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  • [narrator] This is a stretch test, which engineers use

  • to measure the strength and stretchiness of materials, like rubber.

  • But here, it's testing something different:

  • tissue from a human cervix.

  • The cervix is the gate between a woman's uterus and her vagina.

  • It blocks anything,

  • -like a penis, from going any further up. -[whistle blows]

  • [narrator] And it stops important things in the uterus,

  • like a growing fetus, from coming down too early.

  • Think of the uterus like a balloon.

  • You blow up the balloon with air.

  • You have to keep the air in the uterus or the baby inside the uterus,

  • and that cervix is the knot that keeps the uterus closed.

  • As an engineer, what's really struck me about the cervix

  • is that a pregnant specimen in the lab...

  • It just keeps stretching and stretching. It never breaks.

  • [narrator] Over nine months of pregnancy, the cervix gets five times stretchier.

  • When it's soft like the skin on your lips, it opens up.

  • And as you may know from experience

  • or from a common TV trope,

  • that's usually when...

  • Mindy, your water just broke.

  • Ah! My water just broke.

  • Oh! I'm sitting here in a puddle of water.

  • Uh... my water broke.

  • Oh, that's cool. We got another one here in the fridge.

  • After the baby comes out,

  • this very compliant material has to remodel and repair itself.

  • I don't know of any other engineering material

  • that can soften or remodel itself that quickly.

  • [narrator] Put simply,

  • the cervix is an anatomical and engineering miracle.

  • But that doesn't make childbirth itself any less daunting.

  • I'm not really scared. I'm, like... Yeah, I am nervous.

  • [laughs] I'm completely nervous, like, but it's only

  • because this is my first kid, so I don't really know what to expect.

  • [narrator] Around the world, 250 babies are born every minute.

  • In hospitals or at home

  • with midwivesdoulas, and doctors.

  • Some women use drugs for the pain,

  • some have C-sections

  • or use other medical technology.

  • And others don't.

  • [doctor] Sweetheart, show me what you got. Ready? Nice deep breath in.

  • Breath. And push from your bottom. You got this.

  • Two, three, four...

  • [narrator] But childbirth still kills more than 800 women every day

  • around the world.

  • And one global survey found that up

  • to 30% of women rate childbirth as traumatic.

  • I just remember, like, closing my eyes and going inside

  • into, like, the deepest part of myself

  • to just be like, "I have to get through this."

  • I was, like, really traumatized for a really long time.

  • [narrator] So, what makes childbirth so hard?

  • And what can women do to have the easiest and safest experience?

  • -[woman] You got this. -[inhales]

  • -[theme music playing] -[moaning]

  • [gasps, exhales]

  • [narrator 2] The contractions in true labor

  • always have a definite rhythm.

  • [narrator 3] You may suddenly wonder

  • how the baby can possibly get through that small opening.

  • Don't worry, you'll stretch enough.

  • [man] It is not only pathological knowledge

  • which makes the great obstetrician.

  • It is vigilance.

  • One that does not let you forget you have in your hands the lives of two people.

  • [narrator] Most large primates give birth in relatively similar fashion.

  • The female carries the fetus in her womb for 30 to 40 weeks,

  • and then the baby emerges from the birth canal,

  • usually headfirst, within hours.

  • But there's one key difference:

  • humans suffer a lot more.

  • It's not like a baby just falls out,

  • like some Monty Python sketch, for non-human primates.

  • They do struggle, and still,

  • they have a seemingly much more easy childbirth

  • than we have.

  • [narrator] Humans labor around nine hours the first time they give birth

  • and often go much longer,

  • while most chimps labor for just two hours.

  • And there's one part of the struggle of childbirth

  • that's harder to quantify-- the pain.

  • [woman 1] It felt like the bottom half of my body was gonna explode

  • and erupt goo all over the four walls of the room.

  • [woman 2] Like you're in some kind of pain blender,

  • where you're just being spun around,

  • and you don't know what's going on. It feels like you're being ripped in two.

  • [woman 3] Everything painted red,

  • and there's, like, this alarm that's like... [imitates siren]

  • [woman 4] It looked like I was experiencing an exorcism.

  • [narrator] The question of why humans have painful births comes down

  • to anatomy and evolution.

  • The theory goes like this:

  • Humans, unlike other primates, evolved to walk on two legs,

  • which meant pelvises became more complicated and narrow.

  • Our brains also evolved to be bigger than other primates',

  • which means bigger newborn heads.

  • {\an8}So chimps get to push out a small head from wide hips,

  • {\an8}while we're stuck squeezing out a big baby through a narrow space.

  • But why did it stop there?

  • Why didn't we keep evolving our anatomy to make childbirth less painful?

  • Well, why didn't we evolve

  • away from painful bowel movements?

  • And why didn't we evolve out of painful breakups?

  • [narrator] Natural selection doesn't care about pain,

  • just survival. And even though it hurts...

  • [screams]

  • ...we keep making babies anyway.

  • What works, works. And what's good enough is good enough.

  • It's a terribly tight fit.

  • It's a painful labor. It's a long, protracted labor,

  • but it works. It's good enough.

  • [narrator] So, to continue the survival  of our species,

  • women have always been stuck  with difficult childbirths.

  • -[doctor] Almost there. -[Daysha Anthony] How much more?

  • [doctor] Not much more. One push at a time.

  • [narrator] The Old Testament says,

  • "With painful labor, you will give birth to children,"

  • after Eve ate from the Tree of Knowledge.

  • And this scroll from 12th-century Japan shows childbirth as so deadly

  • that it attracted evil spirits who were drawn to near-fatal events.

  • That's why so many cultures throughout history found ways

  • to protect and comfort women during childbirth...

  • with rituals and the support of friends and family.

  • Women also tried to numb their pain

  • with opium and hashish in the Mediterranean,

  • or in ancient Greece, willow bark, which is chemically similar to aspirin.

  • And scientists invented new tools and technologies

  • to help if the baby got stuck.

  • Thanks to medical progress, childbirth got less deadly over time.

  • And one of the biggest areas of progress

  • was the Caesarean section.

  • C-sections actually originated thousands of years ago.

  • They're referenced in almost every ancient culture,

  • and were performed to save the baby

  • when the mother had little or no hope of surviving labor.

  • One of the first known C-sections where the woman actually survived

  • happened in South Africa in 1826,

  • performed by the British surgeon James Barry,

  • who was actually born a female, Margaret Bulkley.

  • But that wasn't discovered till after his death.

  • And around the same time, a medical missionary

  • observed Ugandan doctors performing C-sections.

  • He wrote about one operation where the mother and baby both survived.

  • There was no anesthesia,

  • but the woman was liberally supplied with banana wine.

  • In the 20th century,

  • C-sections started to consistently save women's lives.

  • And then, birthing technology really started to pick up.

  • Scientists started using pelvic X-rays

  • to chart the average length and rate of labor.

  • And for women who didn't progress fast enough,

  • they developed a new drug to artificially speed it up,

  • called pitocin, a synthetic form of oxytocin.

  • It's a naturally occurring hormone,

  • but it floods a woman's body at three events in her life:

  • orgasm, breastfeeding, and labor.

  • Pitocin worked so well that doctors and women

  • started scheduling inductions if a woman went a week over her due date,

  • bringing some certainty to an otherwise unpredictable event.

  • The history of medical intervention, when it comes to childbirth,

  • has a lot to do with the emergence of obstetrics as a medical profession.

  • [narrator] For most of history, doctors didn't deliver babies,

  • midwives did.

  • Women trained in the real world, through experience and observation.

  • {\an8}Then in the 1700s in Europe, midwives opened up schools

  • {\an8}with more official training programs.

  • {\an8}And as waves of European immigrants

  • came over to America in the following century,

  • they brought these skills with them as they settled in the northern states.

  • While in the American South, enslaved black women were forced

  • to attend to the deliveries and care of white children

  • and were torn from their own families.

  • And they continued working as skilled midwives

  • long after slavery ended.

  • They were often referred to as "granny midwives."

  • They tended to be senior, older members of their community

  • who had themselves already given birth

  • and were viewed with respect among their community.

  • [narrator] But in the 1900s,

  • doctors started to edge midwives out of the delivery room,

  • and they made a convincing argument.

  • Birth might look simple. It may have been going on for centuries.

  • But in fact, it was a pathological event that requires medical intervention.

  • [narrator] Like a procedure called the episiotomy.

  • {\an8}During birth, it's common for a woman to tear her vaginal opening.

  • {\an8}Then in the 1920s,

  • {\an8}doctors started proactively cutting the opening instead.

  • I think the idea was that that would... that would be easier to sew up.

  • And it turned out that giving people an episiotomy

  • makes the tearing much worse.

  • [narrator] And around that same time,

  • Western doctors also started offering new pain drugs,

  • like one trend that emerged out of Germany called twilight sleep.

  • It was a mixture of a heavy narcotics:

  • {\an8}scopolamine and morphine.

  • Extremely controversial 'cause it was really dangerous.

  • Many of the women who were behind twilight sleep

  • were involved in the suffrage movement.

  • And their argument was

  • that women should have the right to have a painless childbirth.

  • [narrator] But the drugs didn't actually get rid of the pain,

  • just the memory of the pain.

  • Women in delivery rooms thrashed violently and screamed.

  • They were often hooded or placed in cage-beds while they labored.

  • The birthing experience differed enormously

  • based on where you lived,

  • your class background and the color of your skin.

  • There is a theory that the more civilized a race or a culture is,

  • the more difficulty the women have experiencing childbirth.

  • And so, anesthesia was also required

  • to make sure they could get through the process.

  • Working-class women, women of color,

  • immigrant women, no problem.

  • Babies could just pop out.

  • It was the over-civilized, upper-middle-class women

  • that needed help.

  • [narrator] That stereotype lives on today,

  • and it's one reason black women in the UK

  • are five times more likely to die in childbirth than white women.

  • And they're three times more likely in the US,

  • where disparities exist even at the same income level.

  • Biggest issue, they're not being heard.

  • When women have said, "I'm in pain,"

  • the understanding or stereotype of women of color,

  • that they're not really in pain the way they are.

  • [narrator] So back in the 1950s,

  • while many black women didn't get pain medication

  • even when they needed it,

  • white women started to speak out about being over-medicated.

  • In 1958, The Ladies Home Journal published an investigation,

  • "Cruelty in Maternity Wards,"

  • "They give you drugs whether you want them or not

  • One woman wrote in,

  • "They give you drugs whether you want them or not,

  • and strap you down like an animal."

  • Women start reacting to what they believe to be

  • absolutely horrific birth experiences.

  • They get angry and think they have missed out

  • on what should be the most incredible moment of their lives.

  • And that somehow that gets completely lost

  • in the process of medicalizing birth.

  • [narrator] One of the most influential voices

  • in the grassroots movement

  • was Ina May Gaskin, a midwife-turned-activist.

  • In her 1975 bookSpiritual Midwifery,

  • she said that when women are

  • "empowered to birth without drugs  or interventions,"

  • "birth is a spiritual experience that each woman deserves

  • in a safe and comfortable setting."

  • There were a lot of hippie women involved in the natural childbirth movement,