The fallacy of natural birth: Safeguarding mothers and newborns in modern times

The recent case of an infant death in Pudukkottai district in Tamil Nadu shocked the health authorities. A pregnant woman, despite repeated offers of modern healthcare services, chose to deliver her child at home. Her decision is rooted in the belief in living “naturally”. It left both mother and child in a precarious state, and the infant’s life snuffed out, completely avoidable. This refusal to accept evidence-based medical care not only endangered her life but also violated the right to the health of the unborn child. Such incidents force us to confront a troubling reality—how deeply misplaced beliefs can jeopardize lives in an era where medical science offers safety. 

The idea of natural childbirth, outside the safety net of hospitals, is often romanticised as a return to simpler, more harmonious times. It carries the false allure of a past where childbirth was supposedly safer, and maternal health was ideal. Yet, data tells a starkly different story.

Maternal and infant deaths were heartbreakingly common in the past. Women frequently succumbed to infections, haemorrhages, or prolonged labour, leaving families devastated. What remains of those times are stories of survival, giving rise to a dangerous survivorship bias—the flawed perception that the methods of the past were successful because a few lived to tell the tale. It is human nature to overrate the past and underratethe present. 

Evolutionary burden

Childbirth is unique for humans among mammals. Despite their advanced standing, humans remain one of the few species requiring assistance during delivery. This peculiarity stems from the very trait that defines humanity—our upright posture. Two hundred thousand years ago, when humans evolved to walk on two legs, the structure of the pelvis narrowed to accommodate bipedalism. This evolution happened rapidly, and women did not have time to develop a broader pelvis. This narrowing came with a price. It restricted the passage through which a baby was delivered. Simultaneously, the head of newborn that harbours the brain grew in size, making childbirth even more challenging. As a result, human babies are born at a much earlier stage of development compared to other mammals, making them completely dependent on external care.

This evolutionary compromise—narrow pelvis and large head—shaped human society in profound ways. Childbirth and rearing became a communal responsibility, necessitating the support of families and tribes. Over time, this reliance laid the foundation for civilizations. But the burden of this evolutionary trade-off fell squarely on women. For them, what should have been a natural and physiological event like in other mammals became fraught with danger, leading to death or disability more often than it should. 

Story of Choices

Despite that some narratives glorify childbirth as an untouchable natural process to be endured without intervention. This misplaced idealization leads to dangerous decisions, like the one made by the mother, who rejected institutional delivery. While childbirth is indeed a natural process, it is not without risks. Modern medical care doesn’t pathologise pregnancy—it safeguards it. A pregnant mother is not a patient until complications arise, but when they do, access to timely interventions can mean the difference between life and death.

Why human childbirth is difficult

Human childbirth reflects a delicate balance between two evolutionary pressures: the need for a narrow pelvis to support efficient bipedal locomotion and the requirement to accommodate a large-brained baby. Unlike most mammals, humans have a disproportionately large foetal head relative to the dimensions of the birth canal, increasing the risk of obstructed labour. The human pelvis is adapted to walking upright, resulting in a narrower pelvic inlet and outlet. Moreover, the curvature and length of the human birth canal make delivery more complex, requiring the baby to navigate through rotations.

In contrast, quadrupedal mammals like cows, elephants, and dogs have wider pelvic outlets and straighter birth canals, reducing the mechanical challenges of delivery. Even in primates such as monkeys, the birth canal is relatively less restrictive due to their broader pelvis and smaller relative foetal head size.

Indian paradox

India’s healthcare system is caught in a striking paradox. In remote and rural regions, the cry often resounds for accessible and adequate healthcare, with government initiatives struggling to bridge the gap. Yet, in urban centres, where healthcare facilities are abundant and diverse, a contrasting challenge emerges. Rejection of modern medical interventions, swayed by personal beliefs, cultural norms, or mistrust in the system. This duality of unmet need in one sphere and voluntary abstinence in another reflects the complexity of India’s healthcare landscape. While strides have been made to ensure access to antenatal care through schemes like Janani Suraksha Yojana, cases like this remind us that awareness and education must go hand in hand with accessibility. 

The foundation of human civilization owes to the narrow pelvis, a consequence of evolution that enabled the cognitive ability of humans to make advancements that built cities, conducted revolutions, and sent humans to space. Women who have borne the brunt of this evolutionary compromise deserve every possible safeguard during childbirth. The rejection of evidence-based medicine, or institutional deliveries, is rooted in a misplaced belief. Denying healthcare services not only endangers the mother but violates the unborn child’s fundamental right to live. The health authorities are powerless as they can only request or persuade an adamant mother and her relatives. The judiciary needs to intervene by invoking the doctrine of Parens patriae and empower the health authorities to provide newborn care for the unborn. 

Fantasising the past does not bring back its hardships. It blinds us to the progress we have achieved. Self-denying institutional deliveries under the pretext of natural living is a dangerous illusion. We stand in the golden era of maternal health, with the highest chances in history for mothers and their children to survive and thrive. To squander this progress on baseless ideals is not just a tragedy—it is a betrayal of the very civilisation that has enabled us to overcome the perils of childbirth.