"Fetal EKG may reduce C-sections"

[[email protected]]

Fetal EKG may reduce C-sections
Florida researchers are developing a fetal electrocardiogram, or EKG,
designed to monitor an unborn baby's heart rate during labor, which
could reduce the need for Caesarean sections.
at http://www.washtimes.com/national/20050109-115957-6357r.htm

[alath]

> could reduce the need for Caesarean sections.

What a very poorly written article. It is really muddies up the issues.

The equivocal nature of fetal heart rate tracing interpretation does
contribute to unnecessary c-sections. The most recent attempt at an
alternative more reliable measure of fetal status during labor was
NellCor's fetal pulse oximetry project. It was successful in the sense
that the technology did help distinguish between "ugly looking heart
rate tracing, but the baby's okay" versus "this baby really does need
out." But it wasn't successful in the sense of becoming widely adopted
and having an impact on obstetric practice. OB's these days are feeling
the lawyers breathing down their necks. If there is any question,
they're going to recommend a c-section out of medicolegal
self-preservation. I doubt this technology is going to help the
problems of fetal monitoring in labor.

Fetal EKG could help in diagnosing fetal arrhythmias, but this would
not change the care of most moms and babies out there.

[Ericka Kammerer]

alath wrote:

> OB's these days are feeling
> the lawyers breathing down their necks. If there is any question,
> they're going to recommend a c-section out of medicolegal
> self-preservation.

I hear this said a lot, and I'm sure that there is
at least an element of truth in it (though I'm equally sure
it's not the entire story). What I wonder is what we really
know for sure about *why* the lawyers are breathing down
their necks. Obviously, the cases that are potential
lawsuits are the ones where there is a bad outcome. I know
several studies show that the more involved the patient
is in the decision making, the less likely the patient is
to sue (this is typically one explanation offered as to
why midwives get sued less than OBs, even when there are
bad outcomes). I would imagine another factor is that in
a country where access to medical care is uncertain for
the vast majority, suing is one way to ensure that a child
who has chronic health problems as a result of something
that happened during the birth will have access to decent
quality medical care for life. I'm sure a lot of people
would throw out the notion that it's ambulance chasing
lawyers, though I don't know how big a role that plays.
I'm sure some of it is a common law legal system that
considers what is *common* rather than what is *right*
(e.g., if it's the standard of care, it's okay even if
it's flawed as a form of care).
Anyway, it just seems to me that we talk a lot
about CYA medicine, and I'm sure it's an issue, but we
don't seem to do a lot of good thinking about *why* the
legal pressures are there. I rather suspect that tort
reform isn't going to do much good, but it's the only
solution I ever seem to hear mentioned.

Best wishes,
Ericka

[Renee]

Ericka Kammerer wrote:
> alath wrote:
>
> > OB's these days are feeling
> > the lawyers breathing down their necks. If there is any question,
> > they're going to recommend a c-section out of medicolegal
> > self-preservation.
>
> I hear this said a lot, and I'm sure that there is
> at least an element of truth in it (though I'm equally sure
> it's not the entire story). What I wonder is what we really
> know for sure about *why* the lawyers are breathing down
> their necks. Obviously, the cases that are potential
> lawsuits are the ones where there is a bad outcome. I know
> several studies show that the more involved the patient
> is in the decision making, the less likely the patient is
> to sue (this is typically one explanation offered as to
> why midwives get sued less than OBs, even when there are
> bad outcomes). I would imagine another factor is that in
> a country where access to medical care is uncertain for
> the vast majority, suing is one way to ensure that a child
> who has chronic health problems as a result of something
> that happened during the birth will have access to decent
> quality medical care for life. I'm sure a lot of people
> would throw out the notion that it's ambulance chasing
> lawyers, though I don't know how big a role that plays.
> I'm sure some of it is a common law legal system that
> considers what is *common* rather than what is *right*
> (e.g., if it's the standard of care, it's okay even if
> it's flawed as a form of care).
> Anyway, it just seems to me that we talk a lot
> about CYA medicine, and I'm sure it's an issue, but we
> don't seem to do a lot of good thinking about *why* the
> legal pressures are there. I rather suspect that tort
> reform isn't going to do much good, but it's the only
> solution I ever seem to hear mentioned.
>
> Best wishes,
> Ericka

I think part of it is that people don't expect things to go wrong
when they go to a hospital. When it does go wrong, it's assumed that it
must be the doctor's fault. Add all the new tests and procdures which
might have prevented it, and you have lawsuits. This causes more and
more procedures to become mandatory. I think midwives aren't sued as
much because their patients probably have more realistic expectations
on what is going to happen.

I don't think tort reform is the answer, either, but I would like
frivious lawsuits thrown out.

Renee

[Ericka Kammerer]

Renee wrote:

> Ericka Kammerer wrote:
>
>>alath wrote:
>>
>>
>>>OB's these days are feeling
>>>the lawyers breathing down their necks. If there is any question,
>>>they're going to recommend a c-section out of medicolegal
>>>self-preservation.
>>
>> I hear this said a lot, and I'm sure that there is
>>at least an element of truth in it (though I'm equally sure
>>it's not the entire story). What I wonder is what we really
>>know for sure about *why* the lawyers are breathing down
>>their necks. Obviously, the cases that are potential
>>lawsuits are the ones where there is a bad outcome. I know
>>several studies show that the more involved the patient
>>is in the decision making, the less likely the patient is
>>to sue (this is typically one explanation offered as to
>>why midwives get sued less than OBs, even when there are
>>bad outcomes). I would imagine another factor is that in
>>a country where access to medical care is uncertain for
>>the vast majority, suing is one way to ensure that a child
>>who has chronic health problems as a result of something
>>that happened during the birth will have access to decent
>>quality medical care for life. I'm sure a lot of people
>>would throw out the notion that it's ambulance chasing
>>lawyers, though I don't know how big a role that plays.
>>I'm sure some of it is a common law legal system that
>>considers what is *common* rather than what is *right*
>>(e.g., if it's the standard of care, it's okay even if
>>it's flawed as a form of care).
>> Anyway, it just seems to me that we talk a lot
>>about CYA medicine, and I'm sure it's an issue, but we
>>don't seem to do a lot of good thinking about *why* the
>>legal pressures are there. I rather suspect that tort
>>reform isn't going to do much good, but it's the only
>>solution I ever seem to hear mentioned.

>
> I think part of it is that people don't expect things to go wrong
> when they go to a hospital. When it does go wrong, it's assumed that it
> must be the doctor's fault. Add all the new tests and procdures which
> might have prevented it, and you have lawsuits. This causes more and
> more procedures to become mandatory. I think midwives aren't sued as
> much because their patients probably have more realistic expectations
> on what is going to happen.

I think that is probably also part of it. I think the
whole package feeds on itself in a virtuous cycle--more time
with the patient = more informed patient = more realistic
expectations = more participation in decision making = more
ownership = fewer lawsuits. And actually, this one is the
best in that the lawsuits it prevents are the ones that *ought*
to be prevented (lawsuits where there really isn't malpractice
despite a bad outcome). Of course, as long as it takes a lawsuit
to ensure that a child gets the care he or she needs, many would
sue their best friends to ensure that.

> I don't think tort reform is the answer, either, but I would like
> frivious lawsuits thrown out.

On the face of it I like the idea of throwing out frivolous
lawsuits. However, I wonder how many *truly* frivolous lawsuits
there really are. If frivolous lawsuits comprise only a small
fraction of the lawsuits and it would cost a lot of money to
eliminate them (or if it would require draconian laws that would
get in the way of legitimate suits), then perhaps it's not worth
the price. I'll tolerate some waste if it's cheaper than fixing
the problem ;-)

Best wishes,
Ericka

[Circe]

"Ericka Kammerer" > wrote in message
...
> Renee wrote:
> > I don't think tort reform is the answer, either, but I would like
> > frivious lawsuits thrown out.
>
> On the face of it I like the idea of throwing out frivolous
> lawsuits. However, I wonder how many *truly* frivolous lawsuits
> there really are. If frivolous lawsuits comprise only a small
> fraction of the lawsuits and it would cost a lot of money to
> eliminate them (or if it would require draconian laws that would
> get in the way of legitimate suits), then perhaps it's not worth
> the price. I'll tolerate some waste if it's cheaper than fixing
> the problem ;-)
>
The inherent problem with the idea of preventing frivolous lawsuits is that,
until the case is presented to the court, there's no way to know whether
it's frivolous or not. *Someone* has to make that determination, and making
that determination is going to cost something. Now, I think there are some
rules in some (if not all states) that require paying the other party's
court costs if you're found to have brought a malicious/frivolous suit, but
I'm not sure that this is always practical or enforced (because the party
bringing a suit against, say, a multimillion dollar corporation, probably
couldn't afford to pay the company's legal costs under any circumstances).
Perhaps there ought to be penalties brought against *lawyers* if they
frequently bring suits that are found to be clearly without merit, but by
and large, I don't think there's any way to weed out frivolous lawsuits that
won't simply reduce access to the court system for the meritorious ones as
well.
--
Be well, Barbara

[Todd Gastaldo]

"Ericka Kammerer" > wrote in message
...
> alath wrote:
>
>> OB's these days are feeling
>> the lawyers breathing down their necks. If there is any question,
>> they're going to recommend a c-section out of medicolegal
>> self-preservation.
>
> I hear this said a lot, and I'm sure that there is
> at least an element of truth in it (though I'm equally sure
> it's not the entire story). What I wonder is what we really
> know for sure about *why* the lawyers are breathing down
> their necks.

Oddly, not ONE birth trauma attorney has told a jury that OBs are routinely
closing birth canals up to 30% and routinely KEEPING birth canals closed
when babies get stuck.

Someone correct me if I am wrong.

Birth trauma attorneys apparently need OB experts who will tell the truth -
but there aren't any OB experts who will tell the truth.

More to the point, OB experts are telling obvious lies and there are no OB
experts who can be found to tell this to a jury...

And for some odd reason, birth trauma attorneys can't simply point out the
obvious OB lies.

Before I get to The Four OB Lies, it is worth it to note that it is a
violation of the AMA's Principles of Medical Ethics for physicians
to engage in fraud and deception, as in,

"[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

OBs who are AMA members should be STRIVING to tell juries about The Four OB
Lies!

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


> Obviously, the cases that are potential
> lawsuits are the ones where there is a bad outcome.

Yep

<snip>

> I'm sure some of it is a common law legal system that
> considers what is *common* rather than what is *right*
> (e.g., if it's the standard of care, it's okay even if
> it's flawed as a form of care).

LOL - keeping the birth canal closed the "extra" up to 30% when babies get
stuck is pretty "flawed." (!)

Richard Ikeda, MD - then-medical director of the California Medical Board
agreed that OBs are closing birth canals up to 30% - but said there was
nothing he could do - he said he couldn't even have the Board write to OBs
about it - because it was "the community norm."

> Anyway, it just seems to me that we talk a lot
> about CYA medicine, and I'm sure it's an issue, but we
> don't seem to do a lot of good thinking about *why* the
> legal pressures are there.

OBs *have* to keep closing birth canals up to 30% and keeping birth canals
closed when babies get stuck - BECAUSE of legal pressure - because stopping
would be tantamount to admitting the obvious criminal negligence that
sometimes escalates to criminally negligent homicide - i.e. - some babies
die unexplained deaths and OBs themselves have indicated that closing the
birth canal FAR LESS than 30% can kill.

> I rather suspect that tort
> reform isn't going to do much good, but it's the only
> solution I ever seem to hear mentioned.
>

I'm still wondering why not one birth trauma attorney has told the jury that
OBs are closing birth canals up to 30% and keeping birth canals closed when
babies get stuck.

The "extra" up to 30% routinely denied is quite relevant what with all the
"big baby"/"small pelvis" rhetoric.

Todd

PS I'm also still wondering why Henci Goer - who puts herself out there as
being "the other side" - is saying nothing about OBs closing birth canals up
to 30% and keeping birth canals closed when babies get stuck.

Remember, **MDs** are supposed to be seeking to expose physicians engaging
in fraud and deception.

What's keeping "the other side" quiet?

[Ericka Kammerer]

Todd Gastaldo wrote:


> Oddly, not ONE birth trauma attorney has told a jury that OBs are routinely
> closing birth canals up to 30% and routinely KEEPING birth canals closed
> when babies get stuck.

It's not odd. That information is irrelevant in our legal
system. A doctor who is practicing in accordance with standards
of care is pretty much not going to be convicted of anything. In
US law, "everyone else does it" is a valid legal argument unless
there is a specific law forbidding the action. Until and unless
there is agreement in the profession that it's not acceptable,
or that there are conditions in which it is unacceptable, it is
an irrelevant legal argument.

Best wishes,
Ericka

[Todd Gastaldo]

THE POWER OF THE JURY...

(IF TODD AND ERICKA WERE ON THE SAME JURY...)

"Ericka Kammerer" > wrote in message
...
> Todd Gastaldo wrote:
>
>
>> Oddly, not ONE birth trauma attorney has told a jury that OBs are
>> routinely closing birth canals up to 30% and routinely KEEPING birth
>> canals closed when babies get stuck.
>
> It's not odd. That information is irrelevant in our legal
> system. A doctor who is practicing in accordance with standards
> of care is pretty much not going to be convicted of anything. In
> US law, "everyone else does it" is a valid legal argument unless
> there is a specific law forbidding the action. Until and unless
> there is agreement in the profession that it's not acceptable,
> or that there are conditions in which it is unacceptable, it is
> an irrelevant legal argument.
>
> Best wishes,
> Ericka
>

Ericka,

You snipped the part about the standard of care beinig founded on obvious OB
lies - fraud and deception.

You also snipped the fact that it is a
violation of the AMA's Principles of Medical Ethics for physicians
to engage in fraud and deception, as in,

"[AMA physician[s] shall...strive to expose those physicians...who engage in
fraud or deception."
http://www.psych.org/psych_pract/ethics/ethics_opinions53101.cfm

You also snipped this:

The "extra" up to 30% routinely denied is quite relevant what with all the
"big baby"/"small pelvis" rhetoric.

Ericka, if we were on the same jury hearing a dorsal or semisitting shoulder
dystocia case, as a member of the jury I would be VERY interested to know
that OBs are lying and closing birth canals up to 30% and keeping birth
canals closed when babies get stuck.

This information is QUITE relevant (as I noted) since juries routinely hear
about "big baby" or "small pelvis."

I think other jury member would be very interested as well.

My bet is that no birth trauma attorney has mentioned this relevant info -
again - quite odd given its relevance.

If the judge said the OB lies and birth-canal-closing wasn't to be
considered relevant, I would be informing my fellow jurors regarding jury
nullification of law...

THE POWER OF THE JURY...

According to one website:

"In fact, if you have doubts about the fairness of a law, you have the right
and obligation to find someone innocent even though they have actually
broken the law! John Adams, our second president, had this to say about the
juror: 'It is not only his right but his duty...to find the verdict
according to his own best understanding, judgment, and conscience, though in
direct opposition to the direction of the court.'"
http://www.greenmac.com/eagle/ISSUES/ISSUE23-9/07JuryNullification.html

It would seem that the power to find someone innocent is also the power to
find them guilty...

Here's how the medico-"legal" "just us" system reportedly gets around jury
nullification of law:

"...judges rarely "fully inform" jurors of their rights, especially their
power to judge the law itself and to vote on the verdict according to
conscience. Instead, they end up assisting the prosecution by dismissing any
prospective juror who will admit to knowing about this right, starting with
anyone who also admits having qualms with any specific law..."

From the same website...
"Why is so little known about what is now called "jury nullification"? In
the late 1800's, a number of powerful special-interest groups (not unlike
many we have with us today) inspired a series of judicial decisions which
tried to limit jury rights. While no court has yet dared to deny that juries
can "nullify" or "veto" a law, or can bring in a "general verdict", they
have held that jurors need not be told about these rights!

"However, jury veto power is still recognized. In 1972 the D.C. Circuit
Court of Appeals held that the trial jury has an "...unreviewable and
irreversible power...to acquit in disregard of the instruction on the law
given by the trial judge. The pages of history shine upon instances of the
jury's exercise of its prerogative to disregard instructions of the judge;
for example, acquittals under the fugitive slave law (473F 2dl 113)"
http://www.greenmac.com/eagle/ISSUES/ISSUE23-9/07JuryNullification.html

An unreviewable and irreversible power to convict also exists - or so it
seems...

Todd

PS There is another power of the jury - the grand jury. Grand jurors
generally just look at cases the prosecutor brings for indictment - but
grand jurors can look into anything they want - that's the way it is in
Oregon anyway.

Hmmm.. That gives me an idea. : )

[Ericka Kammerer]

Todd Gastaldo wrote:


> Ericka, if we were on the same jury hearing a dorsal or semisitting shoulder
> dystocia case, as a member of the jury I would be VERY interested to know
> that OBs are lying and closing birth canals up to 30% and keeping birth
> canals closed when babies get stuck.
>
> This information is QUITE relevant (as I noted) since juries routinely hear
> about "big baby" or "small pelvis."
>
> I think other jury member would be very interested as well.

They might be interested, but it would still be largely
irrelevant. You can't convict for malpractice for someone who is
practicing in accordance with the current standard of care.

> "In fact, if you have doubts about the fairness of a law, you have the right
> and obligation to find someone innocent even though they have actually
> broken the law! John Adams, our second president, had this to say about the
> juror: 'It is not only his right but his duty...to find the verdict
> according to his own best understanding, judgment, and conscience, though in
> direct opposition to the direction of the court.'"
> http://www.greenmac.com/eagle/ISSUES/ISSUE23-9/07JuryNullification.html
>
> It would seem that the power to find someone innocent is also the power to
> find them guilty...

Not necessarily--the two are very different things. And if
there were a law regarding this issue, it would be quite different.
Then civil law would apply. But the issue of malpractice essentially
revolves around common law, in which case the standard of care is
the main thing.

This is one of the downsides of a common law system, as
opposed to a civil law system. Doctors aren't going to be
convicted for malpractice for doing what the profession accepts
and promotes as standard care. This is not the avenue through
which change will come.

> "However, jury veto power is still recognized. In 1972 the D.C. Circuit
> Court of Appeals held that the trial jury has an "...unreviewable and
> irreversible power...to acquit in disregard of the instruction on the law
> given by the trial judge. The pages of history shine upon instances of the
> jury's exercise of its prerogative to disregard instructions of the judge;
> for example, acquittals under the fugitive slave law (473F 2dl 113)"
> http://www.greenmac.com/eagle/ISSUES/ISSUE23-9/07JuryNullification.html
>
> An unreviewable and irreversible power to convict also exists - or so it
> seems...

I seriously doubt it. Refusing to convict someone of
something they may have done is *very* different from convicting
someone of something that isn't demonstrably illegal.

Best wishes,
Ericka
>
>

[Todd Gastaldo]

IF THE FOUR OB LIES ARE NOT MENTIONED...

The obvious massive OB crime will continue...

Organized medicine may be paying people to remain silent...

"Ericka Kammerer" > wrote in message
...
> Todd Gastaldo wrote:
>
>
>> Ericka, if we were on the same jury hearing a dorsal or semisitting
>> shoulder dystocia case, as a member of the jury I would be VERY
>> interested to know that OBs are lying and closing birth canals up to 30%
>> and keeping birth canals closed when babies get stuck.
>>
>> This information is QUITE relevant (as I noted) since juries routinely
>> hear about "big baby" or "small pelvis."
>>
>> I think other jury member would be very interested as well.
>
> They might be interested, but it would still be largely
> irrelevant.

Ericka, you also apparently don't think it relevant that a prominent
childbirth educator who bills herself as "the other side" (Henci Goer) can't
manage to explicitly state in her BOOKS that OBs are closing birth canals up
to 30% and keeping birth canals closed when babies get stuck - and lying
about it.

When parents are explicitly informed BEFORE birth that OBs are lying to
cover-up grisly birth behavior - when they are SHOWN the obvious OB lies -
it helps them decide against the grisly "standard of care" that you are
leaning on so heavily.

> You can't convict for malpractice for someone who is
> practicing in accordance with the current standard of care.
>

Ericka, until a jury is explictly told that the current grisly
birth-canal-closing standard of care is based on The Four OB Lies, we can't
know what a jury will and will not do.

>> "In fact, if you have doubts about the fairness of a law, you have the
>> right and obligation to find someone innocent even though they have
>> actually broken the law! John Adams, our second president, had this to
>> say about the juror: 'It is not only his right but his duty...to find the
>> verdict according to his own best understanding, judgment, and
>> conscience, though in direct opposition to the direction of the court.'"
>> http://www.greenmac.com/eagle/ISSUES/ISSUE23-9/07JuryNullification.html
>>
>> It would seem that the power to find someone innocent is also the power
>> to find them guilty...
>
> Not necessarily--the two are very different things. And if
> there were a law regarding this issue, it would be quite different.
> Then civil law would apply. But the issue of malpractice essentially
> revolves around common law, in which case the standard of care is
> the main thing.
>
> This is one of the downsides of a common law system, as
> opposed to a civil law system. Doctors aren't going to be
> convicted for malpractice for doing what the profession accepts
> and promotes as standard care. This is not the avenue through
> which change will come.
>

AGAIN Ericka, until a jury is explictly told that the current grisly
birth-canal-closing standard of care is based on The Four OB Lies, we can't
know what a jury will and will not do.

Remember:

>> "However, jury veto power is still recognized. In 1972 the D.C. Circuit
>> Court of Appeals held that the trial jury has an "...unreviewable and
>> irreversible power...to acquit in disregard of the instruction on the law
>> given by the trial judge. The pages of history shine upon instances of
>> the jury's exercise of its prerogative to disregard instructions of the
>> judge; for example, acquittals under the fugitive slave law (473F 2dl
>> 113)"
>> http://www.greenmac.com/eagle/ISSUES/ISSUE23-9/07JuryNullification.html
>>
>> An unreviewable and irreversible power to convict also exists - or so it
>> seems...
>
> I seriously doubt it.

Sorry to repeat myself but...Again Ericka, until a jury is explictly told
that the current grisly birth-canal-closing standard of care is based on The
Four OB Lies, we can't know what a jury will and will not do.

> Refusing to convict someone of
> something they may have done is *very* different from convicting
> someone of something that isn't demonstrably illegal.
>

Earth to Ericka...until a jury is explictly told that the current grisly
birth-canal-closing standard of care is based on The Four OB Lies, we can't
know what a jury will and will not do.

When parents are explicitly informed BEFORE birth that OBs are lying to
cover-up grisly birth behavior - when they are SHOWN the obvious OB lies -
it helps them decide against the grisly "standard of care" that you are
leaning on so heavily.

Just as it is odd that birth trauma attorneys aren't mentioning The Four OB
Lies...

It is odd that Henci Goer doesn't mention them either.

Same goes for Carl Jones.

And Ericka Kammerer...

I am reminded of the prominent midwives who ignored my pleas and PROMOTED
birth-canal-closing/semisitting.

I am reminded of the former employee of one of these prominent midwives who
suggested that a woman's "trust" in her caregiver is more important that
birth position. (Tell that to the baby being pulled by his skull through a
birth canal senselessly closed up to 30% by a "caregiver." No amount of
trust is going to widen that outlet.)

If I were the powerful cultural authorities who stand to go to prison if
their lies are ever exposed - I would want people just like you on the
usenet, Ericka, "forgetting" to mention The Four OB Lies when discussing
birth position - expressing serious doubt, etc.

Forget about what might happen in court - think about what very definitely
COULD happen if prominent childbirth educators who bill themselves as "the
other side" started explicitly stating The Four OB Lies instead of
studiously ignoring them...

Thanks for reading.

Sincerely,

Todd

Dr. Gastaldo


PS As I've noted before...

OBs are lying - engaging in fraud
and deception and it is a violation of the AMA's Principles of Medical
Ethics for physicians
to engage in fraud and deception, as in,

"[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


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

Why do women have to ASK for the "extra" up to 30%?

Why are OBs being allowed to KEEP birth canals closed when babies get stuck?

Ericka, it is perfectly understandable (though unconscionable) that AMA
physicians are ignoring their own principle of medical ethics and failing to
"strive to expose those physicians...who engage in
fraud or deception."
http://www.psych.org/psych_pract/ethics/ethics_opinions53101.cfm

It is NOT so perfectly understandable that Henci Goer ("the other side") and
those who promote her book are "forgetting" (loathe to?) mention The Four OB
Lies.

It is just plain weird that "the other side" is failing to "strive to expose
those physicians...who engage in
fraud or deception."

The OB crime is obvious and massive.

It is possible that AMA is paying people to be silent about The Four OB
Lies.

Thanks for reading everyone.

Sincerely,

Todd

Dr. Gastaldo

[alath]

> Anyway, it just seems to me that we talk a lot
> about CYA medicine, and I'm sure it's an issue, but we
> don't seem to do a lot of good thinking about *why* the
> legal pressures are there. I rather suspect that tort
> reform isn't going to do much good, but it's the only
> solution I ever seem to hear mentioned.
>
> Best wishes,
> Ericka

Ericka, the legal pressures are there because there is a lot of money
in it. I personally know an OB who is being sued for a shoulder
dystocia case - she handled the emergency appropriately, the baby's
humerus was broken but it was done in a controlled manner and the baby
is now fine with no residual defecits. The parents are suing because it
was upsetting that their baby's arm got broken. This doctor acted
appropriately and saved the baby's life, and now she is being sued. She
will probably win the case after an enormously expensive defense, but
in the mean time, her malpractice insurance has gone up $35,000 per
year. All the other providers in our hospital know about this case, and
it has had a tremendous effect on their practice. Women are now being
offered c-sections any time there is a large baby or a slow labor. I've
argued this is not evidence-based, and the reply is, "I'll start
practicing evidence-based medicine when they start practicing
evidence-based law." The fact is, a lawyer can't make a case out of an
unnecessary c-section. But if you didn't do a c-section and something
goes wrong, then it is easy to make the case that there was something
you should have done but didn't. If you do a c-section and there is
still a bad outcome, you have the defense that "I did everything I
could." In the rules of this game, doing a c-section is a "get out of
jail free card," while any other course of action puts you at risk.
This game is making the lawyers rich and driving up c-section rates
with no benefit to moms or babies in general - outcomes have not
improved.

[Ericka Kammerer]

Todd Gastaldo wrote:

> Earth to Ericka...until a jury is explictly told that the current grisly
> birth-canal-closing standard of care is based on The Four OB Lies, we can't
> know what a jury will and will not do.

Could be, but I think it's a pretty safe bet that the courtroom
situation will be structured in such a way as to follow the precepts of
the legal system. Right or wrong we have a legal system that is
structured in a certain way, and it's structure encourages some things
and discourages (if not outright forbids) others. If you want to make
change, you have to adopt the proper tools. The court system is a poor
tool for this sort of change, as the system is not set up to get the
outcome you desire.

> When parents are explicitly informed BEFORE birth that OBs are lying to
> cover-up grisly birth behavior - when they are SHOWN the obvious OB lies -
> it helps themsin decide against the grisly "standard of care" that you are
> leaning on so heavily.

I didn't say parents shouldn't be informed. I said that
creating change by mopping up through post hoc lawsuits isn't likely
to happen. The way change *IS* likely to happen is through client
education. Obstetrics may not be motivated to change internally,
and the legal system in the US may not be well designed to encourage
this change, but obstetrics *IS* rather sensitive to market demand.
Obstetrics is a cash cow for most hospitals, and with a nine-month
lead-up and a "patient" who is generally healthy and not in imminent
danger, clients can, and do, apply a lot of market pressure. That's
why lots of hospitals have invested quite a bit of money developing
more spacious and "home like" birthing suites. They perceive,
correctly, that such things will draw business. It's just a shame
that the changes are cosmetic rather than substantive. If clients were
more informed, at least some are likely to use that information to
select their care providers and birth locations, which will hit
providers in their pocketbooks and make some change happen. It's
happened before. Many of the changes in obstetrics in the 60s/70s
(husbands allowed in the delivery room, a move toward more natural
birth, etc.) were essentially led by client demand despite
significant objection from the obstetrics community.

> It is odd that Henci Goer doesn't mention them either.

You keep harping on this, but she says clear as can be
(in OMvRR) "The lithotomy position is the worst position because
it increases the incidence of fetal distress, the mother pushes
the baby uphill, and her pelvis, made flexible by the influence
of pregnancy hormones, is fixed in position by the delivery
table." She also cites several studies and reviews promoting
upright positions. Heck, she even uses your favorite term
"lying" when describing the mismanagement of labor and "CPD."

Best wishes,
Ericka

[Todd Gastaldo]

GOOD ONE ERICKA!

Good Henci Goer joke!

See the very end of this post...

"Ericka Kammerer" > wrote in message
...
> Todd Gastaldo wrote:
>
>> Earth to Ericka...until a jury is explictly told that the current grisly
>> birth-canal-closing standard of care is based on The Four OB Lies, we
>> can't know what a jury will and will not do.
>
> Could be,

Thank you for acknowledging this. It's a pretty safe bet that anything can
happen - inside and outside courtrooms - once The Four OB Lies are widely
known.

> but I think it's a pretty safe bet that the courtroom
> situation will be structured in such a way as to follow the precepts of
> the legal system. Right or wrong we have a legal system that is
> structured in a certain way, and it's structure encourages some things
> and discourages (if not outright forbids) others. If you want to make
> change, you have to adopt the proper tools. The court system is a poor
> tool for this sort of change, as the system is not set up to get the
> outcome you desire.
>

I'll stick with "could be"...

>> When parents are explicitly informed BEFORE birth that OBs are lying to
>> cover-up grisly birth behavior - when they are SHOWN the obvious OB
>> lies - it helps themsin decide against the grisly "standard of care" that
>> you are leaning on so heavily.
>
> I didn't say parents shouldn't be informed. I said that
> creating change by mopping up through post hoc lawsuits isn't likely
> to happen. The way change *IS* likely to happen is through client
> education. Obstetrics may not be motivated to change internally,
> and the legal system in the US may not be well designed to encourage
> this change, but obstetrics *IS* rather sensitive to market demand.
> Obstetrics is a cash cow for most hospitals, and with a nine-month
> lead-up and a "patient" who is generally healthy and not in imminent
> danger, clients can, and do, apply a lot of market pressure. That's
> why lots of hospitals have invested quite a bit of money developing
> more spacious and "home like" birthing suites. They perceive,
> correctly, that such things will draw business. It's just a shame
> that the changes are cosmetic rather than substantive. If clients were
> more informed, at least some are likely to use that information to
> select their care providers and birth locations, which will hit
> providers in their pocketbooks and make some change happen. It's
> happened before. Many of the changes in obstetrics in the 60s/70s
> (husbands allowed in the delivery room, a move toward more natural
> birth, etc.) were essentially led by client demand despite
> significant objection from the obstetrics community.
>

Hospitals have an obligation to stop OBs from closing birth canals up to
30%.

Hospitals aren't meeting their obligation because they, too, could be sued.

Hospitals letting OBs KEEP birth canals closed when babies get stuck -
well - the "poor tool" called the jury might just come through like a big
dog one day.

In the meantime, how funny that you pretend that OUTSIDE the courtroom
childbirth educators are stating things "clear as can be"...

>> It is odd that Henci Goer doesn't mention them either.
>
> You keep harping on this, but she says clear as can be
> (in OMvRR) "The lithotomy position is the worst position because
> it increases the incidence of fetal distress, the mother pushes
> the baby uphill, and her pelvis, made flexible by the influence
> of pregnancy hormones, is fixed in position by the delivery
> table." She also cites several studies and reviews promoting
> upright positions. Heck, she even uses your favorite term
> "lying" when describing the mismanagement of labor and "CPD."
>

Good one Ericka!

NOWHERE (in your quoting of her) does she say lithotomy CLOSES.

Nowhere does she say that SEMISITTING closes.

Nowhere does she say that OBs are KEEPING birth canals closed the "extra"
30% when babies get stuck.

These are key lies of omission.

I will keep harping until she stops lying by omission.

Good joke, though!

Todd

[Ericka Kammerer]

alath wrote:

> Ericka, the legal pressures are there because there is a lot of money
> in it. I personally know an OB who is being sued for a shoulder
> dystocia case - she handled the emergency appropriately, the baby's
> humerus was broken but it was done in a controlled manner and the baby
> is now fine with no residual defecits. The parents are suing because it
> was upsetting that their baby's arm got broken. This doctor acted
> appropriately and saved the baby's life, and now she is being sued. She
> will probably win the case after an enormously expensive defense, but
> in the mean time, her malpractice insurance has gone up $35,000 per
> year. All the other providers in our hospital know about this case, and
> it has had a tremendous effect on their practice. Women are now being
> offered c-sections any time there is a large baby or a slow labor. I've
> argued this is not evidence-based, and the reply is, "I'll start
> practicing evidence-based medicine when they start practicing
> evidence-based law." The fact is, a lawyer can't make a case out of an
> unnecessary c-section. But if you didn't do a c-section and something
> goes wrong, then it is easy to make the case that there was something
> you should have done but didn't. If you do a c-section and there is
> still a bad outcome, you have the defense that "I did everything I
> could." In the rules of this game, doing a c-section is a "get out of
> jail free card," while any other course of action puts you at risk.
> This game is making the lawyers rich and driving up c-section rates
> with no benefit to moms or babies in general - outcomes have not
> improved.

Absolutely--I understand that dynamic, and I certainly
agree that we have a legal system does not pay attention to
what the medical evidence says and instead pays more attention
to what is common/expected/accepted (which often runs contrary
to what evidence-based medicine suggests). As I observed
elsewhere, that is partly a failing of having a common law
system. It guarantees that the legal system lags current
knowledge and is a problem in any area where there is fairly
rapid development (like science, medicine, technology, etc.).
But there are also some other players here, especially
the insurance companies who earn a boatload raising malpractice
rates on people who are not shown to be practicing inappropriately.
Another issue is the lack of informed consent, which is absolutely
a joke in our current system. Risks and benefits are not portrayed
accurately based on their relative likelihood. Risks of some
actions are exaggerated and risks of others are downplayed.
And while I sympathize with doctors who are trying
to practice evidence-based medicine and encountering problems,
I also think there are things that doctors (and other caregivers)
can do to make a difference. It's not an accident that midwives
get sued less than doctors even when comparing similar situations.
There's an element of client education and trust developed through
one-on-one interaction that makes a difference. I understand
that those things, also, are affected by situations that make
it expensive and difficult to provide them, but at
some point we have to stop hand-wringing and start getting
clever about how to do things. For instance, ask yourself
what the difference is between the client who sues for a
broken collarbone due to shoulder dystocia and the one who
doesn't? Betcha the client who understands what it is,
that maternal position can have an effect (and that choosing
an epidural can limit the ability of the mother to adopt
positions that can avoid or resolve shoulder dystocia),
and that the remedies are X, Y, and Z with risk/benefit
profiles A, B, and C is much less likely to sue than the
uneducated client--partly because the client understands
the possible outcomes and why they'd be chosen and
partly because the client takes some personal responsibility
for decisions about things like epidurals and position
(assuming, of course, that the client is actually allowed
effective choice in those areas). Obviously, that won't
be perfect. You can lead a horse to water, but you can't
make him drink--and you can educate clients all you want
and some just won't "drink" (or won't choose to be reasonable
despite the information). But it *will* tip the scales.
The question then becomes how to convey this information
given resource constraints. I wouldn't suggest that's easy,
but I do believe it's doable. Midwives, of course, have
a leg up in this department because they typically have
a client base more interested in being educated in the
first place, and less likely to be of a "just get it
over with the least pain and effort possible" mindset.
At any rate, educated clients who accept
some degree of personal responsibility and who are
truly involved in decision-making are the best protection
against this sort of thing given the current legal
situation. I do find it somewhat surprising that doctors
appear not to have attempted to leverage that more.

Best wishes,
Ericka

[Todd Gastaldo]

THE "HIGHER MALPRACTICE" GAME...

OBs MOAN ALL THE WAY TO THE BANK!

"alath" > wrote in message
oups.com...
>
>> Anyway, it just seems to me that we talk a lot
>> about CYA medicine, and I'm sure it's an issue, but we
>> don't seem to do a lot of good thinking about *why* the
>> legal pressures are there. I rather suspect that tort
>> reform isn't going to do much good, but it's the only
>> solution I ever seem to hear mentioned.
>>
>> Best wishes,
>> Ericka
>
> Ericka, the legal pressures are there because there is a lot of money
> in it. I personally know an OB who is being sued for a shoulder
> dystocia case - she handled the emergency appropriately, the baby's
> humerus was broken but it was done in a controlled manner and the baby
> is now fine with no residual defecits. The parents are suing because it
> was upsetting that their baby's arm got broken. This doctor acted
> appropriately and saved the baby's life, and now she is being sued.

If this shoulder dystocia occurred with the woman semisitting or dorsal -
that is obvious criminal negligence given The Four OB Lies.

If the birth canal was KEPT closed during the shoulder dystocia event - well
it just makes the criminal negligence more obvious.

Was the woman semisitting or dorsal?

Are ANY women placed semisitting or dorsal at your hospital, Alath?

At most hospitals semisitting (birth-canal-closing) is routine.

> She
> will probably win the case after an enormously expensive defense, but
> in the mean time, her malpractice insurance has gone up $35,000 per
> year.

If the OB *was* closing the birth canal up to 30% and KEEPING it closed -
and this were to come out in court - I suspect she would not win.

In any event, if the birth canal was closed the parents should be informed
of this so that they can encourage their attorney to discuss The Four OB
Lies in court.


> All the other providers in our hospital know about this case, and
> it has had a tremendous effect on their practice.

All the other providers in your hospital are probably still doing
semisitting and dorsal deliveries - closing birth canals up to 30% and
KEEPING birth canals closed when babies get stuck.

CORRECT ME IF I AM WRONG THOUGH ALATH - AND TELL ME WHICH HOSPITAL - I WILL
WANT TO START RAVING ABOUT THE FIRST HOSPITAL TO STOP CLOSING BIRTH CANALS
THE "EXTRA" UP TO 30%.

> Women are now being
> offered c-sections any time there is a large baby or a slow labor. I've
> argued this is not evidence-based,

Arrrggghhh.. Closing the birth canal up to 30% is not evidence-based.

> and the reply is, "I'll start
> practicing evidence-based medicine when they start practicing
> evidence-based law."

LOL! **OBs** - no doubt on the advice of ACOG attorneys - are practicing
"evidence-based law."

If OBs simply suddenly stopped closing birth canals the "extra" up to 30%
it would be tantamount to admitting the evidence that they are being
criminally negligent.

How SMUGLY OBs are closing birth canals!

> The fact is, a lawyer can't make a case out of an
> unnecessary c-section.

No, the fact is, lawyers are choosing NOT to make a case out of unnecessary
c-sections.

Obstetricians CAUSE cephalopelvic disproportion and failure to progress then
perform c-sections BEcause of cephalpelvic disproportion and failure to
progress, as in,

> Women are now being
> offered c-sections any time there is a large baby or a slow labor. I've
> argued this is not evidence-based,

Nope - not evidence-based - esp. not when OBs are knowingly closing birth
canals up to 30% and keeping birth canals closed when babies get stuck - and
lying to cover-up.

> But if you didn't do a c-section and something
> goes wrong, then it is easy to make the case that there was something
> you should have done but didn't.

Yep! It's easy to make the case that the OB should have allowed the birth
canal to open maximally.

> If you do a c-section and there is
> still a bad outcome, you have the defense that "I did everything I
> could."
>

No, you don't have this defense if you were closing the birth canal the
"extra" up to 30%.

It's obvious assault and battery for OBs to slice vaginas/abdomens -
surgically/fraudulently inferring they are doing/have done everything
possible to open birth canals - even as they close birth canals the "extra"
up to 30%.


> In the rules of this game, doing a c-section is a "get out of
> jail free card,"

TRANSLATION: OBs are committing SURGICAL assault and battery instead of
simply not committing the MECHANICAL assault and battery in the first place.

Allowing the birth canal to open the "extra" up to 30% is not going to
prevent all c-sections or shoulder dystocias - but watch out once a jury in
a birth trauma trial learns of The Four OB Lies...

> while any other course of action puts you at risk.
> This game is making the lawyers rich and driving up c-section rates
> with no benefit to moms or babies in general - outcomes have not
> improved.
>

Correction: The "game" is also making OBs rich. As long as OBs maintain
their illegitimate monopoly on birth, WOMEN (and their families) are going
to pay the OBs' higher malpractice insurance premiums.

The key is the OB monopoly on birth. It must be maintained at all costs or
the "game" will be up.

Higher malpractice insurance premiums feathers nicely into the "homebirth is
dangerous" anti-scientific/anti-competitive authoritative rhetoric of mighty
OBs.

OBs go to legislatures and demand to supervise homebirth midwives (without
actually going to homebirths!) then refuse to supervise homebirth midwives
because their malpractice liability insurers won't allow it.

It's a *sweet* game for OBs as long as it lasts.

Frequent lawsuits - lawyers winning money and OBs losing money - it's just
part of the cost of maintaing the crucial OB monopoly on birth...

Women and babies lose their LIVES occasionally - and OBs lose money but keep
practicing - it's THE COMMUNITY NORM to close birth canals dontchaknow!
(Cue Ericka here.)

What's that? Someone is saying that OBs are being driven from practice?

MAYBE the "game" is finally winding down - a bit. Cue the CNMwives -
physician-extenders waiting in the wings - also birth-canal-closers!

The "game" is maintaining the monopoly on birth.

Higher malpractice insurance premiums - and a lot of public moaning by OBs -
are just necessary parts of the game.

With the monopoly - with the assistance of physician-extenders called
CNMwives - the INTERVENTION-HAPPY birth industry simply passes the higher
costs on to the women whose birth canals they are knowingly closing.

Health insurance costs rise - making health insurers happier too!

Isn't this a FUN game!

Alath, will you find out if OBs and/or CNMwives at your hospital are doing
birth-canal-closing/semisitting births and if they are ask them to stop?

Thanks.

Sincerely,

Todd

Dr. Gastaldo


PS Ericka says to Alath...

"[A]sk yourself
what the difference is between the client who sues for a
broken collarbone due to shoulder dystocia and the one who
doesn't? Betcha the client who understands what it is,
that maternal position can have an effect (and that choosing
an epidural can limit the ability of the mother to adopt
positions that can avoid or resolve shoulder dystocia),
and that the remedies are X, Y, and Z with risk/benefit
profiles A, B, and C is much less likely to sue than the
uneducated client--partly because the client understands
the possible outcomes and why they'd be chosen and
partly because the client takes some personal responsibility
for decisions about things like epidurals and position
(assuming, of course, that the client is actually allowed
effective choice in those areas). Obviously, that won't
be perfect. You can lead a horse to water, but you can't
make him drink--and you can educate clients all you want
and some just won't "drink"..."

Ericka, you are funny!

Obstetricians and midwives and childbirth educators are WITHHOLDING
"water" - "forgetting" BEFORE birth to tell pregnant women that OBs and
midwives are closing birth canals up to 30% and keeping birth canals closed
when babies get stuck - and lying about it...

Then AFTER birth - if there is a poor outcome - women STILL aren't told that
OBs closed the birth canal!

UBPN - the United Brachial Plexus Network still refuses to give this
information to mothers of paralyzed babies!

And you are pretending that Henci Goer is giving out the information "clear
as can be," as in,

> You keep harping on this, but she says clear as can be
> (in OMvRR) "The lithotomy position is the worst position because
> it increases the incidence of fetal distress, the mother pushes
> the baby uphill, and her pelvis, made flexible by the influence
> of pregnancy hormones, is fixed in position by the delivery
> table." She also cites several studies and reviews promoting
> upright positions. Heck, she even uses your favorite term
> "lying" when describing the mismanagement of labor and "CPD."
>

Good one Ericka!

NOWHERE (in your quoting of her) does she say lithotomy CLOSES.

Nowhere does she say that SEMISITTING closes.

Nowhere does she say that OBs are KEEPING birth canals closed the "extra"
30% when babies get stuck.

These are key lies of omission.

I will keep harping until she stops lying by omission.

Good joke, though!

Todd


BIZARRE!

Again Alath, will you find out if OBs and/or CNMwives at your hospital are
doing birth-canal-closing/semisitting births and if they are ask them to
stop?

[Larry McMahan]

Ericka Kammerer > writes:

[well reasoned detailed analysis deleted]

: At any rate, educated clients who accept
: some degree of personal responsibility and who are
: truly involved in decision-making are the best protection
: against this sort of thing given the current legal
: situation. I do find it somewhat surprising that doctors
: appear not to have attempted to leverage that more.

Amen, sister, AMEN!

: Best wishes,
: Ericka

Larry

[Iuil]

"Larry McMahan" wrote
> : At any rate, educated clients who accept
> : some degree of personal responsibility and who are
> : truly involved in decision-making are the best protection
> : against this sort of thing given the current legal
> : situation. I do find it somewhat surprising that doctors
> : appear not to have attempted to leverage that more.
>
> Amen, sister, AMEN!
>

I tried taking personal responsibility when my former Ob was pushing for an
elective c/s because of suspected macrosomia. His response was a dire
warning on shoulder dystocia and ended with the words "if your baby is
injured in any way, you will sue me". Note his phrasing, "will". Not "may"
or "could" or "might". This despite the fact that I had all the relevant
research i could find in my hand and had expressed a wish to at least wait
for spontaneous labour and to re-evaluate as events progressed.

I've changed hospital and gone from being a private patient to using the
public system this time ....

Jean

[Todd Gastaldo]

LARRY IN CHURCH...

See below.

"Larry McMahan" > wrote in message
...
> Ericka Kammerer > writes:
>
> [well reasoned detailed analysis deleted]
>
> : At any rate, educated clients who accept
> : some degree of personal responsibility and who are
> : truly involved in decision-making are the best protection
> : against this sort of thing given the current legal
> : situation. I do find it somewhat surprising that doctors
> : appear not to have attempted to leverage that more.
>
> Amen, sister, AMEN!
>

Larry,

When church lets out please ask Ericka why it is surprising to her that
doctors "appear" not to have attempted to leverage their ability to educate
their clients.

Todd

"That any sane nation, having observed that you could provide for the supply
of bread by giving bakers a pecuniary interest in baking for you, should go
on to give a surgeon a pecuniary interest in cutting off your leg, is enough
to make one despair of political humanity."
--George Bernard Shaw, introduction to "The Doctor's Dilemma"

Obstetricians are SURGEONS. After they grokked the significance of the
pecuniary interest in slicing vaginas and abdomens that society gave them -
they changed the writing on the barn door...

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

Again, 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.

It's chilling to consider, but OB Lie #1 may have been a coldly calculated
decision by OBs to intentionally abuse their cultural authority for
profit...

Todd

[Renee]

> Obstetrics is a cash cow for most hospitals, and with a nine-month
> lead-up and a "patient" who is generally healthy and not in imminent
> danger, clients can, and do, apply a lot of market pressure. That's
> why lots of hospitals have invested quite a bit of money developing
> more spacious and "home like" birthing suites. They perceive,
> correctly, that such things will draw business.

I don't know if I agree with this. Many hospitals in my area have
closed their maternity wards because they were losing money on them.
Though, I do agree that many hospitals have made their suites more
"home like" in order to draw patients.

Renee

[Ericka Kammerer]

Renee wrote:

>>Obstetrics is a cash cow for most hospitals, and with a nine-month
>>lead-up and a "patient" who is generally healthy and not in imminent
>>danger, clients can, and do, apply a lot of market pressure. That's
>>why lots of hospitals have invested quite a bit of money developing
>>more spacious and "home like" birthing suites. They perceive,
>>correctly, that such things will draw business.
>
>
> I don't know if I agree with this. Many hospitals in my area have
> closed their maternity wards because they were losing money on them.

All hospitals are incredibly sensitive to bed usage, so
if there aren't enough maternity patients to keep the unit busy
it's not going to pan out for them. Also, liability insurance is
taking more of a bite these days. On the other hand, one of the
reasons maternity is so useful to hospitals is that it's a great
way to draw in patients for future business. Maternity services
are often a person's first experience of a hospital, and if you
can draw in a patient for maternity, and make them happy, there's
a good chance that they'll return. With more and more patients
using managed care, hospital choices are more constrained. Hook
someone in with maternity (something that many patients plan
in advance, so it can affect their insurance decisions) so that
they choose a plan that encourages use of your hospital and you
have a better chance of having a long-term customer.

Best wishes,
Ericka

[Todd Gastaldo]

"Ericka Kammerer" > wrote in message
...
> Renee wrote:
>
>>>Obstetrics is a cash cow for most hospitals, and with a nine-month
>>>lead-up and a "patient" who is generally healthy and not in imminent
>>>danger, clients can, and do, apply a lot of market pressure. That's
>>>why lots of hospitals have invested quite a bit of money developing
>>>more spacious and "home like" birthing suites. They perceive,
>>>correctly, that such things will draw business.
>>
>>
>> I don't know if I agree with this. Many hospitals in my area have
>> closed their maternity wards because they were losing money on them.
>
> All hospitals are incredibly sensitive to bed usage, so
> if there aren't enough maternity patients to keep the unit busy
> it's not going to pan out for them. Also, liability insurance is
> taking more of a bite these days. On the other hand, one of the
> reasons maternity is so useful to hospitals is that it's a great
> way to draw in patients for future business. Maternity services
> are often a person's first experience of a hospital, and if you
> can draw in a patient for maternity, and make them happy, there's
> a good chance that they'll return. With more and more patients
> using managed care, hospital choices are more constrained. Hook
> someone in with maternity (something that many patients plan
> in advance, so it can affect their insurance decisions) so that
> they choose a plan that encourages use of your hospital and you
> have a better chance of having a long-term customer.
>

RELEVANT QUOTE FROM 1986...

"Obstetrics is now considered to be the service leader in establishing
patient loyalty to the institution. Innovative maternity programs can
increase the patient volume in other areas, through the woman's influence.
Since women tend to decide where the family will go for medical care (in 70%
of families say some researcher), loyalty won through innovative obstetrics
programs transfers to other patient areas." [Innovations in obstetric
design. Hospital Administration Currents 1986;30(3):9-14. In Lerman A.
Birth environments: emerging trends and implications for design. University
of Wisconsin at Milwaukee: School of Architecture and Urban Planning, 198_]






Organized medicine has a HUGE "innovative obstetrics program" going...


"[C]hildbirth is the most common reason for inpatient care in the United
States..." [Annas GJ. Women and children first. N Engl J Med (Dec14)1995]


Don't forget, AFTER the birth there are MORE profits to be made...


"The most common diagnosis for hospitalization among all women is trauma to
perineum due to childbirth."
http://www.ahcpr.gov/data/hcup/factbk3/factbk3.htm

Todd

[Kelly]

soooo, 19 years ago relevant.

Ericka is right, a maternity unit is typically a first time hospital stay
for people.




"Todd Gastaldo" > wrote in message
ink.net...
>
> "Ericka Kammerer" > wrote in message
> ...
>> Renee wrote:
>>[i]
>>>>Obstetrics is a cash cow for most hospitals, and with a nine-month
>>>>lead-up and a "patient" who is generally healthy and not in imminent
>>>>danger, clients can, and do, apply a lot of market pressure. That's
>>>>why lots of hospitals have invested quite a bit of money developing
>>>>more spacious and "home like" birthing suites. They perceive,
>>>>correctly, that such things will draw business.
>>>
>>>
>>> I don't know if I agree with this. Many hospitals in my area have
>>> closed their maternity wards because they were losing money on them.
>>
>> All hospitals are incredibly sensitive to bed usage, so
>> if there aren't enough maternity patients to keep the unit busy
>> it's not going to pan out for them. Also, liability insurance is
>> taking more of a bite these days. On the other hand, one of the
>> reasons maternity is so useful to hospitals is that it's a great
>> way to draw in patients for future business. Maternity services
>> are often a person's first experience of a hospital, and if you
>> can draw in a patient for maternity, and make them happy, there's
>> a good chance that they'll return. With more and more patients
>> using managed care, hospital choices are more constrained. Hook
>> someone in with maternity (something that many patients plan
>> in advance, so it can affect their insurance decisions) so that
>> they choose a plan that encourages use of your hospital and you
>> have a better chance of having a long-term customer.
>>
>
> RELEVANT QUOTE FROM 1986...
>
> "Obstetrics is now considered to be the service leader in establishing
> patient loyalty to the institution. Innovative maternity programs can
> increase the patient volume in other areas, through the woman's influence.
> Since women tend to decide where the family will go for medical care (in
> 70%
> of families say some researcher), loyalty won through innovative
> obstetrics
> programs transfers to other patient areas."
>
>
>
>
>
>
> Organized medicine has a HUGE "innovative obstetrics program" going...
>
>
> "[C]hildbirth is the most common reason for inpatient care in the United
> States..." [Annas GJ. Women and children first. N Engl J Med (Dec14)1995]
>
>
> Don't forget, AFTER the birth there are MORE profits to be made...
>
>
> "The most common diagnosis for hospitalization among all women is trauma
> to
> perineum due to childbirth."
> http://www.ahcpr.gov/data/hcup/factbk3/factbk3.htm
>
> Todd
>
>

[Todd Gastaldo]

"Kelly" > wrote in message
...
> soooo, 19 years ago relevant.
>
> Ericka is right, a maternity unit is typically a first time hospital stay
> for people.
>

Kelly,

The quote (see below) seemed to me to accord with what Ericka said.

This didn't seem so to you?

Todd

>
>
>
> "Todd Gastaldo" > wrote in message
> ink.net...
>>
>> "Ericka Kammerer" > wrote in message
>> ...[i]
>>> Renee wrote:
>>>
>>>>>Obstetrics is a cash cow for most hospitals, and with a nine-month
>>>>>lead-up and a "patient" who is generally healthy and not in imminent
>>>>>danger, clients can, and do, apply a lot of market pressure. That's
>>>>>why lots of hospitals have invested quite a bit of money developing
>>>>>more spacious and "home like" birthing suites. They perceive,
>>>>>correctly, that such things will draw business.
>>>>
>>>>
>>>> I don't know if I agree with this. Many hospitals in my area have
>>>> closed their maternity wards because they were losing money on them.
>>>
>>> All hospitals are incredibly sensitive to bed usage, so
>>> if there aren't enough maternity patients to keep the unit busy
>>> it's not going to pan out for them. Also, liability insurance is
>>> taking more of a bite these days. On the other hand, one of the
>>> reasons maternity is so useful to hospitals is that it's a great
>>> way to draw in patients for future business. Maternity services
>>> are often a person's first experience of a hospital, and if you
>>> can draw in a patient for maternity, and make them happy, there's
>>> a good chance that they'll return. With more and more patients
>>> using managed care, hospital choices are more constrained. Hook
>>> someone in with maternity (something that many patients plan
>>> in advance, so it can affect their insurance decisions) so that
>>> they choose a plan that encourages use of your hospital and you
>>> have a better chance of having a long-term customer.
>>>
>>
>> RELEVANT QUOTE FROM 1986...
>>
>> "Obstetrics is now considered to be the service leader in establishing
>> patient loyalty to the institution. Innovative maternity programs can
>> increase the patient volume in other areas, through the woman's
>> influence.
>> Since women tend to decide where the family will go for medical care (in
>> 70%
>> of families say some researcher), loyalty won through innovative
>> obstetrics
>> programs transfers to other patient areas."
>>
>>
>>
>>
>>
>>
>> Organized medicine has a HUGE "innovative obstetrics program" going...
>>
>>
>> "[C]hildbirth is the most common reason for inpatient care in the United
>> States..." [Annas GJ. Women and children first. N Engl J Med (Dec14)1995]
>>
>>
>> Don't forget, AFTER the birth there are MORE profits to be made...
>>
>>
>> "The most common diagnosis for hospitalization among all women is trauma
>> to
>> perineum due to childbirth."
>> http://www.ahcpr.gov/data/hcup/factbk3/factbk3.htm
>>
>> Todd
>>
>>
>
>

[Kelly]

yes, *years* ago (like you posted, 1986) These days most hospitals are not
redoing their maternity units (okay, where I live) They are nice, don't get
me wrong, but new updates aren't happening with a vengeance like in the late
80's *early* nineties. What is happening are well staffed and well informed
highly progressive care units-lactation services being provided in house as
well as easy to access services once home. There is one hospital in town
that has a humongous OB department, but we nickname them McBirth or
McDrivethrough Birth. You know what a money maker department is? Surgery.
That is big competition nowadays.

Kelly

"Todd Gastaldo" > wrote in message
ink.net...
>
> "Kelly" > wrote in message
> ...
>> soooo, 19 years ago relevant.
>>
>> Ericka is right, a maternity unit is typically a first time hospital stay
>> for people.
>>
>
> Kelly,
>
> The quote (see below) seemed to me to accord with what Ericka said.
>
> This didn't seem so to you?
>
> Todd
>
>>
>>
>>
>> "Todd Gastaldo" > wrote in message
>> ink.net...
>>>
>>> "Ericka Kammerer" > wrote in message
>>> ...
>>>> Renee wrote:
>>>>
>>>>>>Obstetrics is a cash cow for most hospitals, and with a nine-month
>>>>>>lead-up and a "patient" who is generally healthy and not in imminent
>>>>>>danger, clients can, and do, apply a lot of market pressure. That's
>>>>>>why lots of hospitals have invested quite a bit of money developing
>>>>>>more spacious and "home like" birthing suites. They perceive,
>>>>>>correctly, that such things will draw business.
>>>>>
>>>>>
>>>>> I don't know if I agree with this. Many hospitals in my area have
>>>>> closed their maternity wards because they were losing money on them.
>>>>
>>>> All hospitals are incredibly sensitive to bed usage, so
>>>> if there aren't enough maternity patients to keep the unit busy
>>>> it's not going to pan out for them. Also, liability insurance is
>>>> taking more of a bite these days. On the other hand, one of the
>>>> reasons maternity is so useful to hospitals is that it's a great
>>>> way to draw in patients for future business. Maternity services
>>>> are often a person's first experience of a hospital, and if you
>>>> can draw in a patient for maternity, and make them happy, there's
>>>> a good chance that they'll return. With more and more patients
>>>> using managed care, hospital choices are more constrained. Hook
>>>> someone in with maternity (something that many patients plan
>>>> in advance, so it can affect their insurance decisions) so that
>>>> they choose a plan that encourages use of your hospital and you
>>>> have a better chance of having a long-term customer.
>>>>
>>>
>>> RELEVANT QUOTE FROM 1986...
>>>
>>> "Obstetrics is now considered to be the service leader in establishing
>>> patient loyalty to the institution. Innovative maternity programs can
>>> increase the patient volume in other areas, through the woman's
>>> influence.
>>> Since women tend to decide where the family will go for medical care (in
>>> 70%
>>> of families say some researcher), loyalty won through innovative
>>> obstetrics
>>> programs transfers to other patient areas." [Innovations in obstetric
>>> design. Hospital Administration Currents 1986;30(3):9-14. In Lerman A.
>>> Birth environments: emerging trends and implications for design.
>>> University
>>> of Wisconsin at Milwaukee: School of Architecture and Urban Planning,
>>> 198_]
>>>
>>>
>>>
>>>
>>>
>>>
>>> Organized medicine has a HUGE "innovative obstetrics program" going...
>>>
>>>
>>> "[C]hildbirth is the most common reason for inpatient care in the United
>>> States..." [Annas GJ. Women and children first. N Engl J Med
>>> (Dec14)1995]
>>>
>>>
>>> Don't forget, AFTER the birth there are MORE profits to be made...
>>>
>>>
>>> "The most common diagnosis for hospitalization among all women is trauma
>>> to
>>> perineum due to childbirth."
>>> http://www.ahcpr.gov/data/hcup/factbk3/factbk3.htm
>>>
>>> Todd
>>>
>>>
>>
>>
>
>

[Todd Gastaldo]

"Kelly" > wrote in message
...
> yes, *years* ago (like you posted, 1986) These days most hospitals are
> not redoing their maternity units (okay, where I live) They are nice,
> don't get me wrong, but new updates aren't happening with a vengeance like
> in the late 80's *early* nineties. What is happening are well staffed and
> well informed highly progressive care units-lactation services being
> provided in house as well as easy to access services once home. There is
> one hospital in town that has a humongous OB department, but we nickname
> them McBirth or McDrivethrough Birth. You know what a money maker
> department is? Surgery. That is big competition nowadays.
>

Kelly,

Your points are well taken.

I was thinking the 1986 article accorded with Ericka's "on the other hand,"
as in,

>>>> On the other hand, one of the
>>>> reasons maternity is so useful to hospitals is that it's a great
>>>> way to draw in patients for future business. Maternity services
>>>> are often a person's first experience of a hospital, and if you
>>>> can draw in a patient for maternity, and make them happy, there's
>>>> a good chance that they'll return. With more and more patients
>>>> using managed care, hospital choices are more constrained. Hook
>>>> someone in with maternity (something that many patients plan
>>>> in advance, so it can affect their insurance decisions) so that
>>>> they choose a plan that encourages use of your hospital and you
>>>> have a better chance of having a long-term customer.
>>>>

Todd



>
> "Todd Gastaldo" > wrote in message
> ink.net...
>>
>> "Kelly" > wrote in message
>> ...
>>> soooo, 19 years ago relevant.
>>>
>>> Ericka is right, a maternity unit is typically a first time hospital
>>> stay for people.
>>>
>>
>> Kelly,
>>
>> The quote (see below) seemed to me to accord with what Ericka said.
>>
>> This didn't seem so to you?
>>
>> Todd
>>
>>>
>>>
>>>
>>> "Todd Gastaldo" > wrote in message
>>> ink.net...
>>>>
>>>> "Ericka Kammerer" > wrote in message
>>>> ...
>>>>> Renee wrote:
>>>>>
>>>>>>>Obstetrics is a cash cow for most hospitals, and with a nine-month
>>>>>>>lead-up and a "patient" who is generally healthy and not in imminent
>>>>>>>danger, clients can, and do, apply a lot of market pressure. That's
>>>>>>>why lots of hospitals have invested quite a bit of money developing
>>>>>>>more spacious and "home like" birthing suites. They perceive,
>>>>>>>correctly, that such things will draw business.
>>>>>>
>>>>>>
>>>>>> I don't know if I agree with this. Many hospitals in my area have
>>>>>> closed their maternity wards because they were losing money on them.
>>>>>
>>>>> All hospitals are incredibly sensitive to bed usage, so
>>>>> if there aren't enough maternity patients to keep the unit busy
>>>>> it's not going to pan out for them. Also, liability insurance is
>>>>> taking more of a bite these days. On the other hand, one of the
>>>>> reasons maternity is so useful to hospitals is that it's a great
>>>>> way to draw in patients for future business. Maternity services
>>>>> are often a person's first experience of a hospital, and if you
>>>>> can draw in a patient for maternity, and make them happy, there's
>>>>> a good chance that they'll return. With more and more patients
>>>>> using managed care, hospital choices are more constrained. Hook
>>>>> someone in with maternity (something that many patients plan
>>>>> in advance, so it can affect their insurance decisions) so that
>>>>> they choose a plan that encourages use of your hospital and you
>>>>> have a better chance of having a long-term customer.
>>>>>
>>>>
>>>> RELEVANT QUOTE FROM 1986...
>>>>
>>>> "Obstetrics is now considered to be the service leader in establishing
>>>> patient loyalty to the institution. Innovative maternity programs can
>>>> increase the patient volume in other areas, through the woman's
>>>> influence.
>>>> Since women tend to decide where the family will go for medical care
>>>> (in 70%
>>>> of families say some researcher), loyalty won through innovative
>>>> obstetrics
>>>> programs transfers to other patient areas." [Innovations in obstetric
>>>> design. Hospital Administration Currents 1986;30(3):9-14. In Lerman A.
>>>> Birth environments: emerging trends and implications for design.
>>>> University
>>>> of Wisconsin at Milwaukee: School of Architecture and Urban Planning,
>>>> 198_]
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> Organized medicine has a HUGE "innovative obstetrics program" going...
>>>>
>>>>
>>>> "[C]hildbirth is the most common reason for inpatient care in the
>>>> United
>>>> States..." [Annas GJ. Women and children first. N Engl J Med
>>>> (Dec14)1995]
>>>>
>>>>
>>>> Don't forget, AFTER the birth there are MORE profits to be made...
>>>>
>>>>
>>>> "The most common diagnosis for hospitalization among all women is
>>>> trauma to
>>>> perineum due to childbirth."
>>>> http://www.ahcpr.gov/data/hcup/factbk3/factbk3.htm
>>>>
>>>> Todd
>>>>
>>>>
>>>
>>>
>>
>>
>
>