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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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https://afar.info/id=2946

Created on : 05 Apr 2018
Modified on : 20 Jul 2018

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Bibliographical entry (without author) :

Evolutionary perspectives on cesarean section. Evolution, Medicine, and Public Health, Volume 2018, Issue 1, 1 January 2018, Pages 67–81.

Author(s) :

Rosenberg, K.R. & Trevathan, W.R.

Year of publication :

2018

URL(s) :

https://academic.oup.com/emph/article/2018/1/67/49…
https://doi.org/10.1093/emph/eoy006

Résumé (français)  :

La césarienne (ablation chirurgicale d’un nouveau-né par les parois abdominales et utérines maternelles) peut être une intervention médicale vitale pour les mères et leurs nouveau-nés lorsque l’accouchement par voie vaginale est impossible ou dangereux. Toutefois, ces dernières années, les taux de césariennes ont augmenté dans de nombreux pays bien au-delà du niveau recommandé par l’Organisation mondiale de la santé (10-15%). Ces césariennes « en excès » comportent un certain nombre de risques pour les mères et les nourrissons, y compris des complications de la chirurgie pour la mère et des problèmes respiratoires et immunologiques plus tard dans la vie des nourrissons. Nous soutenons qu’une perspective évolutionniste sur l’accouchement humain suggère que beaucoup de ces césariennes «inutiles» pourraient être évitées si nous considérions le contexte social émotionnellement favorable dans lequel l’accouchement a eu lieu pour des centaines de milliers, voire des millions d’années d’évolution humaine. L’idée que l’accouchement humain est habituellement un événement coopératif, voire un événement social dans lequel des femmes sont accueillies par une famille et des amis familiers et favorables, suggère que le milieu clinique difficile dans lequel les femmes accouchent souvent dans le monde développé n’est pas le meilleur environnement pour gérer les forces émotionnelles fortes qui accompagnent habituellement le travail et l’accouchement. Nous soutenons que fournir un environnement sûr et favorable aux parturientes peut réduire le taux d’accouchements chirurgicaux « inutiles ».

accouchement, césarienne, bipédie, encéphalisation, dilemme obstétrical, évolution humaine

Abstract (English)  :

Cesarean section (surgical removal of a neonate through the maternal abdominal and uterine walls) can be a life-saving medical intervention for both mothers and their newborns when vaginal delivery through the birth canal is impossible or dangerous. In recent years however, the rates of cesarean sections have increased in many countries far beyond the level of 10–15% recommended as optimal by the World Health Organization. These ‘excess’ cesarean sections carry a number of risks to both mothers and infants including complication from surgery for the mother and respiratory and immunological problems later in life for the infants. We argue that an evolutionary perspective on human childbirth suggests that many of these ‘unnecessary’ cesarean sections could be avoided if we considered the emotionally supportive social context in which childbirth has taken place for hundreds of thousands or perhaps even millions of years of human evolution. The insight that human childbirth is usually a cooperative, even social event in which women are attended by familiar, supportive family and friends suggests that the harsh clinical environment in which women often give birth in the developed world is not the best setting for dealing with the strong emotional forces that usually accompany labor and delivery. We argue that providing a secure, supportive environment for laboring mothers can reduce the rate of ‘unnecessary’ surgical deliveries.

childbirth, cesarean section, bipedalism, encephalization, obstetrical dilemma, human evolution

Sumário (português)  :

A cesariana (remoção cirúrgica de um recém-nascido através das paredes abdominal e uterina materna) pode ser uma intervenção médica que salva vidas para as mães e seus recém-nascidos quando o parto vaginal através do canal do parto é impossível ou perigoso. Nos últimos anos, no entanto, as taxas de cesáreas aumentaram em muitos países, muito além do nível de 10 a 15% recomendado como ideal pela Organização Mundial de Saúde. Essas cesáreas “em excesso“ acarretam uma série de riscos para mães e bebês, incluindo complicações da cirurgia para a mãe e problemas respiratórios e imunológicos mais tarde na vida dos bebês. Argumentamos que uma perspectiva evolucionista sobre o parto humano sugere que muitas dessas cesáreas “desnecessárias“ poderiam ser evitadas se considerássemos o contexto social de apoio emocional no qual o parto ocorreu por centenas de milhares ou talvez milhões de anos de evolução humana. O insight de que o parto humano é geralmente um evento cooperativo, até mesmo social, no qual as mulheres são assistidas por familiares e amigos de apoio, sugere que o ambiente clínico rigoroso em que as mulheres costumam dar à luz no mundo desenvolvido não é o melhor cenário para lidar com o problema. fortes forças emocionais que geralmente acompanham o trabalho de parto e o parto. Argumentamos que fornecer um ambiente seguro e de apoio para mães que trabalham fora pode reduzir a taxa de partos cirúrgicos “desnecessários“.

parto, cesariana, bipedismo, encefalização, dilema obstétrico, evolução humana

Comments :

Few articles argue that a secure, supportive environment would reduce the cesarean rate as it is difficult to ’prove’. These researchers attempt to do this from an evolutionary perspective. A secure, supportive environment will almost certainly reduce the level of post-partum PTSD (2-6 % in developed countries) and proportion of women experiencing symptoms of PTSD (20-30% in developed countries).

Peu d’articles soutiennent qu’un environnement sûr et favorable réduirait le taux de césarienne car il est difficile de le prouver. Ces chercheurs tentent de le faire d’un point de vue évolutif. Un environnement sûr et favorable réduira presque certainement le niveau de TSPT post-partum (2-6% dans les pays développés) et la proportion de femmes présentant des symptômes de TSPT (20-30% dans les pays développés).

Poucos artigos argumentam que um ambiente seguro e favorável reduziria a taxa de cesárea, já que é difícil “provar“. Esses pesquisadores tentam fazer isso de uma perspectiva evolucionária. Um ambiente seguro e de apoio certamente reduzirá o nível de TEPT pós-parto (2-6% em países desenvolvidos) e a proporção de mulheres com sintomas de TEPT (20-30% em países desenvolvidos).

Argument (français) :

Nous soutenons que fournir un environnement sûr et favorable aux mères qui travaillent peut réduire le taux d’accouchements chirurgicaux « inutiles ».

Argument (English):

We argue that providing a secure, supportive environment for laboring mothers can reduce the rate of ‘unnecessary’ surgical deliveries.

Argumento (português):

Argumentamos que fornecer um ambiente seguro e de apoio para mães que trabalham fora pode reduzir a taxa de partos cirúrgicos “desnecessários“.

Keywords :

➡ attendance ; c-section/caesarean ; ethics ; history, sociology ; iatrogeny ; evidence-based medicine/midwifery ; physiology ; position during labor ; psychology ; public health ; social support

Author of this record :

Veronica Graham — 05 Apr 2018
➡ latest update : Bernard Bel — 20 Jul 2018

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