"Minifingers the reason for mentioning those women is that you said women don't die of exhaustion and pain during childbirth. They do."
Evidence?
In 1953 in the UK the caesarean section rate was 3%. The maternal death rate was 0.3 deaths per 1000 births. Far and away the main causes of maternal death were postnatal haemorrhage and eclampsia. This suggests that women expiring from pain in labour was vanishingly rare in the days before epidurals were widely available. Epidurals (which weren't epidurals in the form we know them) weren't in common use in the UK until the 1970's.
"You say that in healthy women, in the absence of disease, childbirth is usually uncomplicated. However, such women also have access to modern inventions such as antenatal care and antibiotics, and these are also part of the reason for uncomplicated outcomes".
I'm not sure what you're saying. I'm not denying the benefits of modern midwifery antenatal care and scans. But I am pointing out that once we know a mother is healthy and low risk the chances of her having a normal birth are very high, if she's given optimal care. Antenatal care contributes to the outcomes only by identifying those women who need treatment and monitoring. The straightforward births are entirely down to the fact that the mother is healthy and her body is functioning normally.
"So you cannot use this as evidence that we are well designed/suited to childbirth, because you have no idea how much of the good outcomes are down to physiology and how many are down to modern care."
I have every idea. Healthy women are not given any treatment on the NHS, they are simply identified. The only impact antenatal care has had is to give them a green light to give birth away from an obstetric setting.
"which is why I wouldn't and didn't suggest that epidurals improve clinical outcomes. We sure as fuck can't say they make them worse, though."
Well, the society of obstetric anaesthetists says they lead to higher rates of fetal distress, women becoming febrile in labour, 1 in a 100 dural tap, higher rates of forceps and ventouse deliveries, and no decrease in c/s rate. That will do for me. I appreciate that women who are denied the pain relief they need may develop PTSD (as may women who have epidurals which don't work or which result in worrying or unpleasant side-effects). I don't think it's rational to try to find a way of 'offsetting' this against the side effects and risks of epidurals. That's not how it works. They don't cancel each other out.