PREGNANT WOMEN: To allow your birth canal to open an "extra" up to 30% at
delivery...

See THE SOLUTION below.

RADIOLOGISTS! REACH IN VAGINA - PULL ON SACRAL TIP!

See below.

Nigel Anderson MB ChB, FRANZCR et al.^^^ write:

"[The c]omputed tomography [CT] pelvimetry...standard error of
measurement...[of the]...anteroposterior outlet [is]...6.9 mm...The 95%
confidence interval around the recommended anteroposterior outlet of 100 mm
was 88.5-111.3 mm. Observer variation in measurement of anteroposterior
outlet is so large as to make the measurement of doubtful clinical utility."

^^^Anderson N, Humphries N, Wells J.  Australas Radiol. 2005
Apr;49(2):104-7. PubMed abstract.

OPEN LETTER (archived for global access at http://groups.google.com)

Nigel Anderson MB ChB, FRANZCR
Department of Radiology
Queen Victoria Hospital NHS Trust
Holtye Road
East Grinstead
West Sussex RH19 3DZ
UK
Nigel.Anderson@qvh.nhs.uk

Nigel,

BIZARRE FACT #1:  By placing women semisitting or dorsal, OBs are routinely
closing birth canals up to 30% and routinely keeping birth canals closed
when babies get stuck - i.e. - OBs are keeping women dorsal or semisitting
as they pull with hands, forceps and/or vacuum extractors.

See the Four OB Lies below.

BIZARRE FACT #2:  CT pelvimetry and MRI researchers have been aping this
bizarre OB birth-canal-closing practice - ignoring the fact that the dorsal
position denies sacroiliac motion...

In 1995, CT pelvimetry researchers English and Alcoir had patients remain in
a dorsal position as they measured the anteroposterior diameter of the
outlet:

"The pelvimetries were performed according to the methodology described by
Federle et al.11 using a Philips Tomoscan CX/Q. The patients remained in a
dorsal position throughout the study.  A lateral view was used to
obtain...the antero-posterior diameter of the outlet..."
[English J, Alcoair K. Ann Saudi Med 1995;15(3):236-239.  Citing Federle
MP, Cohen HA, Rosenwein MF, et al. Pelvimetry by digital radiography: a
low-dose examination. Radiol 1982;143:733-5.]

Similarly, in 2003 MRI researchers Keller et al. wrote:

"MR pelvimetry...performed with the patient in the supine position."

TM Keller, A Rake, SCA Michel, B Seifert, G Efe, K Treiber, R Huch, B
Marincek, RA Kubik-Huch, Obstetric MR Pelvimetry: Reference Values and
Evaluation of Inter- and Intraobserver Error and Intraindividual
Variability. Radiology 2003;227:37-43.

Nigel, your PubMed abstract did not mention how women were positioned, so I
paid $26 to read your article online.

You offered no patient positioning information there either, so far as I
could tell.

Your article did say this though:

"Technique...Anteroposterior (AP) and lateral scanograms are
performed...Reliability for AP outlet [measurement] was particularly poor.
This was because of variation in marking end-points on the [lateral? - TDG]
scanogram of the CT."

I suspect, as in the English and Alcoair study quoted above, that your
patients remained in a dorsal position throughout the study and a lateral
view was used to obtain the antero-posterior diameter of the outlet...

I suspect this because the lateral view with the patient dorsal/supine can
make it difficult to find the sacral tip....

Which brings me to a remarkable fact...

Borell and Fernstrom's 1957 intrapartum x-rays only ACCIDENTALLY
demonstrated the sacroilac motion mentioned above....

Borell and Fernstrom hung women by their knees to get their buttocks off the
table because they were shooting the films laterally - across the table -
during labor...

With buttocks spread out on the table - lots of soft tissue to shoot
through...

"[T]he lateral view taken with a horizontal beam, with the patient supine,
gives a film of inferior quality...caused by the [thick soft tissues of the]
patient's buttocks resting on the table..." [Borell U, Fernström I.
Radiologic pelvimetry. Acta Rad (Stockh.) 1960;Supp 191]

To avoid this FILM QUALITY problem - they hung women by their knees - and
accidentally demonstrated the sacroiliac motion radiographically...

It is possible that Borell and Fernstrom still didn't understand the
biomechanics they inadvertently demonstrated in 1957...

Ten years later, in 1967, they suggested that, with the woman on her sacrum
and with the
weight of her thighs cranking the pelvis closed, the *abdominal musculature*
pulls up on the pubes, lifting the weight of the thighs multiplied by the
length of the crank, the acetabulo-sacroiliac lever arm. ("[U]pward
displacement at the time of [fetal] passage through the pelvic outlet...is
probably provoked by contraction of the muscles of the abdominal wall..."
[Borell U, Fernström I. Rad Clin N Amer 1967;5:73-85]

Further discussion at: http://home1.gte.net/gastaldo/­part2ftc.html

Nigel, to ensure the best chance of measurement of the MAXIMUM possible AP
(anteroposterior) pelvic outlet diameter, it is necessary to place the woman
so she is not on her sacrum and PULL ON THE SACRAL TIP via the vagina (or
anus) to simulate the baby coming through.

Early last century, sacral tip excursion/AP pelvic outlet diameter change -
was reportedly measured CLINICALLY - accurately - no radiation necessary.

J. Whitridge Williams, MD used the "extreme lithotomy" position and found
one woman in whom the sacral tip moved 40 mm; that is, he was able to
measure a 40 mm increase in the AP pelvic outlet diameter relative to the
standard woman-on-her-sacrum delivery position.

In a later study, Herbert Thoms, MD measured 35 mm of AP pelvic outlet
diameter increase relative to standard woman-on-her-sacrum delivery
position.

I am not sure Williams and Thoms pulled on the sacral tip - I suspect they
did.  Pulling on the sacral tip would both minimize "soft tissue error" and
move the sacrum maximally - though Williams and Thoms likely did not pull
hard enough to simulate the force of delivery.

QUESTIONS:

1. Given that Borell and Fernstrom demonstrated AP pelvic outlet change with
x-ray - why do not radiologists use CT pelvimetry and MRI to either look for
the same change or at least look for the maximum possible AP pelvic outlet
diameter?

2. Given that Borell and Fernstrom took intrapartum x-rays with mothers
supine, their pelvises lifted off the delivery table (suspended by the
knees) TO IMPROVE X-RAY QUALITY - why did subsequent CT pelvimetry
researchers maintain women in the dorsal position?

In 1998, Yamani and Rouzi wrote: "the practice of documenting the 'adequacy'
of the pelvis by CT pelvimetry before VBAC should be abandoned." [Yamani and
Rouzi. Ann Saudi Med 1998;18(1):9-11]
http://www.kfshrc.edu.sa/annals/181/97-119.html

First and foremost, the bizarre obstetric practice of closing birth canals
the "extra" up to 30% should be abandoned.

NOTE:  Placing the woman on her sacrum closing her birth canal up to 30% may
cause NEUROLOGIC inhibition of delivery.  I recently mentioned this in
regard to researchers who used MRI in suggesting that larger pelvic muscles
might inhibit delivery...

See Birth and 'very athletic women'
http://health.groups.yahoo.com/group/chiro-list/message/3499

Thanks for reading.

Sincerely,

Todd

Dr. Gastaldo
Hillsboro, OR
todd@chiromotion.com

PS  THE FOUR OB LIES

OB LIE #1. After MASSIVE change in the AP pelvic outlet diameter was
clinically demonstrated in 1911 and radiographically demonstrated in 1957,
the authors of Williams Obstetrics began erroneously claiming that pelvic
diamaters DON'T CHANGE at delivery.

OB LIE #2. After Ohlsen pointed out in 1973 that pelvic diameters DO
change - the authors of Williams Obstetrics began erroneously claiming that
their most frequent delivery position - dorsal - widens the outlet.

OB LIE #3. After I pointed out in 1992 that dorsal CLOSES - and so does
semisitting - the authors of Williams Obstetrics - put the correct
biomechanics in their 1993 edition - but kept in their text (in the same
paragraph!) - the dorsal widens bald lie that first called my attention to
their text...

OB LIE #4. OBs are actually KEEPING birth canals closed when babies get
stuck - and claiming they are doing everything to allow the birth canal open
maximally. (ACOG Shoulder Dystocia video - also forceps and vacuum births
are performed with the mother in lithotomy.)

See Make birth better: Dan Rather, before you leave CBS...
http://health.groups.yahoo.com­/group/chiro-list/message/2983

I noted some of the OB lies in an Open Letter to the FTC years ago...
http://home1.gte.net/gastaldo/­part2ftc.html

RELEVANT AMA PRINCIPLES OF MEDICAL ETHICS....

"[AMA physician[s] shall...strive to expose those physicians...who engage in
fraud or deception."

"[AMA p]hysician[s] shall...seek changes in those requirements which are
contrary to the best interests of the patient."

"[AMA p]hysician[s] shall...make relevant information available to patients,
colleagues, and the public..."
http://www.psych.org/psych_pra­ct/ethics/ethics_opinions53101­.cfm

AMA physicians are ignoring their own stated ethics - babies be damned.

MASSIVE BABY BLOOD ROBBERY

Retired obstetrician George Malcolm Morley, MB ChB FACOG
indicates that OBs are robbing babies of up to 50% of their blood volume.

This is happening to EVERY CESAREAN BABY, according to Dr. Morley:

"ACOG's routine treatment (B138) of these depressed neonates is immediate
cord clamping to obtain cord blood pH studies.  The child's only functioning
source of oxygen - the placenta - is amputated together with 30% to 50+% of
its natural blood volume.  Total asphyxia is imposed until the lungs
function, and the depressed (asphyxiated, hypovolemic) child starts its
extra-uterine life in hypovolemic shock... B138 was first published in 1993.
Every cesarean section baby, every depressed child, every premie, and every
child born with a neonatal team in
the delivery room has its cord clamped immediately to facilitate the
panicked rush to the resuscitation table.  The current epidemic of immediate
cord clamping coincides with an epidemic of autism...For the trial lawyers,
it is essential that the 'true genesis' of cerebral
palsy remains unknown, because that 'true genesis' (B.138) is a standard of
medico-legal care..."
http://www.cordclamping.com/ac­­­og-cp.htm

My thanks to Canadian Grandmother Donna Young for calling my attention to
the immediate cord clamping mass child abuse.

A GOOD SIGN:  Oregon Health & Science University/OHSU - Oregon's only
medical school - stopped promoting immediate cord clamping and
birth-canal-closing/semisitting delivery online
after I complained.

OHSU's link to the misinformation is now dead - or rather - one is re-routed
to
www.ohsuwomenshealth.com...

See Birth child abuse: Oregon's only medical school (OHSU)
http://health.groups.yahoo.com­/group/chiro-list/message/2986

(If anyone can find a page where OHSU is still promoting immediate cord
clamping and birth-canal-closing/semisitting delivery, I would like to know
about it.)

PREGNANT WOMEN: By using semisitting and dorsal delivery, OBs are closing
birth canals up to 30%.  Also, when babies get stuck, OBs KEEP women
semisitting and dorsal - they KEEP the birth canal closed the "extra" up to
30% as they pull with hands, forceps and vacuums. ANOTHER PROBLEM:  By
immediately clamping cords, OBs are temporarily asphyxiating babies and
robbing them of up to 50%
of their blood volume - see the astonishing quote from Dr. Morley above.

THE SOLUTION:

1.  To allow your birth canal to OPEN the "extra" up to 30%,
simply roll onto your side as you push your baby out - BUT BEWARE - some OBs
will let pregnant women "try" alternative delivery positions - but will roll
them back to semisitting/dorsal - close their birth canals the "extra" up to
30% for the actual delivery.  Talk to your OB.

2.  To allow your baby to have the "extra" up to 50% of blood volume, do not
let the OB or midwife clamp the umbilical cord until it has stopped
pulsating and your baby is pink and breathing and not in need of
resuscitation.

NOTE #1:  Allowing the birth canal to open the "extra" up to 30% will not
prevent all episiotomies or c-sections or forceps/vacuum use - but OBs have
no business closing
birth canals the "extra" up to 30% in the first place.

NOTE #2: There are rare cases where the OB must clamp immediately - but they
are indeed rare.  OBs are routinely clamping cords immediately - routinely
robbing babies of up to 50% of their blood volume.  Talk to your OB today.

I am in favor of pardons in advance for MDs.  As medical
students MDs are TRAINED to perform obvious child abuse which sometimes
kills.

Thanks for reading everyone.

Todd

Dr. Gastaldo
Hillsboro, Oregon
USA
todd@chiromotion.com

Two last notes to Nigel:

1. Your Discussion section begins with this sentence:  "The principal
finding in our study is the poor reproducibility of the AP outlet view at CT
pelvimetry.  It is so prone to error that it is of no clinical value, and
should be abandoned."

Sorry to repeat myself but some of the CT pelvimetry error may be due to
poor scan quality due to patient positioning.

Also, keeping women dorsal denies sacroiliac motion and significant pelvic
outlet diameter which I noted for MRI researchers in a July 4, 2003 post:

See Flip women over, reach in vagina, *pull* on sacrum during MRI!
http://groups-beta.google.com/group/
sci.med/msg/a284f68bdb090f02?hl=en

Alternate URL for Flip women over:
http://health.groups.yahoo.com/group/chiro-list/message/2012

2.  Your concluding paragraph begins:

"We join others in calling for an urgent reassessment of the use of
pelvimetry"...

I hope you will join me in calling for an urgent reassessment of the bizarre
birth-canal-closing practice of both OBs and radiologists...

Remember Nigel:

"[P]elvimetric differences of just a few millimeters could have an important
bearing on obstetric decision making..."

TM Keller, A Rake, SCA Michel, B Seifert, G Efe, K Treiber, R Huch, B
Marincek, RA Kubik-Huch, Obstetric MR Pelvimetry: Reference Values and
Evaluation of Inter- and Intraobserver Error and Intraindividual
Variability. Radiology 2003;227:37-43.

Babies can use every "extra" millimeter they can get.

Thanks for reading everyone.

Sincerely,

Todd

Dr. Gastaldo
Hillsboro, Oregon
USA
todd@chiromotion.com

This Open Letter to Nigel Anderson MB ChB, FRANZCR will be archived for
global access in the Google usenet archive.  Search http://groups.google.com 
for "Radiologists! Reach in vagina - pull on sacral tip!"