Evolutionary perspectives on cesarean section
Cesarean section (surgical removal of a neonate through the maternal abdominal and uterine walls) can be a life-saving medical intervention for both mothers and their newborns when vaginal delivery through the birth canal is impossible or dangerous. In recent years however, the rates of cesarean sections have increased in many countries far beyond the level of 10–15% recommended as optimal by the World Health Organization. These ‘excess’ cesarean sections carry a number of risks to both mothers and infants including complication from surgery for the mother and respiratory and immunological problems later in life for the infants. We argue that an evolutionary perspective on human childbirth suggests that many of these ‘unnecessary’ cesarean sections could be avoided if we considered the emotionally supportive social context in which childbirth has taken place for hundreds of thousands or perhaps even millions of years of human evolution. The insight that human childbirth is usually a cooperative, even social event in which women are attended by familiar, supportive family and friends suggests that the harsh clinical environment in which women often give birth in the developed world is not the best setting for dealing with the strong emotional forces that usually accompany labor and delivery. We argue that providing a secure, supportive environment for laboring mothers can reduce the rate of ‘unnecessary’ surgical deliveries.