ISEMPH Presentation: Wenda Trevathan
"Caesarean section, tocophobia and evolutionary medicine"
New Mexico State University
Despite a WHO recommendation that caesarean section rates should not exceed 15%, rates as high as 36% are reported for a number of countries, often varying widely within nations. Medically necessary c-section has risen with rates of obesity, diabetes, increasing maternal age, and HIV, but the past 2 decades has also seen an increasing demand for cesarean section in the absence of medical indications, a phenomenon known as Cesarean Delivery on Maternal Request or CDMR. A frequently cited reason given by women requesting surgical delivery in the absence of medical necessity is fear of vaginal delivery or tocophobia. Recognizing that extreme fear and anxiety can interfere with normal birth, the view from evolutionary medicine argues that less severe fear of childbirth is deeply rooted in human evolutionary history as a by-product of selection for bipedalism and encephalization, and can often be alleviated, as it has been for millennia, by providing social and emotional support. This very “low-tech” remedy provides an alternative to a medical intervention that has significant risks to both mother and infant, including epigenetic changes that may have transgenerational effects.