prolapse and race

Body: 

In an earlier post we’d talked about white women comprising the major percentage of those with prolapse symptoms. I think that observation by surgeons was probably skewed and is in need of revision. I’ve since found several studies on large populations of military women where no racial differences were noted. :-)

Hi Christine

I don't find that surprising. I do wonder, though, about how much the western way of life might contribute to the prevalence of prolapse, ie the constrictive clothing, labour for childbirth by the clock, 'tuck your butt under' physical education teachers, the masculine-style exercise regimes we learn, high stress, constipation-inducing careers, fast foods etc.

In less developed societies, I wonder whether there is a level of prolapse that is accepted as normal, and we only consider it a medical condition because doctors give it a name and come up with surgical procedures that they say can treat it?

A recent National Geographic article (I can't tell you the exact issue number; can't put my hand on it at the moment), described humankind's march towards bipedalism. A part I found interesting was the theory that pelvic shape had a lot to do with bipedalism, and that the change to pelvic shape necessary for bipedalism was not consistent with the pelvic shape necessary to birth a large-brained baby. The conclusion was that the need for bipedalism was more compelling than the need to birth a big-brained baby, so from then on, human women would have very little margin for error in birthing babies, because of the twists and turns necessary for the baby's head and shoulders to negotiate the birth canal. Human babies would no longer just come out in one plane like all our animal cousins. To me, the article inferred that this is the reason that human babies sometimes get stuck on the way out, which animals don't, or not for the same reasons. I was disappointed that the article did not explore more about the female human pelvic structure, its differences from the male of our species, and the ways in which the female body can compensate during birth, if only the doctors would let it. I hope that may be a topic for another Issue. Christine, when are we going to see you in National Geographic? Perhaps they should be talking to you?

Perhaps in less medicalised societies women simply died giving birth if a baby got stuck halfway, or the baby was stillborn? Or they suffered fistulae and other complications that make mild prolapse look a bit of a picnic? But of course, as so many of these women go unrecorded, giving birth well away from hospital recording systems we will never really know. Can you shed any light on this, Christine?

Cheers

Louise

Hi Louise,

This is a subject worthy of a book and one I don’t have time to write just yet. It’s a topic close to my heart though and one I hope to devote much time to in the future. An English M.D. named Kathleen Vaughan who wrote a book called Safe Childbirth in the 1930s was up in arms over the fact she could see, through her worldwide travels to study the issue, that human childbirth was changing along the exact same lines as loss of early culture’s native food. Women were having a much harder time delivering and she was certain degenerative changes were happening at a skeletal level. This was during the same time period the famous dentist, Weston Price, wrote about previously non-existent teeth and jaw problems showing up in the same marginalized people.

I wouldn’t give a lot of credence to the Geographic article because they probably consulted with the world expert on the subject, an ob/gyn named M.M. Abitbol with a penchant for anthropology, who wrote several papers about the inadequacy of the birthing female pelvis. His work has shown up in gynecologic and orthopedic textbooks as the final say on the issue. Here are a few of his observations:

• As a practicing obstetrician, I can definitely state that the relationship between the narrow human pelvis and the enlarged fetal head is disproportional or at least a tight fit.
• Over the last three million years, hominids (including humans) have managed to find a workable arrangement for efficient bipedal behavior.
• During pregnancy this arrangement, which is already unstable to begin with, falls apart.
• The pelvis and the vertebral spine do not adapt well to human parturition because postural and obstetric requirements make demands in opposite directions on the pelvis.
• Human intervention can either ‘ease’ obstetric demands on the pelvis or completely bypass them, and this can make obstetric demands less imposing from an evolutionary point of view.
• The elegant striding walk, the pride of human erect behavior, is all but gone in advanced pregnancy.
• The obstetric complications resulting from fetal body-maternal pelvic distortion produced by erect posture are numerous and far-reaching.

The guy’s a complete idiot, of course.

Yes, some pretty audacious turning is required of the fetus at birth a situation that probably wires the human brain for problem solving from the beginning! Really though – this is where the ability of our sacrum to nutate really shines. As the baby prepares to drop into the pelvis, the sacrum counternutates. The sacral promontory pulls out of the interior of the pelvis so the width of the top of the canal is maximized. During the second stage of labor, the pelvis nutates. The promontory drops into the part of the pelvis the baby has left and the tailbone lifts up for maximum diameter at the final stage. Hormones have softened the pelvic joints to mush making the pubic symphysis, sacroiliac joints and ischial spines all extremely compliant. It is a biochemistry worthy of our highest exhaltation, yet one that has been feared, ignored, and intervened with for too many hundreds of years.

Do we look like a species that has had a problem reproducing? And by the way, I think vets and zoo keepers would tell us horses, buffalo, giraffes and bears die birthing their offspring too. That’s why almost all zoo births are by c-section these days.

:-)Christine

National Geographic, July 2006, pg. 128-143