Response to letter re: Consent for vaginal delivery

Abstract

Dear Editor, I commend the Journal for promoting a discussion on informed consent for vaginal birth, by publishing the two opinion pieces in the December 2018 issue of ANZJOG. The contrasting views of the authors are mirrored by very different styles of presentation. A/Professor Petersen offers an historical and philosophical argument about the selective advantages of natural childbirth.1 It is both off‐target and biologically incorrect. The obvious mistake occurs in the first sentence. I doubt that A/Professor Petersen could provide any evidence that the process of natural childbirth has materially changed over the course of human evolution. After all, it is one of the selection pressures that evolution applies to produce change. Human anatomy may have evolved. Human culture may have evolved. But the evolutionary function of this selection pressure remains the same as it ever was: to cull mothers and babies. Professor Dietz's main research interest is in uro‐gynaecology, he has little direct involvement in operative obstetrics. However as a scientific observer, he provides a pragmatic and elegant summary of the dilemma facing practising obstetricians.2