Birthing in Evolutionary and CrossCultural Perspectives
Human birthing is often viewed as a physiological act, but it is also a social phenomenon shaped by culture, power dynamics, and local expectations. Since Jordan's classic Birth in Four Cultures in 1978, anthropological studies of the cultural context of birthing have made significant contributions to understanding human reproduction and delivery (see McClain, 1989; Browner and Sargent, 1996; Davis-Floyd and Sargent, 1997). Biocultural approaches reveal that interactions between human biology and culture produce the local circumstances of birth. Birth occurs not as a strictly biological response but one shaped by many social processes that reflect cultural values. Cross-cultural approaches reveal that arbitrary cultural beliefs and practices surround birth and provide a basis for transcultural perspectives to determine natural aspects of human birthing.
Although there may be little "natural" about birth because it occurs within a cultural context, cross-cultural perspectives indicate that many cultures have developed similar adjustments to accommodate the physiological aspects of the birth process. Throughout most of the premodern world, birthing occurred in a supportive setting facilitated by the experience of older women familiar with the process. Women did not deliver their babies alone but in the company of their mothers, grandmothers, and other experienced women. These ancient practices of social and emotional support are crucial for the well-being of the mother-infant dyad. Support for the empirical efficacy of traditional cultural birth practices also comes from evolutionary studies of human birth. Studies of birthing from primate and evolutionary perspectives contribute to an understanding of the importance of female support systems facilitating birth for mother and child (Trevathan et al., 1999; Trevathan, 1999). Women assist the birthing mother, providing physical, emotional, and social support during the delivery. Evolutionary and cross-cultural perspectives reveal the importance of supportive environments that facilitate the formation of mother-infant attachment processes.
Cross-cultural perspectives played a significant role in the resuscitation of midwifery in the United States, providing knowledge about options in the management of birth processes. This cross-cultural fertilization helped reestablish the legitimacy of traditional birth attendants and enlarged the scope of considerations in addressing maternal-child health. Cross-cultural differences in approaches to birth even by physicians reveal cultural aspects of biomedicine, contributing to the development of a critical perspective on the appropriateness of customary obstetric practices. The awareness of arbitrary cultural aspects of modern obstetrics has contributed to redirecting health modernization programs to include rather than replace traditional birth practices. Cultural perspectives help public health planners recognize traditional practices as important complements to biomedical approaches.
The "natural birthing" movement reflects the efforts of modern women to recapture these dynamics through incorporating influences from cultural traditions where the power of women over often result from the disjuncture between the genetic characteristics and contemporary conditions affecting diet, reproduction, and resource allocation.
Our individual development involves tuning our physiological systems in response to input from the environment, which is shaped by cultural adaptations. Culture is the most prevalent form of adaptation in addressing threats to health because culture can make birth remained more intact. The successes of these cultural traditions indicate the inappropriateness of customary obstetric procedures of having women adopt the lithotomy position (on her back with legs extended upward in stirrups) and to undergo episiotomy (surgical opening of the vagina to facilitate passage of the fetus) (Trevathan et al., 1999). Women around the world sit, stand, or recline rather than lie on their backs, as emphasized in modern biomedical obstetrics. The conflict of modern obstetric practices with the evolved needs of pregnant women can be remedied by cross-culturally inspired perspectives. For instance, female birth companions that provide support and reassurance during delivery can likely reduce morbidity and mortality associated with birth, postpartum complications, and malpractice suits against obstetricians. Birthing chairs where women recline are better suited to women's evolved birthing capacity than are beds with stirrups to hang their feet above their heads!
Contemporary dissatisfaction with modern obstetrics is in part due to its failure to accommodate to this evolutionary heritage and its importance in facilitating positive birth experiences and postpartum physical and emotional health. Cultural approaches to childbirth question the presumed superiority of biomedical obstetrics and what constitutes authoritative knowledge in childbirth. Contemporary studies of midwifery (Davis-Floyd and Sargent, 1997) establish it as a reliable health resource with a role in the modern world. American midwives have engaged in formal education and professionalization in modernizing their practices, producing what Davis-Floyd refers to as the "postmodern midwife" who accommodates traditional practices to modern demands and circumstances. Anthropology has played a role in establishing the validity of midwifery and facilitating its political struggle for legitimacy and acceptance, as described in the "Practitioner Profile: Robbie Davis-Floyd" (see Chapter Four and http://www.midwiferytoday.com).
The anthropology of birth focuses on the political dimensions affecting the continued viability of traditional birth practices. For more than a century, biomedical organizations have used the power of the state to oppress and vilify midwifery, placing it in the context of witchcraft and charlatanry. National health programs in the underdeveloped world generally still neglect, marginalize, and even disparage indigenous midwifery. Traditional midwifery practices still constitute the most important maternal-infant health resource in many regions and are generally as effective as or better than biomedicine in routine deliveries. Biomedicine often contributes to undermining access to the basic health resources that women and infants need, neglecting midwifery's potential contributions and, instead, emphasizing high-tech biomedical approaches. Even when incorporated into national health education programs, midwives' knowledge is often marginalized in a focus on Western notions of hygiene instead of focusing on the expansion of midwifery as a basis for effective services. Anthropology's cross-cultural and evolutionary perspectives on midwifery may inspire changes in obstetric practice.
more rapid changes in responses than biological adaptations achieved through evolution. Humans are, nonetheless, left today with many characteristics acquired in our evolutionary history and processes of natural selection that produced features that are poorly adapted to today's ecology or cultural patterns. This is illustrated in the special feature "Biocultural Interactions: Birthing in Evolutionary and Cross-Cultural Perspectives."
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