Dr. Horkel's vagina stretcher (the EPI-NO)

DR. HORKEL'S VAGINA STRETCHER (the EPI-NO)... See below.

First this WARNING...

Obstetricians are *knowingly* closing birth canals up to 30%. See PROOF at
the very end of this post.

PREGNANT WOMEN: It's EASY to allow your birth canal to OPEN the "extra" up
to 30%. See the very end of this post.



PRE-STRETCHED VAGINA

LADIES A pre-stretched vagina is no doubt nice at birth - your vagina is
going to have to stretch anyway - but it makes NO sense to pre-stretch your
vagina and then let your MD close your birth canal!

Again: It's EASY to allow your birth canal to OPEN the "extra" up to 30%.
See the very end of this post.

So maybe pre-stretch AND open your pelvic outlet the "extra" up to 30%?...

(I wonder how daily perineal massage in the last trimester compares with the
EPI-NO.)


DR. HORKEL'S VAGINA STRETCHER (the EPI-NO)...

Andrea Robertson wrote of the EPI-NO:

"...users of the vaginal dilator had lower episiotomy rates than women
generally...this device may have its uses, particularly for women who fear
second stage and face birth in a climate of routine episiotomy. It is
expensive and takes time and commitment to use...it seems to provide a
useful alternative to routine perineal surgery. Reference: Siome Cohain J.
MIDIRS Midwifery Digest. vol 14, no 1, March 2004, pp 37-41.
http://www.birthinternational.com/di...es/000365.html

EPI-NO inventor Wilhelm G. Horkel, MD replied:

"...It took about 3 years to develop the device and I made first EPI-NO
experiences with mothers to be in my gynecological and obstetrical clinic
and praxis in Bavaria...I trusted my idea and I started the first study
worldwide at the University Hospital in Munich together with Prof. Schneider
in 1997. The results of this first study and the acceptance by the women in
my praxis were so overwhelming that I patented the device and started the
production at Tecsana GmbH in Munich. Now a couple of years later EPI-NO is
available in over 21 countries in 5 continents. I am shure that EPI-NO will
start a revolution in birth and after birth treatment and that it will
become standard in birth worldwide in a couple of years..."
--Wilhelm G. Horkel, MD
http://www.birthinternational.com/di...es/000365.html


OPEN LETTER
Wilhelm Horkel
Maximilianstr. 5
82319 Starnberg
Tel.: 08151-746 555
Fax: 08151-2031

www.dr-horkel.de

Wilhelm,

First a little trivia just in case you haven't heard...

A DO-IT-YOURSELF C-SECTION!

"She took three small glasses of hard liquor and, using a kitchen knife,
sliced her abdomen in three attempts...and delivered a male infant that
breathed immediately and cried," said Dr R.F. Valle, of the Dr Manuel
Velasco Suarez Hospital in San Pablo, Mexico."
http://www.cnn.com/2004/HEALTH/04/06...eut/index.html

See: http://health.groups.yahoo.com/group...t/message/2462

Onward...

I wrote: OBs are knowingly closing birth canals up to 30%...

Aribert Deckers (also from Germany) responded:
"That is a blatant lie."

I responded to Aribert as follows...

Aribert is sort of right.

1. Not all OBs know they are closing birth canals; and

2. In some women OBs are closing birth canals MORE than 30%.

Here's my source for the 30% figure...

"[T]he outlet increases with moulding by approximately 20-30 per cent."
--Russell JGB. Moulding of the pelvic outlet. J Obstet Gynaec Brit Cwlth
1969;76:817-20.

NOTE: In 1973, Ohlsen verified Russell's 20% figure on
Borell and Fernstrom's 1957 intrapartum x-rays. Ohlsen pointed out that the
authors of Williams Obstetrics were claiming that the pelvic diameters don't
change during delivery - so the authors of Williams Obstetrics decided
(erroneously) that dorsal delivery widens! See:
http://home1.gte.net/gastaldo/part2ftc.html

MORE THAN 30%...

SOME BABIES ARE **REALLY** GETTING HAMMERED

Check out the following "head must rotate around a line joining the
ischial tuberosities" quote from the 21st (2001) edition of Williams
Obstetrics:

"In obstructed labor caused by a narrowing of the...pelvic
outlet, the prognosis for vaginal delivery often depends on the length of
the posterior sagittal diameter of the pelvic outlet (p. 56)...The posterior
triangle [of the pelvic outlet]...is limited at its apex by the tip of the
last sacral vertebra (not the coccyx) (p. 437)...With increasing narrowing
of the pubic arch, the occiput cannot emerge directly beneath the symphysis
pubis but is forced increasingly farther down...the ischiopubic rami. In
extreme cases, the head must rotate around a line joining the ischial
tuberosities [!] (p. 438)..."

Stated another way, if the mother has a narrow pubic arch, the baby's
head
doesn't go into the arch very
far - which greatly increases the influence of sacro-iliac motion.

Again, some babies are REALLY getting hammered.

In such women the pelvic outlet is likely closed WAY more than 30% if
sacroiliac motion is denied.

MDs knew about what I am talking about early last century....

Harvard obstetrician Arthur B. Emmons, MD wrote in 1913

"[M]oving backward of the tip of the sacrum...enlarges the
available space not merely directly in proportion to the distance backward,
but more nearly by the square of that distance." [Emmons, AB. A study of the
variations in the female pelvis, based on observations made on 217 specimens
of the
American Indian squaw. Biometrika 1913; 9:34-47.]
WEIRD!

######### In the 70s, why *was* Williams Obstetrics saying that the pelvic
diameters don't change? See Ohlsen discussion at:
http://home1.gte.net/gastaldo/part2ftc.html

######### After all, J. Whitridge Williams, MD, the original author of
Williams
Obstetrics clinically demonstrated truly MASSIVE changes in AP pelvic outlet
diameter in 1911!

######### How could MD-obstetricians get something so very important so
very wrong?

######### What if MD-obstetricians INTENTIONALLY got it wrong?

Anyway...

Here's what was added to Williams Obstetrics at my
request:

"It should be noted...that the increase in the diameter of the
pelvic outlet occurs **only** if the sacrum is allowed to rotate
posteriorly, that is,
only if the sacrum is not forced anteriorly by the weight of the maternal
pelvis against the delivery table or bed." [Cunningham, MacDonald, Leveno,
Gant and Gilstrap, Williams Obstetrics Appleton-Lange 1993:285, **italics in
original]

Unfortunately, the authors of Williams Obstetrics left in their text - in
the same paragraph (!)
the "dorsal widens" bald lie that first called my attention to their
text)!!
http://home1.gte.net/gastaldo/part2ftc.html

I had discovered the "dorsal widens" bald lie that Ohlsen (see above)
stimulated...

It is still in the latest (2001) edition of Williams Obstetrics!

Thanks for reading,

Sincerely,

Todd

Dr. Gastaldo


PS1 Wilhelm, there is now MRI evidence that OBs are denying "significant"
outlet area...

But they could have demonstrated MUCH more!
See Flip women over, reach in vagina, *pull* on sacrum during
MRI!
http://groups.yahoo.com/group/chiro-list/message/2136

PS2 Andrea, thank you for writing about Wilhelm's vagina stretcher...

I didn't see anything on your website about OBs knowingly closing birth
canals up to 30%.

I note that ACE Graphics (UK) is part of www.birthinternational.com...

Maybe ACE Graphics (UK) could do medical illustrations that attorneys could
use to show how MDs are closing birth canals up to 30%?

See Medical illustrators: Global effort for babies...
http://health.groups.yahoo.com/group...t/message/2499

It occurred to me to write to you when I read the following:

"We would also welcome your feedback on our web site, our services and
products, or anything else that comes to mind..."
http://www.birthinternational.com/contact/index.html

A website named Birth International should be telling women that OBs
internationally are knowingly closing birth canals - and that it is EASY for
women to offer their babies the "extra" up to 30%...

Copied to:

Birth International (Australia)
PO Box 366 Camperdown NSW 1450
Phone: (02) 9564 2322
Fax: (02) 9564 2388


ACE Graphics (UK)
PO Box 173 Sevenoaks Kent TN14 5ZT
Phone: (01959) 524 622
Fax: (01959) 525 800


Matty van Oosterom (New Zealand Agent)
Birds & Bees NZ Ltd
PO Box 34 406, Birkenhead, Auckland
Phone: (09) 480 1491
Fax: (09) 480 1451
Email:
Web: www.cbe.co.nz

PROOF that OBs are knowingly closing birth canals up to 30%...

According to the Merck Manual:

"When shoulder dystocia occurs...the mother's thighs are hyperflexed to
increase the diameter of the pelvic outlet..."
http://www.merck.com/mrkshared/mmanu...er253/253g.jsp

WHY are OBs and CNMwives (nurse midwives) waiting until the
head is
out and shoulders get stuck before giving the baby maximum pelvic outlet
diameter?

WHY are we letting OBs and CNMwives force babies' heads through birth canals
senselessly closed up to 30%?

OBs and CNMwives are SLICING vaginas (euphemism "routine episiotomy") -
surgically/FRAUDULENTLY inferring everything possible is being done to OPEN
birth canals - even as they CLOSE birth canals - up to 30%!

See Criminal medical CAM at Hawai'i's John A Burns School of
Medicine
http://health.groups.yahoo.com/group...t/message/2256

PREGNANT WOMEN: It is EASY for you to allow your birth canal to OPEN the
"extra" up
to 30%.
Just roll onto your side as you push your baby out - or deliver on
hands-and-knees, kneeling, standing, squatting, etc.

BEWARE though: Some MDs and MBs will let you "try" "alternative"
delivery positions but will move you back to dorsal or semisitting (close
your birth canal!) as you push your baby out!

Talk to your MD or MB about this TODAY. (For further details see the
"Criminal medical CAM" URL above.)

MDs/MBs: If you must push or pull - and sometimes you must - first get the
woman off her sacrum - off her back/butt.

My thanks to Bryna for mentioning Dr. Horkel's EPI-NO on the usenet
(misc.kids.pregnancy).

Thanks for reading, everyone.

Sincerely,

Todd

Dr. Gastaldo


This post will be archived for global access in the Google usenet archive.
Search http://groups.google.com for "Dr. Horkel's vagina stretcher (the
EPI-NO)"

Hee hee, I inspired a Gastaldo post -- this is a big moment in my newsgroup
career!

Be well,

Bryna
Mommy to Yosef, 3
& Temima, 1

DID NAOMI IGNORE "CRAZY" TODD?

See PS2

First this...

Bryna wrote:

"Hee hee, I inspired a Gastaldo post -- this is a big moment in my newsgroup
career! "
http://groups.google.com/groups?selm...&output=gplain

Bryna,

THANK YOU for your EPI-NO post!

You did indeed inspire me to write: "Dr. Horkel's vagina
stretcher (the EPI-NO)."
http://health.groups.yahoo.com/group...t/message/2504

(You are mentioned at the very end.)

Upon reading your humorous "Hee hee" and "big moment in my newsgroup career"
comments, it occurred to me that I did not inspire you to allow your birth
canal open the "extra" up to 30%...

I searched for and found little Yosef's birth story online (excerpt
below)...

Correct me if I am wrong Bryna, but it looks like your little Yosef was
vacuum extracted/pulled through a birth canal closed up to
30%. : (

MOST vacuum births are done with the mother on her back
or semisitting, closing her birth canal up to 30%. Same with shoulder
dystocia. OBs: If
you must pull - and sometimes you must - you do NOT have to keep the
mother's birth canal closed up to 30%.

Assuming you were on your back or semisitting, maybe you birthed Yosef
before you saw one of my posts?

Yosef's Apgars were 9/9 and he grabbed the doctor's pen (again, see the
excerpt below).

It sounds like he did fine.

Then again, an estimated 4.6% of "healthy" term neonates suffer unexplained
brain bleeds and pediatricians find unexplained motor and perceptual
deficits later in life.

KATE ELLIOTT, MD

Another misc.kids.pregnancy subscriber - a medical student - now an MD -
apologized to me in her birth story...

If she knowingly allowed her OB to close her birth canal, she apologized to
the wrong person.

But maybe I am wrong... Maybe she didn't birth on her back, closing her
birth canal up to 30%?

See Do-it-yourself C-section!
http://health.groups.yahoo.com/group...t/message/2462

Whenever I discuss the majority of births - with birth canal senselessly
closed - I usually always mention that like most of us I too was born
through a
birth canal senselessly closed up to 30%.

I also attempt humor, saying something like: Incredible as it may seem I
might have been more
intelligent! : )

All joking aside though...

Why *are* an estimated 4.6% of "healthy" term babies
suffering unexplained brain bleeds?

Why are some babies manifesting unexplained motor and
perceptual deficits later in life?

Why the unexplained DEATHS of babies at birth?

Australian obstetrician Norman Beischer, MD once guessed that 10 to 15% of
stillbirths
were just fine right before delivery.

Fortunately, most babies do fine - but maybe doing "fine" at birth is not
the best measure of future maximum human potential? (Those unexplained
brain bleeds in "healthy" term babies really bother me.)

Bryna, I'm hoping you simply did not see my posts until after Yosef's birth.
(Again, I'm assuming that your vacuum birth was done on your back - or
perhaps semisitting - closing your birth canal up to 30%. My sincerest
apologies if I am wrong - if you insisted on getting off your sacrum as the
OB vacuumed your baby out.)

I am writing this primarily because of your sister's upcoming birth...

You wrote:

"I think my sister's OB does lots of episiotomies, so I don't have
much hope for her avoiding one. Darn it, I *told* her to go with a
midwife!
Little sisters, they never listen. Thanks for responding."
http://groups.google.com/groups?selm...&output=gplain

Most episiotomies constitute obvious mass assault and battery against women.

OBs are slicing vaginas en masse - surgically/FRAUDULENTLY inferring they
are doing everything possible to OPEN birth canals - even as they CLOSE
birth canals - up to 30%.

As always, I am in favor of pardons in advance for MDs. MDs are just
academic prime cuts forced through this culture's most powerful mental meat

grinder - medical school.

Bryna, please make sure your sister knows that OBs are knowingly closing
birth canals - and that it is easy for her to OPEN her birth canal the
"extra" up to 30%.

Maybe your sister could read this post and/or the first post of mine that
you inspired?

See again: "Dr. Horkel's vagina stretcher (the EPI-NO)."
http://health.groups.yahoo.com/group...t/message/2504

Just a thought.

Thanks.

Sincerely,

Todd

Dr. Gastaldo


PS1 Here is that excerpt of little Yosef's birth story I mentioned above...

You wrote: "My doctor wasn't much help...his idea of encouragement was
'You can push harder! Come on!'"

If your doctor was indeed closing your birth canal up to 30% - he wasn't
much help at all - indeed he was hindering little Yosef's progress...


"Bryna729" wrote in message
...
Hee hee, I inspired a Gastaldo post -- this is a big moment in my
newsgroup
career!

Be well,

Bryna
Mommy to Yosef, 3
& Temima, 1

...I started pushing. The first few pushes weren't bad.
After an hour, I was getting pretty tired. Also a bit discouraged. But
still
hopeful that I would be a mother in another half an hour or so. Nope. I
tried
to visualize his head coming down the birth canal to inspire me, but after
a
while I didn't really believe that he was ever coming out and I began to
feel
really exhausted and hopeless. My doctor wasn't much help, since his idea
of
encouragement was "You can push harder! Come on!" It took three hours
of
pushing and a vacuum extraction to produce my son. I had hoped to avoid
an
episiotomy, but once we decided to go with the vacuum, an episiotomy
became a
must. By then, of course, I didn't care anymore. I just wanted this baby
OUT....
As the doctor handed him to the
nurse, my
mischievous newborn grabbed the pen out of the doctor's pocket and
wouldn't
give it back. It was so cute! His Apgars were 9/9.
http://groups.google.com/groups?selm...&output=gplain

END excerpt of little Yosef's birth story

Again Bryna, please make sure your sister knows that OBs are knowingly
closing birth canals - and that it is easy for her to OPEN her birth canal
the "extra" up to 30%.

Thanks for reading.

Sincerely,

Todd

Dr. Gastaldo


PS2 DID NAOMI IGNORE GASTALDO?

When Jamie Clark asked:

"Is Sheila the new Todd Gastaldo?"

Naomi Rivkis replied:

"No. Unlike Todd, Sheila has *admitted* that she's crazy."
http://groups.google.com/groups?hl=e...ts%404ax.co m

See Christina! What about the PELVIS?!
http://health.groups.yahoo.com/group...t/message/2303

I replied:

"OK, I'll admit I'm crazy - if it's crazy for a doctor of chiropractic to
persistently protest MDs senselessly closing birth canals and gruesomely
manipulating most babies' spines...This obvious spinal manipulation crime is
happening in MOST births!"
http://health.groups.yahoo.com/group...t/message/2304

Naomi replied:

"It's crazy for anybody to be that persistent about anything, Todd.
http://groups.google.com/groups?hl=e...2d%404ax.co m

NAOMI! SORRY TO BE PERSISTENT BUT...

It looks to me like an MD committed the obvious spinal manipulation crime
once again - and you and your baby were the victims. (Arrgghhh.)

It looks to me like your baby was violently pushed (oxytocin) and vacuum
extracted through - a birth canal senselessly closed up to 30%...

I'm HOPING that I am wrong...

I'm hoping that you were ACTUALLY squatting (see your text below) - actually
up OFF
your tailbone/sacrum - and not "sort of squatting"/semisitting directly ON
your tailbone/sacrum as the OB pulled your baby out by her scalp!

But I think I am right. : (

Excerpts of little Grace's birth story...

NAOMI GETS TO THE HOSPITAL

HAS "MANIA" PROBLEMS DUE TO PAIN

"MY BODY HAD JUST GONE WEIRD"

"There was almost no break by now in between very hard contractions, and I
was getting
mania problems from the trigger of pain. I literally, physically,
*couldn't* stay still. They finally put me in a rocking chair...I pushed the
rocking chair so
hard, trying to work off the manic energy that Manny had to stand
behind it and make sure I didn't tip it over...I didn't know gliders *could*
tip over...I couldn't slow down the rocking because of the
mania. Finally, somebody got across to the doctor on call from my
practice that I was a danger to myself and the baby if the mania was
not stopped. The doctor...ordered Ativan when it
became clear I wasn't just whining, I was careening off walls. The
Ativan helped with the mania; I asked for a half-dose of Stadol, which
was what I'd decided earlier would be my first fallback if I needed
pain medication...It took the edge off fairly well
and Ann and Manny helped me cope for a somewhat surreal few more
hours. Between the medications and the focus, I wasn't too aware of
time passing, especially since there was still no break between
contractions -- none at all, at this point. They just *stayed*.

"...They told me later that I was having transition-like
contractions from about 2cm on, and they didn't know why; my body had
just gone weird that way...

I COULDN'T CHANGE POSITION

"...changing position -- I couldn't change position; I never
had a moment when I wasn't hurting so much that movement was awful. So
I mostly stayed sitting on the edge of the bed...and then after a while
curled up in bed on my
side. Sometime in the middle of this my water broke on its own; I
wanted them to change the wet sheets but it took quite a while for me
to be able to face moving far enough that they could get the things
out from under me.

GRACE'S HEART RATE DROPPED NASTILY SO THE DOCTOR GAVE ME SOMETHING TO PAUSE
LABOR...

"After that things started getting scary. The doctor came in on a fast
call from a nurse who spotted Grace's heart rate dropping nastily.
They rolled me around into various positions, pain or no, to try and
rearrange her into someplace that would let it come back up, and
eventually it did...

GRACE GETS AN INTERNAL MONITOR^^^

^^^internal monitors used to be corkscrews that screwed into the baby's
scalp - anyone know if this is still the case?

"...[T]hey installed an internal monitor at that point. I
didn't object; I had mostly not wanted an internal monitor because I
wanted the ability to move around during labor. I clearly was not
interested in moving around at this point, and I was scared about the
heartrate. The doctor gave me something to pause labor for a while,
believing that the dipping heartrate, which was still in fluctuation,
was basically a result of the very hard continuous labor stressing her
out....

THE DOCTOR SAID IT WAS TIME TO START THINGS UP AGAIN...

"[T]he doctor said...it was time to start things up again. This was going to
take PITOCIN...If I was going to have pitocin-induced [contractions],
reputed to be tougher, I wanted an EPIDURAL...So they gave me the epidural
and the pitocin...The doctor...thought it was necessary to get Grace out
quickly. VACUUM was the least intrusive of the possibilities for that, so
she'd like to try that one first; other possibilities were foreceps or
Caesarean...I...said I'd accept the vacuum. Let's get this over with...
[emphasis added]

VACUUM DELIVERY

SORT OF SQUATTING OVER THE BED...

"ARCH YOUR TAILBONE BACK..."

"A lot of people gave me very specific instructions on positioning to push,
and it really helped. I don't just mean big things like which way around I
was -- basically vertical, sort of squatting over the bed with its back all
the way up to support mine -- but stuff like 'arch your tailbone back a
little more.' When I got it right I *knew* it; she started sliding very
perceptibly right away [presumably vacuum still attached to Grace's scalp,
doctor pulling - TDG], and came out in two more pushes through one
contraction...

[GASTALDO REMARKS: I like this "arch your tailbone back" advice **IF** it
was meant to get Naomi off her sacrum. The problem is - if the baby's head
slides into the outlet - and the mother let's herself down - she jams her
sacral tip sudden-like into her baby's skull. Naomi was leaning back
against the bed "with its back all the way up to support mine." If she
lifted off her sacrum, I hope she STAYED off it! I've noted before this
possible mechanism of "pingpong" skull fractures in relation to GOOD/BAD
McRoberts maneuver application before the baby's head is out. Most of them
likely pop out spontaneously.]

GRACE IS BORN NOT BREATHING ON HER OWN...

"Grace wasn't breathing on her own, and she spent her first several minutes
over on the other side of the room with the neonatologist and a few other
people working over her...The doctors thought [the baby not breathing] might
have been related to the Ativan I'd taken earlier for the mania...[O]r it
might have just been that she was exhausted by the exceptionally stressful
labor...

TOUCHING GRACE - REASSURANCE SHE IS NOW BREATHING...

"Manny came briefly in from the nursery to report that she was
breathing on her own now and the neonatologist said she was going to
be just fine, that she'd just been a bit worn out. They didn't want
her held or fed for 24 hours because she could use a while without
overstimulation, but we could visit her and touch her....We touched her and
petted her and I reassured myself that she
was breathing..She was born at 11:31 AM Monday the 23rd, about 16 hours
after
the very beginning of labor and 12 hours after I got to the hospital.
It probably would've been 5 hours shorter or so if they hadn't stopped
it in the middle because of the heart rate issues. I settled down to
sleep around 4:30 that afternoon."
http://groups.google.com/groups?selm...&output=gplain

"...It was a rough, though not long, labor, with a lot more in the way of
medical interventions than
I'd hoped for, but since they were actually necessary..."
http://groups.google.com/groups?selm...&output=gplain

One last note about Naomi's "Todd is crazy" sentiment...

Daye was glad to hear me admit I'm crazy - but - she added:

"I did learn about why you shouldn't
labor on your back. That was thanks to Todd."
http://groups.google.com/groups?selm...&output=gplain

I'M GLAD SOME ARE LEARNING!!

About four years ago, Naomi suggested I am not interested in the
welfare of babies...

See 'Nice' doesn't work/RivkisClark mistaken/Gastaldo to 'chill' on valium?
http://health.groups.yahoo.com/group...st/message/689

My sincerest apologies to Naomi if she ended up closing her birth canal
because my style of presentation kept her from grokking my message.

Allowing the birth canal won't solve all birth problems...

But with OBs themselves indicating that closing the birth canal FAR LESS
than 30% can KILL...

I think 100% of babies would agree: Do NOT let the OB close the birth canal
up to 30%!

I *am* interested in the welfare of babies.

I am SO relieved that the neonatologists and staff were able to get Naomi's
little
Grace breathing again!

Thanks for reading everyone.

Sincerely,

"Crazy" Todd

Dr. Gastaldo


PS Neonatologists successfully resuscitating little Grace reminds me...

"10 percent [of babies]...more than four hundred thousand babies a
year...find out the hard way that some hospitals boasting state-of-the-art
facilities for delivering babies are not so good at handling them once
they've been born."
--Edward Humes in Baby ER (p. 13)

"Many hospitals market their luxurious birth suites...neglecting to mention
that they have little to offer the one out of ten babies who ends up needing
an NICU. Those children will have to waste precious minutes or hours being
transported [to a tertiary care facility] by ambulance...bumping through
traffic instead of receiving lifesaving care right where they were
born...[M]any small patients arrive...[in tertiary care facility
NICUs]...via ambulance from other hospitals...their parents pale and
terrified in the car behind them, unable to comprehend...why they made the
mistake of starting out at the wrong hospital in the first place..."
[Humes E. Baby ER: The Heroic Doctors and Nurses Who Perform Medicine's
Tiniest Miracles. NY: Simon & Schuster. 2000:12-13]