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Off the coast of Dominica, scientists recently watched 11 sperm whales gather around a birthing mother. What happened next turned out to have a lot to say about one of the most underfunded corners of American healthcare.

This week, Syris Valentine explores what sperm whales, bonobos, and even hamsters can tell us about why every mother deserves a doula.

Let’s go.

— Willow

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The waters off the coast of Dominica were calm the day Shane Gero saw a sperm whale give birth.

That morning, he readied two small boats along with his colleagues from CETI (Cetacean Translation Initiative) — the group working to decipher sperm whale clicks, where Gero is the lead biologist — and went out searching for whales: a totally normal day absent any expectation of the stupendous.

But as soon as the team found 11 whales in a docile huddle, “we knew something was up,” he said.

Most days, a clan of whales spreads out over a few kilometers with a pair here, a lone whale there, and another couple over yonder, all moving through the ocean in the same general direction together, despite the spaces between them. When they do come together into a tighter pack, "They're usually hyper-social,” Gero said. “They're rolling around; they're defecating and rolling in it; they're making lots of sounds.”

A quiet and calm convening seemed almost ominous in comparison, and when blood gushed from the middle of the herd, Gero feared the worst.

A half-hour earlier, the team had passed pilot whales, which have a habit of harassing sperm whales. “I thought maybe they had snuck in and tried to take a bite out of somebody,” he said, “but then within a few seconds the head of the baby came out of the water, and then the little floppy flukes.”

“Everyone went crazy,” he said.

Even in the West Indian island chain where sperm whales roam wide — with individual families returning to the same island over and over in a display of cultural identity connected to Dominica over Martinique, or Saint Lucia over Grenada — observing a birth is rare.

“I’ve spent thousands of hours with sperm whales across 20 years and never seen a birth,” added Gero. Even his PhD supervisor, with twice the time in the field, has only seen one. So for them to arrive before the delivery began and document it all with hydrophones in the water capturing the chatter and drones in the sky filming the scene, “it was sort of unimaginable,” he said, and the insights, invaluable.

In rare and exceptional moments like this, he added, “you see the values and morals and systems within a society jump into high gear.”

This birth highlighted the cooperation and reciprocity that are core to sperm whale society.

Hours before the calf emerged, the family unit had oriented itself around the birthing mother, a whale Gero’s team refers to as Rounder. Rounder’s mother, Lady Oracle, was side by side with her the entire time, and when Rounder rolled her belly above the sea surface to push her second baby into the world, Lady Oracle dove over her at the same time.

“She’s touching the baby as it’s coming out,” Gero said.

They had assumed the grandmothers would play a central role in the entire process, but once the baby was out, “the younger females moved in and did a lot of the lifting,” he said.

For the next 20 minutes, the whales remained in close contact, with the newborn either squeezed between them or resting on top of them to keep it at the surface of the water or above it, to ensure the baby didn’t sink before its fluke had unfurled and it could swim.

Though Gero and his team wouldn’t call what they witnessed “midwifery,” the assistance on display — which other researchers have observed in a few species of non-human primates — does seem to highlight the importance of those practices in promoting the health of mother, child, and their surrounding community.

No firm answer yet exists to define when or why our distant ancestors began to assist one another through the birthing process.

In whales, according to a paper by Gero and co., the practice of lifting newborns out of the water emerged more than 36 million years ago, back before baleen and toothed whales split from their common ancestor. And based on observations of our closest primate relatives, the behaviors that eventually evolved into primeval midwifery may have emerged millions of years ago as well, though the evidence is mixed.

Bonobos are the closest living relatives of humans, both in terms of anatomy and behavior. Unlike their sister species the chimpanzees, which tend to be combative and competitive, bonobos are highly social and cooperative, especially when one gives birth.

Between 2009 and 2014, Elisa Demuru, a behavioral biologist, had the great luck to witness and document three different daylit bonobo births, which normally occur at night and out of sight. In each case, Demuru noticed that the other females from the mother-to-be’s community surrounded her.

Yet, unlike human women, bonobos can deliver a baby entirely on their own.

“They don't need assistance,” Demuru said, “but what we found is that you can have assistance in the form of social assistance and social proximity.”

Though some of the females put their hands beneath the mother bonobo to catch the baby if it fell out, it was clear that they were there to support the mother. As Demuru looked at how close the other bonobos were to the mother at different stages of labor, she found that they slowly moved away as the delivery progressed. “So they are not there for the placenta; they are not there for the baby,” she said. “They really are there for the mother until the baby is born, and then they dispersed.”

The support system the bonobos displayed, to Demuru, seems to challenge the idea that midwifery and birth assistance among humans evolved out of necessity.

“It was thought that we have what is called obligate midwifery,” she said, because walking on two feet rearranges the pelvis and narrows the birth canal, assisted birth was necessary to ensure both mother and baby survived the delivery since humans are born with heads proportionally much larger than the offspring of other species, supposedly upping the difficulty of delivery.

But not only do Demuru’s observations of bonobos throw that idea into question, so does recent research by evolutionary anthropologist Nicole Grunstra showing that human births, though challenging, are not uniquely difficult.

Grunstra, for her part, finds the idea that midwifery evolved because of a difficult birthing process somewhat hard to believe but wondered instead — given the emergence of birth assistance in sperm whales, certain other primates, and even hamsters — if “the very early origins of midwifery are actually a byproduct of being very social and maybe also having a certain level of intelligence?”

Demuru hypothesized something similar and took it one step further still: “maybe we could give birth to big babies with big heads, because we already had female sociality.”

This suggests, then, that the cultural evolution of doulas and midwives has to do with the fundamental human drive to support and cooperate with one another, and that the people who took on those roles were likely key figures in early human communities.

No matter the origins, assistance and support during and after birth, whether for mother or child or both, seem to be both innately human and surprisingly common in the wider natural world.

Yet, mothers in the United States today are far less likely to receive the support of a midwife or doula during labor than mothers anywhere else in the world — despite the proven benefits of their support.

On average, for every 1,000 births across America, only four midwives are available to support them. Other wealthy nations have 10 to 20 times as many midwives relative to the number of births. Many of those nations also have 10 times fewer maternal deaths.

And while it’s difficult, if not impossible, to prove a direct cause-and-effect between having more midwives and fewer women dying in childbirth, the correlation on its own seems to suggest that something is wrong with the way the American healthcare system handles childbirth.

One report said a key factor in the erosion of the American midwife is “the medicalization of childbirth.” When reading papers about the labor and delivery process in humans to compare to what she witnessed in the bonobos, Demuru noticed “in Western countries, birth is treated very medically,” she said. “It’s like a sort of disease.”

Approaching childbirth in this way has profound implications for maternal and infant health. While there are of course plenty of situations in which medical support beyond anything a midwife is capable of can be an indispensable and life-saving necessity for mother and child; when risks are low, the medicalization of childbirth can create its own, avoidable problems.

The stress of a hospital environment can prolong labor by raising cortisol levels which in turn suppress the self-reinforcing feedback loop of oxytocin production that increases contractions to expel the baby from the body. And if the labor slows enough, that can drive the medical team to intervene to increasing degrees.

In some cases, home births undertaken with the support of a certified midwife help avoid the inherent stress that comes from being in a hospital room with nurses and doctors flowing in and out. But not everyone wants to do that, nor can do so safely.

In such cases, and even outside of them, doulas can provide critical support for people during childbirth.

Unlike a midwife, who is a trained medical professional that can take the place of an OB-GYN in low-risk scenarios, a doula is not a medical specialist but is instead specialized in providing physical and emotional support over the course of the pregnancy, during birth, and in the early postpartum period. Doulas also serve as a mother’s critical advocate and anchor in a hospital room throughout a delivery.

“Doulas dedicate their professional lives to ensuring women get the best experience possible,” Neel Shah, a professor at Harvard Medical School, told the New York Times.

Doula care has been shown to provide a variety of benefits, including reducing the anxiety of mothers. And for Black women, who die during pregnancy and childbirth over three times more often than white women, doulas are arguably lifesavers that can help limit the kinds of medical racism that Black women (and men) are all too familiar with.

In a recent feature story for the Bakersfield New Observer, a reporter said that, for Black mothers, “a doula was the difference between being heard and being ignored, between a birth plan honored or overridden. Between a mother who came home, and one who didn’t.”

Despite the clear benefits that midwives and doulas provide to mothers, they are today out of reach for most women. It can cost thousands of dollars to hire a doula, but the majority of insurers today don’t cover these services.

Over the last several years, campaigns have been waged across America to ensure Medicaid programs cover doulas, and so far 28 states plus Washington, D.C. have made that mandate.

Private insurance, however, is another story: only UnitedHealthcare so far includes coverage for doulas nationwide. So, many maternal health advocates have turned their attention to lobbying for state-level legislation that requires private insurance plans to include doulas.

This fight is likely to be a long one. But when we look at sperm whales and bonobos, among other animals, we can see how essential it is, and how beautiful it can be, to support a mother and a baby during birth — and the ways that attending the delivery of a child can strengthen the bonds that keep communities together.

After all, if Demuru’s hypothesis is right, this support is what helped humans become who we are.