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Both in the modern and the ancient world, among women who are out-of-door workers and among those who live in natural and primitive conditions, childbirth is easy and safe.
The inlet of the female pelvis approaches a circle. The circular form of inlet allows a larger fœtal head to pass than the same measure disposed in any other form.
In the circular pelvis the sacro-iliac joints are well developed by constant use and are freely movable.
In contrast to this, civilization with its confinement of children indoors, and its absence of sunlight on the skin necessary for the proper calcification of growing bone, and the disuse of the sacro-iliac joints, alters the normal shape of the pelvis and makes childbirth difficult and dangerous. This change in pelvic shape leads to an undue proportion of undersized children surviving the ordeal of birth as the children with the larger heads who would easily pass the circular inlet are born dead.
The last report on infant mortality tells us that two-thirds of all the stillbirths and infant deaths are due to prematurity and obstetric trauma, and the New Statistical Review issued in 1927 tells us that 20% more of the stillbirths are males.
The natural proportion of males to females is thus upset, only the smaller children are born alive, hence perhaps the eventual decay of all civilizations, past and present.
I venture to suggest that the solution of our maternal mortality problem does not consist so much in elaborate provision for abnormal childbirth as in trying to regain the lost heritage of natural and easy birth. We must begin with the newborn female child and her development, and return to nature as regards light, food and exercise, and thus we shall ensure proper development of the pelvis so that childbirth becomes again easy and safe.