Shoulder dystocia tomfoolery..attorneys could stop it...

Discussion in 'Health and medical' started by Todd Gastaldo, Jan 29, 2004.

  1. PREGNANT WOMEN: MDs and MBs (and many midwives - esp. CNMwives) are senselessly closing birth canals
    up to 30%. The two most common delivery positions - semisitting and dorsal lithotomy - close the
    birth canal up to 30%.

    Worse, when babies' shoulders get stuck (SHOULDER DYSTOCIA) MDs and MBs are KEEPING birth canals
    closed! See McRoberts maneuver discussion below.

    LADIES: You can easily OPEN your birth canal the "extra" up to 30%. See below.

    ATTENTION WOMEN SUING OBSTETRICIANS - Please show this email to your attorney. It will be instantly
    archived for global access at:

    SHOULDER DYSTOCIA ATTORNEYS: Please tell juries that MD-obstetricians are senselessly closing
    birth canals...

    Copied to shoulder dystocia attorneys nationwide via: http://www.shoulder-dystocia-

    MDs and MBs and CNMwives: If you must push or pull on a baby's head - and sometimes you must - first
    get the woman OFF her sacrum. Women should not be on their sacra (on their backs/butts) in the first
    place, as in the following case study...


    Lithotomy position closes the birth canal up to 30%...yet MDs and MBs (and CNMwives) use the
    position and are surprised when shoulders get stuck...

    Here are Bhavini Lad, MD and with Miss A. Sanghi and Mr. T. Beedham describing what happened in one
    case of shoulder dystocia...

    "By 10.30hrs, Mrs AN was put into the lithotomy position, (image courtesy of Birth Psychology). Here
    the patient lies with her legs in stirrups and her buttocks close to the lower edge of the table.
    She is then in the ideal position for the attendant to deal with any complications which may arise,
    and that she has more power to push against when she gets a contraction."
    casereport.htm (my thanks to Erb's coollist for calling my attention to this paper by Bhavini.)

    Lithotomy *closes the birth canal*! And what is Bhavini talking about "more power to push against"?
    More OBSTRUCTION to push against is more like it! Why are we letting MDs and MBs use this bizarre
    birth-canal-closing position?!

    Bhavini continues...

    "[Shoulder dystocia] is considered to occur when the fetal shoulders impact at the pelvic inlet
    following delivery of the head...The problem with shoulder dystocia is the failure of the fetal
    shoulders to enter the pelvic inlet."

    What?! Bhavini says shoulders are caught at the pelvic INLET? Wrong! If the posterior fetal shoulder
    is caught at the pelvic inlet (WAY up inside the birth canal at the sacral promontory!) how does the
    head stick out the vagina?! The baby's neck can't stretch that far! And even if it could, what force
    could push the baby's head out with the shoulder stuck at the inlet?

    Bhavini does say, "Usually the posterior shoulder enters the pelvis..."


    But why say only USUALLY? In head-out-the-vagina shoulder dystocia - the usual kind - the posterior
    shoulder HAS to enter the pelvis - otherwise the head can't stick out the vagina (unless the MD or
    MB is pulling with a vacuum or forceps - in which case the fetal neck is being stretched WAY too far
    - which may account for some babies having their spinal nerves ripped out of their spinal cords by
    MDs and MBs)...

    Further down in Bhavini's text, one reads MORE about the pelvic inlet: "The problem with shoulder
    dystocia is the failure of the fetal shoulders to enter the pelvic inlet"...

    Bhavini's Conclusion: "It should, however, be appreciated that as the obstruction to shoulder
    delivery is at the pelvic inlet"


    Sorry to get E-motional but babies' lives and limbs are on the line! Some babies are DYING or
    getting PARALYZED.

    Head-out-the-vagina shoulder dystocia is an OUTLET phenomenon.

    Bhavini's source for inlet dystocia is Bernard Gonik...

    In a 1989 paper [Obstet Gynecol Vol. 74] Gonik mysteriously ("scientifically") created the obvious
    inlet shoulder dystocia hoax after he called shoulder dystocia "a true outlet obstruction" in 1983
    [Am J Obstet Gynecol Vol. 145].

    Bhavini, why do you suppose Gonik created the inlet hoax? I think he did it to call attention away
    from the outlet - because closing the outlet is an obvious crime.

    Gonik's paper is pictured in the American College of Obstetricians and Gynecologists' shoulder
    dystocia video which indirectly ADMITS that MDs are routinely closing birth canals by purporting to
    show OBs how to OPEN the birth canal maximally when the shoulders get stuck. Unfortunately, the ACOG
    video teaches MDs how to KEEP THE BIRTH CANAL CLOSED when shoulders get stuck!

    See IMPROPER McRoberts can save tiny lives and tiny limbs...

    Bhavini, you wrote "increased pelvic diameters are proposed" as one possible reason the "All-fours"
    position works well to relieve shoulder dystocia.

    BRAVO! YES! Getting the woman off her sacrum allows her pelvic outlet AREA to increase up to 30%!!


    Bhavini, you CORRECTLY say of the most common version of McRoberts maneuver (the BAD version) that
    it "has no effect on the dimensions of the pelvis," as in,

    "McRobert's Manoeuvre...patient lies in the supine position [ON HER SACRUM - TDG] and her hips are
    flexed so that her thighs lie against her abdomen. This straightens her sacrum relative to the
    lumbar spine and rotates the symphysis pubis towards the patient's head, thereby reducing the angle
    of inclination of the pelvic inletwhen compared with the lithotomy position. It has no effect on the
    dimensions of the pelvis..."

    Why not mention the GOOD version of McRoberts? Why not roll the woman OFF HER SACRUM during
    McRoberts maneuver?!

    If the woman is rolled OFF HER SACRUM - her birth canal is allowed to open the "extra" up to 30%.

    McRobert's maneuver without rolling the mother off her sacrum - does "gets results" because it
    allows the mother to push harder - more efficiently - but it keeps the birth canal closed!

    Thanks for reading.



    Dr. Gastaldo [email protected]

    PS1 INTERESTING FACTOID An estimated six babies per day DIE from vacuum-assisted spinal manipulation
    alone - with birth canals senselessly closed up to 30%.

    See How NOT to do McRoberts maneuver...

    MDs and MBs: Again, if you must pull with vacuum or forceps - and sometimes you must - PLEASE first
    get the woman off her sacrum!

    PS2 OPEN LETTER TO THE LANCET (Never published)

    Richard Horton Editor The Lancet [email protected]


    Buhimschi and Buhimschi et al.'s recent research letter regarding McRoberts manoeuver in shoulder
    dystocia (1) uncritically cited Gonik and Allen's 1989 FALSE report that shoulder dystocia occurs at
    the pelvic inlet. (2)

    Buhimschi and Buhimschi et al. *failed to mention* Gonik's initial 1983 report on McRoberts
    manoeuver (3) which stated that shoulder dystocia is a "true OUTLET obstruction" (emphasis added).

    Why did Gonik flip-flop in 1989 and wind up asserting the FALSEHOOD that shoulder dystocia is an
    inlet phenomenon?

    Certainly when Gonik stated the truth in 1983 - that shoulder dystocia is a true outlet obstruction
    - he should have noted (and accounted for) the fact that Hibbard (and probably others) were stating
    that shoulder dystocia was an inlet phenomenon, as in,

    "With typical shoulder dystocia...the posterior shoulder is lodged [at the inlet,] at the level of
    the sacral promontory...The soft tissues of the...vulva are fitted closely around the infant's
    neck." (4)

    Hibbard is entirely correct that the infant's head sticks out the vagina in typical shoulder
    dystocia - but there is a problem - with the infant's posterior shoulder caught way up the Curve of
    Carus (at the sacral promontory/pelvic inlet) there is no force to push/pull the infant's head out
    the vagina; hence Hibbard's (and Gonik and Allen's) inlet shoulder dystocia is an obvious physical
    impossibility - a MEDICAL MYTH.

    Granted, it is probably possible for a forceps operator to PULL the head out the vagina with the
    posterior shoulder stuck at the inlet - but this likely avulses spinal nerves from tiny spinal cords
    and is NOT typical shoulder dystocia.

    The inlet shoulder dystocia myth was likely manufactured to call attention away from the pelvic
    outlet, where MD-obstetricians are CAUSING shoulder dystocia by closing birth canals up to 30%.

    1. Buhimschi CS, Buhimschi IA, Malinow A, Weiner CP. Use of McRoberts' position during delivery and
    increase in pushing efficiency. Lancet 2001;

    3. Gonik B, Allen R, Sorab J. Objective evaluation of the shoulder dystocia phenomenon: effect of
    maternal pelvic orientation on force reduction. Obstet Gynecol 1989; 74:44-48.

    4. Gonik B, Stringer CA, Held B. An alternate maneuver for management of shoulder dystocia. Am J
    Obstet Gynecol 1983; 145(7):882-4.

    5. Hibbard LT. Shoulder dystocia. Obstet Gynecol 1969; 34:424. Reproduced and reviewed in Obstet
    Gynecol Survey 1970; 25(11):1057-60.

    Ds. Todd Gastaldo Portland, Oregon USA [email protected]

    PS As noted above...


    The American College of Obstetricians and Gynecologist's/ACOG's Shoulder Dystocia video purports to
    tell MDs how to OPEN the birth canal when baby's shoulders get stuck - which obviously means that
    MD-obstetricians know they are closing birth canals.

    WORSE: The ACOG method for opening the birth canal when baby's shoulders get stuck (PROPER (bad)
    McRoberts) - actually keeps the birth canal closed!

    See IMPROPER McRoberts can save tiny lives and tiny limbs...

    FURTHER PROOF (that MDs know they are closing birth canals)...

    The British National Health Service/NHS West Midlands Perinatal Institute/WMPI (Jason Gardosi, MD,
    Director) writes 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..."


    In addition to routinely closing birth canals up to 30%, MDs often GRUESOMELY manipulate babies'
    spines (push with oxytocin; pull with forceps/vacuums) with the birth canal senselessly closed
    up to 30%.

    An estimated six babies per day DIE from vacuum-assisted spinal manipulation alone - with birth
    canals senselessly closed up to 30%.

    See again: How NOT to do McRoberts maneuver...

    PREGNANT WOMEN: To offer your baby the up to 30% "extra" - simply roll onto your side as you push
    your baby out!

    There are LOTS of "alternative" delivery positions that allow the birth canal to open maximally -
    kneeling, hands-and-knees, squatting, standing, etec.

    Talk to your MD or CNMwife NOW - before your delivery!

    BUT BEWARE: Some MDs and CNMwives may still close your birth canal (!), as in,

    "[M]ost doctors and [nurse] midwives are accustomed to the semisitting position...[T]hey may be
    willing to let you try other positions, if you ask...[But] you get close to delivery...[they]
    may ask you to move to [semisitting]..." [Simkin, P, Whalley J, Keppler, A. Pregnancy, Childbirth
    and the Newborn: The Complete Guide (Expanded and updated). Meadowbrook Press: Minnetonka, MN (dist.
    by Simon and Schuster). 2001:201]

    4.6% of "healthy" term babies are born with unexplained brain bleeds!

    And up to 3% of cephalic vaginal deliveries suffer shoulder dystocia!

    LADIES: If your baby's shoulders get stuck inside you, do NOT let the MD pull with you on your
    back/butt, closing your birth canal.

    You should not have been on your back/butt closing your birth canal in the first place!

    It's sort of a chiropractic emergency.

    Please help stop MDs from closing birth canals.

    Please share this info with as many pregnant women as possible.



    Dt. Gastaldo [email protected]