Monday, November 19, 2007

God Still Kills Mommy

Here's the second of my two long overdue items on women's issues. This one relates to another point I brought up in the Carrier-Roth Debate. But it's my interview in the "Special Features" section of The God Who Wasn't There that needs correcting. That's where Brian Flemming shows a larger chunk of his interview of me on the UC Berkeley campus (since many ask, we filmed by Sather Tower). Over the past year or two I've been asked several times about my claim there that without modern medicine 1 in 5 women die as a result of childbirth.

This statistic I had second-hand from several sources I'd read long ago and simply took for granted. Following my usual practice, when someone leads me to doubt my sources, I dig deeper to check, and correct myself if I'm wrong. Though I've already responded to several people on this already, going back more than a year now, it eventually occurred to me I should just blog it. So here you go.

The Numbers

The story turns out to be more complicated. But I'll start by cutting to the chase, and then discuss. The short of it is: I was wrong on specifics. But I wasn't wrong on the general point. God still kills mommy. Just not as often as I thought. Or where and when I thought. For example, I would not have been wrong if I'd said 1 in 5 before civilization, rather than (as I did say) before modern medicine, not only because "modern medicine" is too chronologically vague to be helpful, and too geographically indiscriminate, but more importantly because such high levels of maternal mortality are only documented for pre-civilized populations (though some of the worst modern conditions come close). And no matter what the rate, obviously a baby's monstrous head is not the only thing that kills women in labor. God blasts moms away with a whole physiological shotgun of design flaws.

Now for the long of it.

[1] "Maternal mortality in pre-Columbian Indians of Arica, Chile," by Arriaza, Allison and Gerszten, in American Journal of Physical Anthropology 77.1 (September 1988): 35-41.
Forensic examination of corpses from pre-civilized populations has found a rate of maternal mortality (as in the death of a mother during or soon after giving birth) between 1 in 4 and 1 in 7. The latter held for a population in the Andes until around 600 A.D. when maternal mortality consistently dropped to about 1 in 20. The change appears to correspond more or less with the development of cities and urban economies there, which presumably led to greater (though of course not yet sterling) nutrition and other improved conditions.
[2] "Deaths in Childbed from the Eighteenth Century to 1935," by Irvine Loudon, in Medical History 30.1 (January 1986): 1-41.
Studies of modern records dating back to the 18th century (now an age of scientific medicine, though still lacking antibiotics) have found a rate of maternal mortality varying between 1 in 30 and 1 in 60 (though occasionally better). This gradually dropped during the 19th century, when rates more typically fell between 1 in 100 and 1 in 200, until 1935, after which rates of maternal mortality in Western industrialized countries dropped precipitously to well under 1 in 1000. In fact, in many Western nations it now approaches 1 in 10,000, and in some even 1 in 100,000. The proliferation of antibiotics and other modern conveniences has clearly made a tremendous impact.

So much for the historical parameter. The geographical one remains as varied. For example, the worst modern maternal mortality rate I can confirm is that reported for contemporary Afghanistan, which has reportedly risen to 1 in 6 (according to Pamela Constable, "Many Afghans Lost to Hazards of Childbirth," Washington Post, 6 June 2006: A10). In some regions of Africa it rises to 1 in 40 or even 1 in 20 (e.g. "African Ambassadors Seeking International Help for Women's Health in Africa" and "Maternal Mortality 2100 Times Higher In Sierra Leone Than In Ireland"). But even Africa is not homogenous. Within more prosperous countries the rate drops considerably. For example, in modern Ghana the rate of maternal mortality varies between 1 in 400 and 1 in 900 (according to Martey et al., "Maternal Mortality and Related Factors in Ejisu District, Ghana," East African Medical Journal 71.10 = October 1994: 656-60). Thus, once again, greater access to modern medicines and techniques (and modern nutrition and conveniences) clearly have a huge affect on a mother's chances of surviving childbirth (regardless of the root causes, which appear not to have changed--we can only cope better with their effects).

Which in general is the point I wanted to make...

The Argument

In print I always took care to avoid numbers, sticking only to the general point, which is the same I made in Flemming's interview.
In my book, Sense and Goodness without God (on pp. 153-54) I wrote that if God had actually given us a soul, we wouldn't need a brain, and if we didn't need a brain, our heads wouldn't need to be so big, and if our heads weren't so big, "fewer mothers would die in labor." Though in technical detail that's an over-simplification, it's still true. Regardless of what the maternal mortality rate was before modern medicine, whether 1 in 5 or 1 in 50, or even 1 in 500, it would still have been a lot lower without that mother-killing brain of ours. This is affirmed by Hilliary Creely and Philipp Khaitovich in "Human Brain Evolution," Progress in Brain Research 158 (2006): 295-309.

I incorporated this point more formally in my Argument from Mind-Brain Dysteleology, which I articulated in my opening statement for the Carrier-Wanchick Debate. There I listed several dysteleological attributes of the human brain, only one of them being the fact that a nice God would have given us a mind that "doesn't pose a physical threat to a mother's life or health during delivery (as human brains do, in contrast with all other mammalian brains)." Again, I avoided any specific rate of mortality and stuck with the more general fact of relative mortality. Smaller brains would save more moms.

Afterwards Ted Drange brought up a good point about this, which I should digress on here. I argued that a large cranium (relative to its size prior to evolving consciousness) is the only way you can get a conscious mind on naturalism, but a very unlikely way to get one from intelligent design. Yet maternal mortality is a partial exception to this general rule. For cranial size is only a probable liability for maternal mortality (not a necessary one), and only in certain evolutionary circumstances (such as evolving consciousness within a primate lineage). This makes it very much unlike the other liabilities I listed (such as increases in the material costs to build and maintain a brain, or brain vulnerability to injury and deprivation), which can never be avoided in any natural evolutionary circumstance, yet could easily be avoided by an omnipotent engineer. Increased maternal mortality, on the other hand, could be avoided even by a merely human engineer. All you need is someone willing to give a damn. For a race of manufactured androids or lab-grown humans, for example, could easily avoid the problem.

But accidents of evolution could also dodge the bullet. For example, an alien race that lays eggs, or carries a fetus to term externally (like marsupials), or had already evolved a sufficiently large cranium before evolving a complex brain, would avoid the maternal risks of the cranial enlargement required to evolve consciousness (though none of the other risks). For scientific reasons I suspect these circumstances will arise less frequently in the universe than evolutionary paths comparable to mammalian development on earth (e.g. eggs are not as efficient a means of storing and supplying the vast energy and nutrients required for the development of highly complex embryonic brains, trying to grow such complex embryos outside a protective womb brings its own magnification of attendant risks that reduce its evolutionary frequency, and the convenient good luck of pre-evolving a big head would be inherently rare).

But I must admit my argument might not apply to maternal mortality on all hypothetical worlds (as the question then of relative probability is more problematic). It only applies with certainty when assuming circumstances like those observed on earth. For on earth, given our confirmed history, the only path from pre-human primates to sentient humans is a path of mommy-killing brain enlargement. Unless there is an intelligent engineer in the mix. Hence the use of this item in my AMBD.

The Challenge

More recently I met some rather fanatic defenders of "natural" childbirth (complete with the usual condemnations of hospitals and doctors and all the trappings of modern medical care) who all claimed that women were built perfectly and have no problem pushing out babies, and in fact all maternal deaths are the result of other factors (like, say, various forms of systematic malpractice by evil men). That's exaggerated, and as much propaganda as fact. But it's also a straw man. Obviously most women get through childbirth fine, especially in the modern era of surgery, sanitation, nutrition, antibiotics, and the ever-convenient recourse to calling 911. In fact, even in the worst conditions--like modern Afghanistan or the primitive Andes--most women get through it alive. After all, even if 1 in 5 die, that means 4 in 5 live. Anyone who has a basic grasp of math can tell, even in the worst of places, that most anecdotes will turn out well.

But they don't all do. It's not all roses and mother goddesses. I once personally met a women whose vaginal canal tore during childbirth, and she would have bled to death, but for the surgeons that were conveniently around at the time. Statistics from some of the studies I referenced above show that most women who die in childbirth do so from bloodloss or obstruction, two effects that would certainly be reduced (though not eliminated) if our heads were smaller. To get the point, one need merely compare our rate of maternal mortality in the wild, with that of cats or chimps (which is certainly less than 1 in 60 maternal deaths per child, and probably far lower, judging from what I've seen, though I could find no clear-cut data). At any rate, no matter how many happy stories you have to tell, there will still be some very unhappy ones to go along with them. How many will be a direct factor of where and when you happen to live. In other words, it's a direct factor of access to improved conditions.

Oh, and of course, for many women (though not all), even if it goes well, it hurts like f*cking hell. It seems hard to deny it would hurt a lot less if those heads weren't so big. I have met some women who had no problem with the pain, but then I've met far more who had every problem with it. Of course, God says he did that to women on purpose (Genesis 3:16), which qualifies him as an assh*le. But even if we set aside compassionate design parameters (like "build it to work better so it hurts less"), and even when we add the fact that eliminating maternal mortality altogether would certainly require many more design changes besides, it's still a fact that if babies had smaller heads, they would kill fewer moms. We can only quibble about how many. But that's of no consequence to the general point. The idea of "acceptable losses" in this case is only an option for the impotent. The omnipotent can have nothing like that excuse.

Addendum: More scientific research on this subject is cited in comments by Richard Carrier on January 29 and February 12.

23 comments:

RantingAndRavingAngryPharmacist said...

[quote]Of course, God says he did that to women on purpose (Genesis 3:16), which qualifies him as an assh*le....We can only quibble about how many. But that's of no consequence to the general point. The idea of "acceptable losses" in this case is only an option for the impotent[/quote]

Once again, I agree with a lot of what you say in your article. I don't agree with your conclusion that because of maternal deaths, God *must* be impotent (although that could be posited as a possibility). 3 of the world's major religions--Jew, Christian & Muslim will agree that the large head ie pain was implemented as a direct punishment to women. These 3religions will also say that death was implemented as a punishment for everyone in the Garden of Eden. You could make a better argument about the fairness of this (or even the likeliness of this). A God that lets his creatures die (for whatever reason)is not necessarily impotent.

Another possibility aside from the Genesis account that I've heard posited is that God is not all-knowing, even though he is a supreme being with creative powers. The idea is that God creates, learns & grows from his creation. Like Picasso, his earlier works may look quite different from his later works. Some "guided-design" evolutionists believe this--that God created bacteria, built on that as his knowledge grew, eventually made an ape-like precursor to humans, tweaked it a bit, and got a human. And presumably may tweak his creation again in the future--perhaps giving safer & pain-free births. An argument can be made that this seems an unlikely pathway for the creator, but it's still at least a theoretical explanation of why babies heads are to big for mom's hips.

I'm one who is loathe to totally discount any possible explanation (although in practical everyday living, I, of course, make decisions based on the practical likelihood of an explanation.)

On a tangent, since this has nothing to do with maternal mortality in the wild, but religious belief does directly contribute to deaths in childbirth--from the fanatical natural birth advocates (who range from extreme conservative Christians to Pagan Goddess worshipers) many who eschew even midwives, to Jehovah Witnesses refusal of blood transfusions

(recent sad example)

http://news.bbc.co.uk/2/hi/uk_news/england/shropshire/7078455.stm

Agnostics_R_Us said...

RC,

I follow the argument...I would never make it myself. Partially because I'm not about to keep tabs on obscure statistics and because it brings down considerations of God intentionally doing it from a Scriptural standpoint (which you only “footnoted”). Not enough bang for my word count, I think. By the time you’re done justifying all the extents, you might as well have just made a different argument.

I don't think arguments from "bad design" are that great in general since it’s very arbitrary and anyone can just assume you don't know what you are talking about (and be plausibly correct). As long as it’s really complicated and appears to do something…who knows? There may be some tradeoff at some level you’re not considering, etc or that drag in the system is intentional for some grander extortion scheme. Naturally you should be making moral arguments about the extortion scheme instead. The likelihood of inefficient design (that has no plausible connection to a Genesis curse or degeneration in the meantime) seems high but the probability of proving that to a sufficient degree especially to an audience that is not well known for its…uh…competency is extremely low, imo. In a non-contentious context I would just nod my head at the articulation of a reasonable inference, but in a game where you need to know for certain you are correct…I don’t think it flies. You’d really have to have a proof of concept in a feat of genetic engineering that clearly blew away the competition in measurable long term ways. Not to mention, mom’s everywhere would thank you….or at least the new moms would.

I also wonder about the wisdom of presenting such an “entrepreneurial” argument like this in a debate. Could Wanchick go check all the miscellaneous facts on his own time? I guess it was a write in debate. Perhaps I’ve answered my own complaint here.

On another side of the topic, what I do enjoy is making fun of the creationists that appeal to the Lorber, “ Do You Really Need To Have A Brain?” ‘research’. Lol. It was even asserted that the people who supposedly were missing 95% of their brains exhibited a higher IQ! Thus, I tell creationists to go get lobotomies to prove that the mind is spiritual and to increase their ability to make intelligent arguments. No one has yet taken me up on this. Can’t figure out why. They must think the brain is like Styrofoam chips…just filler so it doesn’t make an unpleasant hollow sound when you smack it up side the head for being so retarded. Lmao

“I know what’s wrong with this watch! It’s full of gears!” -Mad Hatter

ARU

Bad said...

"3 of the world's major religions--Jew, Christian & Muslim will agree that the large head ie pain was implemented as a direct punishment to women."

Didn't you ever watch Batman. It's one thing to cause mothers pain, but if you KILL THEM, then they won't learn nothin.

This is actually a pretty significant point in theodicy. It's one thing to say that maybe pain and destruction play a role in improving human character, or whatever. But designing those calamities so that they kill instead of maim then makes little sense, and especially little when it is infants that are killed: how are they supposed to learn great lessons from suffering if they are killed off before they can even put together a coherent thought?

Agnostics_R_Us said...

Bad...but think of all the lessons those *women* learn from having those unknown miscarriages flushed with their menstrual cycles? You really don't think things through, do you? lol

If God's line of reasoning followed the Riddler, I take it we can expect to defeat God in the end because he didn't do away with us when he had the chance? lol

ARU

Vance said...

Maybe the knowledge of good and evil requires a bigger head. As I read Genesis 3 the pain in childbirth is not part of the curse, but rather a consequence of what Adam and Eve did.

Agnostics_R_Us said...

Um...the curse is a consequence of what Adam and Eve did...just like a spanking is the consequence of what toddler x did at the grocery store yesterday. I don't know why you're trying to make weird distinctions...

Either way, knowledge of good and evil didn't know to grow on trees you know.

Which brings up an interesting point...if money is the* root of all evil, then at one point money really did grow on trees...or at least one of them...half of it...or whatever. haha

*Btw, I know that's a misquote...

ARU

Agnostics_R_Us said...

didn't *need...

Sorry

DFB said...

The pain of childbirth is not part of "The Curse?" Okay, cool. I'm with you there. But wait.. it's a "consequence of what Adam and Eve did??!!"

I don't know. My head hurts. What did they do? Have sex?

Did I miss something while I was busy NOT listening in Sunday School? For god's sake, man. "The Curse" IS the consequence of what Adam and Eve did! Isn't it? What Bible are you reading?

Richard Carrier said...

What did Adam and Eve do? They ate a plant ovary. Did it cause a genetic mutation in their gamete cells that resulted in swollen human baby heads? Does that mean Adam and Eve were pinheads, and only Cane and Abel (and all their progeny) got these monstrous melons on a toothpick?

Humor aside (well, okay, not entirely aside), I think it's fair to call it a curse, since God arranged the cause-effect sequence here, no matter how you interpret it. If God made the fruit have this bizarre, harmful mutating power, he chose to do that.

But no matter, for certainly Eve eating a plant ovary didn't suck the serpent's legs off, yet God included that effect in essentially the same curse, so it looks like a good proper curse to me, not some chemical reaction to eating a weird kumquat or something.

Of course, bad fiction frequently makes little sense, so it's really about what the authors thought. And they clearly thought God was responsible for painful labor. That was the God they chose to worship: the one who did that to women, and counted it righteous.

Richard Carrier said...

Vance said... Maybe the knowledge of good and evil requires a bigger head.

That's exactly what I argue is not the case in the Carrier-Wanchick debate.

For example, such knowledge cannot logically require a big head, since God has no big head and yet has knowledge of good and evil (or so believers should hope!). If it is not logically necessary, then it must be contingent. According to most forms of theism, all contingent facts are created by God.

Or by human free will (assuming that's even a coherent concept to begin with). But I can no more choose to swell human heads by an act of free will than I can choose to leap tall buildings in a single bound. Which leaves God as the only available culprit, or at least an accomplice before-the-fact.

Richard Carrier said...

I'd like to remind everyone, you don't need to use * and can't use [ codes in comments here. You can use some real HTML, i.e. the letter I in angle brackets instead of * will produce italics. For example:

Oh fruit of God's knowledge tree, woggy sucky suck be, forsooth the Eve of our destruction, despite divine instruction, God bestowed her no knowledge of what was wrong to do, then punished her for learning how to tell, for true! Oh the author of Genesis must ever be, the original Joseph Heller, I see.

Okay?

Richard Carrier said...

Agnostics_R_Us:

We don't "need to know for certain we are correct." Thus inferences that follow from what we do know (in the tentative sense entailed by any proper empiricism) validly govern what we are warranted in believing. That is why the argument works well (and you should read its form as I presented it in the Wanchick debate to see why).

In other words, it does no good to claim I "possibly" don't know something. Possibly, therefore probably, is a fallacious mode of argument. I can only warrant beliefs based on what I actually do know. If therefore I am wrong because of something I don't know, the only way you can warrant correcting me is by showing me what I don't know. That's how it works. If you can't, then my beliefs remain warranted by the information available to me.

Don't confuse the question of whether a belief is true with whether it is warranted. Many false beliefs are warranted (cases at law are filled with examples, often associated with the reasonable man defense). But until we find a way to become omniscient, all we can do is rely on warrant, and allow new information to correct us when it becomes available.

The trick is to employ a method that assigns warrant more often than not to what's true, and stick to it. But then all we have to do is keep applying that method until someone presents us with a method demonstrably better. As long as we've done that, we've met our epistemic responsibilities.

Richard Carrier said...

RantingAndRavingAngryPharmacist said... I don't agree with your conclusion that because of maternal deaths, God *must* be impotent...[for] a God that lets his creatures die (for whatever reason) is not necessarily impotent.

Good point. He's just evil. But then, I did mention that very possibility. But in my closing remarks that became moot. For being evil isn't an "excuse" (i.e. no one accepts that as a defense), whereas impotence is.

As to your hypothesis of a modified process theology (let's call it MPT), that would not apply to the Carrier-Wanchick debate (as there Wanchick defined God in such a way as to exclude MPT).

MPT might get around the AMBD, but I doubt in any way that would successfully lead to belief in God (hence my example, similar to yours, on pp. 253-54 of Sense and Goodness without God). Especially since you would have to so arrange and embellish MPT that the proposed God would have an equal (or greater) probability of giving us brains (rather than brainless souls such as he has) than naturalism already has (and that probability is already very high). Otherwise the AMDB stands, even against MPT.

MPT also faces a problem of internal consistency and is thus hard to construct. For example, we humans can already tell what the obvious fixes would be (especially given anything close to godlike powers). So if God hasn't made these fixes yet, then he is stupider and more ignorant than a good portion of the entire human race, which contradicts the intelligence and knowledge (and powers of creation) that he would have to have had in order to design something as complex as even bacteria (much less a universe such as ours, with its extremely complex particle physics).

Hence MPT is internally inconsistent and therefore automatically false...unless you add a whole buttload of ad hoc theoretical "tinkers" to get it to work, which would vastly reduce its prior probability, and thus make it a poor contender against naturalism right from the start. Alhough that would have to be hashed out in a wholly different debate.

Agnostics_R_Us said...

I guess its that difference between undefined theism being able to swallow anything whole and the basic tenets of naturalism given what we know being much more intimate with the data with the fewest assumptions at work. Tricky balance to maintain.

paul01 said...

The last comment you directed to agnostics_r_us reminds me of the Comprehensively Critical Rationalism of William Warren Bartley III. Are you familiar with it?

paul01 said...

Of course I meant to address the last question to Richard.

jqb said...

Why expend so much energy arguing against an idea that has nothing to recommend it in the first place?

Richard Carrier said...

Paul01 said... The last comment you directed to agnostics_r_us reminds me of the Comprehensively Critical Rationalism of William Warren Bartley III. Are you familiar with it?

No.

JQB said... Why expend so much energy arguing against an idea that has nothing to recommend it in the first place?

What "idea" are you talking about?

Wildner said...

Personally, Richard I do agree that you are brilliant. However, I still disagree with you on this point. (I'm guessing I'm one of those "fanatical defenders" of "natural" birth, though I don't disparage necessary technology, only unnecessary and misused modern medical technology.)
There is an abundance of evidence to suggest that current obstetrical practice does more harm than good.
Also, the research you cite is predicated on the ASSUMPTION that birth is painful and dangerous, and that the reason for this is our 'monstrous heads'. Might there be a little bit of Pygmalion Effect in action?
Please see www.fearlessbirthing.blogspot.com to see videos of many women giving birth easily, quickly and painlessly. Please consider the evidence behind the reason WHY birth is not the dangerous event you insist it must be.
I agree with you on the God thing. I agree with you that modern technology, meaning that access to birth control, abortion, antibiotics, blood replacement, emergency access, better nutrition and better sanitation all contribute to better outcomes. My only issue is with the insistence that mortality in humans is due to the birth process itself, specifically the size of the infant brains in relation to the structure of the maternal pelvis. Oh, and the contention that birth must hurt like "f*ckng hell".
Just because you met someone who tore and might have bled to death means little. It would be easy to find numerous examples of situations in which mother and baby were killed by the misuse of technology; mothers who would have lived had they birthed naturally.
Death is inevitable. There will never be a time when there is zero mortality or morbidity in birth, or in life. Period. However, from places where both maternal and infant mortality and morbidity are low we can learn what contributes to both...if we are willing to see. I'm not arguing that Nature is always fair, for humans or any other living thing on the planet. I do however, respectfully suggest, that to sink to a discussion of a "race of manufactured androids or lab-grown humans," or "an alien race that lays eggs" is to reduce this to meaningless rhetoric and perpetuate the belief that "God Kills Mommy", which I don't belief is truly your assertion. (Yes, I do get sarcasm, and in appropriate situations appreciate it. I'm just saying here you are stooping to a low that I feel is below you.) I certainly admit I could be wrong, but I thought your argument was AGAINST the idea of an assh*le God with a warped sense of humor. However, it sure seems to me you are hellbent on proving just the opposite.

Wildner said...

Richard, the god debate is not my thing. I can’t even begin to think about God/not god at your level, not just because it hurts my (big?) brain, but because I don’t care one way or the other if God exists or not.
What I do care about, however, is assertions about birth not based in anything but a stubborn desire to torture the facts until they serve a purpose. In this case, to prove that ‘god kills mommy’, or ‘there is no god because no god but a warped one would do this’ based on your belief (and it is a belief, defied by the facts) that the design for the process of birth has many flaws. I’m going to explain why this isn’t so, not because I believe it will convince you to stop promoting the idea that it is (after all, you of all people should know you can’t change a belief with facts), but because it drives me nuts that you do it, and I feel somehow compelled to set the record straight for other misguided souls who may actually give a damn? (And BTW, I do appreciate that you took the time to look all this up, even though I’m about to explain to you why these are spurious correlations at best.)
I’m not even going to get into the numbers on pre-civilized populations. My problems with your statement in The God Who Wasn’t There were a.) your numbers, which you have conceded were inaccurate and b.) your contention that the reduction in maternal mortality was solely due to modern obstetrics compensating for the damage you insist big heads do.
Beyond that, I think we can agree that better sanitation, the discovery of antibiotics, better nutrition, birth control, blood replacement, education, etc. reduced maternal mortality. I do not argue that in cases where life saving technology is warranted, it isn’t useful; only that it isn’t necessary most of the time because birth is not a dangerous process. This, I believe is where we part ways. It’s like me saying that because millions of people died of diarrhea in the past, and still do in undeveloped places, that digestion is a dangerous and flawed process, requiring all of us to live on Ensure because some people get sick. Could untold millions be saved if we did? Sure. Are there reasons we don’t? Would something be lost in our human experience if we did? Absolutely. How many people have died from pre-civilization until today of choking? Bleeding ulcers? Stomach cancer? Salmonella? E coli? Does that mean that the process of digestion is flawed? Well, it means it isn’t 100% perfect. Certainly it means that the more we know the better we do. It means that in countries with better sanitation, nutritious food, antibiotics, etc. have fewer deaths.
I’ll get to why the statement “God blasts moms away with a whole physiological shotgun of design flaws” is just dead wrong in a minute. First I want to address the evidence you provided to back up your theory.
First, I found "Many Afghans Lost to Hazards of Childbirth: Traditions, Terrain and Inadequate Care Put Mothers and Newborns at High Risk” to be an excellent article. I didn’t see why you would choose it to prove your point. Right in the title, the author lays out that it is culture, geography and an absence of trained midwives that costs women their lives in the childbearing year. She talks about women bearing children every year either due to lack of birth control or the cultural objections to using it if they had it, and of death due to hemorrhage. What she doesn’t tell us is why the women hemorrhage. Do these communities practice the form of female genital mutilation wherein the mother’s genitals have been cut away in puberty, then sewn up, leaving only an opening large enough for urine and menstrual blood? The form of FGM that requires the woman be cut on her wedding night, and then cut when labor begins for before the birth of every child? Do the cases of obstruction have anything to do with this practice if there is no one there to cut her when she does into labor? Is there obstruction due to rickets because nutrition is so poor? She doesn’t say. In story of the mother with the 3 week old baby dying because the mother had an insufficient milk supply, we are not told if the mother subscribed to the belief that colostrum should be with held from the baby until the milk comes in, which would compromise the milk supply. We don’t know if the baby was tongue-tied. In fact, we don’t know why the mother didn’t make enough milk. You of all people surely understand the importance of variables such as these.
She does tell us that these women are illiterate. She tells us that many of these women die because no one in their villages knows how to assist them. She explains that the villages are geographically isolated and further, that dependable transportation costs some women and babies their lives. These are socio-economic and cultural issues, not biological. If anything, these variables illustrate that men are *ssholes who consider women and babies expendable. This is reinforced in "African Ambassadors Seeking International Help for Women's Health in Africa." AIDS is the biggest health concern for pregnant women right now. AIDS that women get from their husbands and little girls get from being raped. The article goes on to say,
"Under-age and forced marriages, adolescent pregnancy, illegal and unsafe abortion, unattended deliveries, and the lack of emergency [emphasis mine] obstetric care are among some of the most serious causes of maternal mortality on the continent," said Khama Rogo, the World Bank's lead Health Sector specialist.
I would respectfully suggest that lack of emergency medical assistance would be a problem in general. Further,
“In the last 20 years, Africa has made little or no progress in lowering child and maternal mortality, in advancing family planning, and in ending genital mutilation, still practiced in 28 African countries”
And:
“Understanding and influencing the politics [my emphasis] of sexuality is key to advancing women's health in Africa,"
All of this supports my point, not yours. In fact, this is pretty well summed up in:
"Promoting women's health is consistent with advancing the broader agenda of women's empowerment, [again, my emphasis]" said Louis Kasekende, the World Bank's executive director for the Africa region.
Finally, all the last article you supplied says is that more mothers die in poor black countries than rich white countries. Duh. Again, this is an economic issue, a woman’s rights issue, a cultural issue…not biological. Besides, I’d venture a guess that ALL mortality is higher in sub-Saharan Africa, so wouldn’t it stand to reason that maternal mortality would be also?

Ok, now onto your assertions in your book Sense and Goodness without God (on pp. 153-54). You said, “…if our heads weren't so big, "fewer mothers would die in labor"” This is where I take issue. You then go on to say (on the blog), “Though in technical detail that's an over-simplification, it's still true.” It’s not. Shoot, using that logic, just because some mothers/babies die due to shoulder dystocia, the fact that we have arms is a design flaw. And because I’ve known cows and dogs to die because their offspring, with small heads and brains, got stuck, the fact that any mammal anywhere gives birth at all is a design flaw. All beings everywhere would just instantly manifest if there was a just God. Nice idea, I suppose.

So, now to the design that IS NOT flawed…

First of all, you have been operating on the premise all along that birth is dangerous and painful. You seem hell-bent on clinging to this, but I hope you at least will consider for a moment that all you have demonstrated so far with your sources is that it is dangerous and painful to be a WOMAN throughout history and in poverty stricken areas, and that it is MEN who make this so, not God, not evolution. As for the pain, this too seems to be an idea to which many people cling, ironically, most of the time because the Bible insists it must be so. There is a correlation between birth and pain to be sure, but birth itself (including the size of the head) is not causal. There are a lot of variables. Go here: http://www.fearlessbirthing.com/Pain.pdf for an explanation, and here: http://www.fearlessbirthing.blogspot.com for videos of painless, fast, easy, not complicated, ecstatic and even orgasmic births. Throughout time and in many places there are plenty of women who give birth easily.
Now, you speculate that “accidents of evolution could also dodge the bullet. For example…”an alien race that lays eggs, or carries a fetus to term externally (like marsupials), or had already evolved a sufficiently large cranium before evolving a complex brain, would avoid the maternal risks…” You actually aren’t far off. Human babies are born with an immature brain, as dependant beings, precisely because evolution works. When human babies are born, they cannot regulate their temperature, they cannot feed themselves, they cannot move from point a, to point b, they cannot communicate, they cannot even regulate their breathing in their sleep very well. They are (or are designed to be) in a symbiotic relationship with their mother that does all that for them. They are meant to be carried at all times next to the mother who provides nourishment, warmth, stimulation for their brain growth, which triples in the first year of life. If we parent the way nature/evolution designed it, human babies are very marsupial-like. Just because we can artificially feed our babies, leave them in cribs and carry them around in plastic buckets we call ‘car seats’ when they are no where near the car doesn’t mean we should. All of these practices lead to unnecessary infant deaths, but that’s another subject. The point is, they are born in this dependant state with small brains so they will fit through the upright maternal pelvis. There is accelerated brain growth for the first 3 years of life, and continued growth through the teen years. In other words, yes, we have big brains, but we aren’t born with Pinky sized heads. We are born with species appropriate sized heads that nature/evolution/God has determined is the biggest we can fit through the maternal pelvis WITHOUT KILLING MOMMY.
So, you once “personally met a women whose vaginal canal tore during childbirth, and she would have bled to death, but for the surgeons that were conveniently around at the time”. Was that woman forced to birth on her back with her legs in stirrups? Was she forced to push against the natural prompting of her body? There are a number of variables that cause perineal tearing that are all about the artificial contrivances of modern obstetrics that have nothing to do with the natural process of birth. Do you know how many women have suffered 4th degree lacerations, leading to cystocele, rectocele, and fistulas because of the “convenient” surgeon? Women are built like accordions, with lots of extra skin that is ‘taken up’ to allow for the passage of a baby, whose skull bones are not fused to allow the fetal head to mold. You knew a woman? Well I’ve known dozens of women, and heard many more, that when allowed to birth naturally, had healthy 10, 11 and even 12 lb. babies over intact bottoms, many painlessly or nearly so.
That is NOT to say that modern medicine is not helpful in childbirth. Just as learning the Heimlich Maneuver has saved chocking victims, the Gaskin Maneuver has saved stuck babies. (Ina May Gaskin is a midwife, incidentally. Many doctors still break the baby’s collarbone or resort to major abdominal surgery if a large baby is suspected.) Did some die before the discovery of the maneuver? Yes. Will some still die where no one is aware of the maneuver that exists? Yes. Will some die even if the maneuver is improperly (or properly, for that matter) executed. Yes. Does that constitute proof that God doesn’t exist because if He did he would have provided us with a way to obtain nutrition that was risk free? Maybe. I guess in my world it just means sh*t happens.
I’m not here to argue for or against the existence of a God. Like I said, I don’t care what anyone believes and I know I’m not smart enough to debate you on it even if I did. What I do argue is that if ‘birth’ is painful and dangerous, it would be so for all births. It’s not. If ‘modern medicine’, which you seem to imply is obstetrical management to deal with this ‘big head’ theory that creates higher maternal mortality rates because ‘god kills mommy’, then why are maternal mortality rates lower in places where the surgical specialty of obstetrics, including all the machines that go ‘pine’, are used sparingly? Why is it that in places where midwives attended and natural birth is preferred to women have better outcomes?
Argue what you will for or against the idea of intelligent design, but please, when it comes to birth, I respectfully suggest you are using the wrong premise for your argument. When it comes to the process of birth, I do know a bit, and conventional science has been working on the wrong premise of what ‘natural’ birth must be because the Biblical assertion that birth must be dangerous and painful is so culturally ingrained, not because it must be so. I would think you would be all over trying to disprove that.

Richard Carrier said...

Wildner: Your long, rambling, just-this-side-of-fanatical rant contains very little of any substance. I actually already agreed with 90% of it in my original blog entry, where I acknowledge nearly every point you make, but show how it does not affect the overall conclusion. The remainder you treat like a dogmatist rather than a scientist.

For example, I agreed that sometimes things turn out as you say (in fact, most times). But I have personally seen the contrary, and know many other cases. This applies to pain, as well, which I know has been commonly reported since antiquity and is commonly reported to me now by many mothers, hence the similarity between the two cannot be due to "modern medicine." And scientists have documented the fact extensively. Hence science, history, and personal experience all contradict your false generalizations.

I think you are engaging the fallacy of selection bias: you are ignoring all evidence contrary to your belief, and only showing evidence that agrees with your dogma. You focus on the easy births and ignore the hard ones. And when contrary evidence can't be ignored, you simply "invent" whatever you need to be true in order to maintain your belief, just like creationists do, "explaining away" any inconvenient facts however you can imagine. For example (and this is just one example...you did this many times) you fabricate the myth that the tearing incident I reported was "caused" by malpractice, despite having zero knowledge pertaining to that case, and citing no scientific studies of any kind whatever even in support of a generalization that would warrant the supposition. In other words, you simply "made up an excuse" to ignore my contrary evidence.

That behavior demonstrates to me that you are not behaving rationally, but simply constructing whatever story you need to maintain your belief. You did this again when you claimed FGM could be responsible for maternal mortality in Afghanistan, even though in literally twenty seconds of searching universally available facts I found that FGM only occurs in Africa and some southern segments of the Middle East, and not Afghanistan (I already knew this, but I checked to see how long it would take to find several authoritative websites demonstrating it, e.g. Wikipedia has an excellent page on it, but don't take its word for it, there are many others of even greater authority). So instead of checking the facts, you just made up a story that was convenient to you.

If a departure from natural birth to medically assisted birth were at fault for maternal mortality (as you claim), why has that mortality consistently declined with increased recourse to medically assisted birth (both geographically and chronologically), and why was it never higher than when medicine didn't even exist, or isn't at all available? It makes no sense to blame "culture" (which you do, confusingly listing dozens of unrelated cultural factors as supposed culprits--again just making up your own theories without any science backing those alleged causal links) when animals don't have these problems. Though they have other problems (as even you observe and, I'll remind you again, as even I said from the start), their maternal mortality rate is substantially lower than ours. So why do humans need culture to prevent maternal death? You never seem to ask that question, and have no evident answer.

Likewise, I already said there were many causes. And you list many yourself...nutrition, for example, is as much a biological problem as a cultural one (see below)...but it is entirely biological for pre-urban populations in the Andes, which are comparable to any wild animal in terms of the resources that are and aren't available for easing maternal mortality, and yet the rate was inordinately high. Malpractice can't be to blame. And you have no scientific evidence it ever has been. You just made up that myth because it's convenient.

As my original blog said, it does not matter how many other causes there are of maternal mortality--for the circumstantial evidence is nevertheless overwhelming that cranial size makes a difference. You can only quibble about how much. Unlike you, science is behind me on this, even with regard to post-natal brain growth, which does not affect anything I said. According to The Cambridge Encyclopedia of Human Growth and Development (1998), section 2.3 (p. 104):

Humans have rapid brain growth before and after birth. Relative to body-size, human adult brain-size is 3.5 times larger than the chimpanzee. The rate of human brain growth exceeds that of most other tissues of the body during the first few years after birth. Human neonates also have remarkably large brains (corrected for body-size) compared with other primate species

Consequently:

A 'human-like' pattern of brain and body growth becomes necessary once adult hominid brain-size reaches about 850 cubic-centimeters. This biological marker is based on an analysis of cephalo-pelvic dimensions of fetuses and their mothers across a wide range of social mammals, including cetaceans [e.g. whales, dolphins], extant primates and fossil hominids. Given the mean rate of post-natal brain growth for living apes, an 850 cubic-centimetre adult brain-size may be achieved by all hominids, including extinct hominids, by lengthening the fetal stage of growth. At brain-sizes above 850 cubic-centimeters the size of the pelvic inlet of the fossil hominids, and living people, does not allow for sufficient fetal growth. Thus, a period of rapid post-natal brain growth and slow body growth--the human pattern--is needed to reach adult brain-size.

In other words, humans are at the maximum possible survivable neonatal brain size, in contrast to all other mammals, which are nowhere near that. Therefore, all complications relating to cranial size will not only be far more frequent for humans than any other mammal (this is necessarily the case as a consequence of the evident facts), but they will also be at the maximum possible frequency for differential reproductive success (i.e. the highest rate of cranial-size-caused mortality that the population can sustain and still have some slight advantage over any other competing population), since we can demonstrate scientifically that any further increase in neonatal brain size would be catastrophically fatal. Thus, we are at the very limit of endurable neonatal cranial size. This makes sense for Mother Nature, who doesn't care how many die or suffer as long as enough live, but it makes no sense for a compassionate Engineer, who could easily do better (especially when we know he can give us minds without brains in the first place).

In fact, ironically, your claim that poor nutrition kills mothers actually supports my point in an entirely additional way: since it is a scientifically documented fact that fetal brain growth requires such enormous nutritional demands that it can easily deprive mothers of needed nutrition for their own bodies, which is in fact linked to another leading cause of maternal mortality: eclampsia. See "Towards a new generation of research in eclampsia." It remains a fact that this would not be an issue if brains were smaller (or if we didn't need them at all, as in fact we wouldn't if a God created us). Thus, even when "culture" causes poor nutrition, it still would kill less mommies if God had made us with smaller brains.

Wildner said...

I’m sure you’ll correct me if I’m wrong, but let me try to get this straight. Your assertions are that ‘god kills mommy’ (your colorful way of saying humans have higher maternal mortality rates than other mammals) because of monstrous heads with big brains, which also means labor hurts like f*cking hell. You then provided references that proved NO SUCH THING because the possible variables were not accounted for in the references you supplied. I questioned what those variables might be. We agree on everything but pain, risk and the medical establishments roll in both. You’ve still supplied no evidence to support your assertions as absolute fact, but since you accused me of making stuff up, I’ve provided references (well, as much as I can fit in a blog response, but I’ll supply as much as you want). Actually, I anticipate you won’t even bother reading (since you obviously didn’t the first time) it or checking my sources, but if there is anyone reading your blog who gives a damn, they may appreciate it. If not, maybe I’ll put it up on my blog, since I’ve already looked all this stuff up. So, here goes.

I did not make up “a story that was convenient” when I questioned what the contributing factors might be in Afghanistan. I ASKED if FGM was a variable, a reasonable question to ask as “clinical association between genital cutting and obstetric morbidity may occur in populations that have undergone more severe forms of cutting” (Abstract, Slanger, Snow and Okonofua, 2002). I will admit I don’t know every single place where FGM MIGHT BE practiced, only that it is common in the Middle East and Africa. However I am really relieved to know that YOU know where FGM might or might not be a variable in obstetric morbidity. In the two sentences preceding my QUESTION about FGM, I had already mentioned some of the other variables when I said, “Right in the title, the author lays out that it is culture, geography and an absence of trained midwives that costs women their lives in the childbearing year. She talks about women bearing children every year, either due to lack of birth control or the cultural objections to using it if they had it, and of death due to hemorrhage. What she doesn’t tell us is why the women hemorrhage.” Therefore, I had touched on several variables that can lead to hemorrhage, and ASKED what OTHERS might be because there were so many possibilities that were not mentioned. I think we have agreement there. I hate repeating myself, but if you are going to distort what I actually said, I have to.

I conceded that we already agreed on many things, but thanks ever so much for scientifically quantifying the amount at 90%. I likewise agreed that there was a correlation between pain and birth, but that there were variables that contributed to that pain, which is to say I questioned the absolute assertion you make that big heads cause painful birth. I did not say labor was never painful. I said it doesn’t always have to be, and if it could be comfortable even with lots and lots of big headed babies, then the big head theory doesn’t make much sense. If the leading causes of maternal death are not a direct, or indirect, result of big heads, then the theory doesn’t make sense. You seem to be using circular logic to support your point. Everyone knows labor is excruciating because you know lots of women who found it excruciating, therefore it has always been excruciating and always will be because everyone knows it is. Thus, I pointed out there are lots of women who have quick, easy, joyful and painless labors. You say my examples are anomalies. I say yours are. I then touched on a few of the things that cause pain in labor and you vehemently disagreed with the contention that much of the pain of labor comes from medical management. Below I detail, with citations, why it does. In any case, dozens of wonderful birth stories can be found in Sheri Menelli’s book, Journey into Motherhood: Inspirational Stories of Natural Birth. I did not dismiss your view, however you have dismissed mine.
You said, “This applies to pain, as well, which I know has been commonly reported since antiquity and is commonly reported to me now by many mothers, hence the similarity between the two cannot be due to "modern medicine." And scientists have documented the fact extensively. Hence science, history, and personal experience all contradict your false generalizations.” I cannot speak to your personal experience, of course, other than to say mine is quite different. I did not dispute what women report. What I did was provided links to video examples and news stories of babies that essential fell out. These happen on a regular basis. I’ve personally seen these sorts of birth intentionally created, and I’ve read hundreds of stories just like them.
As to ‘antiquity’, in The Manner Born: Birth Rites in Cross-Cultural Perspective, the author speaks to birthing in a field with barely a pause. (Dundes, 2003) In Buddhist Women Across Cultures: Realizations, in the entire chapter on childbirth, pain is never mentioned. While that doesn’t mean it doesn’t exist, it’s a pretty important thing to leave out.
There have always been stories of women giving birth painlessly. The most famous is the woman that convinced Dr. Grantly Dick-Read birth didn’t need to be painful. He asked her why she refused pain relief. She said, “It didn’t hurt. It wasn’t supposed to, was it?” He then went on to figure out why, came up with the idea of the “fear-tension-pain” cycle and saw many painless births, as did Dr. Lamaze before his ideas made it to the States in altered form. Both doctors proposed there is no physiological reason for pain, as does Dr. Goldman in Florida and Dr. Campbell in Georgia. I’d be happy to send you Dr. Campbell’s contact information, as he loves to tell people how he reduced his cesarean rate down to 2% and now has mostly comfortable mothers giving birth naturally with fewer complications just because he stopped messing with the natural process when he didn’t need to. Dr. Michael Odent has written books about our similarities to other mammals and has observed many mothers in France to see what women do when they are allowed to birth by instinct and natural reflex.

Then there are the mothers who give birth in their sleep. If you want to talk contemporary U.S. experiences, Montel Williams did a show on precipitous births, which included plenty of mothers who didn’t know they were in labor until the baby fell out, one in her sleep. Perhaps too gauche for you to consider relevant, but they are real women who had real babies. Just last week, a lady in my area was scheduled for induction on a Monday. On Sunday, she said she felt funny. In the car (much to the husband’s displeasure as he had literally JUST bought it) she asked him to look because something didn’t feel right, and the baby’s head was already out. They never made it out of the driveway. I figured their story would be in the paper, but they must have decided it was a private matter. However, I did find another one in Ohio, just this week. A 7 lb. 7 oz. baby fell out, and another one two weeks ago, a 4 lb. 3 oz., although the mother with the smaller baby (and presumably smaller head) was the one who said it hurt. Which is a point worth making: in mothers who experience birth as painful, mothers birthing preemies do not say their labors were any less painful mothers birthing full-term babies with bigger heads.

If you want to talk about ideas global of easy birth, Stanley, says, in (1995). Mother’s and Daughters of Invention: Notes for a Revised History of Technology (1995). “Although primitive women certainly considered childbirth to be painful, observers of both sexes consistently report that they give birth with relative ease (Goldsmith, 21ff; Murphy & Murphy, 163; Holmberg, 178; Du Bois, 31; Bates, 235). Tlingit women of Alaska have reportedly given birth while sleeping (Goldsmith, 23!) Even the Greeks and Hebrew myths underlying our own culture contain hints of a time when birth was less painful; Artemis’s mother Leto bore her without pains, leaving the Fates to make Artemis patroness of childbirth (Graves, Myths 1:83, 84); and the Expulsion form Eden condemns Eve to painful childbirth, implying that in the Garden things had been otherwise...” pp. 225

I do not dispute that there are scientist who assume that pain is inherent in birth, then working on that assumption ‘prove’ what makes it so. If pain in labor, length of labor, and complication rate can be reduced or eliminated naturally by controlling variables, and it can, (Gallagher, 2001; Martin, 2001; Tyre, 1990) then pain and inordinate risk are not inherent in labor, any more so than any other natural, physiological function. If they are not inherent in labor, and the theory is that big heads are causative in painful birth AND higher maternal mortality, then big heads are cannot always be a significant factor to maternal mortality. If big heads are not always a contributing factor to maternal mortality (or morbidity), then it is YOU who tenaciously cling to dogma in the face of facts, not me. I, on the other hand, continue to consider both evidential and empirical evidence.

Now, as for medical interventions creating pain, yes they do. See Wagner, Elkin and Goer for dozens of studies showing that: withholding food and water can create pain because muscles don’t function optimally; pitocin creates pain as contractions are longer, stronger and closer together; forcing mothers to lie on their backs puts the weight of the baby on the back, creating pain; unnecessary episiotomies and cesareans create pain; environmental dystocia if it leads to incoordinate uterine contractions (because we are mammals and the primitive brain gets thrown out of whack by all of the same things that impact the labors of other mammals). I could go on. Nearly every routine intervention done in current obstetrical management, without medical indication, creates stress, which creates tension, which leads to pain. When we are dealing with a medical indication, we expect to deal with some pain. Why introduce it where it didn’t exist when there’s no benefit but there is substantial risk? (In the books I cite throughout by Elkin, Goer and Wagner, there are too many medical studies to count that show most of what constitutes American obstetric management is of questionable benefit in a healthy population, and often introduces risk.)

Most often the ‘big head/upright pelvis’ is given as the reason that labor must hurt. As I asked before, what if they started out asking the wrong question? The Scientific Revolution didn’t happen until the mid 1500s, right? Christianity had infected much of the world by that time, through waves of Crusades, so the Biblical notion of pain in birth as punishment was firmly entrenched by the time any might even bother to question if it must be so. If they were working on an erroneous assumption, then the conclusions that follow are faulty. IF we are to conclude that a big head leads to higher mortality, we must show a plausible causation on a regular and predicable basis. Just consider, WHAT IF I’M RIGHT. Isn’t that what scientists do; ask ‘what if’? What would it take to convince you if videos of ecstatic birth don’t do it, and the scientific literature itself doesn’t do it? For if you bother to read the books cited here, you will find the data is taken directly from medical journals and WHO data. If I’m right the person who can prove it is a hero and goes down in history. If I’m wrong, only some women who believe me will be happier with their experience. I can live with that. But if you are wrong and keep perpetuating an idea that leads to such fear that women prefer to be cut open rather than experience it, or to flood their body’s with narcotics and ‘caine derivatives to avoid it, much harm is done. (Haire, 2001)

Besides modern medicine’s roll in the current state of birth, and the difference of opinion on pain, it would seem the only other thing we disagree on here is the big head. So, let’s just look at the fetal head and the maternal pelvis. The one thing that could reasonably be blamed on a ‘big head’ might be obstructed labor.

The WHO chart found here http://www.who.int/reproductive-health/MNBH/epidemiology.html says obstruction accounts for 4.1 percent of deaths in Africa, but 13.4 percent in Latin America. Is the contention that HUMANS have larger brains and big heads or LATIN AMERICANS?
Not all of these obstructions are due to big heads of course, some of the causes are malpresentation (head size not relevant), hydrocephalus (head size relevant, but due to pathology, not design), nutrition (those rickets I asked about in addition to FGM in my first post…just one of those pesky fake scenarios you insist I made up), and early marriage, which is one thing I didn’t even mention before, although it would be relevant in comparisons of historical maternal morbidity/mortality as well as global comparisons. In any case, you’ll notice that in developed countries, obstruction isn’t listed at all, which makes sense, right? After all, we have the ability to perform cesareans when obstruction occurs. But wait, there’s more! The authors say, “In developed countries, the most important cause of maternal death is "other direct causes" (21%), which includes largely ///complications during interventions such as those related to caesarean section and anaesthesia///…” [emphasis mine] Please note, the death rate from “other direct causes” is higher than the higher than the highest rate of obstruction.
Then, darn if deficient nutrition and early marriage don’t come up again in regard to obstructed labor in American Journal of Clinical Nutrition, in an article titled Nutrition and obstructed labor.
“The prevalence of obstructed labor varies from one country to another, but it is more common in developing countries (12) because of the lack of adequate health care delivery facilities, poor nutrition, poverty (13), and socioeconomic and cultural factors” (Konje & Ladipo, 2000) Please note, I am not ignoring ‘adequate health care delivery facilities’; that could include trained midwives. In areas where midwives are trained to serve birthing women at home and provide timely referrals to surgeons when necessary, which occurs 30% of the time or less (Wagner, 2006) outcomes are far better then the US in all areas. He also shows that in areas where sanitation, birth control, sanitation, education and nutrition all improved, but birth was NOT medicalized as in the US, outcomes improved much faster than here and are currently far better than here.

In one 10 year study of maternal mortality in India, where the MMR was 879/100,000 live births (the study spanned 10 years with 542 deaths out of 61, 660 births) there was NOT ONE obstructed labor listed as a cause of death. There were obviously many different causes of death, but not attributable to big heads. Do they have smaller heads in India?

Incidentally, I had already agreed with you that evolution led us to a place where our infants have the biggest brain they can have and still be born, so I don’t know what your point was there. You seem to use this information to prove acceptable loss in a flawed design. I see it as proof that evolution works, and it is highly unusual for mothers to grow babies that they can’t birth if the women are fully mature, have been adequately nourished while they were developing, and have not suffered pelvic damage, none of which have anything to do with design. You are saying evolution allowed the brain grew too large (if I understand you correctly). I say it grew just as big as it could and no more…in other words, just right. I further said that is why babies are born with immature brains, dependant on a symbiotic relationship with mom for months after birth. I did NOT ‘just make it up’. Dr. Harvey Karp talks about the ‘Fourth Trimester Theory’ in The Happiest Baby on the Block. His techniques works, the idea makes sense to me, and I sure hope it will be studied in depth.

If obstruction isn’t encountered often in the absence of pathology, what ARE the leading causes of maternal mortality? It depends on the source. If we are talking environmental/sociological/economic/geographical contributors, then “Maternal Mortality, AIDS Leading Causes of Death for Women Worldwide” according to The U.N. Population Fund (2005). That has nothing to do with big heads. The British Journal of Psychiatry says that suicide is the leading cause of maternal death, with murder also a leading cause. Still, these have nothing to do with big heads.

According to the WHO, hemorrhage is a leading cause of death in Asia and Africa. The Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, U.S. Agency for International Development says that hemorrhage is THE leading cause of death worldwide.

Ok, why? The leading causes of hemorrhage, include, “…uterine atony, vaginal or cervical tears (which has little to do with size of the head, but much to do with birth practices, and yes, it is cited later when I go into more detail), retained fragments of placenta, placenta previa, placenta accreta and uterine rupture. Hereditary abnormalities in blood clotting may cause hemorrhage as well” (Miller, 2004). Of those, only uterine atony or uterine rupture COULD be associated with cephalo-pelvic disproportion, but these are not even listed as a cause for hemorrhage, which according to Miller includes the following: prolonged labor, fetal macrosomia, [My note: not a ‘big head’ but a ‘too big baby’ which is largely a nutritional issue, and while I could go into why that is and cite dozens of references, I’ll leave that for next time so we can stay on task, something I will admit is exceedingly hard to do since you pose so many faulty assumptions about the process of birth that if I addressed all of them I’d have my own blog. Oh, wait. I do, and it does explain a lot of this, and I did provide a link, but obviously because you are sure you are right you didn’t bother looking at any evidence that might contradict what you already believe. And I’M myopic? Please! KW] oxytocin, grand multiparity, general anesthetics (halothane), Couvelaire uterus (due to abruption of the placenta), multiple gestation, dystocia, polyhydraminos, infection (chorioamnionitis).

Not listed is cesarean delivery even though as Miller points out, “Excessive blood loss or "postpartum hemorrhage" complicates approximately 4% of vaginal deliveries and 6-7% of cesarean sections”. The current U.S. c-section rate is 31%, twice the WHO recommendation, despite the fact that “…the maternal mortality rate for C-section—combining emergency and elective—is four times higher than the maternal mortality rate for vaginal birth. And the rate of women dying is still nearly three times higher when it is a routine or “elective” C-section without any emergency.” (Wagner, 2006) Episiotomy is also a significant factor in blood loss over 500 cc, which is obvious to anyone who has seen the difference between birthing over an intact perineum and being cut. It’s only common sense. When an episiotomy is cut through healthy tissue, there is a sheet with a pocket beneath the mother to catch all the blood, which in the cases I’ve personally seen is about 800-1000 cc.; a preventable, iatrogenic hemorrhage. There are several studies that show that 3rd and 4th degree lacerations, with the accompanying blood loss, are a result of episiotomy. I’ll supply them if you really want them, but they are also cited in the books referenced. (Enkin; Goer; Wagner)

In any case, please note that oxytocin and general anesthetics are included in the list about what causes hemorrhage, which brings me to my next point.

You used modern-day anecdotal evidence that big heads tear vaginas, causing hemorrhage. I offered anecdotal evidence that it doesn’t. As a woman with an actual vagina through which an actual human baby has passed, and having attended over 100 births, and having seen babies come out of other intact vaginas (as well as several that were cut without justification), and having access to thousands of birthing stories that could illustrate my point, somehow I felt qualified to join the discussion. I wasn’t aware I needed to be a scientist. I’ve never claimed to be one. I don’t even play one on TV. However, I can provide citations for everything I said. I wasn’t aware I was submitting anything for review. But please, for any topic I bring up that you question, I will gladly supply the science.

You say I fabricated “…the myth that the tearing incident I reported was "caused" by malpractice, despite having zero knowledge pertaining to that case, and citing no scientific studies of any kind whatever even in support of a generalization that would warrant the supposition. In other words, you simply "made up an excuse" to ignore my contrary evidence.” I DID NO SUCH THING. Again, I ASKED about the variables. Please note the question marks and use of the word ‘was’ beginning each sentence, “Was that woman forced to birth on her back with her legs in stirrups? Was she forced to push against the natural prompting of her body? There are a number of variables that cause perineal tearing that are all about the artificial contrivances of modern obstetrics that have nothing to do with the natural process of birth.” These are not generalizations. They are perfectly reasonable questions to ask considering both of these interventions in the 2nd stage of labor are known to cause damage to the pelvic floor (Hansen, Clark & Foster, 2002; Roberts, 2002; Moyer, 2004). In addition, according to A Guide to Effective Care in Pregnancy and Childbirth (Oxford Press, 2000) both are obstetrical interventions that should be abandoned due to lack of support by scientific evidence of safety and/or efficacy, as are many routine interventions in current obstetrical care.

Which leads directly to your question of, “If a departure from natural birth to medically assisted birth were at fault for maternal mortality (as you claim), why has that mortality consistently declined with increased recourse to medically assisted birth (both geographically and chronologically), and why was it never higher than when medicine didn't even exist, or isn't at all available?”

Actually, it didn’t. Faith Gibson, in her work on the history of midwifery/obstetrics cites Transactions for the Study and Prevention of Infant Mortality (1910 – 1915), which she accessed through the Stanford University Medical Library, quotes two doctors providing maternal mortality rates of that time. Dr. Ira Wile, in 1911, says, "In NYC, the reported cases of death from puerperal sepsis occur more frequently in the practice of physicians than from the work of the midwives’" Dr. Levy in 1917, says, "Of the babies attended by midwives, 25.1 per 1000 ... died before the age of one month; of those attended by physicians, 38.2 per 1000 .... died before the age of one month; and of those delivered in hospitals, 57.3 per 1000 died before the age of one month.” I’m sure that because Gibson is a midwife, you’ll consider her chosen quotes biased, which is fine, because I consider yours to be. In any event, if you doubt the numbers, I bet you have access to the library to verify the quotes. I do not.

In any case, that’s a historical perspective, which has some limited applicability, again due to the variables we’ve already agreed upon. However, Dr. Marsden Wagner (perinatologist, neonatologist, former Director of Women’s and Children’s Health at the World Health Organization and author of 131 scientific papers) has written an entire book on current obstetrical practice called, Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. He points out that maternal mortality in the US has actually worsened over the last 20 years as obstetrical intervention increased. Child Health USA must be working from different numbers, because they say, “the maternal mortality rate has not declined significantly” in the last 25 years. Either way, these are from reputable sources that refute your assertion that “mortality consistently declined with increased recourse to medically assisted birth”. If YOU had bothered to look up the numbers, you’d find them in many valid places. WHO is making stuff up?

Comparing contemporary natural birth with contemporary medically managed birth, Wagner spends 250 pages looking at the two systems from every angle. In addition, Henci Goer has compiled the science on individual interventions, and examines the medical literature in Obstetric Myths Versus Research Realities. For most of what constitutes current medical management, there is no scientific evidence to support safety or efficacy, which is also the conclusion of A Guide to Effective Care, which was compiled from the Cochrane Data base, a comprehensive global database on the effects of healthcare interventions.

I suppose you can dismiss all of the experts and evidence that don’t agree with your theories and you can still insist I’m the one ranting (though please note, I’ve not resorted to ad hominem attacks as you have). However, I still would like a couple of points clarified.

You say that human maternal mortality rates are higher than other mammals, but you provide no scientific proof of that statement (apparently only an unforgivable sin if I do fail to do so). I’ve never lived on a farm, but I’ve had dogs and cats that have reproduced, and I’ve known lots of farmers who raised horses, cows, pigs and sheep. There is a fair amount of death in relation to birth in domesticated mammals. I have friends and family who don’t sleep much when they have breeding animals due to deliver because if they don’t check on them often they could wake up to a dead animal, often due to obstruction. I couldn’t find any figures either, but I did ask an actual farmer about where I might find some. His response was it is so common that you probably wouldn’t find any numbers, because it is just a fact of farming. When you have heifers calving, you either hire someone to watch them at night, with a winch or a tractor handy to pull out calves, or you stay up yourself. Cows are dumber than soup, even before they ARE soup. They have teeny little brains and great big bodies. Yet they get stuck all the time. So, if you are going to make and assertion that compares apples to oranges, it would be great if you could back that up with some facts. You have access to far more resources than I, a mere mortal, and obviously are far more efficient at looking up unbiased (cough) evidence to support your claims, as an ‘objective’ scientist.

I am fully aware you are not arguing FOR the idea that a god actually kills mommies. I get that you are an atheist saying that IF there was a god, birth would be easier.

What I am saying is it IS, or can be, easier than what most women currently experience. It is not big brains, but how those brains are used that mucks up birth. It is not a dangerous medical event. It is not ALWAYS painless, but it can be by controlling some of the variables, none having to do with the size of the baby’s head. Nor SHOULD it always be painless; pain is a form of communication from the body that serves a useful purpose when it is telling us something is wrong that needs attention. But labor isn’t pathological (or flawed), it’s physiological (and works amazingly well if women understand they aren’t cursed either by an angry god or a glitch in evolution). If you like, I’ll give you the whole A & P lesson in how birth can be easy and comfortable, including all of the amazing design features that make it work so well, but I provided that in a link in my last ‘rant’ and you ignored it.

As an example of when one would think labor would be unbearable but wasn’t, I had a client who gave birth vaginally, to an 7 lb. 6 oz. baby presenting face first (widest diameter possible, no way for the baby’s head to mold) without damaging her body or her baby. She arrived at the hospital at 8 cm because she hadn’t been sure she was far enough along in labor to be admitted! Another gave birth to a 10 lb. 4 oz. baby with a Charlie Brown head over an intact bottom in an hour and a half and her first words were, “It’s over? Already? That was so easy!” One fellow HypnoBirthing instructor I doubt is 120 lb. soaking wet when she’s not pregnant. She gave birth to 11+ lb. babies, and she said her largest with the biggest head was the fastest and easiest. These are not isolated cases that I choose to see while ignoring that problems can and do occur. Do other women suffer? Yes, and that’s too bad. Unless they can get past the idea that they are designed in such a way (by God or by Nature) that they must suffer, they will continue to do so. And because of the fear perpetuated by those who insist it must be that way, they will choose unproven medical interventions that, while useful in selected cases, are harmful when routinely applied to a healthy population. I am not the one taking an ‘all or nothing’ stance here.

I realize the notion that birth is safe is heresy to those who blindly believe otherwise, and that’s ok. However, prove it wrong and you can be $50,000 richer. Jock Doubleday has had a standing offer to pay $50,000 “to the first person who sends me by email, and in its entirety, a controlled comparative study published in a recognized industry journal from any country, in any time period, demonstrating hospital birth to be safer in any category (i.e., infant morbidity, infant mortality, maternal morbidity, or maternal mortality) for most mothers or babies than home birth with a midwife in attendance.” You may think him a nut, but he’s a nut with money and he’s willing to give it away. The offer has thus far stood for over ten years.
http://www.spontaneouscreation.org/SC/NWNM2006/TheUnequivocalSafetyOfHomeBirth.htm

I have not disputed a correlation between birth and pain, birth and risk, or birth and death for that matter. I’ve only said there is risk in everything in LIFE and that the risks in birth are not innate in a flawed process that ‘kills mommy’, are not higher than many other bodily functions, and can be due to any number of variables. My only reason for even continuing what I realize is a futile exercise with an expert in rhetoric, is that I DO dispute that the process of BIRTH itself, because of some fetal head/maternal pelvis design flaw, is the CAUSE of pain and risk. I fully anticipate that my experts will not be expert enough, that my chosen resources will be somehow, flawed invalidated because they are not cited properly or are incomplete, that my character will be impugned, and that you will find a way to dismiss every point I’ve made as illogical. After all, every one knows the earth is flat, why question it? It’s been ‘proved’ beyond a shadow of a doubt by smart men who wrote about it.

There is a way to resolve this disagreement though.

The scientific method is used to explore cause and effect in nature, correct? Then apply the steps of the scientific method. If you are going to continue to use this particular point argue that either God is an *sshole or doesn’t exist, then you have a duty to make sure that this isn’t just something ‘everybody knows’. Your contention is that big heads and upright pelvises create pain and danger. You dismiss the births that are comfortable and easy as flukes (despite your contention that I am the one doing so with difficult births, which I have not done). Homebirth has been studied fairly recently (http://www.bmj.com/cgi/content/full/330/7505/1416?ehom). The HypnoBirthing Institute has been compiling stats on hundreds of mothers for several years, these including home, hospital and birthing center births. They track complications, interventions and comfort levels. What I would think would need to happen would be to study the mothers who birthed with midwives at home AND used HypnoBirthing (since those are the mothers that report labors averaging 5 hours, and painless, or relatively comfortable, birth with fewer complications). Head size is one of those things that cannot be controlled. I would think that would be perfect, since most of the other variables could be.

But, as you pointed out, I’m no scientist. I’m perfectly happy if the women who come to my classes have the best birth possible for them. I just get frustrated that I have to deprogram them from the ideas that their bodies are flawed and /or they are being punished by God.


Child Health USA, 2004 http://mchb.hrsa.gov/mchirc/chusa_04/pages/0409mm.htm
Dundes, L., (2003). The Manner Born: Birth Rites in Cross-Cultural Perspective. Rowman Altamira

Enkin, M., Keirse, M., Renfrew, M., Neilson, J., (1995). A Guide to Effective Care in Pregnancy and Childbirth, 2nd ed. A more recent edition than the one I have is available in electronic form here: http://www.childbirthconnection.org/article.asp?ClickedLink=194&ck=10218&area=2

Gallagher, S., (2001) Hypnosis for Childbirth: A retrospective survey of birth outcome using prenatal self-hypnosis, Retrospective Survey

Goer, H., (1995). Obstetric Myths versus Research Realities: A Guide to the Medical Literature. Bergin and Garvey.

Haire., D., (2001). FDA approved obstetric drugs: Their effects on mother and baby. http://www.aimsusa.org/obstetricdrugs.htm
Hansen, S., Clark, S., Foster, J., (2002). Active Pushing Versus Passive Fetal Descent in the Second Stage of Labor: A Randomized Controlled Trial
Obstetrics & Gynecology 2002;99:29-34.
Karma, T., Karma, B., (1999). Buddhist Women Across Cultures: Realizations

Khan KS, Wojdyla D, Say L, G├╝lmezoglu AM, Van Look PF, (2006). WHO analysis of causes of maternal death: a systematic review. The Lancet.
http://www.ncbi.nlm.nih.gov/pubmed/16581405
Konje, J., Ladipo, O., (2000). Nutrition and obstructed labor. American Journal of Clinical Nutrition, 72(1)

Kulkarni, S., Huligo, A., (2001). Obstetric Papers: Maternal Mortality-10 years study. Journal of Obstetrics and Gyecology, India. 51(2), pp. 73-76.
http://www.journal-obgyn-india.com/articles/issue_march_april2001/o_paper_73.asp

Martin, A.A., et al., (2001). Effects of Hypnosis on the Labor Processes and Birth Outcomes of Pregnant Adolescents, Journal of Family Practice, May 2001

Medical News Today, (2005). Maternal Mortality: AIDS Leading Causes of Death for Women Worldwide; Investment in Gender Equality Needed, UNFPA Report Says. http://www.medicalnewstoday.com/articles/32014.php
Miller, D. (2004). Obstetric Hemorrhage. OB Focus. http://www.obfocus.com/high-risk/bleeding/hemorrhagepa.htm
Moyer, P., (2004). Less Pelvic Floor Damage Associated With Uncoached Than Coached Pushing During Labor. http://www.medscape.com/viewarticle/484738
Oats, M., (2003). Suicide: the leading cause of maternal death. The British Journal of Psychiatry http://bjp.rcpsych.org/cgi/content/full/183/4/279
Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, U.S. Agency for International Development. http://www.pphprevention.org/pph.php
Roberts, J., (2002). Women in Labor who Push without the "Urge"
May Experience More Complications. Journal of Midwifery & Women's Health.

Slanger, T., Snow, R., Okonofua, F., (2002), The Impact of Female Genital Cutting on First Delivery in Southwest Nigeria. Studies in Family Planning, Vol. 33, No. 2 (Jun., 2002), pp. 173-184. Retrieved January 30, 2008 from http://links.jstor.org/sici?sici=0039-3665(200206)33%3A2%3C173%3ATIOFGC%3E2.0.CO%3B2-P

Stanley, A., (1995). Mother’s and Daughters of Invention: Notes for a Revised History of Technology. Rutgers University Press. Pp.225

Tyre, T., (1990). Study on obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of Consulting and Clinical Psychology 58:5

WHO, (2005) Systematic review identifies main causes of maternal mortality and morbidity http://www.who.int/reproductive-health/MNBH/epidemiology.html

Wagner, M., (2006). Born in the USA: How a broken maternity system must be fixed to put women and children first. University of California Press, Berkeley.

Richard Carrier said...

Wildner: You continue to rely on standard fallacies and ramble on in a disorganized, desperate way that doesn't encourage me to continue with you much longer.

Among the fallacies you resort to:

(1) False Generalization (e.g. because there are cases of easy maternity, therefore all maternity would be easy without evil doctors).

(2) Selection Bias, i.e. ignoring contrary data (indeed, a lot of contrary data, like the nutritional demands of large brains, and much of the scientific data in the articles I have cited).

(3) Begging the Question (e.g. assuming factors exist to explain away contrary evidence even though you have no personal or documented information confirming they did--and then pretending you aren't doing this by claiming you only suggested it and then persisting in asserting your false generalization to the contrary, even though the latter requires you to believe your suggestions are actually facts).

(4) Straw Man (attributing to me claims I never made, or exaggerating what I did say).

You also engage such absurdist notions of history I can't believe you are serious (e.g. "even the Greeks and Hebrew myths underlying our own culture contain hints of a time when birth was less painful" -- the Greeks and Hebrew myths were written thousands of years before modern medicine, so I have no idea what you think is supposed to have changed that suddenly made birth more painful all across the entire globe as of 500 B.C....and then you blame Christianity for spreading the idea of a painful birth...what, even retroactively into Greek and Jewish literature centuries before Jesus is supposed to have been born?).

For all these reasons I am not going to address every fallacy and abuse of evidence you engage in. That's a waste of my time. I'm going to cut to the chase.

First of all, I have no interest in your argument that American medical practice could be improved for childbirth, since I'm sure that's always true. It simply has no bearing on what I'm talking about. So stop venting all your irrelevant complaints about that. Since maternal mortality in America is vanishingly small, the possibility for improving it is not relevant to what I am talking about, which pertains to populations in which the rate is vastly higher.

Secondly, your theory is that the cranial-size-caused maternal mortality rate is zero. My theory is that the cranial-size-caused maternal mortality rate is higher than zero. I also argue it is higher than any other documented mammal, and I know several scientists agree with me, and the evidence seems to confirm it (as I noted, and see below). But I do not claim that all maternal mortality is caused by this factor. As I said, one can only quibble about the numbers. You keep ignoring this so I will repeat it: you can only quibble about the numbers.

But to contend that number is zero is simply an irrational dogma. Show me a scientific study that actually confirms this and I'll correct myself on this point. But inventing it from the armchair by abusing a hoard of unrelated research, unscientific data, and mere propaganda is not rational.

For example, you strangely cite data that shows midwifery more successful than hospital care in the early 20th century, in which the rates you cite are higher even for midwifery than any data I have seen! Indeed, a peer reviewed collection of scientific data (cf. Louden, which I cited) found less than 10 in 1000 in that period. You are quoting numbers like 25 deaths for every 1000 midwived births, as though those numbers were good, when in fact they would be considerably worse than the scientific data confirms for hospitals of that period--and far, far worse than at present, when the rate is now less than 1 in 10,000--precisely when and where modern medicine is most available, exactly contrary to what your crazy theory should predict.

Even more bizarre, you then think a variation in rate between 25 and 38 is a significant increase, when I am talking about a variation between 25 and 0.1, a difference of 250 times! Indeed, compared to prehistoric data (over 100 maternal deaths in 1000), I'm talking about an improvement in survival rate of 1000 times! How you can then blame modern medicine for increasing maternal mortality simply defies all credulity.

As another example, you cite data confirming a higher rate of obstruction-related maternal mortality in Latin America than Africa, and then ask whether I think Africans have smaller heads than Latin Americans. It apparently didn't occur to you to ask whether I think Africans have wider hips than Latin Americans. Guess what. It is a scientifically documented fact that they do. Of course, large heads kill mothers in far more ways than obstruction, and obstruction, as you concede, has many more causes than relate to normal cranial size, but you are right that in all this noise there should be at least a slight signal corresponding to my theory and not yours. And there is.

In fact, it has been confirmed by peer reviewed research that height, which correlates with hip-to-cranium ratio, also correlates with obstruction and other causes of maternal mortality: cf. Guegan, Teriokhin, and Thomas, "Human Fertility Variation, Size-Related Obstetrical Performance and the Evolution of Sexual Stature Dimorphism," Proceedings: Biological Sciences (22 December 2000) 267.1461: 2529-35. Here they demonstrate that "women are taller, relative to men, in populations where high levels of fertility are likely to counter-select short women because of their higher incidence of obstetrical complications."

Furthermore:

Our comparative analysis...supports the idea that maternal death caused by deliveries and complications of pregnancy (a variable known to be size related) could be a key determinant explaining variation in sexual stature dimorphism between populations... [since] it is necessary to multiply the risk of dying for a given birth (i.e. maternal-mortality ratio) by the number of birth events during the reproductive lifetime... [and] what seems clear is that women in many countries still experience this selective pressure, for instance in rural areas in Africa where fertility values are among the highest and obstetric interventions are limited or absent.

In fact, so strong is the data that it refutes the hypothesis that differing access to nutrition is a factor in stature dimorphism:

Under [the nutrition] hypothesis, rich countries would probably show lower levels of dimorphism than poor countries because parental discrimination against girls is less frequent in rich countries. Our results indicate the opposite trend: sexual dimorphism is higher in rich than in poor countries... [And] the 'nutrition hypothesis' ... [that] well-nourished populations are more sexually dimorphic than malnourished ones because male growth is more susceptible to nutritional deficiencies during development than is female growth, is not supported either.

In other words, stature (and thus hip-to-cranium ratio) is so strongly correlated with maternal mortality that it overwhelms even differences produced by poor nutrition: basically, African women are taller even despite poor nutrition because all the short ones are dying in labor, while American women are shorter because modern medical intervention reduces all size-related maternal mortality. This is a confirmed scientific fact.

This pertains to height relative to men within the same populations, though of course entire populations (men and women together) also differ in stature (e.g. all Africans vs. all Americans) as a product of other causes (e.g. selection effects due to factors of thermal regulation). But even this should have comparable effects: e.g. because Latin Americans have evolved a shorter average stature (due to other factors), they should have a higher rate of maternal mortality when all other conditions are equal (though they are not, so this data can't be used), but they should also have a higher rate of obstruction-related deaths even when conditions are unequal (unless the inequalities are extreme, or the effect is small). Notably, the rate of maternal mortality overall is much higher in Africa and yet obstruction-related deaths are much lower there, which is a strong signal contrary to statistical expectation, which means size matters a lot, so much so it can overwhelm all other factors. Thus your data supports my theory. It certainly does not support yours.

Another example of your illogical abuse of science is your claim that "not one obstructed labor" occurred in Kulkarni & Huligo's ten-year study in a modern Indian hospital. That is entirely false: that paper nowhere lists the rate of "obstruction-caused mortality," much less that it was zero, but it does list the rate of deaths caused by c-section (over 7% of deaths, in fact near 9% since half the hysterectomies followed a c-section) and failure to deliver (over 33% of deaths), which would both include obstruction-related causes. So also for the other causes of resident patients, where, e.g. PIH and PPH were leading causes of mortality in this study, and yet either of these can be the result of obstruction-related complications--moreover, as I've said many times, these kinds of complications can result from cranial size without involving an actual obstruction. So once again, this study fails to confirm even what you claim it said, much less your theory that cranial size has zero effect on maternal mortality, or even the more limited theory that it has zero effect on rate of obstruction.

Another example of how your own arguments and data support my theory and not yours is nutrition. This, as I demonstrated, is also a leading factor in cranial-size-caused maternal mortality, a point you ignore: because women have to feed such large brains, they suffer relative deficits, as a consequence exacerbating all nutrition-related causes of maternal mortality (even those not directly related to cranial size). In other words, if mothers did not have to feed such large brains, they would suffer smaller nutritional deficits, and as a consequence all nutrition-related causes of maternal mortality would decline by some definite amount. I see no way to deny this.

Besides all this, you keep resorting to anecdotal evidence rather than scientifically collected data. But the reason we need science is precisely because anecdotal data routinely mislead: we have to control for all factors, including the human propensity to miscalculate frequencies of events. Only scientific methodologies can avoid these problems. This doesn't mean you have to be a scientist or do science. But it does mean you have to go see what scientists have determined the facts to be, and those facts have to actually support the predictions of your theory, not run contrary to them.

For example, I mentioned data pertaining to maternal mortality in animals. It is all indirect, but it does support me. Since you ask about it, here are some examples:

Rogers, et al., "A questionnaire-based study of gestation, parturition and neonatal mortality in pedigree breeding cats in the UK," Journal of Feline Medicine and Surgery 8.3 (June 2006), p.145-157. Though not documenting rate of mortality, it does document rate of c-section, which we can expect to be higher than the rate of maternal mortality (since c-section will be over-used as a precautionary, and thus exceed the rate at which mortality would naturally result without intervention). The overall rate of c-section was 1 in 60 per kitten (1 in 12 per litter), but this differed greatly by breed, and for some breeds the rate of c-section was zero. As these are cats who often have been bred contrary to natural survival characteristics (e.g. some breeds have unnaturally weak constitutions or distorted physical features), the rate per kitten of 1 in 60 is probably higher than in nature (e.g. ordinary household cats), and is (again) certainly higher than the actual mortality rate (since this is only the rate of recourse to c-section), and yet this is significantly lower than the natural rate of actual maternal mortality in humans (which was evidently worse than 1 in 10 and rarely better than 1 in 20 until more modern times).

Toshisada Nishida, et al., "Demography, Female Life History, and Reproductive Profiles Among the Chimpanzees of Mahale," American Journal of Primatology 59.3 (March 2003), pp. 99-121. Though not discussing causes of maternal death, their data confirm no more than 2 deaths out of 126 observed births in the wild, which indicates a rate of about 1 in 63, again a rate that scientific evidence confirms was not achieved by humans until relatively modern medicine and civilization. And these are animals with a large cranial ratio, though still not as large as in humans (as confirmed by the articles I cited), so we can expect their maternal mortality also to be higher perhaps than most other mammals but still not as high as for humans comparably in the wild. And that appears to be the case. Exactly as my theory predicts.

According to scientific data collected by the USDA National Agricultural Statistics Service, in the U.S. only 187,000 cows died while calving in 2005. In that same year the total population of cattle (cows included) was 95 million, and all years before and after show comparable numbers maintained. In 2005 a total of 4 million of those cattle died due to unmarketable losses (predators, diseases, etc.) and 33 million were slaughtered for market, and these numbers appear to be roughly the same in all other years (roughly 45% of these numbers are cows). This entails that to maintain the population (as in fact it has been), approximately 37 million cattle have to be born each year to replace losses. That means there are on average 37 million live births each year, which entails a rate of maternal mortality in domesticated cows of roughly 1 in 198. Though presumably that rate would be higher in the wild (given the probable recourse to medical assistance for livestock), unless you have data confirming a rate for wild cattle comparable to humans in the wild, this data still supports my theory more than yours.

Though no single study proves the point, all the relevant scientific data (these and all the others I have cited) converges on matching what my theory predicts and not what yours predicts. In contrast, your repeated recourse to fallacies and abuse of sources is enough to warrant ending this conversation.