Hey! So, a few weeks ago Bill and Melinda
Gates reached out to us about making a
collaborative video based on a theme in
their annual letter.
This is something that they write every
year to share their philanthropic goals
for the coming months. One of their
priorities for 2017 has to do with
maternal and infant health. They want to
support initiatives that ensure women
remain healthy throughout pregnancy and
birth and in the first years of their
child's life—we put it in the
description so you can go check it out
for yourself. The Gates have been a lot
of great work to elevate important
topics around global health and
education and I'm really excited to be
working with them on this project, so
check it out!
So you might remember Dr.
Robert Martin, who you're familiar with
from episodes like "Breast Episode Ever"
and "Why did King Tut have a flat head?"
He's a biological anthropologist and has spent
his career researching various aspects
of Hominid evolution. A big part of his
work focuses on the physical aspects of
human reproduction and childbirth and
how trends and practices in childbirth
have changed throughout time. They got me
thinking of that face that I made in the
King Tut video.
Before then, I'd never truly realized the
logistical constraints of human child
birth. I mean you've got to navigate this
grapefruit sized head and shoulders
through an opening of roughly the same
size and make a turn to get around the
tailbone in the process. When you compare
the pelvic size and shape to that of our
closest great ape relatives, ours is
disproportionately smaller and more
obtuse—and that's because the act of
walking permanently upright, known as
bipedal locomotion, actually changed the
shape of that pelvic opening. This, in
addition to human babies having a longer
gestation time, overall larger body size,
and massive heads, leads to a lot of
complications when it comes to human
birthing practices. In fact, in a recent
blog post, Dr. Martin wrote "astute analysis
of brain size and pelvic anatomy and
our fossil predecessors have confirmed
that birth first began to become
challenging when the genus Homo emerged
around two million years ago."
This means that women may have been
relying on personal assistants in order
to give birth for as long and 2 million
years! So I started to wonder how has our
inability to give birth easily impacted
mortality rates for both mother and
child. Save the Children estimates that a
million babies die the day they're born
every year. So why does this happen and are
things getting any better?
Spoiler alert: these things are actually
improving and I went to talk to Dr.
Martin to get some answers.
This is what a baby's head looks like at
birth and that head has to fit through
the pelvis. So the baby goes in with his
head facing sideways and then when it's
halfway through the pelvis it turns
through 90 degrees to point backwards. It
all boils down to a difficult passage
through the pelvis because of this
trade-off between adaptation of the
pelvis for upright walking and this big
brain. So all of that points to the need
for some kind of assistance. We don't
know exactly when, but we can trace this
process through the fossil record fairly
effectively and my guess is that we
started needing midwives about a million
years ago, there's some kind of help. EG: You
mentioned earlier that we have a great
record for knowing how, uh,
how humans have evolved over time and
how the evolution of birthing practices
have evolved over time, so you can talk—
can you talk a little bit about some of
the examples that we have in the fossil
record? RM: So this here is— this is one
side of the pelvis of Lucy, the famous
Australopithecus from Ethiopia. So if you
mirror image the pelvis and put it
together, you can work out how
big the birth canal was. EG: Great. RM: ...and we can
calculate how big the baby's head was
likely to be. But then, when you get up to
Homo erectus, by 1.5 million years ago
with early homo,
we almost certainly had the beginnings
of a difficult birth. They would have had
slower births and maybe they already
needed midwives at that stage, it's quite
possible. I think midwives have been
undervalued. I mean has been a medicalization
of birth and a drive towards
having births in hospitals. It's much
better for women psychologically, at
least, to be working with a midwife
than to go into the impersonal
environment of a maternity. There was a
study in Holland which showed that if
you had a midwife in hospital compared
to an obstetrician in that same
hospital, birth took twice as long with
the obstetrician than it did with the
midwives. I mean, it's pretty dramatic
evidence to me. EG: Something like 300,000
women die because of pregnancy-related
issues, but most of those are preventable.
I mean sometimes you get blockage of the
birth canal but a lot of that just has
to do an access to basic health care and
assistance in the process. It seems
pretty logical to think that if you
provide more access to healthcare and to
nutrition, to decrease the number of
children who are dying of malnutrition,
then that would be beneficial all around.
This is absolutely true. I mean medical
science has made huge leaps forward but
in industrialized countries we've
managed to get birth related mortality
down, so that we're talking about a few
per hundred thousand, so I mean these are
really pretty low levels. But here's the
thing, if you just take industrialized
countries where because of
hospital services, we've managed to
reduce mortality and the lowest country
on the list for industrialized countries
is the United States. How come the
richest country in the world has one of
the highest levels of mortality around?
There was one drastic case which is the
state of Texas. In the state of Texas,
maternal mortality was actually not
rising very much until 2011. And then it
doubled. EG: Wow.
RM: It shot up and it stayed at that level ever
since. There's no health-related factor
that can explain that and the only
explanation I've seen is within 2011, a
lot of prenatal clinics were closed. And,
so I think there is a good possibility
that a political decision in the state of Texas
has actually doubled the rate of
mortality and that stayed. EG: Wow, so that's
kind of a shocking example of how
decreasing the access to healthcare
facilities actually exponentially
increases the rate of infant mother
mortality. Despite those kind of
statistics, things are improving globally
for, for women and for infant care. I mean
especially if you're looking in the
scale of the last hundred years or so,
the percentage of children that are
dying between ages 0 and 5 had decreased
forty percent in the last hundred years.
From instances that might look like
things might be getting worse but
overall things are improving.
Oh absolutely, and I, I don't want to over-
exaggerate things over in the United States
is last on the [league?] list for
industrialized countries which is still
pretty low. Medical intervention and
monitoring has got the death rate down
considerably.
It's quite a bit worse in developing
countries and the highest rates are in
Africa. Africa has real problems with
health provision, I think, and so we can
see there the problems you get if you
don't have regular monitoring. EG: We have
the benefit of technology and medical
resources that hypothetically could be
available to everybody alive today.
122 million children have
been able to live
thanks to access to healthcare and
education. So that, to me, seems like a huge
progress.
What do you imagine for the future of
humanity if everybody could have access
to health care, provided that, you know,
you have some idea of what our
evolutionary trajection [sic] might be. RM: Yes,
the first thing I would say is a key to
the improvement you've mentioned is
prenatal care. That has already reduced
the problems enormously and improved the
prospects of birth. Unfortunately a lot
of people think the easy way out is to
have cesarean births because then you
don't have any problem of passing
through the pelvis. EG: Yeah. RM: That has got out
of hand because WHO reckons that the
medical reasons you might need to have
cesarean every one in ten or one in seven
births something like that. In the United
States right now one in three births is
by cesarean, so it's, it's increa—it's more
than tripled in, over the course of 40
years or so. You have full anesthesia
for a cesarean and some major
operation, and it has all kinds of side-
effects. But the example I, I've given in my
writings is that in bulldogs, dogs with
with really wide heads, we're talking about
85 to 95 percentages cesarean. And if we don't
watch it we're going to end up like
Bulldogs. [laughing] EG: Wow. Man, I'm
just, I'm grateful for
mothers everywhere! [both laughing]
This episode of The Brain Scoop is
brought to you by Bill and Melinda Gates
and the Field Museum in Chicago, Illinois.
... it still has brains on it.