            I think that’s the correct reading … but it is still incredibly damning that they feel they have to spell out that there is even ANY QUESTION that a vaginal birth is not a goal to be pursued above a live baby!

          • Nick Sanders

            Worse is that it’s likely just lip service.

          • Mattie

            I mean, it is in the sense that saying it when nobody is listening is not going to do much good, and also who knows whether she practices what she preaches. However, she is saying it, and MANA are letting her, and maybe that’s a start =/

          • Sue

            Confirmed by the language used – “let go of” means that it is an ideology that they normally hang on to.

          • Roadstergal

            After reading the quote above, I agree. The whole tone of the piece, man. “There _might_ be some situations where the trauma of having a C-section is just barely worth having a healthy baby, and we might have to look past our lofty goal of vaginal birth for these poor benighted women.”

          • KeeperOfTheBooks

            That was my understanding, too, and I kept scrolling thinking, “is it just too late at night, and I’m not understanding something?” :p Glad I’m not alone. 😉
            Still…dude, just having to say that a live baby outcome is sometimes (?!?!!?!!!) better than a dead baby outcome? Really? To be filed under “You Know Your Organization Has Problems When…”

    • Lana Muniz

      The full quote is:

      “F. We value skills that support a complicated pregnancy or birth to move toward a state of greater well-being or to be brought to the most healing conclusion possible. We value the art of letting go.6

      “G. We value the acceptance of death as a possible outcome of birth. We value our focus as supporting life rather than avoiding death.7”

      And in the footnotes:

      “6 This addresses our desire for an uncomplicated birth whenever possible and recognizes that there are times when it is impossible. That is to say, a woman may be least traumatized by having a Cesarean and a live baby, when a spontaneous vaginal birth is not possible. We let go of that goal to achieve the possibility of a healthy baby. Likewise, the situation in which parents may choose to allow a very ill, premature or deformed infant to die in their arms rather than being subjected to multiple surgeries, separations and ICU stays. This too, is a letting-go of the normal for the most healing choice possible, given the circumstances, within the framework of the parent’s ethics. What is most healing will, of course, vary from individual to individual.

      “7 We place the emphasis of our care on supporting life (preventive measures, good nutrition, emotional health, etc.) and not pathology, diagnosis, treatment of problems, and heroic solutions in an attempt to preserve life at any cost of quality.”

      This is from Foster’s book, but the words are from MANA. (I was already corrected for wrong attribution.)

      So basically MANA is saying both that they let go of the ideal birth experience AND they let go of the lives of babies who might have been saved in a hospital. They don’t care what modern medicine could have done for those babies. They’ve just decided that death is an acceptable outcome.

      http://www.babymed.com/blogs/lana-muniz/homebirth-midwives-and-art-of-letting-go

      • Mattie

        wondering if their super gross wording of ‘death being an outcome of birth’ refers to the second part of 6 relating to parents who do not wish to have their baby hospitalised if it will likely not recover…now that is all kinds of ethically questionable, but is it a choice available to parents? I actually don’t know what the law says, if a baby is incredibly prem, or has a medical condition incompatible with life, are parents required to attempt resuscitation/intensive care?

        (whatever they mean but that, the wording is awful and kinda creepy, not up to the care provider to ‘let go’ it’s up to the family)

        • Elizabeth A

          Not treating an infant who is unlikely to recover or survive isn’t an ethical grey area – in cases where death cannot be prevented, palliative care is an appropriate choice, and many hospitals offer that choice to parents in such cases. Neonatal hospice care is an unavoidable aspect of OB and NICU care.

          The grey area is when parents and doctors disagree, either because the parents want heroic efforts made and the doctors believe those efforts to be futile, or because the doctors feel the odds and the prognosis are good enough to proceed with treatment and parents feel otherwise.

          • Mattie

            That seems reasonable, also IMO midwives are not sufficiently trained to make those decisions, they can support parents emotionally after a loss, or provide supportive end of life care to newborns and their parents. But making those decisions should not be up to them. In terms of insurance in the US (anyone who knows) is the cost of treating a very sick baby a reason for some families to choose a gentle end to life, rather than intensive treatment? What happens in those situations, cause parents wanting to let their baby die even with a good enough chance of survival must be pretty desperate in one way or another 🙁

          • Elizabeth A

            Seriously ill, disabled, or very premature infants are often eligible for state health insurance. IMO, this should be true more often.

          • Mattie

            Yeh, it is tough for me to understand living somewhere where all healthcare for children under 16 is free, but I think when health insurance will only fund so much, the financial burden of a severely ill baby can influence parental decisions which is so sad. Especially in cases where malpractice did not play a part in the illness/injury, or when there’s no ‘fault’ to use a civil claim to help fund care….it must be very hard, I can’t imagine many parents wanting to give up on their babies, unless they felt that they had no choice.

          • Sarah

            It should be true always!

          • Liz Leyden

            The New York Times printed an opinion piece by a transport doc last month that sheds some light on that.
            .
            http://opinionator.blogs.nytimes.com/2015/02/26/a-mission-of-mercy/

          • Mattie

            Wow, what a brave lady and how sad it had to end that way. Also what an incredible person the author is, things like that are always tough on the healthcare workers, but it seems she dealt with it with compassion and love, which is so important to the baby and also the family.

          • Mac Sherbate

            My thinking is that if the parents don’t want to or couldn’t afford the care the option would be to turn over care to the state and put the baby up for adoption (Provided the doctors think the baby has good chance at life). I was just reading an adoption story of a very premature baby the other day! In some cases, if the family qualifies the state will cover the costs.

          • Mattie

            Yeh definitely, I do wonder though if in some ways some families might find it harder, especially the not knowing if the baby survived, how long for, then if the baby died as ‘someone else’s child’ not being able to visit a grave, or have mementos, or if the child grew up and then found the family, to explain that the burden of the child at the time (financial or otherwise) was too great…I don’t know, it’s very sad, and very complicated.

        • Lana Muniz

          The ACNM doesn’t say anything in their literature about accepting death as an outcome. There wouldn’t be a need for that statement among midwives who fight for babies to live.

          • Elizabeth A

            there is a huge conceptual distance between “some babies just aren’t meant to live,” and “tragically, some babies have congenital malformations incompatible with life.”

          • Lana Muniz

            I also think this statement from MANA is just a dressed up version of “some babies just aren’t meant to live.”

            More than being a huge difference, I think MANA midwives and hospital midwives are ideologically opposed. In the hospital, they hope for ever baby to live, fight for life, develop new technology and new treatments to save every life they can. MANA midwives are content to sit on their hands and let babies die. They don’t care what modern medicine could do for babies. They are like Luddites.

          • Sue

            Indeed. A “a very ill, premature or deformed infant ” hasn’t become that way because of the way the labor was managed.

          • Mattie

            Yeh, it is really gross and creepy, it just brings to mind an attempt to absolve themselves as care-providers for bad outcomes, like nope. From my experience working in a hospital, when a neonatal death or maternal death occurred the death was only ‘accepted’ in the sense that everyone would agree that it happened, there was no acceptance of it being ok, in fact everyone would be scrutinising their own practise to ensure that it would be understood, and prevented in future.

          • Lana Muniz

            There’s a part of the quote above where they DO try to shove the blame onto parents, “within the framework of the parent’s ethics. What is most healing will, of course, vary from individual to individual.” So if the baby dies for lack of intervention, the parents must have wanted it that way, and the midwife is just there to approve or something.

          • Mattie

            That is just super icky in so many ways

          • Amazed

            It’s a sad proof that midwifery which used to be a profession that saved women and babies according to the best practices of the day – no matter whether they were truly good or harmful, they were accepted to be the best – has started slipping into the same dangerous turf that accommodates homeopathy and naturopathy. Why, a few days ago I read an old article about a girl who DIED of asthma while being cared by a naturopath. The woman’s reaction? “I told them to go to the hospital but they didn’t wanna.” (Mother’s version sounds a lot different.) Then, the ND goes on, “Well, everyone knows that there are limits to naturopathy and they accept them when they sign for it”. IOW, it’s your fault for being as stupid as to choose me.

            Really, it’s the same.

          • Roadstergal

            “no matter whether they were truly good or harmful, they were accepted to be the best ”

            That’s the part that makes being a health care provider really difficult. You do the best you can – and then, sometimes, the thing you do turns out, based on new evidence, to not be the best. Sometimes, it turns out to be actively harmful.

            What do you do, then? Do you look honestly at what you’ve done and say, “Although it was the best evidence at the time, we have new evidence, and I know what I did was harmful. I will act according to the new evidence, and continue to try to do the best I can with the best evidence we have.” That’s hard, really hard. And it must grind your soul to know that even the current best evidence that you’ve switched to might be overturned tomorrow.

            I wonder if the ‘intervention-free vaginal birth uber alles’ sort of midwife has, as a motivation, the desire to do the least possible. If you never intervene, you will never harm with an intervention. Injury, death, and pain that come about specifically because you chose not to intervene aren’t ‘on you’ in the same way, since you didn’t actually _do_ anything…

          • Amazed

            The problem, as I see it, is that once upon a time, there were no clinical trials the way we see them now. At the time, it was much easier for health care providers to go with their instincts, their experience, and the experience of those close to them. There were very few things to overturn them. Now, we have the chance to re-examine our practices, in all fields, on the basis of proofs that far surpass our individual experiences and cognitive biases. There’s every chance that harmful practices would be revealed before they got the time to do nearly as much damage as they did in the past. We have scientific guidance the way we never had before. If health care providers don’t want to use it because it *mighjt* be proven faulty one day and instead resort to practices that that were proven to be more dangerous – vaginal breech births, inducing with whatever you have at hand, because pit is evil, – that’s a serious problem. It has nothing to do with honouring choice and nature but defending one’s own turf.

      • Daleth

        Call me high maintenance, but I insist that my healthcare providers be focused on avoiding death. I realize that means I am not as SPIRITUALLY EVOLVED as MANA midwives, but at my current state of spiritual development, avoiding death is kind of a high priority for me.

    • Sarah

      I smell a rat. A spontaneous vaginal birth is ALWAYS possible.

  • On the tech front – the technology we have available greatly expands the number of women and babies who survive pregnancy and birth, however I would say that it is perfectly designed to EVOLVE to enable ever greater numbers of women and babies to survive and have healthier lives. The current state of technology in healthcare is no where near stable, advances are continually being made.

  • Nick Sanders

    So, I’m not entirely sure if this is off topic or not, but a woman in Indiana was just sentenced to 20 years in prison for having a miscarriage:

    http://www.wncn.com/story/28664509/first-woman-in-us-sentenced-for-killing-a-fetus

    • yugaya

      I don’t think it is off topic, it involves misogynist laws, issues of accessibility of abortion, patriarchal cultural stigma of out of wedlock pregnancy and a woman being denied right to exercise her body autonomy.

    • Cobalt

      Unacceptable.

    • Daleth

      That is so insane. All the more so because there was absolutely NOTHING, NOTHING, NOTHING she could possibly have done to save the child’s life–she was somewhere in the vicinity of 23-25 weeks’ gestation and nowhere near a NICU (she was in Mishikawa, Indiana).

    • Dr Kitty

      It is not illegal to choose not to go to hospital if you are in labour, even if you are 23 weeks along. Even if the baby was born alive, it wouldn’t have survived more than a few minutes.

      The most this woman should have been charged with is concealing a death, failing to call 999 and improperly disposing of a body.

      I’m not sure how one can have comitted feticide AND neglected a dependent- as one requires killing a foetus and the other requires neglecting to provide care for a live child.

      As was pointed out on another website I visit, it is quite possible that if someone had killed MS Patel in cold blood they would have been sentenced to less than 20 years.

    • Medwife

      If they couldn’t decide gestational age, how on earth can they have pursued charges based on viability? The investigation should have ended there IMO. And no physical evidence of having ingested the drugs either.

  • Lana Muniz

    OT: Weigh in on the active midwifery legislation in Maryland and North Carolina. My latest blog post at babyMed: http://www.babymed.com/blogs/lana-muniz/maryland-and-north-carolina-consider-legalizing-dangerous-midwives

  • Bugsy

    “Technology is our secret weapon.”

    It’s also the secret weapon for those of us who would have been declared barren in previous generations. The very fact that I am a mom is due to the impressive extent of modern reproductive technology. When I saw a test tube containing the embryo that became my healthy son 9 months later, my appreciation for medical science only heightened. We are so lucky to have the resources we have, whether ART, OB or other forms of medicine.

    • Daleth

      Yup. Me too.

  • Cait

    I was browsing the listings of upcoming NMC hearings (as you . . . do. Other people do that, right?), and stumbled on the fitness to practice charges raised against a midwife from Morecambe Bay. It makes for really sobering reading:

    http://www.nmc-uk.org/Hearings/Hearings-and-outcomes/April-2015/Charges-RATCLIFFEMarie/

    • Medwife

      So many cases for just one responder. Including at least 2 fetal or neonatal deaths! God, their numbers must be crazy to look at, in terms of bad outcomes.

      • Mattie

        It’s literally sickening 🙁 it breaks my heart, all those families, all those lives ruined. Additionally, the time span of this is outrageous, almost 10 years where it was allowed to continue, so many times when people failed to act to stop this, makes me want to cry, and this doesn’t even look at any incidents where nothing went ‘wrong’ but the care may still have been bad, a lot of times women will be treated badly and be very upset about it after but won’t complain because they just want to move on, the baby was healthy, they were physically fine, but had felt bullied by midwives or not respected/listened to, but because no complaints were made no action was taken 🙁

    • Mattie

      I do this too, and thank you for sharing, I was looking for this earlier. I am glad they publish the hearings, because it’s beneficial to know what happens and that the NMC can be held accountable for its decisions as well as the midwives for theirs.

    • Dr Kitty

      That case, BTW, is one of the senior midwives.
      Band 7 is often ward supervisor.
      Which makes it worse.

      • Mattie

        Yeh it actually says in one of the charges that she was labour ward co-ordinator at one stage, which is terrifying.

    • Mishimoo

      Wow! It was horrific that baby Joshua died (along with the other unnamed babies), but seeing the utter lack of responsibility demonstrated by a senior midwife makes it that much worse.

    • Mattie

      Also just thought I’d add this here for reference if people choose to follow these cases. This is the page explaining the sanctions the NMC can impose http://www.nmc-uk.org/Hearings/How-the-process-works/Sanctions/ (not sure I agree that the sanctions shouldn’t be used as punishment, but that’s a whole other discussion)

    • Dr Kitty

      Which is which is it scheduled to run for a month, as opposed to two or three days at most for the majority of the other cases.

      It occurred to me that part of the issue with how the culture at Morecambe Bay was allowed to develop is the way junior doctors work.

      Foundation Doctors and GP trainees will spend AT MOST 6months in any specialty placement, meaning they spend 12 weeks at most in L&D, and probably much less than that (as they’ll be in outpatients, theatre, admissions, day unit etc too).

      The SHOS and Regs on run-through OB/GYN training schemes are rarely in any single post for longer than 12 months, with 6 months being much more usual. There may be locums filling roles short term.

      The only doctors who have any chance of actually identifying a long term pattern of poor outcomes and doing anything about it are the consultants and any staff grades who might be there for years at a time.

      The juniors either won’t have anything to compare with the care they see, would be able to dismiss any poor outcomes they see as just a run of bad luck during their stint, or won’t feel able to call out experienced senior midwives based on their observations over a few days or weeks.

      When the aim of training is breadth of experience in as many different places as possible, one of the things you sacrifice is continuity of care…and sometimes you need that to spot patterns.

      Anyway…just a thought.

      • Ceridwen

        Funny that breadth of experience is valued in the education of doctors but not the education of the midwives (as mentioned by Mattie, the midwives are training largely in one place and then often staying at the place they trained).

      • Aliciaspinnet

        I think that’s a really good point. I’m from Ireland originally, and for my first 3 years after graduating I switched jobs (and sometimes hospitals) every 3-6 months. “Junior doctors” (I hate that phrase for various reasons related to the Irish healthcare system, but I’ll use it for simplicity’s sake here) are pretty much powerless in Ireland and I would imagine it’s pretty similar in the NHS. And part of that is certainly the fact that they are shuffled around so much – there’s never a chance to really settle into a job, by the time you get a good grasp of how your department works you get moved on again. You also don’t get to build strong relationships with the nurses. I remember one department where it was well known that the consultant would always side with the nurses over his interns as the interns would be moving on in a few weeks whilst he would have to deal with the nurses long term (although in fairness the nurses on that unit were generally excellent). There was also a major culture of bullying throughout that system, so it would be extremely difficult to speak up if you had any concerns.

        After 3 years of working in Ireland, I emigrated to Australiaand started working in a hospital in regional Queensland, where I stayed for over 2 years. When I arrived the department was in a shambles, with the vast majority of consultants and regs being locums. There were major issues with the handover system both overnight and at weekends but I could not make any changes for months because nobody cared – they were all moving on in a few weeks anyway so why should they bother. Once we got some more long term consultants and regs, I was able to get a proper handover system in place. Also, because we stayed in that hospital for a few years, my husband (also a doctor) and I were able to work on the intern education program (I’m biased but it seemed quite successful and we both noticed a real improvement in the work done by interns that year). None of that would have been possible if we had been switching jobs every few months.

        Sorry for the ramble, tl:dr Dr Kitty makes a good point

  • staceyjw

    I think NCBers and others with similar views have a really distorted view of nature, and they are dependent on denial and cherry picking to maintain their beliefs.

    For example, many try to emulate- even promote- organic “paleo” diets, claiming they are the only way to real longevity and health. It IS true that “paleo” kids that lived to 15, were just as likely to live to a healthy 70 years as modern humans in good situations. This is proof to them, that their way of eating is superior. Fine.

    But then they totally ignore that the odds of living to 15 back then were pretty low, with most deaths at birth, much the rest before age 2. Even when they admit this, they don’t seem to get how this impacts their NCB views of “babies know how to be born”. There is no connection there, just a “I’m right”, with denial of anything at odds.

    They “forget” about all those deaths even though they also love to appropriate indigenous cultures celebration of babies making it to the 1st or 2nd year of life; celebrations which existed because it was a milestone most kids never made. Besides birth hazards, malnutrition from lack of B milk also killed, but that is just one more thing they ignore in their push for “all moms can BF if they try!”.

    They don’t REALLY want to live like those indigenous tribes they claim to revere. They just want to make THEIR life, their kids, as perfect as possible, without a care for anyone else. As long as THEY can take their hybrid to the store and buy some fair trade coffee and organic leeks, all is well. Its is rare that any zealous NCBer actually cares about nature, or others, they usually see everyone outside of their bubble as inferior.

    As for the tech-
    You don’t have to send everyone back to the tropics if you give up heating oil and electric- people managed to live there for a millennia before industrial civilization, and their solutions were often very clever, and didn’t leave the planet in ruin. Tech is only smart if it doesn’t destroy where you live long term (aka earth), and many people DO argue that lots of currently used tech needs scrapped because it is incompatible to the environment needed for (human) life.
    (Even dogs know you don’t shit where you sleep, but modern humans have seemed to have lost this lesson, and are busily poisoning every river, and choking up the air.)

    • Amy M

      Re: the paleo diet people. Another thing is that let’s say those who made it past childhood had life spans we’d consider normal, or even long, that’s not proof that the food they ate magically kept them in perfect health. I guess we can assume that if someone from that era lived that long, he/she had ENOUGH food, and wasn’t starving, but that doesn’t mean there weren’t lean times. Evidently that person was lucky enough to avoid predators, but that has little to do with diet as well.

      And here, I don’t know if this is true, I’m getting my information from Jared Diamond, but in Guns, Germs and Steel he talks about how contagious diseases didn’t really arise until people were living in non-nomadic communities. I suppose there must have always been viruses, and bacterial infections from wounds or bad water, but if what Diamond says is correct and the indigenous people in question were hunter-gatherers, they weren’t exactly having measles epidemics.

      So it all comes back to what Dr. Amy said about being the most fit for the current environment. A hunter-gatherer in the stone age who lived to be 70 was the most fit for that time, but would not be if you dropped him off in NYC today. Same if you took a New Yorker and could send her back to the stone age—we are not equipped to fight off cave bears because we don’t have to.

      • Modernist Mom

        The contagious disease angle is a chicken/egg question. The ideas of contagious diseases is an advent of modernity. Before that, it was the humours (one was out of balance, causing symptoms of illness). Now, did contagious diseases appear when people stopped moving (when industrial modernity allowed people to live/work in one place)? Or, did medical technology that arrived with industrial modernity (people are sticking around so you can actually examine a population) give us the theory?

        Chicken/egg. It’s a hard question to answer because there aren’t a ton of historians of science out there. Even my knowledge comes from a very specific element of my research/teaching that even I don’t dedicate enough time to (read: I have a toddler).

        • Amy M

          Yeah, I don’t know, like I said, I’m going off what Jared Diamond said. Still, we do know that some viruses, like flus tend to originate in pigs or ducks and then mutate and jump to the humans who live in close proximity. So, if the people weren’t living with pigs and ducks, they weren’t as likely to catch flu, no?

          • Modernist Mom

            Totally. I think the guy may right, but my question has always been what came first? Did we figure out germ theory because of the shift in how people live or did the shift in how people live actually change how we transmit diseases. I don’t know, but it’s an interesting question about how we figure these things out.

          • Roadstergal

            Generally speaking, we’ve figured things out when we’ve had the leisure time to sit down and think about them. Which comes way after the shift in how people lived.

            The ancient Romans observed the concept of immunity – it comes (AFAIK, not a Latin scholar) from a Latin word for ‘exempt.’

          • fiftyfifty1

            We know there were many epidemics (plague is one that comes to mind) long before germ theory was figured out.
            The shift in how we live (close quarters) made the spread of certain epidemics possible. We figured out germ theory because science was advanced enough by the time it was figured out to even conceive of the idea, and to derive experiements to give proof.

          • SuperGDZ

            It’s very plausible that certain diseases only arose after people started keeping livestock. The proximity of the livestock to each other, firstly, would have increased opportunities for the spread of disease, as well as mutations of disease, and the proximity of the livestock to humans allowed disease to jump to humans. Measles, for example, is thought to have mutated from the rinderpest (a disease of cattle). That’s not to say that there were no contagious diseases before the keeping of livestock though. Disease spreads to humans from hunted animals too (TB, ebola).

          • Cobalt

            HIV is thought to have come from chimpanzees, and spread to humans who hunted them, starting around 100 years ago.

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234451/

        • Medwife

          I cannot imagine STDs didnt hop around throughout human history. They’re just too good at what they do. They’ve found chlamydia and syphillis in modern day chimps!

          • Modernist Mom

            Yup, but they conceptualized it as all about imbalance and the loss of your “essence.” Too much sex = bad because of excessive semen/fluid loss. That’s why the French still call an orgasm, “le petit mort” (the little death).

          • Nick Sanders

            And? How is that relevant?

          • Modernist Mom

            That contagious diseases existed, but we didn’t conceptualize them as contagious. They used the prevailing medical theory (humours and imbalance of them) to explain it. I wasn’t disagreeing with her (quite the opposite), just adding a subsequent tidbit of info.

          • DiomedesV

            STDs have been hopping around Kingdom Animalia for millions of years.

      • Mariana Baca

        The reason nomadic communities didn’t have much disease has to do with transmission rates. Most viruses your body either heals or kills you pretty swiftly. It needs to infect a new host in that time to propagate. If you are always seeing the same 20 people, you all have the same immunities, and there are no new hosts for diseases to reproduce and thus mutate and reinfect people. The rare times you meet another group, one of the other group needs to coincidentally be sick for disease to spread (if they are sick, they may have not come to important tribal meeting). The odds of this are low, so most diseases don’t live to reproduce or mutate into persistent diseases.

        In comes agriculture. Suddenly you are all living in a group together. There are plenty of hosts for disease to spread. You are also living in close proximity to biologically similar animals that might mutate diseases of their own for you. There mis stagnant water around to breed diseases. Problems of waste disposal arise. This is a great environment for disease.

        See? nothing to do with diet, everything to do with population density and the problems thereof.

        • Sue

          The other misunderstanding about diet is the assumption that what ancient people ate was somehow consistently manna from heaven and perfect for human existence.

          On the contrary, people ate what they had access to, in an effort to stay alive. In a drought or flood, or through a frozen winter, many starved.

          In ancient Inuit adapted to eating whale and seal blubber because that’s all there was to eat – not because it was the perfect diet for all humans.

        • Amy M

          Yes, that’s what I was trying to say with the help of Jared Diamond.

    • Busbus

      I agree with you. But even with the tech stuff, I believe that our best option has always been the technical improvement of whatever problems we detect with what we already have or do. One reason that the developed world is so much cleaner and more livable than a lot of parts of the developing world (while also being able to produce a ton of resources for a huge number of people) is that we have better and cleaner technologies available, in a society that is affluent enough to actually devote resources to such “secondary goals” and where it is feasible to introduce regulations that cut down on emissions and the like. One big contributor to global warming, for example, is the smoke from wood-burning stoves that are used extensively throughout the developing world. There is no first world city I know of that has the kinds of issues with smog and pollution that are common in many developing countries, and that used to be a huge problem in lots of places here, too (just think of the London “fog,” etc.).

      There are a lot of very promising technical innovations that are being researched and developed right now, and I am sure the future will bring even more ideas and possibilities. So, even for global warming and other resource/sustainability problems, I believe that humanity’s best bet is to use science and technology to make sure our earth remains (or, maybe, becomes) livable for all.

      • Roadstergal

        Yes, exactly this. Technology is a tool, and it can be used to clean up/conserve if we bend it to that purpose.

        That’s one of the big issues I have with the anti-GMO people. Affluent folk having a knee-jerk reaction to technology they don’t understand that could have immediate and down-stream benefits for the developing world.

      • Mer

        I’m going to be pedantic here, just a tiny bit. Fairbanks Alaska has issues with pollution from wood fire smoke in the winter and in the summer. Winter is caused by all the home heating with wood stoves and summer is from all the wildfires that burn in the region (its a rare summer that there isn’t a forest fire near enough for smoke to be noticeable). And while Alaska is the “last frontier” Fairbanks is most definitely part of the developed world.
        That said, Alaska is weird mix of developed and undeveloped, plus the remoteness makes everything more difficult to obtain and thus more expensive.

    • DiomedesV

      One of the biggest problems with the way most people conceptualize evolution is the unqualified belief that only “ancient” evolution matters. Ie, humans stopped evolving right around the emergence of agriculture.

      Rubbish. There’s plenty of signal of recent evolution that has resulted from social and ecological shifts in the past few thousand years. Not just a few cases, either, like the emergence mutiple times of the ability to digest lactose. The human genome is rife with the signal of soft sweeps and other evidence of recent evolution.

      • The Bofa on the Sofa

        One of the biggest problems with the way most people conceptualize evolution is the unqualified belief that only “ancient” evolution matters.

        I agree. You hear it all the time, “We have evolved to do X” as if that matters. So what? C-sections are bad because it causes epigenetic changes in the genome. So what?

        We will evolve away from being able to give birth naturally!

        So what? If we can save more babies, go for it.

        Then again, I am the one who dismisses claims of “if we all did it, the human race would die out!!!”
        a) But yeah, who says everyone is going to do it? And
        b) Why do I care about whether the human race is still thriving in a thousand years? I feel absolutely no obligation to propagating the human race. I’m happy to propagate myself, with my kids, but other than my kids having playmates, I really don’t care how many kids anyone else has. Negative population growth doesn’t bother me, and no one has ever given me a reason why it should.

        I’m not for deliberately killing anyone of course, or preventing anyone from having kids, but if there are natural barriers that keep it from happening, meh.

        • Sue

          Well said, Bofa. It’s tempting for each generation to believe that they way they see and do things represents the peak of all civilisaiton, trumping both what came before and what might come after.

          Trouble is, it’s so selective. We want to eat like a paleo while tweeting about it like a hipster.

          • Roadstergal

            I think people consider evolution as a climb towards a Platonic pinnacle, rather than a meandering around as the niche changes around us.

            Or, in some cases, an increasingly resource-intensive arms race.

  • demodocus’ spouse

    Not that medicine is *perfectly* designed, but it’s intentionally designed and a heck of a lot better than letting nature take its course. Mom has 5 children who survived birth, and lost 4 late enough to notice the miscarriage or stillbirth, then helped raise her eldest grandson for a few years. So, she was an evolutionary success, enough anyway. When these guys were in high school science class, they must have been either too busy flirting or paying so much attention to the prettiest flowers that they didn’t notice the garden.

  • NewMom

    So true! And to whole “it’s all natural” mantra is extended to breastfeeding too. Claiming that all women and all babies can breastfeed is just as incorrect. Nature does not ensure that. Same claim: babies know how to nurse, let the baby lead etc etc.

  • Trixie

    Hence, why it’s part of MANA’s statement of values and ethics to practice “the art of letting go”. Because they think that if a midwife can’t deliver the baby, it wasn’t meant to live.

  • Stacy48918

    It is disturbing the lack of understanding of evolution and natural selection within the NCB/homebirth community.

    • Mac Sherbert

      And you know it really doesn’t take an understanding of evolution or natural selection. All they really need to do is take a walk in an old cemetery or find an 80 to 90 something year old woman and ask her about birth horror stories she heard in her youth.

    • DiomedesV

      It parallels the lack of understanding of evolution and natural selection by the general public.

      “Another curious aspect of the theory of evolution is that everybody thinks he understands it.” –Jacques Monod

    • Sue

      Yep – along with misuse of the concept of epigenetics.

  • Mel

    Nature is a callous bitch and if you trust birth, I have a bridge in Brooklyn I’m selling cheap.

    Nature plans babies to be expendable.
    Examples from my department/farm.
    Martins – small weasel family member – being studied by a coworker about reproductive habits. She found two denned mothers. One mother ejected her two unweaned pups from the den who died within hours. The mother herself died two days after ejecting the pups. When the mother was sick, her instincts told her to get rid of her pups so she’d have a chance at survival.
    Beef cows on cow-calf operations – been bred for generation for one purpose: bear and raise calves. The first calf often dies from a combination of maternal confusion and low milk production. Beef production manuals/guides explicitly say “After the first calf, any dam that doesn’t successfully raise a calf a year should be culled.” What they don’t say is that the first calf is completely expendable.
    Dairy cows: Most common cause of death for multiple birth calves: maternal crushing. Literally, mom loses track of where the calves are and lays down on one or more of them. Also, not uncommon in pigs who also can view the piglets as nice little protein snacks.
    Feral barn cats: Seem to reproduce successfully at age 2+. They get pregnant at age 1, but either lose the litter during gestation or freak out and abandon the entire litter at birth. (Yes, we spay and neuter – if we know they exist and can catch them. Often, we find an abandoned nest or a cat we’ve never seen before with kittens.)
    Birds: Many large predatory birds – eagles and some hawks – practice obligate siblicide. The first chick either bullies, outcompetes, attacks or ejects other siblings from the nest. Oh, so do parakeets as my mom learned when we were small and the two parakeets we had produced three eggs with one surviving chick.

    • Amy M

      There were even some human cultures where the practice was to abandon one twin, if multiples were born, because better to raise one healthy, than lose both. I’ll have to look up where that was, but I was reading about how different cultures value multiples and some saw them as a curse.

      • Amy M
      • Kesiana

        I used to wonder how on EARTH twins could be seen as a curse. Then this site taught me about the mortality rates involved with giving birth to same…

        (There’s also the issue of feeding them, but fiction gave me the impression that finding a wet nurse wasn’t difficult in any reasonably large tribe/town/city. Oops.)

        • SporkParade

          What would be interesting is a study about how cultures that see twins as a curse differ from cultures that see them as a sign of divine favor. Maybe the latter figure, if the twins survive, that’s pretty darn amazing?

      • Sue

        There were many societies that practised infanticide during famines – they had to rationalise the division of limited food between many mouths, and plan for the most robust to survive.

    • The Bofa on the Sofa

      Nature is a callous bitch

      I disagree. It’s not that nature is callous, it is that she is not anthrocentric. Nature cares just as much about bacteria, viruses, and even the laws of physics and chemistry as it does about people.

      Hence, nature doesn’t prevent bacteria from killing someone just because they are a person, nor does it prevent one from going through the windshield of a car in a crash. That’s not nature being callous, that is a triumph of the conservation of momentum. We may not like it, but you know, life would be a lot worse if you couldn’t rely on it.

  • Elisabetta Aurora

    Yes, in natural childbirth, there is this idea that evolution is something that has already happened rather than something that is ongoing. The idea is that we’ve already evolved to be fit rather than we are continually evolving and those that are least fit will get weeded out. You could argue that modern medicine is weakening the human race, but who would like to be first to offer themselves on the alter of eugenics?

    • Mel

      Yes.
      Also, evolution is not directional.
      Evolution does not produce more fit individuals.
      Evolution produces more individuals who are then culled out by natural selection.
      In other words, you are not necessarily more fit than your ancestors.

      Reproductive genetics gets really complicated really fast because humans will alloparent offspring. So, a woman could give birth to a living child, die, and the kid still has a chance of surviving by being raised by someone else. Or your genes work well enough for births 1-3, but your uterine muscles aren’t terribly strong so you successfully birth baby 4, then bleed out. The reproductive fitness of babies 1-3 isn’t necessarily better than baby 4. If baby 2 is female and has the same genetic combination as mom, she could be less fit than baby 4 who is male and has no problems from the gene combination.

      And all of these are ignoring development / environmental effects – which are not negligible.

      The more I study evolution, the less I trust it – and I’ve always been skeptical of trusting a messy natural process.

      • The Computer Ate My Nym

        Exactly. Also, evolution produces critters that are more adaptive for a given environment. When the environment changes, they can go from perfectly adapted to deep trouble quickly. For example, pandas: they have a great niche eating plants that other animals can’t digest…except that their food source is disappearing and they’re too specialized to move on to others. If we let evolution take its course in terms of birth (i.e. just let any woman or baby who couldn’t give birth/be born without help die) we might, in time, get humans who were better at being born without help. But we might lose something else that we value. For example, there would be pressure to have smaller brains at birth so it might be that we’d evolve into a less smart species. It’s all good as far as evolution is concerned: whatever survives survives.

      • Mac Sherbert

        Been studying the old family tree…Most of my great something or other mothers had at least 6 children! I was lucky to get two!

        • Medwife

          There were a few women in my family tree who had around 8 kids with husband #1, outlived him, and had 2-3 more with husband #2, then died at 90 yrs old. Then there were quite a few who had 1-2 or none and died very young; men who married 3 wives (sequentially!). There were these superproducers, then dead ends.

  • SporkParade

    Typo at the end of paragraph 2: It should be “to a lessER extent.”

    • Amy Tuteur, MD

      Thanks!!