Pelvic girdle pain after birth?

PELVIC GIRDLE PAIN AFTER BIRTH? See below.


PREGNANT WOMEN: OBs are knowingly 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...


LADIES: You do NOT have to squat to allow your birth canal to open
maximally...

BUT... Could SQUATTING in every day life be a "SPECIFIC STABILIZING
EXERCISE" for the pelvis? Could women in squatting cultures experience less
pelvic girdle pain postpartum?

Just wondering because...

IN PELVIC GIRDLE PAIN AFTER BIRTH...

"SPECIFIC STABILIZING EXERCISES" plus physical therapy appeared to be more
effective than physical therapy alone...

"A randomized controlled trial...Eighty-one women with pelvic girdle pain
were assigned randomly to two treatment groups for 20 weeks. One group
received physical therapy with a focus on specific stabilizing exercises.
The other group received individualized physical therapy without specific
stabilizing exercises...After intervention and at 1 year post partum, the
specific stabilizing exercise group showed statistically and clinically
significant lower pain intensity, lower disability, and higher quality of
life compared with the control group. Group difference in median values for
evening pain after treatment was 30 mm on the Visual Analog Scale.
Disability was reduced by more than 50% for the exercise group; changes were
negligible in the control group...."
--Britt Stuge et al.^^^ Spine. 2004 Feb 15;29(4):351-9. PubMed abstract

^^^Stuge B, Laerum E, Kirkesola G, Vollestad N. Section for Health Science,
University of Oslo, Oslo, Norway.


LESS knee osteoarthritis (for men) after a lifetime in a squatting culture!

See 'Science' vs Squatting? (Zhang et al. 2004)...
http://health.groups.yahoo.com/group...t/message/2476




DID STUGE ET. AL.'S PHYSICAL THERAPY INCLUDE THE OPTION OF INCLUDING SPINAL
MANIPULATION?

I'll cc Britt Stuge at



As I've previously noted on the usenet...

IL Rist of the Norwegian Association of Women with Pelvic Girdle
Relaxation reported in 1991:

"Invalidity is a shocking experience. You
cannot get out of your bed and you need nursing and help to everything
like making food and washing yourself. You have constant, intense pains
day and night, year after year..." [Rist IL (The Norwegian Association of
Women with Pelvic Girdle Relaxation). A fight against pains and
ignorance. Scand J Rheumatology 1991; Suppl. 88:17]

Similarly, MC Jensen, a founding member of the Norwegian Association,
reported in an abstract that from week 17 of her pregnancy "it became
painful to walk"; after which "the pains increased." After delivery she
remained in bed "with immense pains for 7 months." [Jensen MC. A
patient's story. Scand J Rheumatology 1991; Suppl. 88:17.])

Jensen's 1991 report further stated that "the association has increased
continuously and has shown that this is a comprehensive and hidden
problem in Norway"...

Incredibly, in the same issue of Scand J Rheumatology, Australian
obstetrician
Alistair MacLennan ignored this "hidden problem" possibility and made a
puzzling reference to "the apparently high incidence of the problem in
Scandinavian women compared to other nationalities." (!)

Obstetrician MacLennan offered NO evidence that "other nationalities" had
even looked
for the problem. (Jensen indicates in her abstract that it is indeed
necessary to look. She writes: "I was amazed and scared by the lack of
knowledge and understanding in the [Norwegian] public health system."
Perhaps the public health systems of other nations are similarly
afflicted.)

MANIPULATION to relieve severe pelvic pain

Jensen mentioned that manipulation helped her, i.e., she is now "in
pretty good health" and "the following kinds of treatment did
help...manipulating the pelvic [sic]...training in hospital
physiotherapy, acupuncture, autogenic training." [Jensen 1991]

U. Akre of Ullevå Hospital in Oslo, Norway also mentioned manipulation,
writing that,

"In Norway, manual therapy is a system for examination and
treatment of dysfunctions in the musculoskeletal apparatus...based on
orthopaedic and osteopathic methods which have been further developed and
systemized by Norwegian physiotherapists...The choice of therapy is
determined by clinical findings." [Akre U. Training of the pelvic girdle
muscles. Scand J Rheumatology 1991; Suppl. 88:23.])

Akre [1991] wrote further: "50% of women experience backache during
pregnancy" and state that the pain "may theoretically have two
biomechanical causes...1. Hypermobility; and 2. Hypomobility with
subluxation in one of the sacroiliac joints...The treatment is different
in the two conditions."

Two CNMs, Benetti and Marchese
[1996], came to the conclusion that CNMs should make referrals to
chiropractors "when necessary"; but unfortuately, Benetti and Marchese
[1996] gave no indication as to WHY it might be necessary for
nurse-midwives to make referrals to chiropractors. [Benetti MC, Marchese
T. Primary care for women: management of common musculoskeletal
disorders. JNM 1996;41:173-87]

CNMs branching into the management of musculoskeletal conditions should
not restrict themselves (or their patients) to NSAIDs, heat and ice.

Benetti and Marchese note that NSAIDs - non-steroidal anti-inflammatory
drugs like aspirin and ibuprofen - are "relatively contraindicated in
patients with...pregnancy" [1996:173].

Oddly, although Benetti and Marchese [1996] mention
referral to chiropractors, they fail to mention spinal
manipulation.

To all pregnant women who are suffering spinal/pelvic pain, there are
practitioners of all professional stripes who specialize in adjusting
pregnant women. I am, of course, biased toward chiropractors. : )

MORE ON PELVIC PAIN AFTER DELIVERY

According to Dutch researchers Mens et al. [1996],

"Maximal flexion of
spine and hips" during delivery might enhance the risk for peripartum
pelvic pain (PPPP). [Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders
CJ. Understanding peripartum pelvic pain: implications of a patient
survey. Spine 1996;21(11):1363-70.]

Unfortunately, Mens et al. don't state exactly what they mean by "maximal
flexion of spine and hips."

I suspect they may be referring to - and cautioning against - the
birth-canal-closing "Bradley Classic" delivery position where the woman sits
in maximal flexion - squarely (and only) on her buttocks/sacrum during
delivery? (Semisitting delivery is also recommended by ASPO/Lamaze.)

See The Bradley "Classic" and PPPPain and adjusting babies' skulls and
spines...

....in Bradley Method Students: Check your workbook...
http://health.groups.yahoo.com/group...t/message/2581

Norwegian physiotherapist N Bjørnstad similarly cautions against sitting
on the sacrum at delivery:

"Birth positions recommended are...various sitting positions where sacrum
will not be locked against the bed...avoid unnecessary stretching of the
pelvic ligaments and locking of the joints." [Bjørnstad N. Obstetric
physiotherapy, observation and treatment (abstract). Scand J Rheumatology
1991; Suppl. 88:22-23. (N. Bjørnstad, Bjerkåsen 5, 1310 Blommenholm,
Norway)]

Mens et al., just quoted, cited radiographic studies from the 1930s but
FAILED to cite Borell and Fernström's 1957 radiographic study when they
mentioned increased sacroiliac mobility during pregnancy as having been
"observed in an anatomic study and in radiographic studies."

Borell and Fernström's work is decades old but is still cited in the 1995
British Gray's Anatomy as evidence that "radiological pelvimetry has
become a refined technique" (p. 671).


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 known since early last century..

I discussed this matter in 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