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Question #2 for Dr. Sarah Vaughan (should women have to ASK?)



 
 
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  #1  
Old October 25th 04, 05:10 AM
Todd Gastaldo
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Default 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?)"


  #2  
Old October 25th 04, 10:44 PM
Helen
external usenet poster
 
Posts: n/a
Default

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?)



  #3  
Old October 26th 04, 07:15 AM
Todd Gastaldo
external usenet poster
 
Posts: n/a
Default

BLOW ME DOWN!

Copied to the NHS via Dr. Grace Lomax

After I wrote:

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

Helen the Midwife replied:

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.


This is good news!!! (But watch those caps - Sarah hates caps. : )

From a UK midwifery journal...circa 1996...

"Dr. Todd Gastaldo, a chiropractor in Oregon, USA...states that the
'semi-recumbent posture, and indeed any posture which places the labouring
client on her sacrum, denies mother and fetus the benefit of sacro-iliac
motion.' I welcome and solicit your comments on this statement, as well as
any referrals to relevant research findings." [Levine MA. Midwives' network.
Midwives (Nov)1996;109(109):295. Royal College of Midwives, 15 Mansfield
St., London W1M 0BE England. Prof. Mary Ann Levine, Department of Nursing,
Humboldt State University, Arcata, CA 95521; Phone: 707-826-5137 ; E-mail:
; Fax: 707-826-5137. ]

You continued...

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.


"Not always possible" suggests semisitting and dorsal deliveries are
infrequent!!! BRAVO!!!

This is AWESOME news! I wish Sarah (Dr. Vaughan) had mentioned - regarding
births she attended in her medical doctor training - that the midwives were
telling the women that dorsal and semisitting closes the birth canal.

Then again...

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).

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...

Truly bizarre... Maybe UK women aren't offered assistance to go to
side-lying?

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.)

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!??

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%??


Well, it seems to me that death and paralysis of babies - the risk of which
likely increases when the birth canal is closed a lot less than 30%
(according to an old edition of Williams Obstetrics) - should be mentioned
when UK women are insisting on closing their birth canals up to 30%...

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!)....

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)?

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?)


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...

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...

Todd

Dr. Gastaldo


PS You signed...

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%.

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.

Todd


  #4  
Old October 26th 04, 06:43 PM
Helen
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Posts: n/a
Default


"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




  #5  
Old October 26th 04, 10:11 PM
Pip
external usenet poster
 
Posts: n/a
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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



  #6  
Old October 27th 04, 05:40 PM
Todd Gastaldo
external usenet poster
 
Posts: n/a
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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




  #7  
Old October 28th 04, 06:56 PM
Todd Gastaldo
external usenet poster
 
Posts: n/a
Default

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





  #8  
Old November 1st 04, 10:55 AM
Zaz
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Posts: n/a
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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






  #9  
Old November 8th 04, 12:00 AM
Sarah Vaughan
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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

  #10  
Old November 8th 04, 12:03 AM
Sarah Vaughan
external usenet poster
 
Posts: n/a
Default

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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