The New “Obstetrical Dilemma”
May 15, 2024There is a theory so deeply ingrained in medicine and society that it remains hard to question. It centers on the belief that because we walk on two feet and grow large-brained infants, human childbirth is inherently risky and in need of intervention. It is known as the “obstetrical dilemma” (OD). The hypothesis argues that the evolutionary trade off for bipedal motion and intelligence made women’s bodies less able to accommodate giving birth.
This has always struck me as strange—that evolution would make giving birth harder rather than easier. Biological anthropologist Holly M. Dunsworth, professor at the University of Rhode Island, must have thought something similar. In her article “There is No ‘Obstetrical Dilemma’: Towards a Braver Medicine with Fewer Childbirth Interventions” she thankfully challenges the validity of the OD.
Yet, obstetrical interventions are so mainstream it is difficult for most people to imagine childbirth as anything but a technological event. Today, approximately 98 percent of women in the United States give birth in a hospital where ubiquitous interventions are not only the norm, they’re what make up the specialty. Practitioners do what they’ve been trained to do—alter the birth process—by speeding it up and circumventing it through things like labor induction, anesthesia, and surgery.
This technocratic approach, now roughly 100 years in the making, has initiated a “new” obstetrical dilemma—not whether women can accommodate birth, but rather, should women accommodate pregnancy and give birth at all?
Absurd as that might sound, it is an outcome worth consideration. Medicine already alters and controls childbearing with increasing use of tools and techniques. Artificial womb technology (which I address in detail in Outer Origin) may eliminate the entire pregnancy and delivery altogether.
The new obstetrical dilemma must seek answers these questions: Does natural gestation and childbirth have any place in the technological age? Should we, or should we not, get rid of pregnancy and childbirth?
The answers may determine one of the most significant shifts of our time—how humans come into being.
Dunsworth, Holly M. “There is No ‘Obstetrical Dilemma’: Towards a Braver Medicine with Fewer Childbirth Interventions” Perspectives in Biology and Medicine 61, no. 2 (2018): 249-263. https://muse.jhu.edu/article/701861.
