What's everybody's take on whether elf-babies can be born with birth defects? Or if elf-women can die in childbirth?
First, what Steel said. Second from JRRT's Letter 153:
This [Elvish indefinite longevity] is a biological dictum in my imaginary world. It is only (as yet) an incompletely imagined world, a rudimentary 'secondary'; but if it pleased the Creator to give it (in a corrected form) Reality on any plane, then you would just have to enter it and begin studying its different biology, that is all.And from the same letter, referring to his sub-creation:
Its economics, science, artefacts, religion, and philosophy are defective, or at least sketchy.All righty then! I have been given permission to study its different biology and fill in the gaps so here we go.
In my 'verse, elven-children born with birth defects are unlikely if not impossible occurences. In our primary world, the whole process of pregnancy from conception to birth is affected by the interplay of maternal and fetal immune systems. That is a
fact in humans, and unless one is ready to state that Elves are not humans, then it is also a fact for them in Tolkien's secondary world. But that interplay could be a bit different than in mortals.
Take a look at the sheer complexity of the human genome. Then think of the process of meiosis (formation of haploid oocytes and sperm). There is a huge chance that genetic "glitches" will occur in meiosis. For example, trisomy 21 (Down's syndrome) which Aearwen mentioned. To clarify, trimsomy 21 becomes more
likely as a woman's eggs age but age does not cause it. The chromosomal aberration that causes trisomy 21 can happen at any time during a woman's reproductive life. That's just one example. There are all sorts of things that can occur during meiosis -- frameshift mutations, deletions, point mutations -- these can all occur randomly. They are a factor of the complex process of chromosomal assortment and recombination. All can result in birth defects.
Now in the Pandë!verse, something that distinguishes the Elves from Men is the the former's ability to exert more conscious control over what we call "involuntary functions." Maybe there's something subtly different in the architecture of the elven cerebral cortex that allow this. This conscious control -- which can link into immune function -- may be what helps them avoid succumbing to infection and their overall resilience to injury.
Anyway, for conception to occur, the potential mother and father "mediate," for lack of a better word, prior to conception, connecting conscious control with the pituitary-hypothalamic-gonadal axis which would then induce ovulation and perhaps a) increase sperm count and b) optimize conditions that would enhance sperm motility. This is a tricky process. Some elves can do this more effectively than others [*cough* Fëanor and Nerdanel *cough*]. But the conscious control is not strong enough to work at the molecular level of meiosis. So there would be genetic glitches.
These glitches, whether in sperm or egg, might then result in some biological trigger in either gamete that would prevent conception of a healthy egg with a defective sperm or vise versa. Or a defective embryo would not implant (very common in our primary world). There may be a factor or factors in the mother's immune system combined with properties of the uterine lining that "recognizes" the defective embryo and prevents it from implanting. In either case, this is pretty devastating for the elven parents given how much it takes for them to even get the whole process of conception working.
Miscarriages can also occur in the elven women of my 'verse. They're rare and not due to genetic or fetal abnormality, but from physical trauma. Elves are not invulnerable to such.
And that leads into death in childbirth. Yes, that occurs in the elves of my 'verse. It's less common than among mortals due to elven resilience against infection, but as Steel aptly said, there are other events that can result in the death of mother and child that do not invoke infection, but trauma and blood loss. In my 'verse, it is not common but also not so rare as to be unheard of. Given that there appears to be the need for skilled elven-healers in Tolkien's legendarium (and many are women), then I assume they are required for injuries and ailments, including trauma in childbirth or its prevention. The elves of my 'verse put a heavy biological investment in conception and pregnancy so they are bound and determined to have a good outcome.
Childbirth itself is just as painful as it is for mortal women. Again, elves = humans. They have a central and peripheral nervous system and the various pain receptors that go with it. If you're going to have oxytocin for the let-down reflex in lactation or orgasm, then you're gonna have it for labor & delivery. Those powerful contractions will be felt. Aforementioned conscious control probably helps ameliorate this but not completely.
Childbirth is not "instinctual" among elves of my 'verse. These women are humans with big complex brains, and don't lie down in a field like a cow or a pig to give birth. The difficulty of passing a large-headed infant through the pelvic girdle of a human biped cannot be overemphasized. So in my 'verse, ideally there is a network of elven-women, in addition to the healer who may function as midwife, that will support and help the laboring mother. That's a very human thing, too, and apparently a practice that is quite ancient in our primary world.
Because of the high premium elves place on a good birth outcome in my 'verse, their healers know how to perform C-sections and have the technique to stave off bleeding during such surgery. Although the elf-woman is resistant to infection, the healer may augment this with medicines (herbal or mineral) to aid healing. The healer's knowledge of this particular surgery will come into play in the impending chapter of
The Elendilmir when Brethilion -- the elven healer who has accompanied Sámaril into Khazad-dûm -- is called upon to perform such surgery...but not on an elf.
Good lord and all that with a mild hangover and only one cup of coffee.