Someone following the obstetrical dilemma (OD) debate and discussion may be wondering, “Well, is there or isn’t there?”
I wrote two papers saying there is no obstetrical dilemma (here and here). Many others have critiqued the OD (kindly cited in the paper linked below, but see especially here). In summer 2023 a large team of researchers wrote a paper saying that there is, indeed, an OD: There is an obstetrical dilemma: Misconceptions about the evolution of human childbirth and pelvic form. Here, I’d like to offer a way to think through that open-access paper.
As the title reveals, the paper is positioned in support of
the OD and in opposition to critiques and the notion that there is no OD.
As the paper advocates for the OD, it redefines it. The new, more complex, “wider
sense”, 21st Century obstetrical dilemma is this (my paraphrase):
The obstetrical dilemma is the evolutionary explanation for difficult childbirth. Antagonistic selection on the human female pelvis and between maternal pelvis and neonatal size causes difficult childbirth. As such, the female pelvis is limited (but not necessarily *only* because of bipedal efficiency, like the old idea). And, in turn, the female pelvis limits neonatal size. Because there is no evidence of early birth, the old, original idea that human babies evolved to be born "prematurely" to solve the dilemma is dropped from the OD.
For the rest of the reading guide, I’m going to quote from the paper’s abstract.
“Here we explain
why [critiques of the OD] are important…”
The paper’s got a kind collegial tone throughout, but it’s
not easy to find where they explain why critiques are important.
Calling the critiques “misconceptions” in the title is the first of many signs that the debate about the OD is based on different approaches to interpreting the facts and different beliefs about what counts as evidence.
Calling some views misconceptions usually means that disagreements are not valid. But, the critiques are valid. Here are the major themes of disagreement between OD advocates and critics:
(1) how evolution works, specifically, how to conceive
of and narrate nature/life/existence
(2) what we can and cannot say (based on what we can and
cannot know) about how evolution occurred in the past, including selection
pressures, adaptation, and causation, as well as whether something in the past
or present has been, or is, prevented from evolving
(3) what sex differences in pelvic morphology and locomotion
do and do not tell us about how evolution has occurred in the past
(4) what data from hospital births do or do not say about
the evolution of birth, specifically regarding the fit between pelvis and
neonate
(5) what data from the following births do or do not say
about the evolution of birth, specifically regarding the fit between pelvis
and neonate: teen births, births of those who’ve been circumcised,
births in the “fistula belt” of Africa, births of the undernourished
and in the context of disease, and births where community midwifery has been eradicated (passively
or actively) by colonialism and capitalism but the nearest hospital is hours
and hours away
“… but [the critiques] do not invalidate evolutionary explanations of human childbirth.”
Throughout the paper, the obstetrical dilemma is referred to
as “the” evolutionary explanation. It’s synonymous with that phrase. I take
that to mean that the authors believe there is only one way to think evolutionarily
about childbirth difficulty.
The authors agree with critiques of the OD that we are not born
early, so this part of the O.G. OD is removed. (I've rather enjoyed saying that "without a
solution, then where’s the dilemma?") This new common ground, say the
authors, does not invalidate the OD.
Above all, this assertion (that critiques do not invalidate
the OD) raises the important question: What would “invalidate” the “obstetrical
dilemma”?
“Compared to other
primates, modern humans face high rates of maternal and neonatal morbidity
[trauma and illness] and mortality [death] during childbirth.”
Do the authors state those rates anywhere in the paper?
Do they state what role the pelvis or the tight fit play in
those rates?
“We argue that
evolutionary research does not hinder appropriate midwifery and obstetric care,
nor does it promote negative views of female bodies.”
Can you find these arguments? What are they based on?
How does “understanding the evolutionary entanglement of
biological and sociocultural factors underlying human childbirth help us to
understand individual variation in the risk factors of obstructed labor”?
And how does that, in turn, “contribute to more
individualized maternal care”?
“We present robust
empirical evidence and solid evolutionary theory supporting an OD, yet one that
is much more complex than originally conceived in the 20th century.”
Section by section, what is the empirical evidence that is presented?
What is the solid evolutionary theory that supports the OD?
Do they mention what would invalidate the OD?
**
Maybe I’ll write a follow-up post with my own answers to those questions. Maybe not.
But I will add that I was wrong to
refer to the obstetrical dilemma as a hypothesis. Originally, I did so in hopes
of shaking it loose from its automatic treatment as fact, which I had been doing
(like so many others) until I started looking into it (originally just to roll
around in the evidence like a pig in shit, definitely not expecting to find none!).
It’s not a hypothesis. I can’t think of a way to test it,
let alone test it against alternative explanations (yes, including evolutionary
ones). And I’ve never seen anyone describe how to test it, or alternatives,
either. There is also a sense (that I get from students) that if the “EGG hypothesis” is wrong then the OD is right. But that’s not logical, either. In
science, we should be free to reject a story regardless of whether or not there
is a new one to take its place.
There is no falsifying or failing to falsify the obstetrical
dilemma. And that makes the advocacy for the idea so disorienting to me.
It’s existential, which is why I struggle to engage anymore on this topic. I
do not think like so many/most (?) biological anthropologists, so I do not feel
like I belong with them or as one anymore and that’s not been an easy feeling.
There is no demonstrating that the pelvis cannot evolve to be wider, or that
babies cannot evolve to be smaller, or that the fit between mother and neonate
cannot be loosened so that childbirth can evolve to be easier. There is no
demonstrating the obstetrical dilemma.
The obstetrical dilemma is a state of mind and a narrative
that interprets extremely messy, culturally shaped phenomena (and interpretations thereof) that the authors
call “empirical evidence” with “solid evolutionary theory” colored by adaptationism,
determinism, optimization, and knowable tradeoffs. As long as people believe
there is only one way to think evolutionarily about difficult childbirth, then
the obstetrical dilemma will seem like the obvious, hands-down, no-contest way
to explain it. And it will be framed as “the” or “the only” evolutionary
explanation, as the authors have.
But we can think evolutionarily and also see no need
for the obstetrical dilemma framework to explain difficult childbirth. We
evolved. Our pelvis is unique. Our babies are too. Childbirth can be difficult. But
the OD is unknowable and we don’t need it to know that evolution is
true.
Further, Crucial Resources (because the stakes are not low when it comes to our scientific narratives)
@badassmotherbirther, @birth.like.a.badass
Birth Control by Allison Yarrow
Birth and the Big Bad Wolf: Biocultural Evolution and Human Childbirth, Part 1 by Melissa Cheney and Robbie Davis-Floyd
