Obstructed Labour: The Classic Obstetric Dilemma and Beyond

  • Emma Pomeroy
  • Jonathan C. K. Wells
  • Jay T. Stock
Part of the Advances in the Evolutionary Analysis of Human Behaviour book series (AEAHB)


The obstetric dilemma (OD) proposes that women have a prolonged, painful childbirth with high risks of obstructed labour and consequent maternal and neonatal deaths because our species’ large brain size and bipedal gait place opposing selective pressures on pelvic size and shape. While widely cited in the anthropological and medical literature, there is growing evidence that obstructed labour is not an inevitable consequence of the OD but a problem that has waxed and waned, tracking temporal changes in phenotype, lifestyle and environment. This implies that obstructed labour is not an inevitable character of our species and that mediation of the environment (diet, activity, health) and changes in birth posture can potentially reduce obstetric complications in the short and longer term. In addition, it may be possible to better assess individual risk by evaluating parental and offspring phenotype.


Obstetric dilemma Encephalisation Pelvis Obstructed labour Cephalopelvic disproportion Stature 



Cephalopelvic disproportion

The infant’s head is too large to pass through the bony birth canal of the mother’s pelvis, necessitating Caesarean delivery

Obstructed labour

Where labour fails to progress as a result of mechanical problems, e.g., cephalopelvic disproportion, shoulder dystocia or malpresentation of the foetus, which prevent its passage through the birth canal [2]


The physical characteristics of an individual, population or species. They represent the interplay of genetic and environmental influences on the body


The degree to which a given biological characteristic can be modified in response to environmental factors. Characteristics that are more responsive to the environment, and so less strongly genetically determined, are described as plastic

Shoulder dystocia

During labour, the shoulder is trapped behind the maternal pelvis (typically the pubic symphysis, or the sacrum) following passage of the head


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Emma Pomeroy
    • 1
    • 2
  • Jonathan C. K. Wells
    • 3
  • Jay T. Stock
    • 2
  1. 1.Newnham College, University of CambridgeCambridgeUK
  2. 2.Department of Archaeology and AnthropologyUniversity of CambridgeCambridgeUK
  3. 3.Childhood Nutrition Research CentreUCL Institute of Child HealthLondonUK

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