There is no obstetrical dilemma

Josie Glausiusz wrote a very nice piece published at Undark today called,

Of Evolution, Culture, and the Obstetrical Dilemma: Anthropologists are revisiting long-held beliefs about human evolution and the difficulty of human childbirth

In it, I'm thrilled to get something I furiously worry about across to a wide audience with this part toward the end of the piece:

“I worry that this idea [of the obstetrical dilemma] is justifying status-quo high rates of C-sections and other childbirth interventions,” Dunsworth says. “People say, ‘it’s just evolution — there’s nothing we can do, and here’s how technology helps, and that’s fabulous. But I know we’re overdoing it. Everybody knows that.”

It's a complicated issue, the obstetrical dilemma (OD), so it's no surprise that there are missing pieces in this particular discussion. The most important, biggest flaw in OD thinking is its assumption that we're born early, an assumption that is featured at the start of the piece with Karp and Washburn. But it's not true. We are not born early and that didn't make it in there. When you stop believing we're born early, the whole thing starts to crumble.

And here's where I am now with some of this...

First of all, we need to change the story so that it's not, no matter how slightly, bolstering unnecessary childbirth interventions. Though my OB/GYN seemed unfamiliar with the obstetrical dilemma hypothesis when I explained it to her as she gave me a pap smear, I think the thinking is pervasive in medical schools. This hunch is getting support on Twitter as we speak. (For some context, I am the first that I know of, several decades after the 'obstetrical dilemma' was born, to tack on "hypothesis" to the name of the idea.)

And, second of all, here's where I get "crazy"(see the piece for crazy) but all over again... Okay. In 2012, in one of a series of blog posts about our then recent paper questioning the obstetrical dilemma hypothesis I wrote this:

Women aren't called broads for nothing. We have, on average, larger dimensions of the pelvis that comprise the birth canal (linked into broader hips) than men do and this is not just relatively but absolutely and this is not just in the U.S., this is species-wide (1). 

There is no better explanation for this than it's due to selection for successful childbirth.

I think I was wrong. I think I know a better explanation for why women have bigger "obstetric" dimensions in the pelvis than men and I THINK IT'S BECAUSE WE HAVE FEMALE-SPECIFIC ORGANS THAT GROW INSIDE AND OCCUPY THAT SPACE AND THEY DO NOT.

Stay tuned for more about vaginal, clitoral, and uterine growth and space-taking... yessssss.