Having read Ellice Lieberman's work at some length now, I'm still convinced of her goddess status - a midwife in doctor's clothing? Probably not, medical intervention is acknowledged by her to be overused, but there is still an acceptance of it in places that wouldn't follow a true midwifery model.

But that's okay, it gives her "street cred" - in that as an MD, she can pass off info that a midwife could not, unfortunately.

But I haven't heard back from her yet. I did follow up my first e-mail with a "just in case the first try went to your SPAM folder" addendum.

So there's the Guru update. Now for The Gunk, aka what I see as sloppy research.

I'm reading an article about clavicular fracture in "normal" labor and delivery. To the authors, it appears (thought it was not clearly defined) that that means "vaginal".

Over 12 years, and out of over 27 thousand births, they had 403 infants "diagnosed" with clavicular fractures. Of those, they only used 87! They excluded infants who were not occiput anterior (now, I would think that malpositioning would be a risk factor for clavicle fractures), and who did not have a fetal weight estimate done on sonogram (so the expectation of "big baby" was already set up - my guess is that the management of that labor would be less than "normal").

Additionally, their diagnostic criteria for clavicular fracture included:

• asymmetry of the clavicles
• absence of the supraclavicular notch
• local edema or hematoma
• crepitations (a soft crackling sound/feeling) upon palpation
• local tenderness (did the baby cry upon exam)

And they specifically add that Xray films were not a part of their diagnosis unless brachial plexus injury was suspected.

Findings include significant relationships between clavicular fractures and maternal height, duration of second stage of labor, fetal weight estimation (but not actual birth weight, weird, no?), and birth length. None of this makes intuitive sense to me.

In the end, they acknowledge no way to accurately predict clavicular fracture risk, and that it is a very small risk.

Could be interesting to follow up some day, though, take a look at variables that were intentionally eliminated here.

Reference:
Kaplan, B, Rabinerson, D, Avrech, O.M., Carmi, N., Steinberg, D.M., & Merlob, P. (1998). Fracture of the clavicle in the newborn following normal labor and delivery. International Journal of Gynecology & Obstetrics, 63, 15-20.