<p>Human childbirth is regarded as uniquely difficult among primates, due to a tight cephalopelvic fit thought to result from an evolutionary trade-off between adaptations to bipedal locomotion and increasing brain size. This impression, however, may be an artefact of past adoption of anthropocentric measurements that underestimate birth challenges in non-human primates. Here we re-evaluate cephalopelvic proportions using species-specific three-dimensional data of the pelvic inlet along with neonatal cranial dimensions from a broad sample of extant primates. Results reveal that maternal body size is a key factor to consider. A tight cephalopelvic fit occurs in species with proportionately larger neonates, smaller pelves or a combination of both. The latter is the case in humans, producing the tightest fit among extant apes, but a similar combination of factors explains much more extreme cephalopelvic proportions in other species. Our findings reveal a diversity of obstetrical dilemmas across primates.</p>