Anatomical Variations in the Female Pelvis: Their Classification and Obstetrical Significance

Caldwell, William E.; Moloy, Howard C.

doi:10.1177/003591573803200101

Cited by 43 publications

(64 citation statements)

References 10 publications

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“…In these cases, the pelvis presents with complete disfigurement of the pelvic girdle, resembling something like a figure eight (Figs. Clinically, in the 19th century, flattened pelvic shape was recognized as a primary risk indicator for obstructed labor (Caldwell and Moloy, 1938;Kerr, 1939;Walrath, 2003;Brickley and Ives, 2008;Wells et al, 2012), as the neonate cannot descend the birth canal. This process can be exacerbated by lack of activity or increases in load bearing.…”

Section: Constructing Obstetrical Riskmentioning

confidence: 99%

“…The obstetrical dilemma hypothesis focuses on the evolutionary changes in humans to smaller bipedal pelves and largebrained neonates to reinforce the belief that human childbirth is always difficult (Schultz, 1949;Krogman, 1951;Washburn, 1960;Tague and Lovejoy, 1986;Rosenberg, 1992;Rosenberg and Trevathan, 1995;Roy, 2003;Wittman and Wall, 2007;Walsh, 2008;Weiner et al, 2008;Franciscus, 2009;Trevathan, 2011;Grabowski, 2013). These ideas were well supported, as rates of maternal mortality in modern western populations were increasing (Turner, 1885;Caldwell and Moloy, 1938;Krogman, 1951;Washburn, 1960). Difficult childbirth over the last 100 years has been used to justify moving all births into the biomedical arena, to explain racial differences, and to understand hominin evolution.…”

Section: Human Birth and Evolutionmentioning

confidence: 99%

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Biocultural perspectives on maternal mortality and obstetrical death from the past to the present

Stone

2016

American J Phys Anthropol

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Global efforts to improve maternal health are the fifth focus goal of the Millennium Development Goals adopted by the international community in 2000. While maternal mortality is an epidemic, and the death of a woman in childbirth is tragic, certain assumptions that frame the risk of death for reproductive aged women continue to hinge on the anthropological theory of the "obstetric dilemma." According to this theory, a cost of hominin selection to bipedalism is the reduction of the pelvic girdle; in tension with increasing encephalization, this reduction results in cephalopelvic disproportion, creating an assumed fragile relationship between a woman, her reproductive body, and the neonates she gives birth to. This theory, conceived in the 19th century, gained traction in the paleoanthropological literature in the mid-20th century. Supported by biomedical discourses, it was cited as the definitive reason for difficulties in human birth. Bioarchaeological research supported this narrative by utilizing demographic parameters that depict the death of young women from reproductive complications. But the roles of biomedical and cultural practices that place women at higher risk for morbidity and early mortality are often not considered. This review argues that reinforcing the obstetrical dilemma by framing reproductive complications as the direct result of evolutionary forces conceals the larger health disparities and risks that women face globally. The obstetrical dilemma theory shifts the focus away from other physiological and cultural components that have evolved in concert with bipedalism to ensure the safe delivery of mother and child. It also sets the stage for a framework of biological determinism and structural violence in which the reproductive aged female is a product of her pathologized reproductive body. But what puts reproductive aged women at risk for higher rates of morbidity and mortality goes far beyond the reproductive body. Moving beyond reproduction as the root causes of health inequalities reveals gendered-based oppression and inequality in health analyses. In this new model, maternal mortality can be seen as a sensitive indicator of inequality and social development, and can be explored for what it is telling us about women's health and lives. This article reviews the research in pelvic architecture and cephalopelvic relationships from the subfields of evolutionary biology, paleoanthropology, bioarchaeology, medical anthropology, and medicine, juxtaposing it with historical, ethnographic, and global maternal health analyses to offer a biocultural examination of maternal mortality and reproductive risk management. It reveals the structural violence against reproductive aged women inherent in the biomedical management of birth. By reframing birth as normal, not pathological, global health initiatives can consider new policies that focus on larger issues of disparity (e.g., poverty, lack of education, and poor nutrition) and support better health outcomes across the spectrum of life for women globally.

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Section: Constructing Obstetrical Riskmentioning

confidence: 99%

Section: Human Birth and Evolutionmentioning

confidence: 99%

Biocultural perspectives on maternal mortality and obstetrical death from the past to the present

Stone

2016

American J Phys Anthropol

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“…The incidence of CS increased in proportion to decreasing pelvic outlet capacity. As early as 1938, Caldwell and Moloy noted this relationship between a narrow outlet and instrumental or operative delivery.…”

Section: Introductionmentioning

confidence: 98%

Pubic arch angle in prolonged second stage of labor: clinical significance

Gilboa

Kivilevitch

Spira

et al. 2013

Ultrasound in Obstet & Gyne

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“…Detailed understandings of the variation in pelvic geometry among human populations and the factors that produce this variation have much to contribute to this discussion. The recognition of this variation in human pelvic geometry is of importance, given the persistence of typological approaches to obstetric risk assessment deriving from studies dating to the first half of the 20th Century (e.g., Caldwell and Moloy, 1938;Greulich and Thoms, 1938), and a mechanistic approach to childbirth in modern clinical practice (e.g., Cunningham and Williams, 2005;Gibbs et al, 2008; see also Walrath, 2003).…”

mentioning

confidence: 99%

Bony pelvic canal size and shape in relation to body proportionality in humans

Kurki

2013

American J Phys Anthropol

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Obstetric selection acts on the female pelvic canal to accommodate the human neonate and contributes to pelvic sexual dimorphism. There is a complex relationship between selection for obstetric sufficiency and for overall body size in humans. The relationship between selective pressures may differ among populations of different body sizes and proportions, as pelvic canal dimensions vary among populations. Size and shape of the pelvic canal in relation to body size and shape were examined using nine skeletal samples (total female n = 57; male n = 84) from diverse geographical regions. Pelvic, vertebral, and lower limb bone measurements were collected. Principal component analyses demonstrate pelvic canal size and shape differences among the samples. Male multivariate variance in pelvic shape is greater than female variance for North and South Africans. High-latitude samples have larger and broader bodies, and pelvic canals of larger size and, among females, relatively broader medio-lateral dimensions relative to low-latitude samples, which tend to display relatively expanded inlet antero-posterior (A-P) and posterior canal dimensions. Differences in canal shape exist among samples that are not associated with latitude or body size, suggesting independence of some canal shape characteristics from body size and shape. The South Africans are distinctive with very narrow bodies and small pelvic inlets relative to an elongated lower canal in A-P and posterior lengths. Variation in pelvic canal geometry among populations is consistent with a high degree of evolvability in the human pelvis.

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Anatomical Variations in the Female Pelvis: Their Classification and Obstetrical Significance

Cited by 43 publications

References 10 publications

Biocultural perspectives on maternal mortality and obstetrical death from the past to the present

Biocultural perspectives on maternal mortality and obstetrical death from the past to the present

Pubic arch angle in prolonged second stage of labor: clinical significance

Bony pelvic canal size and shape in relation to body proportionality in humans

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