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


Todd Gastaldo

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!


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]