In message . net, Todd
Gastaldo writes
NHS (via Dr. Grace Lomax ):

DR. SARAH DISAPPOINTS...

"I've attended lots [of births], both as a student and as a junior doctor.
Most of them have been lying/semisitting."
--Dr. Sarah Vaughan of Britain

Readers,

Dr. Sarah Vaughan unapologetically states (in effect) that she attended
"lots" of births where the birth canal was closed up to 30%.

Dr. Sarah Vaughan seems to think it was OK that birth canals were closed

I said the first, but not the second. Please don't put words in my
mouth.

[...]
Dr. Sarah Vaughan again snipped my text about OBs obviously lying.

No ****, Sherlock. Remember me mentioning that I feel your posts get
very long to the point where the important bits in what you're saying
tend to get lost/obscured? I wasn't kidding. As a veteran of many,
many debates that have turned nasty in one way or another, I can
genuinely sympathise if you've had to put up with lying opponents. I'm
just not sympathetic enough to spend hours going through lengthy posts
working out who said or did what and what the truth of it all was in
order to comment. That wouldn't make a difference to anyone's birthing
position, though it would make a considerable difference to my chances
of ever getting ready for this baby.

Dr. Sarah Vaughan ignores the OB lying: She says (in effect) that she needs
"specific evidence" about the risks of letting OBs lie and close birth
canals before she will say whether OBs should be automatically offering
women the "extra" up to 30%.

I didn't actually say that either, though in this case I can see why you
thought I did. Recapping:

Todd asked me
QUESTION #2: Do you personally think that the medical treatment of
closing the birth canal up to 30% (and keeping it closed when babies get
stuck) should be described to pregnant women along with particularly
important risks (like c-section, forceps, vacuums and death and paralysis
of babies) and how easy it is for pregnant women to allow their birth
canals to OPEN the "extra" up to 30% - or should women have to ASK for the
"extra" up to 30%?

........to which my simplest answer, based on the data I've got
currently, would be 'No'. As in 'No to both of the alternatives you
gave'. I don't think that women should be told that particular risks
exist unless we have specific evidence that they _do_ exist, but nor do
I think that women should have to come up with information on better
birthing positions for themselves - it should be suggested to them.

What I would say to a woman considering her birthing position would be
something like: "In labour, it's likely to be a good idea if you can try
positions that get you off your tailbone - avoid sitting/lying
back/lying flat. If you can stay off your tailbone, especially in second
stage, it gives your pelvis space to open up, and this can really make
quite a big difference in the amount of space your baby gets to come
out. It's quite possible that this may make a difference to your
chances of ending up with a caesarean, forceps or vacuum delivery and to
how easy the delivery will be on your baby as well as you."

If you have any specific evidence as to what the relative figures are
for these risks for the different birthing positions, I'll be happy to
amend the "It's quite possible that this may......" accordingly. But
I'm not going to tell someone that a risk _is_ reduced if all we have is
a theory that it _may_ be reduced. Which is why, when you originally
wrote that, I answered:

[Sarah] Depends on what specific evidence we have about the risks. Most
pregnant women probably aren't that interested in measurements and by
what percentage they change - they're interested in what, specifically,
this means for them and their babies. What specific figures do you have
on the risks you've mentioned according to different types of delivery
position?

To which you've now answered:
[Todd] The specific evidence is that babies are suffering UNEXPLAINED brain
bleeds, unexplained deaths, unexplained paralyses - unexplained lesser
sensory and motor deficits.

So what research has been done on frequency of these tragic outcomes
according to different types of birthing position, and what did the
research show?

[Todd] The specific evidence is that OBs LIE and claim they are allowing
birth canals to open the "extra" up to 30% even as they keep birth canals
closed when babies get stuck.

That's not evidence of anything except that you probably shouldn't buy a
used car from an OB. I hate lies, but this tells us nothing about what
the outcomes are.

[Todd] Are you saying that women should have to ASK for the "extra" up to
30% - that you need "specific evidence about the risks" before you'll agree
that OBs should automatically offer the women the "extra" up to 30%?

No. I think women should be advised to try to avoid lying/semisitting
positions during delivery. I'm saying that I will not embroider that
advice with claims that will potentially scare the hell out of women and
send them on guilt trips unless I have good evidence for what I say.
Not every woman _can_ deliver in the positions you've advocated - try
googling for Pat Harris's birth story on this group, a few months back,
for example - and I'm not going to give a woman advice that has the
potential to leave her feeling horribly guilty over the way her baby's
birth went unless I'm bloody sure it's accurate information in the first
place. There is a big difference between "It's possible that this might
increase your risk of ending up with a Caesarean section" and "This
_will_ increase your risk not only of a Caesarean section but of your
baby suffering brain damage." That's where the evidence comes in.

One last note Sarah. You don't need to acknowledge that in response to your
sarcastic request for a better system I quickly found one - right there in
the UK.

shrug I already acknowledged it by saying something like "That's
good", as I recall. BTW, the sarcasm wasn't aimed at you, just a sort
of weary cynicism about the insolubility of many of the world's
problems.

See what you snipped, restored below.

The hell with that. Todd, I'm really _not_ going to plough through long
detailed discussions of who said what when. Have you got any research
comparing outcomes of labours according to position? Specifically,
research that shows that opening the birth canal actually does lead to a
lowered risk of the problems you've mentioned? If so, I would be happy
to incorporate it into the advice I give to women. If not, I'm sticking
with "This _might_ reduce your risks."


All the best,

Sarah

--
"I once requested an urgent admission for a homeopath who had become depressed
and taken a massive underdose" - Phil Peverley