In regards to Mr. Levine's comments.
I am repeating information gleaned from numerous experts in the BPI field, including from expert witnesses that Mr. Levine has himself employed. Keep in mind that it is not in Mr. Levine's financial interests to see a complete end to birth injury. Or, for that matter, any other lawyer for birth injury plaintiffs or even surgeons who make their living treating the results of birth injury. Picking away around the edges of the problem with malpractice suits, and blaming individual doctors without any change in the overall system of birthing only leads doctors to increasingly rely on C-sections as legal "self-defense" measures. It doesn't address the problem, which is that babies are getting larger, they will continue to get stuck, they will sometimes need assistance to be birthed safely... and America's doctors are increasingly losing the ability to help safely without directly causing or increasing the risk of injury.
There are numerous explanations for why some babies are more "robust" to externally applied forces than others. Some such explanations relate to pre-positioning in the womb. There are probably others. I don't point them out to somehow remove "blame" on the doctors but to point out that the solution to eliminating BPIs must proactively apply to ALL deliveries. You just cannot know which babies can "handle it" and which can't. The safest route is to assume that every child is at risk for externally applied traction and use methods which do not increase the forces applied to the child. To do that, doctors need to learn manuevers that do not increase the risk of traction on the plexus and get stuck babies out safely.
One such method is direct rotation of the baby in the birth canal. Mr. Levine is being very disingenuous by picking on my use of the terms "manual" and "rotation" because both these manuevers - Rubin's and Wood's corkscrew - are more than adequately described in this way. What else would you call a manuever where the baby's shoulder is partially rotated in the birth canal by the external application of force, Mr. Levine? I frankly cannot think of a better way to describe it without going into great detail. Perhaps it is my failing that I am not well versed in other obstetrical terms and the term "Manual Rotation" has another well-known meaning to OB/GYNs. That is possible, but I'm not talking to OB/GYNs here, and for me, "manual" and "rotation" seem to describe these manuevers pretty clearly.
Here is a good interview where studies of various direct fetal manipulations are described:
http://doctor.medscape.com/viewarticle/496721
"The particular fetal maneuver studied was a slight, 30-degree ROTATION of the fetal shoulders from their pathological anteroposterior orientation within the pelvis to the more physiologic oblique orientation. This maneuver is known as Rubin's maneuver and can be PERFORMED BY ROTATING the shoulders to either oblique diameter of the pelvis. We distinguished the two options as anterior Rubin's, in which the shoulders were rotated so that the fetus is oriented with its spine anteriorly, relative to the mother, and posterior Rubin's, in which the shoulders are rotated to the opposite oblique diameter with the fetal spine oriented posteriorly." [CAPS added]
To address whether or not a BPI could be caused solely by natural forces. I believe it can, and I've seen a video that proves it to me. However, I believe that MOST brachial plexus injuries, and especially severe ones, are either caused or their severity was dramatically increased by inappropriate traction applied by doctors. But I've also seen and heard enough to know that children obviously vary tremendously in how susceptible to injury they are. Some children can withstand considerable pulling without injury, some have injuries that seem completely incongruent with the amount of force applied.
The notion that one side of the neck can be fore-shortened due to intrauterine positioning, large infant or low amniotic fluid is not nonsense... it is an accepted possible cause of congenital torticollis. This type of torticollis results from the sterno-cleido-mastoid muscle getting torn during delivery. Basically, the muscle becomes shortened because of positioning prior to birth and when stretched during the "natural" birthing process, can be torn. If natural birthing forces can routinely tear muscles in the neck, due to this kind of fore-shortening, I personally do not think it nonsense at all to expect that such a phenomenon might also contribute to increased risk for BPI. There is also the fact that this type of torticollis and BPI are very highly correlated.
Kate