Caesarians and evolution

TweetiePieRN · Nov 21, 2005

I don't know if I really believe this. My mom birthed 5 babies with no problems! I had to have a c-section for CPD. I guess we will have to see with my future daughters if they have this issue too.

midwife2b · Nov 21, 2005

I saw this article that is about a new study in Australia over the caesarian rate. The article is not new to anyone who is aware or keeping informed about the whole caesarian "debate," but something at the end got my attention.
Dr Molloy said obstetricians were also seeing an increasing number of second-generation women having caesarean deliveries as a result of inheriting their mothers' small pelvises.

"The treatment for that years ago was to say no more children, but in the past 40 years we have hauled those people out of trouble with a caesar and so they're passing on their smaller pelvis to their daughters."

This made me realize that if you believe in evolution, or maybe more appropriately, adaptation, that continued caesarians could lead to more women with smaller pelvises and therefore, more caesarians. (disclaimer) I realize genetics plays a big part of this and that any adaptation is likely to take several generations to be a possible factor. However, it is certainly something to think about. If true, another example of the medical industry propagating itself even if unintentionally.

Mary Breckinridge made similar comments about her clients in the mountains of Kentucky. (she started the Frontier Nursing Service, the beginning of American Nurse Midwifery). She thought because her population was so isolated and didn't mix with others that "the strong survived" and genetically those women were more able to have lady partsl births.

mitchsmom · Nov 21, 2005

I think it totally makes sense!

SmilingBluEyes · Nov 21, 2005

It seems to have merit. IT is certainly something to think on.

palesarah · Nov 21, 2005

That's really interesting. I hope to see more research on it in the future.

ayndim · Nov 21, 2005

I saw this article that is about a new study in Australia over the caesarian rate. The article is not new to anyone who is aware or keeping informed about the whole caesarian "debate," but something at the end got my attention.
Dr Molloy said obstetricians were also seeing an increasing number of second-generation women having caesarean deliveries as a result of inheriting their mothers' small pelvises.

"The treatment for that years ago was to say no more children, but in the past 40 years we have hauled those people out of trouble with a caesar and so they're passing on their smaller pelvis to their daughters."

This made me realize that if you believe in evolution, or maybe more appropriately, adaptation, that continued caesarians could lead to more women with smaller pelvises and therefore, more caesarians. (disclaimer) I realize genetics plays a big part of this and that any adaptation is likely to take several generations to be a possible factor. However, it is certainly something to think about. If true, another example of the medical industry propagating itself even if unintentionally.

This seems to make sense -- except that true CPD is actually very rare. Drs just don't seem to want to help by having mom change positions. Everyone knows that lying flat (or nearly flat) on your back is the worst and most unnatural way to give birth but that is how most births occur. I think that it is more likely that drs see that mom had a section and have convinced themselves that the daughter also needs one. Had I had a dr and not a MW I believe I would have been a "victim of CPD" with my first. It took some time and changes in position to get my 1st child into the pelvis and finally out but I did it with no epidural and no episiotomy (just 4 stitches for a skin only tear). Turns out mine was sunny side up. Thank goodness for my old school CNM.

Dayray, RN · Nov 21, 2005

Labors do tend to run in families. However the label of CPD and c/s resulting from them is ambiguous.

CPD is supposed to mean that the head is too big to fit threw the pelvis or that the pelvis is shaped funny and the head doesn't rotate properly. The problem is that there really isn't a way to tell for sure that someone has an inadequate pelvis. Pelvametry (a technique that was supposed to predict weather or not a pelvis was adequate to allow lady partsl delivery) has been largely abandoned because it doesn't work.

That being the case it really isn't accurate to say anyone has CPD. Sure CPD does exist but it is impossible (except in very dramatic cases) to say arrest of decent is due to the mothers pelvis. A baby may not come out because of the position it is in, because contractions aren't strong enough, because the mother isn't able to push well enough, because the doc has a tee time to make, or any number of reasons. Many people get the label of CPD but no one really knows what happened, other then that the baby just couldn't come out that way.

I believe that what is said in this article could be happening. Still you cant say, "because my mom had CPD I will" because she may not have had CPD the baby may have just been in a funny position. Also if your mom had 10 vag deliveries you may still get labeled with CPD when in fact you don't have it but your baby was just in a funny position or you could actually have it. Who knows?

Pelvis shape and size does seem to have a strong tendency to be inherited but it's only 1 variable in labor. What is it they teach in nursing school? Passage passenger and power (or something)?

I believe if they trace the numbers they might find a slightly significant correlation in the number of women having C/S due to CPD whose mothers also had CPD. So I can believe that some of the increase in C/S can be attributed to adaptation. However, it can't be a very strong correlation because if it were then all the people with true CPD would have been bread out before C/S was possible. The label of CPD wouldn't be as prevalent as is it today.

I would however also like to see a study on early AROM and it's effect on C/S rate I'd bet a dollar that it has a much larger effect on supposed CPD then genetics.

JaneyW · Nov 21, 2005

I would however also like to see a study on early AROM and it's effect on C/S rate I'd bet a dollar that it has a much larger effect on supposed CPD then genetics.

I'd bet more than a dollar!

allnurses Guide · Nov 21, 2005

Dayray - I agree with you. Very interesting post.

steph

fergus51 · Nov 21, 2005

Dayray said it. If the ability to have children lady partslly were in fact completely inherited, the inability would have been bred out of us thousands of years ago.

futureTMA · Nov 22, 2005

Thanks for the great posts.

midwife2b - Thanks for the insight.

Dayray - Many thanks for your great post with lots of good information and things to think about.

I was sharing this to possibly show yet another way that elective caesarians and the high rate of them harms birth and to pose the question what's the long term result of this. Of course, as Dayray stated, there are many other factors in this that negatively affect it as well. However, I believe that "life will find a way" and that women, as a whole, will not lose the ability for lady partsl birth (although some may). This gets into the whole midwife versus medic debate.

edited to add: I agree with Dayray as well. My point is that the medical field intervenes in birth without really considering the long term and widespread influence of their actions. Also, as said in the OP, they seem to propagate themselves which is a never-ending spiral with healthcare cost going for the ride.