Midwifery Prof. Mary Renfrew: 'Salutogenesis' in UK midwifery?

Open Letter (archived for global access)

Mary Renfrew, BSc RGN SCM RN (Canada) PhD
Professor of Midwifery Studies
Director of Mother and Infant Research Unit (MIRU)
University of Leeds
22 Hyde Terrace
Leeds LS2 9LN
United Kingdom

www.leeds.ac.uk/miru

Mary,

Regarding the paper you recently co-authored with Downe et al. [Midwifery.
2004 Jun;20(2):157-68.]

It looks like you may have conducted your research unethically - by failing
to inform women that you were closing their birth canals up to 30%.

This bizarre obstetric practice ("supported sitting") is the "norm" for most
midwives and OBs -
but it should be ended immediately - both in research and practice.

If after being asked if they want their birth canals closed up to 30% - if
women still want that - well - let me know how often that happens.

I can't imagine that there is a single fetus that would want that.

Thanks.

Sincerely,

Todd

Dr. Gastaldo


PS I'll bcc this to MIRU staff - just in case one of them is attending the
Normal Birth Conference with Dr. Soo Downe...

----- Original Message -----
From: "Todd Gastaldo"
To:
Cc:
Sent: Saturday, June 05, 2004 10:36 PM
Subject: 'Salutogenesis' in UK midwifery - was Sitting vs.
Side-lying (also: 'We haveTodd...' LOL!)


Carol,
OBs and midwives senselessly closing birth canals up to 30% in "normal
birth" is sort of urgent.
Please ask Soo to discuss this matter at the Normal Birth Conference.
Thanks.
Todd
Dr. Gastaldo


----- Original Message -----
From: "Soo Downe"
To: "tgastaldo"
Sent: Saturday, June 05, 2004 10:08 PM
Subject: 'Salutogenesis' in UK midwifery - was Sitting vs.
Side-lying (also: 'We haveTodd...' LOL!)


Sorry I will be away from the ofice until 14 June on holiday and at the
Normal Birth Conference - anything urgen - please contact Carol Kelshaw
on 01772 893813 or


----- Original Message -----
From: "Todd Gastaldo"
To: ; ;
;
; ;

Sent: Saturday, June 05, 2004 10:02 PM
Subject: 'Salutogenesis' in UK midwifery - was Sitting vs. Side-lying
(also: 'We have Todd...' LOL!)


"SALUTOGENESIS" IN UK MIDWIFERY See below.

PREGNANT WOMEN: OBs are closing birth canals up to 30%. See PROOF
below.

For simple instructions on how to allow your birth canal to OPEN the
"extra"
up to 30%, see the very end of this post...

"SALUTOGENESIS" IN UK MIDWIFERY

Attention Downe et al. (Downe S, Gerrett D, Renfrew MJ.)
Midwifery Studies Research Unit, University of Central Lancashire,
Preston,
Lancashire, UK.

via Professor Soo Downe

Soo,

"The overall philosophy underpinning the majority of the research in the
unit is that of salutogenesis - the creation of well-being."
http://www.uclan.ac.uk/facs/health/midwifery/research/

Closing birth canals up to 30% in midwifery research (see below) is
obviously not the best way to accomplish salutogenesis.

(I'm assuming "supported sitting" is semisitting - placing the woman on
her
sacrum thereby closing her birth canal up to 30%.)

Please work to stop this obstetric tomfoolery.

Sincerely,

Todd

Dr. Gastaldo





SITTING vs. SIDE-LYING...

According to Downe et al. [June 2004]
"[In]...nulliparous women using epidural analgesia...the lateral
versus
the
supported sitting position...Lateral position was associated with
lower
rates of instrumental birth [33% vs. 52%]...episiotomy [45% vs.
64%]...RECOMMENDATIONS FOR PRACTICE:: the lateral position is likely
to
be
at best beneficial, and at the worst no less harmful than the sitting
position for most women and their babies..."
--Downe et al. ^^^ Midwifery. 2004 Jun;20(2):157-68. PubMed abstract

I WONDER: When Down et al.^^^ obtained informed consent to do this
study,
did they inform women that "supported sitting" closes the birth canal
up
to
30%?

^^^Downe S, Gerrett D, Renfrew MJ. Research in Childbearing and Health
(ReaCH) Group, Midwifery Studies Research Unit, University of Central
Lancashire, Preston, Lancashire, UK.



PROOF that OBs and CNMwives are routinely closing birth canals up to
30%...

The fact that semisitting and dorsal close the birth canal is simple
biomechanics.

See Gastaldo TD. Letter. Birth 1992;19(4):230.

Here's my source for the 30% figure...

"[T]he outlet increases with moulding by approximately 20-30 per cent."
--Russell JGB. Moulding of the pelvic outlet. J Obstet Gynaec Brit Cwlth
1969;76:817-20.

NOTE: In 1973, Ohlsen verified Russell's 20% figure on
Borell and Fernstrom's 1957 intrapartum x-rays. Ohlsen pointed out that
the
authors of Williams Obstetrics were claiming that the pelvic diameters
*don't
change* during delivery (!) - so the authors of Williams Obstetrics
decided
(erroneously) that dorsal delivery widens!

Interestingly, early last century, J. Whitridge Williams, MD, the
original
author of Williams Obstetrics demonstrated MASSIVE amounts of change in
pelvic outlet diameter change at-term - and the just mentioned 1957
intrapartum x-ray study accorded with the average amount of pelvic
outlet
diameter change Williams found clinically...

See: http://home1.gte.net/gastaldo/part2ftc.html

Jason Gardosi, MD, director of the British National Health
Service/NHS West Midlands Perinatal
Institute/WMPI states the grisly biomechanics of the semirecumbent
delivery position (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..."
http://www.wmpi.net/reviews/oe/oe_shoulder_dystocia.htm

The funny thing is, Jason Gardosi, MD also *recommends* semisitting
(closing
the birth canal) - or used to!

"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: Jason Gardosi, MD and his fellow British OB pal Malcolm Griffiths
once
got me censored from an international OB/GYN listserv - but fortunately
not
before two of my posts were archived thereon:
http://forums.obgyn.net/forums/ob-gy...9707/0128.html
http://forums.obgyn.net/ob-gyn-l/OBGYNL.9707/0153.html

Anyone interested in some entertaining obstetric reading, check out
Jason's
1989 Lancet "randomised controlled trial of squatting" - where nobody
squatted...

See Sarah Key's huge balls (also: Kids can SQUAT motionless for
hours)...
http://groups.yahoo.com/group/chiro-list/message/2084

MORE PROOF According to the Merck Manual:

"When shoulder dystocia occurs...the mother's thighs are hyperflexed to
increase the diameter of the pelvic outlet..."
http://www.merck.com/mrkshared/mmanu...er253/253g.jsp

WHY are OBs and CNMwives (nurse midwives) waiting until the
head is
out and shoulders get stuck before giving the baby maximum pelvic outlet
diameter?

WHY are OBs and CNMwives forcing babies' heads through birth canals
senselessly closed up to 30%?

WHY are OBs and CNMwives KEEPING birth canals closed when babies'
shoulders
get stuck?

(Merely hyperflexing the thighs does NOT get the woman off her sacrum.
This
is BAD McRoberts maneuver. ON A POSITIVE NOTE: Gardosi et al.'s WMPI
site
(quoted above) recommends a version of GOOD McRoberts
if the shoulders get stuck...
http://www.wmpi.net/reviews/oe/oe_shoulder_dystocia.htm)

LADIES: HELP PROTECT YOUR VAGINAS...

OBs and CNMwives are slicing vaginas (euphemism "routine episiotomy") -
surgically/FRAUDULENTLY inferring everything possible is being done to
OPEN
birth canals - even as they CLOSE birth canals - up to 30%!

See Criminal medical CAM at Hawai'i's John A Burns School of
Medicine
http://health.groups.yahoo.com/group...t/message/2256

Sorry to be repetitive but...

WEIRD: In 1993, the authors of Williams Obstetrics published the
correct
biomechanics at my request but they left in their text (in the same
paragraph!) the "dorsal widens" bald lie that first called my attention
to
their text.

The "dorsal widens" bald lie was created when Ohlsen informed the
authors
of
Williams Obstetrics in 1973 that they were still claiming that the
pelvic
diameters *don't change* at delivery!

ALSO WEIRD: Before Ohlsen stimulated their "dorsal widens" bald lie,
the
authors of Williams Obstetrics were ignoring Borell and Fernstrom's 1957
RADIOGRAPHIC demonstration that the diameters DO change - and this MANY
years after (way back in 1911) J. Whitridge Williams, MD - the first
author
of Williams Obstetrics - clinically demonstrated 4cm of AP outlet
diameter
change!

For details: See my Open Letter to FTC at:
http://home1.gte.net/gastaldo/part2ftc.html


SIMPLE INSTRUCTIONS

PREGNANT WOMEN: It is EASY for you to allow your birth canal to OPEN
the
"extra" up
to 30%.
Just roll onto your side as you push your baby out - or deliver on
hands-and-knees, kneeling, standing, squatting, etc.

BUT BEWA "Midwives...encourage...semisitting." (closing the birth
canal!)
--Yale CNMwifery Prof. Helen Varney. Varney's Midwifery. Sudbury, MA:
Jones
and Bartlett. 4th ed. 2004:839]

Some MDs and MBs will let you "try" "alternative"
delivery positions but will move you back to dorsal or semisitting
(close
your birth canal!) as you push your baby out!

If your baby's shoulders get stuck OBs and CNMwives will KEEP your birth
canal closed!

Yale CNMwifery Prof. Varney (just cited) writes:

"In the event of...shoulder dystocia...the woman should be
in a lithotomy position..." (p. 839)

Lithotomy position keeps the birth canal closed! So does semisitting!

Talk to your CNMwife or MD or MB about this TODAY. (For further details
see
"Criminal medical CAM," URL above.)

CNMwives/MDs/MBs: If you must push or pull - and sometimes you must -
first
get the
woman off her sacrum - off her back/butt.

Thanks for reading everyone.

Sincerely,

Todd

Dr. Gastaldo



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