Biomarkers of fetal conditions: Finger ridge-counts, facial fluctuating asymmetry, and digit ratio (2D:4D)-are they correlated in women?

OBJECTIVES: Fetal environmental conditions are crucial for life-long health. Direct measurements of developmental conditions are limited in humans; thus, several biomarkers of those conditions have been proposed: that is, finger ridge-counts, level of facial fluctuating asymmetry (FA), and digit ratio (2D:4D). Since all of these biomarkers share a similar gestational time of formation, we hypothesize that their values are significantly correlated. MATERIALS AND METHODS: Data were collected at the Mogielica Human Ecology Study Site in southern Poland among 234 women. Finger ridge-counts, level of facial FA, and 2D:4D have been measured. The two-step analyses included Pearson's correlations of simple values of the biomarkers and correlations of composite variables calculated based on principal component analysis. RESULTS: We did not find any statistically significant correlations between finger ridge-counts, FA, and 2D:4D in women. Similarly, we did not observe any correlations between three composites created from the biomarkers. DISCUSSION: Our results indicate that there are no relationships between the biomarkers, suggested as proxies of the quality of prenatal conditions, in a single population. This is the first study analyzing three different markers simultaneously. The lack of correlations may indicate that the tested biomarkers reflect, in fact, different environmental conditions, occurring in separate "critical windows" of development, or that the biomarkers are not valid as proxies of developmental conditions.

Inflammaging: Blame the sons. Relationships between the number of sons and the level of inflammatory mediators among post-reproductive women.

OBJECTIVES: Reproduction is costly, but sons and daughters differently influence maternal physiology, also in older age. In particular, having sons may negatively influence maternal health and may be associated with a shorter life span of mothers. Sons may also contribute to increased inflammaging, a chronic sub-clinical systemic inflammatory state characterized by elevated levels of serum inflammatory mediators. The aim of this study was to examine the impact of the total number of children, and the number of daughters and sons separately on concentrations of C-reactive protein (CRP), and proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α). MATERIALS AND METHODS: The participants were 378 women aged 45-92 who had 3.9 (SD 2.12, median = 4, range = 0-13) children, including 2.1 (SD 1.46, median = 2, range = 0-8) sons and 1.8 (SD 1.44, median = 2, range = 0-7) daughters on average. RESULTS: We found a positive relationship between the overall number of children and IL-6 levels. CRP and IL-6 concentrations were positively associated with the number of sons but not with the number of daughters. Each son increased maternal CRP level by 11%, and IL-6 level by 6%. Neither the total number of children nor the number of daughters or sons were related to the TNF-α concentration. DISCUSSION: Aging-associated inflammation in post-reproductive mothers with a higher number of sons supports the hypothesis of trade-offs between reproduction and health. Furthermore, these results provide new evidence contributing to the idea that having sons may have more detrimental effects on the maternal organism than having daughters.

Season of birth and biomarkers of early-life environment.

OBJECTIVE: Early-life conditions play an important role in human development, affecting health status and survival. Conditions in utero partly depend on the external environment and thus vary in relation to the season of birth. The aim of this study was to investigate if people born in different seasons of the year differ in values of biomarkers that reflect conditions during fetal development. METHODS: The study was conducted among Polish rural women recruited at the Mogielica Human Ecology Study Site. The participants were 234 women aged 45 to 92 (mean = 60.2; SD = 10.44). The indicators of early-life environment analyzed in the study were: Absolute Finger Ridge Count (AFRC), the difference between mean number of ridge counts in both thumbs and both little fingers (Md15), overall facial fluctuating asymmetry (OFA), central facial asymmetry (CFA), right and left hand 2D:4D. RESULTS: Values of biomarkers of fetal development did not vary among groups of women born in different seasons of the year. CONCLUSIONS: Lack of differences in values of biomarkers according to birth season may indicate that: (a) season of birth is not a good indicator of early-life conditions; (b) tested biomarkers do not reliably reflect the prenatal environment; (c) season of birth does not fully overlap with the sensitive periods of biomarker development and thus fails to capture differences in developmental conditions.

Accelerated senescence as a cost of reproduction: Testing associations between oxidative stress and reproductive effort in rural and urban women.

OBJECTIVES: Oxidative stress is hypothesized to contribute to age-related somatic deterioration. Both reproductive and ecological context may necessitate tradeoffs that influence this outcome. We examined whether measures of lifetime reproductive effort were related to levels of oxidative stress biomarkers in peri- and post-menopausal women and whether associations were moderated by rural or urban residence. METHODS: We surveyed 263 healthy women (age 62.1 ± 10.0 SD) from rural (N = 161) and urban Poland (N = 102), collecting sociodemographic data and urine samples to analyze biomarkers of oxidative stress (8-oxo-2'-deoxyguanosine, 8-OHdG) and antioxidative defense (copper-zinc superoxide dismutase, Cu-Zn SOD). Linear regression models, adjusted for residence, were used to test for associations between reproductive effort and 8-OHdG and Cu-Zn SOD. RESULTS: Univariate models demonstrated significant associations between gravidity and the biomarkers of oxidative stress (8-OHdG: R2  = 0.042, P ≤ .001; Cu-Zn SOD: R2  = 0.123, P ≤ .001). Multivariate models incorporating potential confounding variables, as well as cross-product interaction terms, indicated that gravidity was associated with 8-OHdG (P < .01, R2 adj  = 0.067) and Cu-Zn SOD (P = .01, R2 adj  = 0.159). Residence (ie, urban vs rural) did not significantly moderate the associations between the biomarkers and reproductive effort. CONCLUSIONS: Higher lifetime reproductive effort contributes to increases in oxidative stress and antioxidative defenses. Our results provide evidence of potential mechanisms underlying the physiological tradeoffs influencing senescence for women with high reproductive effort. We illustrate the value of applying an evolutionary perspective to elucidate variation in human health and senescence.

Digit ratio (2D:4D) is not related to cardiovascular diseases or their risk factors in menopausal women.

OBJECTIVES: Digit ratio (2D:4D) is widely used as a biomarker of prenatal hormonal environment linked to the growing number of adult health and disease-related characteristics. It has been suggested that 2D:4D is a good predictor of cardiovascular diseases (CVD) risk among men, but results in women are still inconclusive. Here we test the relationship between 2D:4D and the incidence of cardiovascular diseases (CVD), and their risk factors in Polish, rural women. METHODS: The participants were 410 women age 50 and older. Structured questionnaire was used to gather personal and medical data, including the history of CVD diagnosed by a medical doctor. Anthropometric measurements of body height, weight, and finger lengths were performed. Right-hand and left-hand 2D:4D, mean 2D:4D, Dl-r , and BMI were calculated afterward. For a subgroup of participants (n = 329) fasting blood sample was collected (in order to assess the lipid profile and glucose levels) and blood pressure was measured. Age, education level and BMI were included as potential covariates. RESULTS: No statistically significant association was observed between 2D:4D markers and the incidence of CVD (eg, heart attack, stroke) or CVD risk factors (dyslipidaemia, dysglycaemia or hypertension), when controlled for age, education and BMI. CONCLUSIONS: The results of our study add to the growing number of studies investigating the sex-difference of the association between 2D:4D and cardiac health. We conclude that from a public health perspective 2D:4D may not be a valuable biomarker of elevated risk of CVDs in women.

Costs of reproduction are reflected in women's faces: Post-menopausal women with fewer children are perceived as more attractive, healthier and younger than women with more children.

OBJECTIVES: The costs associated with reproduction (i.e., gestation, lactation, childcare) have long-term negative consequences by elevating risk of disease and reducing lifespan. We tested the hypotheses that high parity, and thus high reproductive costs bear by women, is perceived by other people when they evaluate facial appearance of health, attractiveness and age of mothers. MATERIALS AND METHODS: Using computer software we created average facial images based on real photographs of post-menopausal women with varying number of children; 3 parity categories were created (1-2, 4-5, and 7-9 children). Study participants (N = 571) were asked to choose the face they perceived as more attractive, younger and healthier via two-alternative forced choice questions asked in three randomized blocks. RESULTS: Women who had given birth to fewer children were judged both by men and women as more attractive, younger and healthier than women with more children. In each category the lowest scores were received by women from highest parity category (7-9 children). DISCUSSION: Mechanisms behind the observed variation in facial appearance are not known but higher levels of oxidative stress among women with high parity may explain their faster aging and lower attractiveness in older age. These results suggest that costs of reproduction might affect women's physical appearance.

Age difference between parents influences parity and number of sons.

OBJECTIVES: Among couples, women usually prefer slightly older men, and men tend to choose much younger partners. Age difference between partners has been shown to influence their parity; however, results of previous studies are inconsistent. This study analyzed relationships between husband and wife age difference and their total number of children, and number of daughters and sons in a contemporary, rural Polish population. METHODS: Demographic and reproductive data were collected from 384 postmenopausal women from rural Poland who were married only once. Regression models were used to evaluate the impact of the age gap between partners on total number of children and on number of daughters and sons. Women's age, age at marriage (as an indicator of reproductive value), and years of education were used in analyzes as potential confounders. RESULTS: There was an inverted U-shape association between parental age difference and number of children and also the number of sons. The highest number of children and sons was observed when men were approximately 6.5 years older than their wives. There was no significant relationship between parental age difference and number of daughters. CONCLUSIONS: Age difference between partners is important for reproductive success (with younger wives having higher reproductive potential) and is also related to number of sons. Older husbands might provide more resources for the family, thus facilitating production of well-nourished male offspring. Future research should evaluate not only number of children but also their biological condition, health, and lifetime achievements in relation to the age difference between their parents.

Women with more feminine digit ratio (2D:4D) have higher reproductive success.

OBJECTIVES: Prenatal development has a long-lasting influence on biological condition and health. Second-to-fourth digit ratio (2D:4D) is suggested as an indicator of sex hormone exposure during fetal development, and it is likely that women with a more feminine digit ratio were exposed to higher prenatal estrogen levels. Therefore, we tested if 2D:4D was related to a woman's reproductive characteristics. METHODS: We studied 319 women aged 46-92, who went through a natural menopause and whose husbands were alive at least until their menopause were studied. Women were recruited at the Mogielica Human Ecology Study Site located in rural Poland. RESULTS: Women with more feminine 2D:4D had a higher number of children (P = 0.002), gave birth to their last child at a later age (P = 0.02), and had a longer reproductive lifespan (P = 0.04) than women with more masculine 2D:4D. Age and number of years of education were included as potential confounders in the analyses. CONCLUSIONS: The results indicated that women with more feminine 2D:4D had higher reproductive success. While the exact mechanisms were not known, and the relationship between 2D:4D and adult sex hormone levels was questioned by previous studies, there might be other biological pathways explaining the observed results, that is, via behaviors that were indirectly related to fertility. Am J Phys Anthropol 160:549-553, 2016. © 2016 Wiley Periodicals, Inc.

Fertility decline and the changing dynamics of wealth, status and inequality.

In the course of demographic transitions (DTs), two large-scale trends become apparent: (i) the broadly positive association between wealth, status and fertility tends to reverse, and (ii) wealth inequalities increase and then temporarily decrease. We argue that these two broad patterns are linked, through a diversification of reproductive strategies that subsequently converge as populations consume more, become less self-sufficient and increasingly depend on education as a route to socio-economic status. We examine these links using data from 22 mid-transition communities in rural Poland. We identify changing relationships between fertility and multiple measures of wealth, status and inequality. Wealth and status generally have opposing effects on fertility, but these associations vary by community. Where farming remains a viable livelihood, reproductive strategies typical of both pre- and post-DT populations coexist. Fertility is lower and less variable in communities with lower wealth inequality, and macro-level patterns in inequality are generally reproduced at the community level. Our results provide a detailed insight into the changing dynamics of wealth, status and inequality that accompany DTs at the community level where peoples' social and economic interactions typically take place. We find no evidence to suggest that women with the most educational capital gain wealth advantages from reducing fertility, nor that higher educational capital delays the onset of childbearing in this population. Rather, these patterns reflect changing reproductive preferences during a period of profound economic and social change, with implications for our understanding of reproductive and socio-economic inequalities in transitioning populations.

Early-life reproduction is associated with increased mortality risk but enhanced lifetime fitness in pre-industrial humans.

The physiology of reproductive senescence in women is well understood, but the drivers of variation in senescence rates are less so. Evolutionary theory predicts that early-life investment in reproduction should be favoured by selection at the cost of reduced survival and faster reproductive senescence. We tested this hypothesis using data collected from preindustrial Finnish church records. Reproductive success increased up to age 25 and was relatively stable until a decline from age 41. Women with higher early-life fecundity (ELF; producing more children before age 25) subsequently had higher mortality risk, but high ELF was not associated with accelerated senescence in annual breeding success. However, women with higher ELF experienced faster senescence in offspring survival. Despite these apparent costs, ELF was under positive selection: individuals with higher ELF had higher lifetime reproductive success. These results are consistent with previous observations in both humans and wild vertebrates that more births and earlier onset of reproduction are associated with reduced survival, and with evolutionary theory predicting trade-offs between early reproduction and later-life survival. The results are particularly significant given recent increases in maternal ages in many societies and the potential consequences for offspring health and fitness.

Apolipoprotein E (ApoE) polymorphism is related to differences in potential fertility in women: a case of antagonistic pleiotropy?

The alleles that are detrimental to health, especially in older age, are thought to persist in populations because they also confer some benefits for individuals (through antagonistic pleiotropy). The ApoE4 allele at the ApoE locus, encoding apolipoprotein E (ApoE), significantly increases risk of poor health, and yet it is present in many populations at relatively high frequencies. Why has it not been replaced by natural selection with the health-beneficial ApoE3 allele? ApoE is a major supplier of cholesterol precursor for the production of ovarian oestrogen and progesterone, thus ApoE has been suggested as the potential candidate gene that may cause variation in reproductive performance. Our results support this hypothesis showing that in 117 regularly menstruating women those with genotypes with at least one ApoE4 allele had significantly higher levels of mean luteal progesterone (144.21 pmol l(-1)) than women with genotypes without ApoE4 (120.49 pmol l(-1)), which indicates higher potential fertility. The hormonal profiles were based on daily data for entire menstrual cycles. We suggest that the finding of higher progesterone in women with ApoE4 allele could provide first strong evidence for an evolutionary mechanism of maintaining the ancestral and health-worsening ApoE4 allele in human populations.

The Paternal Provisioning Hypothesis: effects of workload and testosterone production on men's musculature.

OBJECTIVES: Testosterone supports male reproduction through a broad range of behavioral and physiological effects, including the maintenance of sexually dimorphic muscle used in male-male competition. Although it is often assumed that a persistent relationship exists between men's testosterone production and musculature, most studies either fail to find evidence for such a relationship, or document very weak associations. In nonhuman primates, by contrast, correlations between testosterone and muscle mass are higher. Here, we propose the "Paternal Provisioning Hypothesis," which predicts that men's skeletal muscle is less dependent on the effects of androgens than that of other primates, and more sensitive to the physical demands of men's work. This permits human fathers to downregulate testosterone, which has negative impacts on pair-bonding and parenting effort, but without sacrificing the strength and musculature necessary to provision mates and offspring. METHODS: We tested predictions of the Paternal Provisioning Hypothesis by assessing parental status, salivary testosterone levels, anthropometry, and strength among 122 men (ages 18-78) at the Mogielica Human Ecology Study Site in rural Poland. We chose this population because men practice subsistence agriculture, regularly engaging in physically demanding labor. Grip and chest strength were assessed using a dynamometer, and upper-body musculature was estimated from arm muscle circumference. RESULTS: In this population, testosterone showed no association with measures of strength or musculature, and was lower in older men and pair-bonded fathers. Marital and parental status and workload, by contrast, were positive predictors of muscle mass and strength measures. DISCUSSION: These findings offer support for the Paternal Provisioning Hypothesis.

Being born after your brother is not a disadvantage: Reproductive success does not depend on the sex of the preceding sibling.

OBJECTIVES: The aim of the present study is to examine whether being born after a brother versus after a sister differentially impacts reproductive outcomes in a contemporary population. The sex of the preceding sibling may influence an individual's fitness, and, in fact, individuals born after a brother have been shown to have lower reproductive success in historical populations. Males, as the more expensive sex, constitute a drain on maternal resources and elicit an immune response during pregnancy, which may have negative consequences on subsequent siblings. METHODS: A questionnaire was used to collect data on reproductive health and family history from 951 women and 380 men between 20 and 92 years of age in villages throughout the Mogielica Human Ecology Study Site in southern Poland. Number of children, number of sons and daughters, age at menarche, age at marriage, age at menopause, and age at first and last reproduction were tested as components of reproductive success. RESULTS: The sex of one's preceding sibling had no statistically significant impact on any of the reproductive characteristics tested. CONCLUSIONS: Our results suggest that potential immunological and nutritional disadvantages experienced during prenatal life by individuals born after male siblings do not have long-lasting effects in modern, well-nourished populations.

The effect of socio-economic status and food availability on first birth interval in a pre-industrial human population.

Individual variation in nutritional status has direct implications for fitness and thus is crucial in shaping patterns of life-history variation. Nevertheless, it is difficult to measure in natural populations, especially in humans. Here, we used longitudinal data on individual life-histories and annual crop yield variation collected from pre-industrial Finnish populations experiencing natural mortality and fertility to test the validity of first birth interval (FBI; time between marriage and first birth) as a surrogate measure of nutritional status. We evaluated whether women with different socio-economic groups differ in length of FBI, whether women of poorer socio-economic status and experiencing lower crop yields conceive slower following marriage, and whether shorter FBI is associated with higher lifetime breeding success. We found that poorer women had longer FBI and reduced probability of giving birth in months with low food availability, while the FBI of richer women was not affected by variation in food availability. Women with shorter FBI achieved higher lifetime breeding success and a faster reproductive rate. This is, to our knowledge, the first study to show a direct relationship between environmental conditions and speed of childbirth following marriage, highlighting the value of FBI as an indicator of nutritional status when direct data are lacking.

Community-level education accelerates the cultural evolution of fertility decline.

Explaining why fertility declines as populations modernize is a profound theoretical challenge. It remains unclear whether the fundamental drivers are economic or cultural in nature. Cultural evolutionary theory suggests that community-level characteristics, for example average education, can alter how low-fertility preferences are transmitted and adopted. These assumptions have not been empirically tested. Here, we show that community-level education accelerates fertility decline in a way that is neither predicted by individual characteristics, nor by the level of economic modernization in a population. In 22 high-fertility communities in Poland, fertility converged on a smaller family size as average education in the community increased-indeed community-level education had a larger impact on fertility decline than did individual education. This convergence was not driven by educational levels being more homogeneous, but by less educated women having fewer children than expected, and more highly educated social networks, when living among more highly educated neighbours. The average level of education in a community may influence the social partners women interact with, both within and beyond their immediate social environments, altering the reproductive norms they are exposed to. Given a critical mass of highly educated women, less educated neighbours may adopt their reproductive behaviour, accelerating the pace of demographic transition. Individual characteristics alone cannot capture these dynamics and studies relying solely on them may systematically underestimate the importance of cultural transmission in driving fertility declines. Our results are inconsistent with a purely individualistic, rational-actor model of fertility decline and suggest that optimization of reproduction is partly driven by cultural dynamics beyond the individual.

Digit ratio (2D:4D) as an indicator of body size, testosterone concentration and number of children in human males.

OBJECTIVES: The 2nd to 4th digit ratio (2D:4D) is thought to reflect exposure to androgens during foetal development. This study examined the relationship between low (more masculine) and high (more feminine) 2D:4D and body size at different stages of the life course, adult testosterone levels and number of children among males. METHODS: Five hundred and fifty-eight men from rural Poland at the Mogielica Human Ecology Study Site participated in this study. Life history data and anthropometric measurements were collected. Salivary morning and evening testosterone levels among 110 men from the same population were measured. RESULTS: Low 2D:4D was related to higher birth weight (p = 0.04), higher birth length (p = 0.01), higher body mass during childhood and adolescence (p = 0.01), higher BMI (borderline significance, p = 0.06), higher number of children among fathers (p = 0.04) and higher testosterone levels during adulthood (p = 0.04). CONCLUSIONS: This study shows, for the first time in a single population, that digit ratio is related to sub-adult body size at different stages of the life course, adult testosterone levels and number of children. The observed results suggest that digit ratio might be a valuable predictor of male body size and reproductive characteristics.

"We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine.

BACKGROUND: After the outbreak of the full-scale war in Ukraine, about 2 million people sought protection in Poland. Providing high-quality care for migrants and refugees, especially in times of significant arrivals, can be particularly challenging. AIM: To learn about the experiences and strategies of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine. METHODS: Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed. RESULTS: We identified the barriers experienced by midwives in providing high quality care to migrants to be mainly on the individual and interpersonal levels and levels of management and organization. First, at the individual and interpersonal level, we have identified: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for women fleeing war. Second, at the management and organizational level we have identified: lack of organizational support, and interpreting services. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units. CONCLUSIONS: The Polish health care services need systemic solutions prepared jointly by state and local authorities and taking into account the voices of midwives to support the provision of high-quality care to migrant population.

First birth interval, an indicator of energetic status, is a predictor of lifetime reproductive strategy.

OBJECTIVES: Women should differ in their reproductive strategies according to their nutritional status. We tested a hypothesis that women who have a good nutritional status early in life, as indicated by a shorter waiting time to the first birth (first birth interval, FBI), are able to afford higher costs of reproduction than women who have worse nutritional condition. METHODS: We collected data on 377 women who got married between the years 1782 and 1882 in a natural fertility population in rural Poland. The study group was divided into tertiles based on the length of FBI. RESULTS: Women with the shortest FBI had a higher number of children (P = 0.005), higher number of sons (P = 0.01), and shorter mean interbirth intervals (P = 0.06). Women who had ever given birth to twins had shorter FBI than women of singletons (20.1 and 26.1 months, respectively; P = 0.049). Furthermore, women with a shorter FBI, despite having higher costs of reproduction, did not have a different lifespan than women with a longer FBI. CONCLUSIONS: Our results suggest that women who were in better energetic condition (shorter length of FBI), achieved higher reproductive success without reduction in lifespan. FBI reflects interindividual variation, which may result from variation in nutritional status early in life and thus may be a good predictor of subsequent reproductive strategy. We propose to use FBI as an indicator of women's nutritional status in studies of historical populations, especially when information about social status is not available.

Relationships between biomarkers of inflammation, ovarian steroids, and age at menarche in a rural Polish sample.

OBJECTIVES: To test the hypothesis that life history trade-offs between maintenance and reproductive effort would be evident through inverse associations between levels of a biomarker of inflammation [C-reactive protein (CRP)], and ovarian hormones. Associations between CRP and age at menarche were also explored. METHODS: Urinary CRP, salivary progesterone, and estradiol were measured over one menstrual cycle from rural Polish women (n = 25), representing a natural fertility sample. Age of menarche was assessed through interview recall methods. We used minimum second-order Akaike Information Criteria as a means of multiple regression model selection, and repeated measures ANOVA to test cycle-dependent hypotheses. RESULTS: Comparisons of individuals in high and low CRP tertiles revealed that those with high CRP had significantly lower progesterone (luteal P = 0.03, mid luteal P = 0.007) but not estradiol (follicular P = 0.21, luteal P = 0.15) concentrations through the menstrual cycle. However, when the age at menarche was included in the analysis, both age at menarche and urinary CRP were negatively associated with estradiol (R(2) = 0.44, P = 0.0007). Age at menarche and estradiol were the strongest negative predictors of CRP (R(2) = 0.52, P = 0.0001). CONCLUSIONS: Inflammation itself may suppress ovarian function, or indicate immune challenges that lead to ovarian suppression. The timing of menarche may also influence adult inflammatory sensitivity and ovarian hormone concentrations. This lends support to existing models of trade-offs between maintenance and reproduction in women.

Investment in the peace of mind? How private services change the landscape of maternity care in Poland.

For over two decades midwifery research advocated for the continuity of care and the ability to establish a relationship between care providers and care users as an important features of quality maternity services. In many countries, while unavailable through public services, continuity of care became commercialized and can be access as a private service. In Poland, private prenatal consultations and dedicated midwifery care allow women to access continuity and establish personal relationships with care providers. In this study, we explore, how accessing these private services, impact the rates of medical interventions and type of care women receive during labour and birth. We analyse data collected through an online questionnaire from 4402 first-time mothers in healthy pregnancy who had given birth in Poland between 2020 and 2021. We show that while private consultation did not translate into any significant differences in care, women who accessed private dedicated midwifery services experienced more attentive and less medicalized care, namely were more likely to give birth in vertical position, move freely during labour and less likely to experience emergency caesarean section. However, private dedicated midwifery care did not shield them from negative experience. While private care offers benefits for women who can afford it, it also contributes to inequalities in access to quality care and puts women with less social and financial resources in a vulnerable position. Efforts should be made to develop a more universal and equitable model of care that allows for building personal relationships between maternity care providers and women.