Evolutionary mismatch in emotional support during childbirth: Lessons from the COVID-19 pandemic.

Background and objectives: Selective pressures on human childbirth have led to the evolution of cooperative birth practices, with birth attendants playing a crucial role in providing emotional support during labor.

Methodology: We leveraged COVID-19-related healthcare disruptions to investigate the impact of the evolutionary mismatch in the availability of emotional support persons on perceived birth stress among a US-based convenience sample (N = 1082).

Results: Individuals who stated during pregnancy that they desired support from their partner or a doula but who did not receive this support had significantly higher perceived childbirth stress (B = 12.5, P < .0001; and B = 5.2, P = .02, respectively, measured on a scale of 0-100). The absence of any support persons (B = 6.7, P < .001), the number of emotional support persons present (B = -5.8 for each additional support person, P = .01), and the feeling that the healthcare provider was busy or distracted during labor (B = 15, P < .001) was significantly associated with childbirth stress. Virtual support did not attenuate these effects.

Conclusions and implications: Not being able to have desired emotional support during labor was associated with significantly higher childbirth stress, even after adjusting for clinical childbirth complications. These effect sizes were substantial, comparable to the elevated stress associated with cesarean section delivery and other childbirth complications. These findings underscore the importance of preventing an evolutionary mismatch in emotional needs during labor by ensuring access to continuous support, even during public health emergencies.