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Question #2 for Dr. Sarah Vaughan (should women have to ASK?)
Attention NHS Net/Dr. Grace Lomax, phone: 01202 666366 via
Dr. Sarah Vaughan's answer to Question #1 (see my reply to her answer below) led to new information from Dr. Grace Lomax/doctoronline.nhs.uk which necessitates Question #2... QUESTION #2 FOR DR. SARAH VAUGHAN... I was pleased that your midwife said "That's quite right" regarding semisitting and dorsal closing the birth canal up to 30%... One new assumption (three total)... 1. Assuming (again) that OBs and midwives are ignoring simple biomechanics and the medical literature and closing birth canals up to 30%... 2. Assuming (again) that OBs are KEEPING birth canals closed (keeping women semisitting or dorsal) when they pull with forceps and vacuum extractors... 3. Assuming (new assumption) that the Medical Ethics Committee of the BMA states (as quoted by NHS; URL below) that "ideally, the doctor should inform the patient about any risks inherent in the treatment which might be particularly important to that patient, as well as explaining the risks and benefits of alternatives and non-treatment..." http://www.doctoronline.nhs.uk/maste...nPress/hra.htm 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%? Sarah: Apparently, new British law - the Human Rights Act - which I read about after reading your answer to Question #1 - suggests even more strongly (than current BMA medical ethics; I'm assuming you agree with me) that OBs should be informing women they are closing birth canals and keeping them closed... See below. PS AGAIN THOSE KEY DETAILS... As you ponder Question #2 above, please keep in mind the following details which you snipped in answering Question #1.... 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. SOME PERTINENT HISTORY... On Oct. 21, 2004 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." Sarah 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... No idea Sarah!? You said the midwife said THAT'S QUITE RIGHT (emphasis added) Finally, Sarah wrote on Oct. 21: "However much you might want it to be against the law, it isn't. " http://groups.google.com/groups?selm...&output=gplain SO I ASKED SARAH QUESTION #1: Are you saying that [closing birth canals and keeping them closed when babies get stuck] is within the law? SARAH ANSWERED... 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. I REPLY... Sarah, you are apparently quoting "the Bolam test" as described in the Sidaway case... According to www.doctoronline.nhs.uk, an NHS Net website: "The locus classicus of the test for the standard of care required of a doctor is...McNair J's direction to the jury in the case known as Bolam: 'he is not guilty of negligence, if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.' "The case of Sidaway applied this principle to the doctor's duty to inform his patient. The House of Lords held that 'the Bolam test.. also applies to the doctor's duty to warn his patient of risks inherent in treatment recommended, in accordance with a practice accepted at the time by a responsible body of medical opinion'..." http://www.doctoronline.nhs.uk/maste...nPress/hra.htm SARAH PLEASE NOTE: The NHS Net website quotes Sidaway further: "...the disclosure of a particular risk of serious adverse consequences might be so obviously necessary for the patient to make an informed choice that no reasonably prudent doctor would fail to disclose it.'" Obviously, I think CURRENT British case law strongly suggests that the reasonably prudent OB should be disclosing that his/her treatment consists of keeping birth canals closed when babies get stuck AND disclosing that there are serious adverse consequences possible - like forceps, cesareans and paralysis or death of the baby - as in Question #2 above. Sarah, you are apparently relying on the old "reasonable doctor" standard, as in your statement, 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. It appears that NHS thinks that incorporation of the European Convention on Human Rights into English law (via the Human Rights Act) means that the "reasonable doctor" standard is being/has been superceded with a "best practice" standard. See below. And, yes, I know that this isn't a great system. Got a better one? Yes...apparently one is in place: BEST PRACTICE. Quoting an NHS NET website... "In essence, claimants who feel aggrieved by the lack of information they received prior to treatment, may be able to bring a claim because a doctor failed to meet the level of 'best practice' rather than the previous, less demanding requirement, namely 'the practice accepted at the time by a responsible body of medical opinion'... "Dr Grace Lomax, founder of Doctor Online, (nww.DoctorOnline.nh s.uk) [discusses]...Best practice vs Accepted practice... "[Dr. Lomax] The Human Rights Act incorporates the European Convention on Human Rights into English law. As the UK has been signed up to the European Convention on Human Rights since 1951, the Department of Health states that 'best practice' in the Health Service already probably respects the Act. "[Dr. Lomax]...Reliance on the principle that a reasonable body of doctors would not have informed the patient of a particular risk, may no longer suffice as a defence...In essence, claimants who feel aggrieved by the lack of information they received prior to treatment, may be able to bring a claim because a doctor failed to meet the level of 'best practice' rather than the previous, less demanding requirement, namely 'the practice accepted at the time by a responsible body of medical opinion'...The Human Rights Act incorporates the European Convention on Human Rights into English law...[and]...the Department of Health states that 'best practice' in the Health Service already probably respects the Act." http://www.doctoronline.nhs.uk/maste...nPress/hra.htm 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. Dr. Lomax seems to say that evidence-based medicine guidelines are undermining the validity of the "reasonable doctor" principle... "Even without the advent of the Human Rights Act, the growing number of guidelines and the greater importance placed on them is undermining the validity of the 'reasonable doctor' principle. With rafts of guidelines declaring that good practice means open and candid involvement of patients, doctors may no longer be able to rely on the defence that their reasonable peers would have refrained from providing information on conditions, treatment, risks and alternatives." http://www.doctoronline.nhs.uk/maste...nPress/hra.htm We all know that today's accepted practice can be tomorrow's hopelessly outdated way of doing things. Closing the birth canal up to 30% should have been "hopelessly outdated" as soon as it was radiographically demonstrated in Britain in 1969 by consultant radiologist JGB Russell - or in 1911 when it was clinically demonstrated by American obstetrician J. Whitridge Williams, MD that the AP outlet diameter changes massively! MDs (and MBs) lied to cover up! Later authors of Williams Obstetrics were stating that the pelvic diameters DON'T CHANGE at delivery! 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. Yep - medicine isn't all that brilliant what with OBs and medwives closing birth canals up to 30% routinely and KEEPING birth canals closed when babies get stuck. Add in the fact that the medical literature is now far too vast for anyone to keep up with it in detail, Ummm.... The medical literature was comparatively SMALL when OBs started covering up what OBs discovered in 1911. Plus, it must be noted that How to open the birth canal an "extra" up to 30% is pretty basic stuff... ...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. Yeah - but closing the birth canal up to 30% - and KEEPING it closed when the baby gets stuck - that's pretty stupid - an obvious felony given the MD and MB cover-up behavior - or so I say - and perhaps the Human Rights Act will bear me out in future cases... I hope women don't have to wait for cases to be brought before GPs start informing OBs that they should not be closing birth canals. Women should NOT have to ask for the "extra" up to 30%. If you arrest all the medical practitioners who do that, YOU would have them arrested. I want to pardon them in advance. See below. 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. Again, I want to pardon MDs and MBs in advance. MDs and MBs are just academic prime cuts forced through this culture's most powerful mental meatgrinder - medical school. As med students, MDs and MBs are TRAINED to perform felonies... Sarah, you mentioned a birth you attended in your training. Was it a semisitting birth? Anyway, having depressed you with that one, Sarah, I am quite pleased that you stimulated me to look at current British law and its ramifications. I am actually quite HOPEFUL upon reading at the NHS Net site possible ramifications of following sentence: "The Human Rights Act incorporates the European Convention on Human Rights into English law." http://www.doctoronline.nhs.uk/maste...nPress/hra.htm With OBs keeping birth canals closed up to 30% when babies get stuck... I was particularly pleased to read Dr. Grace Lomax's statement that, "Even without the advent of the Human Rights Act, the growing number of guidelines and the greater importance placed on them is undermining the validity of the 'reasonable doctor' principle. With rafts of guidelines declaring that good practice means open and candid involvement of patients, doctors may no longer be able to rely on the defence that their reasonable peers would have refrained from providing information on conditions, treatment, risks and alternatives." http://www.doctoronline.nhs.uk/maste...nPress/hra.htm 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." Great! Did you tell your old schoolfriend explicitly that dorsal and semisitting CLOSE the birth canal up to 30%? I have found that women can really wrap their minds around that fact - which may explain why MDs and MBs are running from that same fact - see below... 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. ;-) I hope you told your old school friend that **MDs and MBs** were saying that "Squatting opens" a long time ago. NOTE: When I noted that the medical literature actually demonstrates that dorsal and semisitting CLOSE the pelvic outlet - up to 30%... Murray Enkin, MD of Canada censored mention of the relevant radiographic literature from Guide to Effective Care in Pregnancy and Childbirth! (NOTE ALSO: The relevant radiographic literature had been mentioned in Enkin and Chalmers et al.'s huge "Effective Care" tome - and in the first edition of the "Guide" to that tome.) Then, when I complained to Enkin's "Effective Care" co-author Iain (now Sir Iain) Chalmers, MD... Iain told me (in effect) that we can't tell pregnant women that OBs are closing birth canals up to 30% and lying about it - until there are randomised controlled trials demonstrating that there is benefit to such a strategy! Medical doctors - even "evidence-based" gurus - are abusing science - babies be damned. Sarah, I was convinced that closing birth canals was not legal before you answered Question #1 above. Your answer has only led to new information - previous/current medical ethics and the Human Rights Act - which strengthens that conviction and leads to Question #2... 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%? Sincerely, Todd Dr. Gastaldo This post will be archived for global access within 24 hours in the Google usenet archive. Search http://groups.google.com for "Question #2 for Dr. Sarah Vaughan (should women have to ASK?)" |
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In the UK it is mainly midwives who attend normal deliveries, and as a
Midwife we certainly make sure we tell women at EVERY possible opportunity that lying on their backs and semi recumburrant (or semi sitting) are the worst positions to deliver in as it reduces the available space. Like Dr Vaughan I have attended many birth where women are delivering in these positions, we have tried to encourage them into more appropriate positions but this is not always possible. Women now are very much more aware of what is beneficial for them during pregnancy and birth, if you ask most women which is the best position to give birth in they will know, but they may not want to do it. do you really think it is appropriate to tell a woman who has lost a baby or who has a baby with a birth injury that it was caused by 'closing the birth canal by 30%?? There is a need to inform women of the CHOICES available to them, we all know what is ideal, and we are striving to ensure that women are well informed and well equipped to deal with labour and delivery. Helen the Midwife Madeline 17/5/04 with the extra 30% room supplied!!! One little angel 18/10/04 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 - that there is no real need for OBs and midwives to tell women that they have been closing birth canals up to 30%. (What about women whose babies died unexplained deaths or suffered unexplained paralyses after OBs pulled on tiny necks - sometimes ripping spinal nerves out of tiny spinal cords?) |
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"Not always possible" suggests semisitting and dorsal deliveries are infrequent!!! BRAVO!!! I would really hope that these positions are now becoming less frequently used, I know that my collegues and I do our best to encourage women into better positions, and hopefully explain to them why this is not an ideal position, informed choice........... It seems a little bizarre to me that Sarah had to mention this news to a midwife recently - and it sounded like it was indeed news to her (Sarah) - news based on reading my posts. In other words - Sarah did not apparently hear this news while attending births in her medical training - which had to be rather recent - from Sarah's youthful appearance (looks can be deceiving I know)...Hopefully, Sarah will correct me if I am wrong (about semisitting closing the birth canal being news to her). I qualified as a midwife 3 years ago, during our training we learnt about the Rhombus of Michaelis, (J Sutton) and how maternal position was vital in allowing this movement to occur, and how certain 'traditional' birthing positions can and do inhibit this movement there by decreasing the available space, although the Rhombus is high in the pelvis, the movement does affect the outlet space available. Truly bizarre... Maybe UK women aren't offered assistance to go to side-lying? Women who have chosen not to be mobile, or those who can't for various reasons are most certainly encouraged into the left lateral position, and the benefits are fully explained to them, obviously I cannont speak for every delivery suite in the UK, but it certainly happens where I work. Women now are very much more aware of what is beneficial for them during pregnancy and birth, if you ask most women which is the best position to give birth in they will know, but they may not want to do it. Wow. UK midwives are explicitly telling UK women that semisitting and dorsal close the birth canal - and some are insisting on closing their birth canals!! *Sacre bleu*!!!! One might be tempted to say that these UK women *deserve* any unexplained baby deaths or unexplained baby paralyses! But what about the babies!?? Nobody 'deserves' that fate, as the old saying goes you can lead a horse to water but you cant make it drink, I think that is often the case here. Women know ( or are starting to learn) what is best for them but it doesnt mean they will do it. Don't forget, Helen.... Here in the US...OBs and CNMwives are ignoring my pleas and RECOMMENDING semisitting (closing the birth canal up to 30% - without telling women they are doing so!).... That is very frustrating and upsetting.Wwe often hear in the UK that birth is much more medicalised in the US, I'm not sure if that is true, hopefully its not or is becoming less so, but if that is the case semi sitting and lying are much more convient if you are 'medicalising' birth, its easier to see and to perform certain interventions. Here in the US...when babies get stuck...OBs are violently pushing on tiny spines (with oxytocin and Cytotec) and gruesomely pulling (with hands, forceps and vacuums) - with birth canals SENSELESSLY closed up to 30%. QUESTION FOR HELEN: Do you really think when a mother here in the US discovers that her baby is PERMANENTLY PARALYZED (after an OB cranked/yanked with forceps) - do you really think that she and her attorney should NOT be informed that the OB closed her birth canal up to 30% (as he cranked/yanked on her baby's neck with forceps)? The woman hopefully should be informed a long time before this point. I am quite relieved that you posted, Helen, because (as I wrote - now changing the tense)... Dr. Sarah Vaughan seem[ed] to think it was OK that birth canals were closed - that there is no real need for OBs and midwives to tell women that they have been closing birth canals up to 30%. (What about women whose babies died unexplained deaths or suffered unexplained paralyses after OBs pulled on tiny necks - sometimes ripping spinal nerves out of tiny spinal cords?) I dont think that Dr Sarah Vaughan thought that it was ok at all. and I'm sure that as far as is possible in her capacity as a Dr, and I am not sure what sort of Dr she is, she will try to make people aware of this. I think as health care professionals we have a responsibility of care to our patients (or clients) to try to ensure they have a much information as possible to allow them to make informed choices for their care. Actually, if it is so common for UK midwives to explicitly tell women that semisitting closes the birth canal up to 30% - it is astonishing that *Sarah* did not instantly relay this news to me when I specifically asked her if she thought women should have to ASK for the "extra" up to 30%. Are you sure that UK OBs aren't routinely closing birth canals up to 30% (placing women semisitting or dorsal) as they pull with forceps and vacuums? I guess if some UK women don't mind before their babies get stuck - it might not matter to them when UK OBs start clanking the forceps... unfortunately yes this does still happen, but not always. I'd guess though that it DOES matter to babies - which is why I post... Helen the Midwife wrote further... There is a need to inform women of the CHOICES available to them, we all know what is ideal, and we are striving to ensure that women are well informed and well equipped to deal with labour and delivery. If UK midwives and OBs are explicitly informing UK women that semisitting and dorsal close the birth canal up to 30% - and some UK women are insisting on semisitting/dorsal - well - blow me down - I am pleased that they are being so informed - but astonished some UK women are ignoring this info - and sad for UK babies affected... it is sad that people ignore advice, but sadly it is a human trait, look at smoking for one, people know its harmful but still do it, the same can be said for many things, to get people to change there habits you have to change their attitudes, and that takes time. Helen the Midwife Madeline 17/5/04 with the extra 30% room supplied!!! One little angel 18/10/04 Helen, I always put "extra" in quotes and say "up to" 30%. Again, I am sorry to read of your recent loss. thank you for your thoughts Todd Helen the Midiwfe Madeline 17/5/04 with up to 30% extra room supplied ;-) one little angel 18/10/04 |
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Hope this isn't a private conversation but I would quite like to offer my
questions/experiences. I am in New Zealand and on the Discovery Channel I often watch a program called "Maternity Ward" made in America. Now this program often leaves me pondering because of the many many episodes I have watched of the program I have only every seen 1 women doing anything other than lying down whilst trying to give birth. It has often made me wonder, is this because lying down births are easier to film? or is it because the bulk of American women have an epidural during labour so need to be on their back to be monitored? Or because that's just the way American women choose to give birth? (Not trying to label just to understand) The most frightening thing I saw was a women whose very large baby got VERY stuck in the birth canal. The doctor attending couldn't use forceps due to the baby being so wedged so used the ventous (sp?) this nearly gave me a heart attack as I thought if the force of a women's contractions and her pushing couldn't shift the baby how could the ventous!? In the end a nurse on the women's left side pushed down very hard on the women's leg and hip to force the pelvis apart (so they said) a little to allow the baby more room. The whole time I was almost screaming at the t.v because I couldn't understand why they wouldn't put her into a squatting position to get gravity to help! From my own personal experience I was very annoyed at the birth of my only child at 35 weeks, because once labour was fully established I was made to lie flat out as they had to monitor the baby. I was told I couldn't even labour on my side as it affected the monitor. I ignored them on this point and decided if I couldn't give birth squatting as I wanted then I would at least do it on my side. So with the help of my DH and Mother moved myself onto my side and re-arranged the foetal monitor) (This helped labour greatly being on my side as my daughter was back to back which caused me a great amount of pain) About 10 minutes before my DD was delivered they manually shifted me to my back (without asking) as they said it would aid in bearing down. My daughter was born weighing 4lb 12oz and I tore pushing her out!!! God help me had my baby been of a normal gestational age and size as I'm sure I would have been in real trouble. My whole birth plan had been to stay very active during labour and let my body tell me the best way to help the baby out. Shame it didn't turn out as I planned. Thanks for letting me put in my input. Pip |
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Copied to the NHS via Dr. Grace Lomax
NHS: WHY DR. GARDOSI SUCKS... I quoted Helen the Midwife and remarked: "Not always possible" suggests semisitting and dorsal deliveries are infrequent [in the UK]!!! BRAVO!!! Helen the Midwife replied that she HOPES this is true... I would really hope that these positions are now becoming less frequently used, I know that my collegues and I do our best to encourage women into better positions, and hopefully explain to them why this is not an ideal position, informed choice...... Helen, Alas, it was mere hope on both our parts... I suspect that semisitting and dorsal deliveries are still quite common in the UK... If they weren't Sarah would have said so - instead of telling me first that she isn't saying anything because she is a GP not an obstetrician - and most recently - that - in effect - she would have to have data before telling women that OBs are lying as they close birth canals. Sarah ignores the lies of OBs - babies be damned. A UK site describes the grisly biomechanics of semisitting... "...the weight of the mother is in part taken on the sacrum which is therefore pushed upwards, thus decreasing the antero-posterior diameter of the pelvic outlet...[THEREFORE this bizarre form of McRoberts - TG]...The buttocks need to come over the edge of the bed, allowing the sacrum to rotate backwards." http://www.perinate.org/reviews/oe/o...r_dystocia.htm Here is a UK site that PROMOTES semisitting/closing the birth canal... "The second stage...You might want to remain in bed with your back propped up with pillows...As you push, try to let yourself 'open up' below..." http://www.preg.info/book/chapter11.htm Note that the graphic art on both sites is similar. I think the sites used to be linked - and Jason Gardosi, MD was director of the project... I've previously remarked that this is a sick joke - knowing that the birth canal is being closed - exhorting women to "try to let yourself 'open up' below.... British OB Jason Gardosi once told me that two randomised controlled trials in English hospitals demonstrated that squatting wouldn't work in sedentary women... Here is the relevant quote from the PubMed abstract of his own trial: "...squatting was, despite all assistance, too difficult to maintain..." --Gardosi J et al. Alternative positions in the second stage of labour: a randomized controlled trial. Br J Obstet Gynaecol. 1989 Nov;96(11):1290-6. After a few years of dickering with me (participating in CENSORING me; see below), Jason decided squatting WOULD work! He is so quoted by American midwife Faith Gibson, LM, CPM: "I think the first and best maneuver in any suspected SD is to get the mother squatting..." http://www.collegeofmidwives.org/pro...1/shoulder.htm Gardosi knew - because he visited the Paciorniks - that women don't have to maintain the squatting position for very long - just during contractions - to benefit from the posture during late second stage. If Gardosi had said this in his "squatting" Birth Cushion trial - maybe Samra Tang and Obhrai would not have let a woman try to squat for long periods unassisted after which she sat on her baby's head and killed it - after which the grisly description of the tragedy was used to promote Gardosi's "squatting" Birth Cushion. See below. I will copy Faith at Hopefully, Faith will change her website to note that Jason originally thought - based on "scientific" studies (one of them his) - that squatting would NOT work - LOL. Wait a minute! Hold the phone! Arrgghhh - it looks like Faith - who knows better - is promoting semisitting/closing the birth canal! http://www.collegeofmidwives.org/ --PHOTOS Faith and I once had a conversation about her observing a semisitting birth in a hospital. "Did you tell the doctor he was closing the birth canal?" I asked... Faith argued for awhile - but eventually told me that no - she did not tell the doctor he was closing the birth canal. With babies' BRAINS on the line - with MDs admitting the simple grisly biomechanics - one would think midwives would be more bold. But then again, midwives have been trained to tread softly and respect the delicate sensibilities of MDs. I wrote: It seems a little bizarre to me that Sarah had to mention this news to a midwife recently - and it sounded like it was indeed news to her (Sarah) - news based on reading my posts. In other words - Sarah did not apparently hear this news while attending births in her medical training - which had to be rather recent - from Sarah's youthful appearance (looks can be deceiving I know)...Hopefully, Sarah will correct me if I am wrong (about semisitting closing the birth canal being news to her). Helen the Midwife remarked... I qualified as a midwife 3 years ago, during our training we learnt about the Rhombus of Michaelis, (J Sutton) and how maternal position was vital in allowing this movement to occur, and how certain 'traditional' birthing positions can and do inhibit this movement there by decreasing the available space, although the Rhombus is high in the pelvis, the movement does affect the outlet space available. My sense is the Rhombus of Michaelis is being used to conceal the simple biomechanics/movement of the sacral tip that is so obviously denied when the mother is on her sacrum (semisitting or dorsal). I hope I am wrong. I never heard back from Midwife Jean Sutton. (I will copy this post - "NHS: Why Dr. Gardosi sucks" - to her at ) Here is what I wrote to her earlier this year... From: Todd Gastaldo ) Subject: Rhombus of Michaelis/Midwife Jean Sutton Newsgroups: misc.kids.pregnancy, misc.health.alternative, sci.med Date: 2004-08-18 10:27:29 PST RHOMBUS OF MICHAELIS/MIDWIFE JEAN SUTTON Larry McMahan quoted midwife Jean Sutton writing about "the Rhombus of Michaelis" and wrote: "So Todd was right all along. ... But we all knew that anyway, right?" http://groups.google.com/groups?selm...utput= gplain OPEN LETTER (archived for global access; see below) Jean Sutton Midwife Jean, While I appreciate Larry's compliment, I am having difficulty reconciling your description of movement of "the Rhombus of Michaelis" with published biomechanics of movement of the sacroiliac joint and sacral tip at delivery. When I looked further on the web, I found that Midwife Sarah Wickham quoted you thusly: "[Y]ou need to allow the rhombus of Michaelis to move backwards to give the baby the maximum amount of space to turn his shoulders in. Although the rhombus appears high in the pelvis and the lower lumbar spine when it moves backwards, it has the effect of opening the outlet as well." http://www.withwoman.co.uk/contents/info/rhombus.html I'm assuming you are saying that backward movement of "the Rhombus of Michaelis" simultaneously opens the pelvic inlet and the pelvic outlet. My understanding of at-term sacroiliac motion is that when the pelvic outlet opens, the pelvic inlet CLOSES (a little) and vice versa. See Young [1940] referenced in the 1995 British Gray's Anatomy; and see Borell and Fernstrom [1957] also referenced in the 1995 British Gray's...Both are discussed further below. Regardless whether the two biomechanical descriptions can be reconciled, we seem to be in agreement that women should not give birth semisitting or dorsal - while lying or sitting on their sacra. Is there a reason you don't mention that if the woman is on her sacrum - semisitting or dorsal - her sacral tip cannot move back and this denies 20 to 30% of pelvic outlet area? (If mention of this remarkable fact was in either essay, obviously, I missed it - and I apologize.) Todd Dr. Gastaldo PS Oddly, although, the 1995 British Gray's Anatomy (mentioned above) cites Borell and Fernström's remarkable intrapartum radiographic determination that 1.5 to 2.0 cm of outlet diameter is routinely denied in woman-on-her-sacrum delivery positions - the 1995 British Gray's makes no mention of this remarkable fact! Instead, Gray's cites the above alluded to 1940 radiographic study by Young which concluded that ligamentous relaxation during pregnancy (quoting Gray's) "PERHAPS allow[s] alterations in pelvic diameters at childbirth, although the effect is PROBABLY SMALL (p. 678, emphases added)." There is nothing "probably small" (to mothers and fetuses) about ONE centimeter of denied pelvic outlet diameter - or two or three or FOUR centimeters of denied pelvic outlet diameter! After the original author of Williams Obstetrics clinicially observed that massive FOUR centimeter change in AP outlet diameter in 1911, Borell and Fernstrom demonstrated radiographically the average 1.5 to 2.0 cm AP pelvic outlet diameter change that Williams had demonstrated clinically. In 1973, Ohlsén noted that Williams Obstetrics was claiming that there were NO changes in the pelvic diameters at delivery! [Ohlsén H. Moulding of the pelvis during labour. Acta Radiol Diag 1973;14:417-434] Ohlsén's revelation is no doubt what prompted the authors of Williams Obstetrics to start claiming that dorsal widens... Dorsal CLOSES - as does semisitting. In 1992, at my request, the authors of Williams Obstetrics noted the correct biomechanics (that the sacrum can't move back if the woman is on her sacrum) - but they kept saying dorsal widens! The 2001 edition of Williams Obstetrics still has this bizarre juxtaposition of correct biomechanics and biomechanical buffoonery in the same paragraph! PREGNANT WOMEN: For simple PROOF that OBs are knowingly closing birth canals up to 30%... For simple instructions on how women can allow their birth canals to OPEN their birth canals the "extra" up to 30%... See I ain't no Semmelweis, but... http://health.groups.yahoo.com/group...t/message/2591 IT'S OBVIOUS OB CRIME... OBs are slicing vaginas en masse (euphemism "routine episiotomy") - surgically/FRAUDULENTLY inferring everything possible is being done to OPEN birth canals - even as they CLOSE birth canals - up to 30%. OBs are slicing abdomens en masse ("c-section") - surgically/fraudulently inferring everything possible has been DONE to open birth canals - even as they CLOSE birth canals - up to 30%. Now - to be sure - allowing the birth canal to open the "extra" up to 30% is not going to prevent all caesareans and episiotomies - but it can't hurt. Incidentally, when babies' shoulders get stuck, OBs KEEP the birth canal closed - even as they say they are opening it maximally. See ACOG birth crime video evidence http://health.groups.yahoo.com/group...t/message/2300 OBs don't charge for their mass vagina slicing - but it is known to increase severe perineal tears by 50X - and perineal tearing is the most common reason for hospitalization of women: "The most common diagnosis for hospitalization among all women is trauma to perineum due to childbirth." http://www.ahcpr.gov/data/hcup/factbk3/factbk3.htm See also: Criminal medical CAM at Hawai'i's John A Burns School of Medicine http://health.groups.yahoo.com/group...t/message/2256 Thanks for reading everyone. Sincerely, Todd Dr. Gastaldo END what Gastaldo wrote to Jean Sutton regarding "Rhombus of Michaelis"... MORE ON GARDOSI... I wrote (in the post to which Helen the Midwife replied): Whatever the case with the birth-canal-closing births Sarah in effect said she attended - "lots" she said - it seems bizarre to me that some UK women informed that they are closing their birth canals up to 30% and how easy it is to allow the birth canal to OPEN the "extra" up to 30% - would not do so... I wrote further... Truly bizarre... Maybe UK women aren't offered assistance to go to side-lying? Helen the Midwife snipped the following: I ask because I remember Samra, Tang and Ohbrai's letter to The Lancet years ago - a tragedy where no one assisted a woman who insisted on squatting. She finally got so tired she sat on her baby's head and killed it. It was a bizarre, grisly promotion of Gardosi's Birth Cushion. Oddly, The Lancet refused to publish Brazilian obstetrician Prof. Dr. Moyses Paciornik's report-in-reply of 20,000 squatting births and the fact that women do NOT have to squat for long periods to use the position during labor. When Lancet refused publication, I asked Prof. Paciornik to send his amazing report (20,000 squatting births in a modern obstetric facility!) to the journal Birth - which published it - appropriately edited - alongside my letter describing the grisly biomechanics of semisitting delivery. See Paciornik M and Gastaldo TD. Letters. Birth. 1992;19(4):230-31. (NOTE: The Paciorniks are squatting dogmatists - but squatting is not a bad dogma when the alternative is semisitting - and back then semisitting was a common birth position in the UK.) End part that Helen the Midwife snipped... Helen wrote: Women who have chosen not to be mobile, or those who can't for various reasons are most certainly encouraged into the left lateral position, and the benefits are fully explained to them, obviously I cannont speak for every delivery suite in the UK, but it certainly happens where I work. Getting back to Gardosi - he stated the grisly biomechanics in one of his studies - but said he had to compromise with midwives who insisted on semisitting deliveries! I think the Gardosi gang was trying to fob off onto midwives a nasty birth-canal-closing habit that midwives picked up from medical "science." I think Gardosi's "Birth Cushion" was organized medicine's lame attempt at solving the problem by creating a device (his "Birth Cushion") that allows sacroiliac motion in the semisitting position. Gardosi had the temerity to call his "Birth Cushion" trial - a "randomised controlled trial of squatting" - and The Lancet published it under that title - even though no one squatted! Peer-review - ya can't beat it - LOL! Here's the PubMed abstract... To their credit, they did say "supported squatting" - but these women weren't even on their feet! Gardosi's Birth Cushion is actually "supported semisitting" - to allow the sacrum to move - but this wasn't mentioned in the abstract. Lancet. 1989 Jul 8;2(8654):74-7. PubMed Comment in: Lancet. 1989 Nov 11;2(8672):1150-1. Lancet. 1989 Sep 2;2(8662):561-2. Randomised, controlled trial of squatting in the second stage of labour. Gardosi J, Hutson N, B-Lynch C. Department of Obstetrics and Gynaecology, Milton Keynes General Hospital, Buckinghamshire. A new obstetric aid, the 'Birth Cushion' allows the parturient to sink into a supported squatting posture for the second stage of labour and delivery; it fits onto conventional delivery beds. A prospective, controlled trial of 427 primiparae compared the outcome of labour in women randomly allocated to squatting (218) or conventional semirecumbent (209) management. The squatting group had significantly fewer forceps deliveries (9% vs 16%) and significantly shorter second stages (median length of pushing 31 vs 45 min) than the semirecumbent group. There were fewer perineal tears, but more labial tears, in the squatting group. Apgar scores, blood loss, and post-partum vulvar oedema were similar in both groups. 82% of the women in the squatting group maintained upright positions for most of the second stage, and reported great satisfaction with the supported squatting position. The traditional birth posture of squatting can be easily adapted for modern labour management and has advantages for women in their first labour. END PubMed abstract of Gardosi et al's "squatting" trial... Again, I think Gardosi's "Birth Cushion" was organized medicine's lame attempt at solving the problem by creating a device (his "Birth Cushion") that allows sacroiliac motion in the semisitting position. BTW, Gardosi et al's "squatting" trial is linked on PubMed to the cite for Samra, Tang and Obhrai's grisly promotion of Gardosi's Birth Cushion: Lancet. 1989 Nov 11;2(8672):1150-1. PubMed Comment on: Lancet. 1989 Jul 8;2(8654):74-7. Birth in the squatting position. Samra JS, Tang LC, Obhrai MS. Again... Gardosi knew - because he visited the Paciorniks - that women don't have to maintain the squatting position for very long - just during contractions - to benefit from the posture during late second stage. If Gardosi had said this in his "squatting" Birth Cushion trial - maybe Samra Tang and Obhrai would not have let a woman try to squat for long periods unassisted after which she sat on her baby's head and killed it - after which the grisly description of the tragedy was used to promote Gardosi's "squatting" Birth Cushion. Gardosi went along with the gag as his fellow UK obstetrician Malcolm "Big Malc" Griffiths called me a "mad" "malicious" "nutcase" and called for my censorship from OB-GYN-List... Fortunately, my OB-GYN-List post was archived before I was censored. http://forums.obgyn.net/forums/ob-gy...9707/0128.html snip I wrote: Here in the US...OBs and CNMwives are ignoring my pleas and RECOMMENDING semisitting (closing the birth canal up to 30% - without telling women they are doing so!).... Helen the Midwife replied: That is very frustrating and upsetting.Wwe often hear in the UK that birth is much more medicalised in the US, I'm not sure if that is true, hopefully its not or is becoming less so, but Yep - we were both only hoping. I suspect that semisitting delivery is just as common in UK as in USA... if that is the case semi sitting and lying are much more convient if you are 'medicalising' birth, its easier to see and to perform certain interventions. Yep - the old convenience-of-the-doctor gag... Here in the US...when babies get stuck...OBs are violently pushing on tiny spines (with oxytocin and Cytotec) and gruesomely pulling (with hands, forceps and vacuums) - with birth canals SENSELESSLY closed up to 30%. QUESTION FOR HELEN: Do you really think when a mother here in the US discovers that her baby is PERMANENTLY PARALYZED (after an OB cranked/yanked with forceps) - do you really think that she and her attorney should NOT be informed that the OB closed her birth canal up to 30% (as he cranked/yanked on her baby's neck with forceps)? The woman hopefully should be informed a long time before this point. Ah, there's the word hopefully again... Since midwives are now getting "science" (finally; like chiropractors) - maybe they could do a scientific study and find out what percent of women are indeed informed that standard medical (and midwifery) delivery positions close the birth canal. I am quite relieved that you posted, Helen, because (as I wrote - now changing the tense)... Dr. Sarah Vaughan seem[ed] to think it was OK that birth canals were closed - that there is no real need for OBs and midwives to tell women that they have been closing birth canals up to 30%. (What about women whose babies died unexplained deaths or suffered unexplained paralyses after OBs pulled on tiny necks - sometimes ripping spinal nerves out of tiny spinal cords?) I dont think that Dr Sarah Vaughan thought that it was ok at all. This is my sense too. I think that most MDs and MBs - like most midwives - are deathly afraid of doing something positive - pro-active - to stop the massive obstetric/midwifery felony. and I'm sure that as far as is possible in her capacity as a Dr, and I am not sure what sort of Dr she is, she will try to make people aware of this. Sarah said she cannot say anything to OBs because she is a GP - and that besides doctors don't listent to doctors (I'm loosely paraphrasing this last; I'll find the exact quote if you like)... I think as health care professionals we have a responsibility of care to our patients (or clients) to try to ensure they have a much information as possible to allow them to make informed choices for their care. Yep - but Sarah fell back on the old "reasonable doctor" gag - and fail to acknowledge that when she sarcastically asked me if I had a better system - I found one right there in the UK... Like most medical doctors - Sarah cares first and foremost about her own PROFESSIONAL health - and the health of her profession.... She does not wish to speak out professionally - and publicly - about the grisly obstetric felony that may be sending her some of her patients... She needs data about specific risks before she can say whether women should be automatically offered up to 30% of "extra" room!! See again: NHS: Dr. Sarah disappoints - was Question #2 for Dr. Sarah Vaughan (should women have to ASK?) http://health.groups.yahoo.com/group...t/message/2906 I wrote: Actually, if it is so common for UK midwives to explicitly tell women that semisitting closes the birth canal up to 30% - it is astonishing that *Sarah* did not instantly relay this news to me when I specifically asked her if she thought women should have to ASK for the "extra" up to 30%. Are you sure that UK OBs aren't routinely closing birth canals up to 30% (placing women semisitting or dorsal) as they pull with forceps and vacuums? I guess if some UK women don't mind before their babies get stuck - it might not matter to them when UK OBs start clanking the forceps... Helen the Midwife replied: unfortunately yes this does still happen, but not always. Helen, my bet is that MOST forceps and vacuum deliveries in the UK are accomplished with the birth canal senselessly closed up to 30%. I would be SO relieved to know otherwise - but I think we are both only hoping for this - to no avail. I'd guess though that it DOES matter to babies - which is why I post... Helen the Midwife wrote further... There is a need to inform women of the CHOICES available to them, we all know what is ideal, and we are striving to ensure that women are well informed and well equipped to deal with labour and delivery. If UK midwives and OBs are explicitly informing UK women that semisitting and dorsal close the birth canal up to 30% - and some UK women are insisting on semisitting/dorsal - well - blow me down - I am pleased that they are being so informed - but astonished some UK women are ignoring this info - and sad for UK babies affected... it is sad that people ignore advice, but sadly it is a human trait, Women should not have to ask for the "extra" up to 30%. It is sad that Sarah the medical doctor ignores my advice to speak out publicly and professionally. You came to her defense - and that is laudable - but nice as she is - she is first and foremost concerned about her professional health - and her profession's health - THEN babies' health. It is truly bizarre that Sarah needs to know about "specific risks" before she will say whether women should be automatically offered an "extra" up to 30% at the pelvic outlet. look at smoking for one, people know its harmful but still do it, the same can be said for many things, to get people to change there habits you have to change their attitudes, and that takes time. Apples and oranges, Helen... OBs are KEEPING birth canals closed when shoulders get stuck. Helen the Midwife Madeline 17/5/04 with the extra 30% room supplied!!! One little angel 18/10/04 Helen, I always put "extra" in quotes and say "up to" 30%. [Helen snipped: The "extra" room to be had is not actually extra - and fortunately (since it is often denied) it is often less than 30%...] Again, I am sorry to read of your recent loss. thank you for your thoughts Todd Helen the Midiwfe Madeline 17/5/04 with up to 30% extra room supplied ;-) one little angel 18/10/04 Oops - don't forget - "extra" should be in quotes... Again: The "extra" room to be had is not actually extra - and fortunately (since it is often denied) it is often less than 30%... Thanks for reading everyone. Sincerely, Todd Dr. Gastaldo |
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BABY ASTRONAUT - ALSO THE MAURICEAU MANEUVER...
See below. Pip, Sorry for the delay in replying... Comments are interspersed below... "Pip" wrote in message ... Hope this isn't a private conversation but I would quite like to offer my questions/experiences. I am in New Zealand and on the Discovery Channel I often watch a program called "Maternity Ward" made in America. Now this program often leaves me pondering because of the many many episodes I have watched of the program I have only every seen 1 women doing anything other than lying down whilst trying to give birth. It has often made me wonder, is this because lying down births are easier to film? or is it because the bulk of American women have an epidural during labour so need to be on their back to be monitored? Or because that's just the way American women choose to give birth? (Not trying to label just to understand) Lying down births close the birth canal up to 30% and OBs KEEP birth canals closed (women on their backs) when babies get stuck and forceps and vacuums are used. Televising lying down births - further making them "normal" - is about the only "legal" strategy since the OB felony is so obvious. In America, closing birth canals is just one of many OB felonies... See Pediatrician 'ethics' (Attn: Gesundheit et al.) http://health.groups.yahoo.com/group...t/message/2908 The most frightening thing I saw was a women whose very large baby got VERY stuck in the birth canal. The doctor attending couldn't use forceps due to the baby being so wedged so used the ventous (sp?) this nearly gave me a heart attack as I thought if the force of a women's contractions and her pushing couldn't shift the baby how could the ventous!? In the end a nurse on the women's left side pushed down very hard on the women's leg and hip to force the pelvis apart (so they said) a little to allow the baby more room. The whole time I was almost screaming at the t.v because I couldn't understand why they wouldn't put her into a squatting position to get gravity to help! BABY ASTRONAUT Gravity is a rather minor concern (IMO) when the birth canal is being closed up to 30%... I think a powerful uterus makes short work of gravity - a midwife I know - uses good (birth-canal-opening) McRoberts routinely - woman on her back with with ankles up around her neck - positioned as if she is going to launch a baby astronaut. : ) Was the woman still lying on her back when (as you wrote) "a nurse on the women's left side pushed down very hard on the women's leg and hip to force the pelvis apart (so they said) a little to allow the baby more room..."? If so - they committed a rather obvious felony (given the simple biomechanics) - i.e. - they KEPT her birth canal closed up to 30% as they claimed to be trying to open it... THE MAURICEAU MANEUVER In the "Mauriceau maneuver" for vaginal breech births, an assistant helps to impale the after-coming fetal skull on the sacral tip. This is illustrated in the 1993 Williams Obstetrics. (Fig. 25-7) It is interesting to note that, in addition to this grisly breech delivery maneuver, the semi-sitting position itself is credited to Francois Mauriceau (1637-1709); though he apparently plagiarized the idea from Aristotle. [Dunn PM. Francois Mauriceau (1637-1709) and maternal posture for parturition. Arch Dis Child 1991;66:78-9. Address: Prof. Dunn, Southmead Hospital, Southmead Road, Bristol BS10 5NB]) It is also interesting to note that medical "science" arrived at the conclusion that singleton term breech's should be taken via abdominal surgery (c-section) - after studying breech births with birth canals closed up to 30%! From my own personal experience I was very annoyed at the birth of my only child at 35 weeks, because once labour was fully established I was made to lie flat out as they had to monitor the baby. I was told I couldn't even labour on my side as it affected the monitor. I ignored them on this point and decided if I couldn't give birth squatting as I wanted then I would at least do it on my side. Bravo Pip! So with the help of my DH and Mother moved myself onto my side and re-arranged the foetal monitor) (This helped labour greatly being on my side as my daughter was back to back which caused me a great amount of pain) Bravo DH and Mother! About 10 minutes before my DD was delivered they manually shifted me to my back (without asking) as they said it would aid in bearing down. This may be true if they did McRoberts - good or bad. (In McRoberts, you look like you are squatting on your back - your feet up in the air. If they rolled you off your buttocks it was good McRoberts - your sacrum could move - your birth canal was allowed to open maximally. If they didn't roll you off your sacrum - if they only flexed your thighs on your abdomen - it likely aided in bearing down - but closed your birth canal up to 30%..) My daughter was born weighing 4lb 12oz Large baby or small - I don't think there is any reason to close the birth canal - I hope they didn't. and I tore pushing her out!!! God help me had my baby been of a normal gestational age and size as I'm sure I would have been in real trouble. My whole birth plan had been to stay very active during labour and let my body tell me the best way to help the baby out. Shame it didn't turn out as I planned. Thanks for letting me put in my input. Thanks for writing. Todd Pip |
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I watched that program a few times too (one where the woman was in the tub
was quite good, actually, but quite different too from all the others). After seeing horror stories like the one you describe below, I stopped altogether. We have a version of that show here in Québec, which I also stopped watching. I would stare in total shock at those women laying on their back and ask DH: why on earth doesn't she stand or squat? His answer: "She's under epidural, she CAN'T stand"... Mmmm. There must be truth in that, as all these births were happening at the hospital and we have a 74% rate of epidural here. I watched three episodes where the birth was occuring in a Birth Centre (mine, once), and those were totally different. I saw women in the tub, squatting, on an exercise balloon, on all four, etc. Whenever I watch now, if they are not to give birth in a Birth Centre, I switch to something else! "Pip" wrote in message ... Hope this isn't a private conversation but I would quite like to offer my questions/experiences. I am in New Zealand and on the Discovery Channel I often watch a program called "Maternity Ward" made in America. Now this program often leaves me pondering because of the many many episodes I have watched of the program I have only every seen 1 women doing anything other than lying down whilst trying to give birth. It has often made me wonder, is this because lying down births are easier to film? or is it because the bulk of American women have an epidural during labour so need to be on their back to be monitored? Or because that's just the way American women choose to give birth? (Not trying to label just to understand) The most frightening thing I saw was a women whose very large baby got VERY stuck in the birth canal. The doctor attending couldn't use forceps due to the baby being so wedged so used the ventous (sp?) this nearly gave me a heart attack as I thought if the force of a women's contractions and her pushing couldn't shift the baby how could the ventous!? In the end a nurse on the women's left side pushed down very hard on the women's leg and hip to force the pelvis apart (so they said) a little to allow the baby more room. The whole time I was almost screaming at the t.v because I couldn't understand why they wouldn't put her into a squatting position to get gravity to help! From my own personal experience I was very annoyed at the birth of my only child at 35 weeks, because once labour was fully established I was made to lie flat out as they had to monitor the baby. I was told I couldn't even labour on my side as it affected the monitor. I ignored them on this point and decided if I couldn't give birth squatting as I wanted then I would at least do it on my side. So with the help of my DH and Mother moved myself onto my side and re-arranged the foetal monitor) (This helped labour greatly being on my side as my daughter was back to back which caused me a great amount of pain) About 10 minutes before my DD was delivered they manually shifted me to my back (without asking) as they said it would aid in bearing down. My daughter was born weighing 4lb 12oz and I tore pushing her out!!! God help me had my baby been of a normal gestational age and size as I'm sure I would have been in real trouble. My whole birth plan had been to stay very active during labour and let my body tell me the best way to help the baby out. Shame it didn't turn out as I planned. Thanks for letting me put in my input. Pip |
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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 |
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In message et, Todd
Gastaldo writes Helen the Midwife replied that she HOPES this is true... I would really hope that these positions are now becoming less frequently used, I know that my collegues and I do our best to encourage women into better positions, and hopefully explain to them why this is not an ideal position, informed choice...... Helen, Alas, it was mere hope on both our parts... I suspect that semisitting and dorsal deliveries are still quite common in the UK... If they weren't Sarah would have said so I suspect they are as well, but I don't know either way - I haven't done a survey on the subject. All the best, Sarah -- "I once requested an urgent admission for a homeopath who had become depressed and taken a massive underdose" - Phil Peverley |
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