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The Evolutionary Origins of Obstructed Labor: Bipedalism, Encephalization, and the Human Obstetric Dilemma

Wittman, Anna Blackburn MA*; Wall, L Lewis MD, DPhil†‡

Obstetrical & Gynecological Survey: November 2007 - Volume 62 - Issue 11 - p 739-748
doi: 10.1097/01.ogx.0000286584.04310.5c

Obstructed labor is a common complication of human childbirth. In parts of the world where access to emergency obstetric services is limited, obstructed labor is a major cause of maternal mortality. Women who survive the ordeal of prolonged obstructed labor often end up suffering from an obstetric vesicovaginal fistula or another serious birth injury that leaves them crippled for life. Compared with the other higher primates (chimpanzees, bonobos, gorillas, and orangutans), these problems are uniquely human. This article reviews the evolutionary origins of the human obstetric dilemma with special reference to the changes imposed on pelvic architecture by the assumption of upright, bipedal posture and locomotion. The subsequent development of progressively increasing brain size (encephalization) in hominins led to the present human obstetrical conundrum: how to balance the evolutionary advantage of bigger babies with larger brains against the presence of a narrow pelvis that is difficult for a fetus to traverse during labor.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to recall the slow evolutionary progress and the importance of standing erect, and summarize development of the maternal and fetal brain and their evolutionary changes that occurred to overcome obstructive labor.

*Doctoral Student in Anthropology, †Professor, Department of Anthropology; and ‡Professor, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2007. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprint requests to: L. Lewis Wall, MD, DPhil, Department of Obstetrics and Gynecology, Campus Box 8064, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.