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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 |
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