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Tight fetopelvic proportions can result in obstructed labour and contribute to high rates of maternal and neonatal mortality. Ideas summarised under the \u2018obstetrical dilemma\u2019 have contributed to this assumption by explaining difficult childbirth as the outcome of a unique evolutionary history of bipedalism and encephalisation. However, a comprehensive review of the literature and an analysis of collated data demonstrate that human birth is not truly exceptional in its risk. Dystocia (birth difficulties) occurs across a phylogenetically wide range of placental mammals, including wild populations where natural selection would be expected to minimise its occurrence. Various species show similar or higher dystocia prevalence compared to humans, and fetopelvic disproportion is particularly common in species with precocial, large\u2010bodied offspring. The underlying causes and risk factors are also highly comparable. Contrary to long\u2010standing assumptions, natural selection has not eliminated dystocia in natural mammal populations, suggesting that parturition in placentals may be characterised by a persistent baseline risk of complications. This persistent risk likely reflects a life history trade\u2010off between the improved survival of large offspring and the occasional costs of birth complications. A cliff\u2010edge model of selection can explain the evolutionary dynamics underlying this trade\u2010off and the persistent fraction of fetopelvic disproportion and related forms of obstructive dystocia. An additional trade\u2010off involving litter size is evident in litter\u2010bearing, often altricial species, where both small and large litters increase the risk of dystocia. Phenotypic plasticity further maintains dystocia in populations despite selection, while also contributing to variation in birth difficulty within and among species. These findings reposition human birth difficulties within a broader mammalian pattern rather than as a uniquely human phenomenon requiring exceptional explanations. Reframing human childbirth in this broader context challenges entrenched assumptions and highlights the value of a comparative evolutionary perspective.<\/jats:p>","DOI":"10.1002\/brv.70174","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T10:06:41Z","timestamp":1778062001000},"page":"2214-2239","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Humans are not unique: difficult birth is common in placental mammals"],"prefix":"10.1002","volume":"101","author":[{"given":"Nicole D. 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