Question for Dr. Sarah Vaughan

QUESTION FOR DR. SARAH VAUGHAN

See below...

On Oct. 21, Dr. Sarah Vaughan said she said to a midwife:

"I've been reading that if you lie or sit down in the second stage,
it closes off quite a lot of the space in your birth canal because of
the pressure on your tailbone. What I've read is that you should try
positions like squatting, or on all fours, or lying on your side, or
maybe even standing, to *get off your tailbone*, because it just gives
so much more space."

She quoted the midwife's reply: "THAT'S QUITE RIGHT..." (emphasis added)
http://groups.google.com/groups?selm... output=gplain


Also on Oct. 21, Dr. Sarah Vaughan wrote:

"I have no idea whether you have the biomechanics
right or not...However much you might want it to be against the law, it
isn't. "
http://groups.google.com/groups?selm...&output=gplain


QUESTION FOR DR. SARAH VAUGHAN...

Assuming OBs and midwives are ignoring simple biomechanics and the medical
literature and closing birth canals up to 30%...

Assuming OBs are KEEPING birth canals closed (keeping women semisitting or
dorsal) when they pull with forceps and vacuum extractors...

Are you saying that such behavior is within the law?

Todd

Dr. Gastaldo


PS SOME KEY DETAILS... Sarah, as you ponder my question, please keep in
mind the following details I offered in one of the posts to which you were
replying (URLs above)...

1. OBs demonstrated early last century massive change in AP pelvic outlet
diameter; but then changed to saying that obstetric diameters don't change.

2. When informed (by Ohlsen in 1973) of radiographic evidence that pelvic
diameters DO change, OBs shifted to saying (erroneously) that dorsal widens.

3. When OBs were informed (by me in 1992) that dorsal CLOSES - they
re-published their dorsal widens falsehood - but included (as I requested)
the correct biomechanics.

Finally Sarah, you wrote of your fellow medical doctors: "I think _they_
dismiss you as a total kook, etc., and then don't think about it further.
That's my point."
http://groups.google.com/groups?hl=e...el.demon.co.uk

Hopefully you can re-word this short post such that it does not offend the
delicate sensibilities of your fellow medical doctors. Some of them (OBs)
are closing birth canals up to 30% and KEEPING birth canals closed when
babies get stuck. Assuming I am right... MY QUESTION AGAIN: Are you
saying that such behavior is within the law?

On Sat, 23 Oct 2004 04:07:09 GMT, "Todd Gastaldo"
wrote:

QUESTION FOR DR. SARAH VAUGHAN

A "mini me" post!! Way to go, Todd!!!

--
Daye

"Daye" wrote in message
...
On Sat, 23 Oct 2004 04:07:09 GMT, "Todd Gastaldo"
wrote:

QUESTION FOR DR. SARAH VAUGHAN

A "mini me" post!! Way to go, Todd!!!


There will be more of these "mini me" posts - except when the the Zeal
Monster attacks. : )

For your viewing enjoyment.

"Dr. Evil's Mini-Me plots world domination."
http://poslfit.homeip.net/images/jjc.../DSCN4223.html

Mini-Me dressed as Dr. Evil...
http://www.cardboardcutouts.com/0390.html

Todd

In message . net, Todd
Gastaldo writes
QUESTION FOR DR. SARAH VAUGHAN...

Assuming OBs and midwives are ignoring simple biomechanics and the
medical literature and closing birth canals up to 30%...

Assuming OBs are KEEPING birth canals closed (keeping women semisitting
or dorsal) when they pull with forceps and vacuum extractors...

Are you saying that such behavior is within the law?

No idea about US law. The law in this country is that clinical practice
is legal if you can show that 'a responsible body of medical opinion'
would support acting in this way. This, of course, is vague enough to
be open to all kinds of interpretation, but basically - if it's common
and widely accepted practice to do things a certain way (from the
clinical POV, I mean), then you can't *legally* fault a doctor for
continuing to do things that way.

And, yes, I know that this isn't a great system. Got a better one?
Basically - who decides what's malpractice and what isn't, clinically?
Evidence-based medicine, for all its advantages, can be a very woolly
area indeed. We all know that today's accepted practice can be
tomorrow's hopelessly outdated way of doing things. Even in only a
relatively few years in the medical profession, I've also seen that
today's brilliant new finding can be tomorrow's thalidomide equivalent.
Add in the fact that the medical literature is now far too vast for
anyone to keep up with it in detail, and you can see that someone,
somewhere, is always and inevitably going to be doing things in a way
that either will be or has been shown to be suboptimal or even harmful.
If you arrest all the medical practitioners who do that, you simply
won't have any medical practitioners left - a situation which I like to
believe would do more harm than good, though I may be flattering myself
excessively.

Anyway, having depressed you with that one, here's a snippet to cheer
you up:

We've just had an old schoolfriend of mine & her husband visiting us for
the weekend. She was very solicitous of me and my 'delicate condition'
all weekend and, on seeing me squat down to put some plates in the
cupboard, said "Oh, I ought to be doing that for you!"

"Oh, no," I assured her, "squatting is good for pregnant women - good
practice for the second stage of labour."

Later on in the evening, she brought the subject up again. They have no
children yet, but want to try hopefully in a year or so, so she was very
keen on finding out as much as she could from me about the whole
business. So she asked me to tell her more about squatting in labour.
I explained that the trick was to get off your tailbone and that
squatting, all fours, or possibly side-lying might work. She thought
this made a lot more sense than lying down. And she's agreed to tell
any of her friends that are pregnant. ;-)


All the best,

Sarah

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

In message , Todd
Gastaldo writes
For your viewing enjoyment.

"Dr. Evil's Mini-Me plots world domination."
http://poslfit.homeip.net/images/jjc.../DSCN4223.html

Too cute! Thanks, Todd!


All the best,

Sarah

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

In ,
Sarah Vaughan wrote:

*No idea about US law. The law in this country is that clinical practice
*is legal if you can show that 'a responsible body of medical opinion'

US law also incorporates the concept of the "standard of care." I was
instructed in veterinary school that I could support my medical practice
being within the "standard of care" in court by providing things like
textbooks (recent), journal articles, continuing education notes, or even
lecture notes from school.

h.

--
Hillary Israeli, VMD
Lafayette Hill/PA/USA/Earth
"Outside of a dog, a book is a man's best friend. Inside of a dog, it is
too dark to read." --Groucho Marx