Shaping birth: variation in the birth canal and the importance of inclusive obstetric care

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Regional variation in pelvic morphology and childbirth has long occurred alongside traditional labour support and an understanding of possible normal courses of childbirth for each population. The process of migration and globalisation has broken down these links, while a European model of ‘normal’ labour has become widespread. The description of ‘normal’ childbirth provided within obstetrics and midwifery textbooks, in fact, is modelled on a specific pelvic morphology that is common in European women. There is mounting evidence, however, that this model is not representative of women’s diversity, especially for women of non-white ethnicities. The human birth canal is very variable in shape, both within and among human populations, and differences in pelvic shapes have been associated with differences in the mechanism of labour. Normalising a white-centred model of female anatomy and of childbirth can disadvantage women of non-European ancestry. Because they are less likely to fit within this model, pelvic shape and labour pattern in non-white women are more likely to be considered ‘abnormal’, potentially leading to increased rates of labour intervention. To ensure that maternal care is inclusive and as safe as possible for all women, obstetric and midwifery training need to incorporate women’s diversity.

© 2021, The Author(s). This is an author produced version of a paper published in PROCEEDINGS OF THE ROYAL SOCIETY B: BIOLOGICAL SCIENCES uploaded in accordance with the publisher’s self- archiving policy. The final published version (version of record) is available online at the link. Some minor differences between this version and the final published version may remain. We suggest you refer to the final published version should you wish to cite from it.
Original languageEnglish
Article number20200024
Publication statusPublished - 3 May 2021


  • pelvis
  • childbirth
  • human variation
  • human evolution
  • shape
  • diversity

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