A Comparison Between Electroencephalograms of Indians Born in the Squatting Position and "Civilized" People Born in the Dorsal Decubitus Position Delivery

INTRODUCTION

The better anatomical and physiological conditions of the pelvic “floor” of the Indians of the South of Brazil convinced the authors of this work that the adoption of the squatting position for giving birth is much advantageous to the mothers, as it is common among the Indians.

The employ of that method in the hospital has allowed a comparative study with the births in which the women were in the dorsal decubitus (lying down) position. If the observation was easy and direct in relation to the women, the same didn’t happen in relation to the children.

Besides the newborn’s conditions, furnished by the APGAR test, what other tests could measure the development of the child, aiming to prove that to give birth in the squatting position was less harmful for the children?

The personal experience, very recent, and the few number of cases were insufficient for a study with clear conclusions. From there came the decision to gather data in the Indian reservations, where it is usual to give birth squatting down.

The difficulty of verbal communication has prevented the common psychological and other tests, as well as those for neurological evaluation. There was no availability of specialized personnel that could go to the Reservations to apply the test.

In order to overpass such difficulties, we have chosen the electroencephalogram as an easy, mechanical process, simple to apply and to interpret. From the scientific literature we brought data for comparison.

MATERIAL AND METHOD

The sample studied consisted of 200 patients observed.

The program was developed during the weekends, starting in the Reservations closer to Curitiba and followed by the more distant ones.

The readings were registered by a clinical electroencephalograph “Nihon Kohden mod. 7109”, that was installed in the infirmaries of the Reservations that counted with electrical generations in the South of the country.

To begin the work, the objectives of the study were explained to the chief of the reservation, a public servant belonging to FUNAI.

After that our intentions were also transmitted to the Indian chiefs, that took charge of inviting the Indians to take part in the exams.

Approval and cooperation were immediate. Everybody wanted to help. In none of the Reservations we found any difficulty. The Indians know and fear epilepsy very much.

At the beginning we took few readings and the work progressed slowly. The Indians were mistrustful and few came to the exams. After they were sure that the exams were innocuous, they started to come in larger numbers. Presents were given, which helped to conquer their confidence.

We visited four reservations in the state of Paraná and one in the state of Santa Catarina. Afterwards our observations also included the reservation of Ibirama, Santa Catarina, which analysis was presented separately at the end of this work.

RESULTS

On the following diagrams the results obtained on the first five reservations are described, which were Ivaí, Marrecas, Rio das Cobras, Mangueirinha and Chapecó.

Diagram I makes reference to the areas visited, population and number of readings. 

Examinations made:

214 Caigangues - 173 Paraná

10 Guaranis - 51 Santa Catarina

Total: 224

ANALYSIS OF THE FIRST 200 CASES OF THE FIRST FIVE RESERVATIONS

Age: from 6 to 81 years. The minimum age was fixed at 6 years old. Less than this would make it too difficult to have the collaboration of the subject for the exam. Only under sedation we could obtain a reading in this case; there was no reason for such a drastic resource.

Age Group - Diagram II

Birth Order - Diagram III

Disritmia and the Type of Birth (including Ibirama) - Diagram V

COMENTS

A comparative study, to obtain acceptable and less disputable conclusions should limit observations to similar individuals, or at least belonging to the same ethnic group.

In the civilized environment that would not be possible at the moment. We decided to make the observations where that was possible, at the Indian reservations, where it is usual to give birth squatting down. Later we tried to complement the observations at the Ibirama Reservation, where we were informed that Indians were giving birth lying down.

That number, nevertheless, was small, amounting only to 24 readings, insufficient for a comparison study. We have compared our data with that of the classical authors.

Authors consulted estimate between 5 and 10% the incidence of dysrhythmia among the different peoples.

Epilepsy, well characterized and defined, happens in a proportion of 1:200  (0,50%) of the population of the United States of America, while in England 0,40% of the population have that illness,  in what amounts to 1:250. Between the Indians the proportion is of 1:650. In a closed community, like the Indian reservation, everybody knows everything that happens, especially when we are talking about epilepsy. The convulsions are attributed to the most curious reasons.

In all the reservations the question: “How many between you suffer from the convulsion illness?” was promptly answered, without hesitation. They could even mention similar persons in other tribes. Some of them hundreds of kilometers far.  They could give the names, place of living and other details about those that were ill.

CONCLUSIONS

From the analysis of the data that was gathered, resumed in Diagram V, we can draw the following conclusions:

1. Four dysrhythmic readings found in 200 Indians born in the squatting position correspond to 2%, a very low number, especially if compared with that of the “civilized” people which is between 5 and 10%.

2. Three dysrhythmic readings found in 24 Indians born in the lying down position (12,5%) put them in a higher percentage than that of the “civilized” born in the same position, whose cases of dysrhythmia are between 5 and 10%.

It is necessary to consider that, in the Indian Reservations free from outside influences, the woman about to give birth only lies down when she is very tired, in an excessively long labor caused by grave dystocia, in general due to a disproportion between the embryo and the pelvis, or a bad presentation of the baby. It is generally understood that the babies born at that kind of delivery suffer more and are more prone to brain lesions. That is a possible explanation to the higher incidence of dysrhythmia in those Indians.

3. The existence of one case of epilepsy between 650 individuals born squatting down, against 1:200 or 1:250 of the “civilized” is a number that deserves better considering.

We can also ask to which point are those indexes due to racial peculiarities and to the Indian’s peculiar conditions of life.

4. The results of this comparative study, although maybe not conclusive, can serve as a subsidy in the choice of position that the woman can adopt at the moment of birth.

5. It remains the impression that the low incidence of dysrhythmia and epilepsy among the Indians is not due to racial conditions, but mainly to the Indian birth method – squatting down – which is quicker, easiest and less traumatic.

Not considering Ibirama, we found the proportion of 1:670 incidence of epilepsy among the Indians of the area under study, corresponding to 1,85% in a population of 3.350, against 5 to 10% of the “civilized”. Considering that the lesions of the central nervous system are frequently consequence of birth problems, it is admissible that the low incidence of dysrhythmia and epilepsy in the Indian population is probably due to the Indian position of birth – squatting.

We would like to comment on the observations we made among the Xokleng Indians of the Itajaí-açu Reservations, of the city of Ibirama, Santa Catarina.

We had been told that a great number of Xokleng Indians went to the city hospital to give birth, where that happened in the lying down position.

That fact would represent an ideal comparative material for this work: the comparison of similar individuals, ethnically similar, Indian with Indian. An interesting fact is that the Xokleng of Santa Catarina and the Caingangue of Paraná belong to the same Indian family, the Botocudos, that speak the same language, have the same physical type, customs, etc.

When we planned the observation in Ibirama it was planned to examine only Indians born from births in the lying down position. In reality, among the first 24 Indians that came to the examination, only 6 were born at the lying down position.

Ibirama: Type of Birth and Occurrences - Diagram VI

The fact that in 6 births in the lying down position there were two cases of epilepsy has drawn our attention, since it would be a very high incidence, but the sample we studied is very small to allow more than its registration. It was not used in this statistical study.

SUMMARY

Electroencephalograms were made in 200 Indians in some Reservations in the South of Brazil, determining the existence of epilepsy. Dysrhythmia was found in four electroencephalograms (2%), a lower index than that of the “civilized” population – 5 to 10%. Epilepsy was found in a proportion of 1:650; between the “civilized” population that proportion is of 1:200. Those differences are attributed to the Indian method of giving birth in which the woman squats down, differently of the civilized women that give birth lying down.

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