Dr. Phil and the 30%

From: Todd Gastaldo (tgastaldo_at_earthlink.net)
Date: 12/02/04 

Date: Thu, 02 Dec 2004 00:00:18 GMT

I forgot to mention: I hope Dr. Phil doesn't edit out Lisa's mention of the
30%...

Donna,

I, too, am pleased to see Lisa Muscarella speaking out.

It is quite false though to say that only mothers whose babies have been
victimized can speak out.

We ALL have an obligation to speak out when wrongs are being committed
against helpless persons.

Mothers should not have to ASK obstetricians (or midwives) for the "extra"
up to 30% of room in the birth canal.

Todd

Dr. Gastaldo
todd@chiromotion.com

PS Lisa, you expressed only part of my sentiment in response to the Merck
Manual admission.

It is important to clearly state that OBs are closing birth canals up to 30%
then KEEPING birth canals closed when babies get stuck.

OBs are actually LYING in a lame attempt to cover-up.

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

  ----- Original Message -----
  From: Donna Young
  To: Lisa
  Cc: todd.watkins@cma.ca ; Todd Gastaldo ; Kelly Moscarello ; Cory Mermer ;
CBC Ombudsman ; Sounds Like Canada ; fifth@toronto.cbc.ca ; national@cbc.ca
; dsherriff-scott@blgcanada.com ; M HALIBURTON ; HARLEY HARASYM ; Carley
  Sent: Wednesday, December 01, 2004 1:13 PM
  Subject: this is excellant on child-birth position. Now write, please,
giving blood of babies to cord blood banks, how misguided it is, eh.

  ONLY the mothers who have victimized babies, can speak out. Us
grandmothers, our part, is to encourage you to come forward. God's
blessings. May your voice be heard around the world.
  Donna 1-250-782-9223

<snip>

  FOR IMMEDIATE RELEASE

  December 1, 2004

  Contact: Lisa Muscarella

  Home (928) 779-6354

  Cell (928) 856-1513

  ARIZONA MOTHER OF INJURED BABY ON DR. PHIL, AIRING DEC. 13th

  On December 13th Dr. Phil will be airing a show on medical controversies
and how the injury to a child at birth can impact a family. My husband,
daughter, and I will all be on a segment of the show. Having an Arizona
family on the Dr. Phil show is exciting and interesting in itself,
especially considering the topic; however, there is much more to this story,
and there is clear potential to create an amazing news piece, which could be
highly provocative, interesting and informative.

  The injury my son sustained at birth is called a brachial plexus injury.
He was a big baby, and during the time of delivery, after his head came out,
his shoulder became stuck, a phenomenon known as shoulder dystocia.
Shoulder dystocia can result in clavicle fractures, fracture of humerus,
brachial plexus injuries, fetal hypoxia (with or without permanent
neurologic damage, or even death. Although shoulder dystocia is fairly
common and something that all doctors find worrisome, some doctors and
midwives are not adequately trained or prepared to handle it the way they
should be, and they panic or overreact, applying excessive traction to the
baby's head and neck in an effort to dislodge the baby. This is tragic
because applying excessive traction to the baby's head is not one of the
maneuvers designed to release the baby, actually it is clearly
contraindicated, since pulling or turning the head can tear the nerves
coming from the baby's spinal cord.

  Immediately after my son's birth his arm was completely limp, lifeless and
paralyzed due to the severe damage of the nerves (the brachial plexus
network of nerves) that come from the neck and down into the shoulder, arm,
elbow, wrist and hand. Through endless hours of daily therapy for years and
surgery, he has regained a lot of function, but has many limitations,
weakness, deformity of the shoulder joint, deformity of the elbow joint,
along with many other lifelong issues. We were fortunate enough to capture
our son's birth on video, sadly though, the hospital banned video tapping
births shortly thereafter.

  Recoveries from this birth injury vary from child to child. Some children
have complete recovery in time, some have partial recovery and some have
limited if any recovery. This injury is known to be one of the most complex
injuries there is (next to spinal cord injuries) and it is often
misunderstood, especially in terms of its treatment and long-term
implication, which are numerous.

  Large infants are certainly at risk for shoulder dystocia, but normal
weight infants may also suffer this complication. One of the most common
risk factors for shoulder dystocia is the use of a vacuum or forceps during
delivery. Brachial plexus injuries (also known as Erb's Palsy & Klumpke's)
occur much more frequently than people realize. This injury affects
approximately 12,000 babies each year in the United States. Brachial plexus
injuries are one of the most litigated, if not "the" most litigated of all
birth injuries. They occur in an estimated 2-4 per 1,000 births. More
newborns suffer birth-related brachial plexus injuries than Down's syndrome,
Muscular Dystrophy and Spina Bifida. This birth injury also occurs as
frequently as Cerebral Palsy, yet it is often swept under the rug and not
even mentioned in many prenatal books. Why? Perhaps because the medical
field continually minimizes the injury and does not acknowledge the possible
lifelong implications. Most of us are sent home from the hospital with our
babies paralyzed arm pinned to their shirt and told the baby should be fine
in a day or two. Perhaps it is because the cause of this preventable birth
injury lies in the very hands of the doctors and midwives who have
unnecessarily injured our babies. Perhaps it is because today's hospital
birthing positions often encourage moms to remain on their back or
semi-reclined when trying to push a baby out. These positions do not allow
sacro-iliac joint motion and they actually close the mothers birthing canals
by up to 30%, thus not allowing enough room for the baby to safely pass
through. If birthing mothers were not put on their backs in the first
place, there would be a lot fewer babies getting stuck, less injury, less
trauma to the baby and less trauma to mother's bodies as well.

  Having your precious baby injured for life, before they even began their
life, is truly heartbreaking. But having your baby endure an unnecessary
and preventable lifelong birth injury is a true travesty and enough to make
any parent lose their mind. This injury requires relentless effort and
commitment on the family's part. Battles with insurance, enduring a
stressful litigation process, hours of daily home therapy performed by mom
and dad, financial stress, relationship stress, multiple weekly therapy
appointments outside of home, appointments across the nation to see bpi
specialists, surgery, etc., etc.

  Having seen the impact on my family and so many others out there, I have
realized just how important support and an accurate source of information
are for families. I currently serve on the board of directors for the
United Brachial Plexus Network (www.ubpn.org). The United Brachial Plexus
Network (UBPN) is a registered non-profit 501(c)3 organization devoted to
providing information, support and leadership for families and those
concerned with brachial plexus injuries worldwide. In addition, I am also
the President of In-Reach, Arizona's brachial plexus injury support network,
which is composed of children and adults who have sustained brachial plexus
injuries. All of our gatherings are held in the Phoenix area. For
individuals and families dealing with this injury, support, information and
referrals to specialists are crucial.

  All expecting parents should inform themselves regarding safe birthing and
prevention of unnecessary injury to the baby. I feel so bad and so guilty
that I was not informed. As a mother, you do everything in your power to
protect that little miracle growing inside of you for 9 months. It is
devastating when the health of a baby is taken away, when you as a mother,
could have done so much to protect your baby and ensure their safety during
delivery. It just hurts so deeply. I only wish I had known what I know now,
for I could have spared my precious baby from an unnecessary lifelong
injury. I could have also spared our family of the stress, grief and
heartache that this injury has brought to all of our lives.

  We feel honored to have had the opportunity to meet Dr. Phil. I know I
need to put the pieces of my life back together and to find more balance in
my life. I know I need to let go of the guilt and anger, and I know I need
to be there more for my other child and husband as well. I will certainly
take his words and advice to heart. I know I cannot be consumed by this
injury in a negative way. I think by helping others inflicted with this
injury and by working towards birth injury awareness and prevention, that I
can channel my energies in a positive direction.

  There is nothing more precious in this world than a newborn baby, and
there is nothing more important than the health of your baby. I believe
there are many people who would be very interested and could potentially
benefit from such a news story.

  I have attached a few pictures of my son and below I have included some
information and links as well. If you would like further information, I
would be more than happy to provide additional sources and references.

  Sincerely,

  Lisa Muscarella

  http://catalog.nucleusinc.com/generateexhibit.php?ID=2601&ExhibitKeywordsRaw=&TL=16353&A=2
(illustrated diagram)

  "The majority of brachial plexus injuries occur during birth, most often
as a result of significant force applied to an infant's head during
delivery. Larger babies, whose shoulders tend to be wider, can have
difficulty passing through the birth canal, and they are at higher risk of
injury to the plexus."
http://www.texaschildrenshospital.com/carecenters/BrachialPlexus/Understanding_BP.aspx

  www.ubpn.org United Brachial Plexus Network website

   "Five Reasons Not to Birth on Your Back: It will hurt mother. It can
harm baby. Labor slows. Episiotomy or tears more likely. It makes no
sense." Sears, W. & Sears, M. (1994) The Birth Book. p. 186. Boston:
Little, Brown and Company.

  "Semi-sitting and lithotomy pushing positions can also result in another
serious problem of shoulder dystocia. Dr. Jason Gardosi MD FRCS MRCOG from
the Queen's Medical Centre in Nottingham, UK explains, "The
anterio-posterior (outlet) diameter is reduced in recumbent (semi-sitting)
and lithotomy positions where the weight is taken on the sacrum. The sacrum
is capable of rotational movement through an axis at the upper part of the
sacro-iliac joint." He goes on to add, "Many so called 'shoulder dystocias'
are just difficult deliveries caused by a recumbent position. Apart from the
sacrum being pushed upward, reducing the AP diameter, it is difficult to
allow lateral flexion when the presenting shoulder abuts on the mattress."
Dr. Todd Gastaldo adds, "And when the shoulders get REALLY stuck, MDs pull
REALLY hard."
http://www.storknet.com/cubbies/childbirth/pushingpositions.htm

  "If possible, try to find a pushing position that doesn't attempt to defy
gravity. Instead, use gravity to your advantage by kneeling, squatting, or
sitting up with your legs and knees spread far apart." Ford-Martion, P.
2003. The Everything Pregnancy Book. p. 260. Avon: Adams Media
Corporation.

   "When shoulder dystocia occurs, all available personnel should be
summoned to the room, then the mother's thighs are hyperflexed to increase
the diameter of the pelvic outlet." Beers, M. & Berkow, R. (1999) The
Merck Manual, 7th edition, p. 2065, Witehouse Station: Merck Research
Labortatoires. (it is most unfortunate that they are actually closing birth
canals to begin with and then trying to open them after there is a problem
and danger presented to the baby)

  Borell, U. & Fernstrom, I. 1957. "The mechanism of labour." Radiol Clin
North Am. Apr;5(1):73-85.

  Borell, U. & Fernstrom, I. 1957. "A pelvimetric method for the
assessment of pelvic mouldability." Acta Radiol. 1957 May;47(5):365-70.

  Borell, U. & Fernstrom, I. 1957. "Shape and course of the birth canal; a
radiographic study in the human." Acta Obstet Gynecol Scand.
1957;36(2):166-78.

  Borrell, U. & Fernstrom, I. 1957. "The movements at the sacro-iliac joints
and their importance to changes in the pelvic dimensions during parturtion."
Acta Obstet Gynecol Scand. 1957;36(1):42-57.

  Caldeyro-Barcia, 1979 "The Influence of Maternal Position on Time of
Spontaneous Rupture of the Membranes, Progress of Labour and Fetal Head
Compression," Birth and the Family Journal 6, no. 1 (Spring);7-15; I.N.

  Diehl, J. & Fernstrom, I. 1966. "Radiologic pelvimetry with special
reference to widest transverse diameter of pelvic inlet." Acta Radiol Diagn
(Stockh). Sep;4(5):557-68.

  Gardosi, J., et al. 1989. "Randomized Controlled Trial of Squatting in the
Second Stage of Labor." Lancet 74-77 (July 8)

  McKay, S. 1984. "Squatting: An Alternative Position for the Second
Stage of Labor." Maternal Child Nursing 9:181-83.

  Ohlsen, H. "Moulding of the pelvis during labour." Acta Radiol Diagn
(Stockh). 1973 Jul; 14(4):417-34

  Roberts, J., et al. 1983. "The Effects of Maternal Position on Uterine
Contractility and Efficiency." Birth 10 (4):243-49

  Russell, J.G. B. 1969. "Moulding of the Pelvic Outlet." J. Obstet. Gynaec.
Brit. Cwlth. 76:817-20

  Weisl, H. 1955. "The movements of the sacroiliac joint." Acta Anat
(Basel). 23(1):80-91.

   "Labour Among Primitive Peoples" written in 1883 by Dr. G. J. Englemann
who studied the various birthing positions around the world. He found that
"upright positions always predominate.

  "Active Birth" by Janet Balaskas

  ".. Certain principles of physics apply to childbirth, and these are
opposed when a woman gives birth lying down." P. 12

  "The benefits of squatting were radiographically confirmed in the 1930's,
when it was shown that the cross-sectional surface area of the birth canal
may increase by as much as 30 percent when a woman changes from lying down
on her back to the squatting position. And it is nearly thirty years since
Scott and Kerr demonstrated the disadvantages of having the weight of a
full-term pregnant uterus pressing down on the back. When the woman lies
supine, the weight of the contracting uterus reduces the placental blood
flow by compressing the large artery of the heart (the descending aorta) and
the large veins leading to the heart (inferior vena cava.) This is a
clinical fact that should not be ignored by anyone involved with
childbirth." P. 12

  "As long as the mother is upright for the birth, the pelvic joints are
free to expand, move, and adjust to the shape of the baby's descending head.
When the mother squats, the sacrum is free to move, allowing the
anterior-interior diameter of the pelvic outlet to widen by as much as 30
percent more that it would if the mother's weight were resting directly on
it - that is, if she were semireclining. The sacrococcygeal joint, the
joint between the sacrum and the coccyx or tailbone, also softens in
pregnancy; it is designed to swivel backwards to widen the outlet of the
pelvis as the baby emerges. Of course, this is impossible if the mother is
sitting on her coccyx." P. 15

  "In the semisitting position the mother's weight rests on her coccyx and
the pelvic capacity is reduced." P. 15

  "In the semireclining position the sacrum is immobile and the pelvic
outlet narrows." P. 15

  In reference to your pelvis while squatting.. "It is open at its widest in
this position, and your sacrum and coccyx are free to move if your child is
passing through your pelvic outlet." P. 138

  "Your coccyx is designed to move out of the way as your baby's head
descends. Sitting on your coccyx during birth restricts the pelvic outlet
and can also lead to dislocation of the coccyx, which can be extremely
painful for months after the birth." P. 139

Relevant Pages

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