The Dilemma: birth ‘from above’ or ‘from below’?
Humanity has to face an unexpected challenge. At the beginning of the twenty-first century a great proportion of the world population does not use the vaginal route to be born. The time has come to try to anticipate the probably enormous effects on the characteristics of our civilisations of such a sudden turning point in the history of childbirth.

In the fifties low segmental caesareans figure in the region of 1 per cent. In the Western world it has risen to 20 per cent, while in Southern America it has rocketed to 50 per cent, in private hospitals even to 80 per cent. Do we grow to a policy to perform a caesarean unless the woman requests otherwise?

We are facing a dilemma: On the one hand, to be born ‘from above’ allows the birth of humans with larger brain size, humans who would not survive the way ‘from below’ and therefore could not transmit the tendency for larger brain size on to future generations.

On the other hand, by not admitting humans to be born ‘from below’ might deprive them from a very crucial period immediately after vaginal birth triggered by a release of a cocktail of love hormones, especially oxytocin.

This would match with the phenomenon that most societies ritually disturb the first contact between mother and baby to avoid the development of the capacity of love. By doing so there is the evolutionary advantage in developing the human potential for aggression rather than the capacity of love. But we need love more than ever before.

Simplified, we’d better perform a two-option strategy: either a straight forward birth by the vaginal route or a caesarean during labour. As for the former, as many women as possible would have the chance to give birth ‘from below’ so that newborns would have an undisturbed flow of love hormones. As for the latter, if a birth ‘from above’ is inevitable, then perform the caesarean during labour, aiming at providing the newborn at least with some hormones.

Dr. Bart van der Lugt is a consultant obstretrician-gynaecologist and Chair of the Network Board.