PowerPoint Presentation

WARNING PREGNANT WOMENSeat Belts Can Kill Your Baby

Written and Narrated By Jim HofferberthFormer Director, National Highway Traffic Safety AdministrationRetired Director, Vehicle Research & Test Center, NHTSA1Hi. My name is Jim Hofferberth

40 years ago, I was working for the National Highway Traffic Safety Administration, usually called NHTSA. My office was responsible for developing many of the safety standards for cars, including the standards for restraint systems. At that time we knew that seat belts would not work for small children. Thats why we issued the special standards for infant and child restraints. We also knew that seat belts were dangerous for the unborn babies of pregnant women, but there was a major effort to get more people to use the seat belts, and it was decided that publicizing the risks to unborn children of seat belts would cause more people to reject the belts, and possibly prevent the states from adopting seat belt usage laws.

I reluctantly went along with this scheme with the understanding that if seat belt usage increased significantly, the problem of the unborn babies would be dealt with. Understand that we knew how to protect these babies. It was simply a matter of the government having decided that increasing belt usage was more important. In those days very few people used the belts, and pregnant moms didnt drive as much as they do today.

Now, 40 years later, set belt usage has reached over 80%, but NHTSA has still not done anything about protecting the unborn children of pregnant women. What they have done is mislead pregnant women, and almost everyone else, by telling them that if the lap belt is worn low, or under the belly, both the mother and her baby will be protected.

Im going to show you the data that proves that statement to be absolutely false.

Injuries During PregnancyTracking & Understandingthe Hidden EpidemicHank Weiss PhD, Associate ProfessorCenter for Injury Research and ControlUniversity of PittsburghAMCHP 2005 Conference

2Several years ago, Hank Weiss at the Center for Injury Research and Control at the University of Pittsburg did a study of the accident data regarding fetal injury and death in car crashes. In most cases, fetal death is not even recorded in the official records, but Hank and his team were able to study the individual case records in several of the states.The unborn child of a pregnant woman is

5 Times More Likely To Be Injured Or Killed

in a crash than another infant or childriding in the same car.

He determined that the when a pregnant woman is driving or riding in a car, her unborn baby is 5 times more likely to be injured or killed in a crash than another infant or child riding in the same car.3Risk of Fetal DeathWith Lap & Shoulder Belt16 mph26%22 mph51%28 mph76%34 mph90%Research Projections based on Computer Modeling

4In face he found that the fetus of a pregnant woman is at high risk even in low speed crashes.

At 16 MPH, 1 in 4 fetuses will be killed, and in a 30 MPH crash, fetal death is the expected outcome.Clinical Studies Have Shown Thatthe lap belt has been implicated in causing specific trauma to the placenta and fetus in relatively minor vehicular accidents.

And

the tightened lap belt can cause direct injury to the fetus without severely injuring the pregnant woman.

[Crosby, W. M. and Costiloe, J. P. (1971). Safety of lapbelt restraint for pregnant victims of automobile collisions. New England Journal of Medicine, 284, 632], [Klinich, K.D., Schneider, L.W., Moore, J.L., and Pearlman, M.D. (1998). Injuries to pregnant occupants in automotive crashes. In 16'* ESV Conference Proceedings. Washington, DC: National Highway Traffic Safety Administration, 98-SP-P- 17,2046-2056

[Griffiths, M., Hillman, G., and Usherwood, M. M. (1991). Seat belt injury in pregnancy resulting in fetal death. A need for education? Case reports. British Journal of Obstetrics and Gynaecology, 98,420-321]

These findings have been confirmed in clinical studies that have shown that the lap belt has been, implicated in causing specific trauma to the placenta and fetus in relatively minor vehicular accidents.

And, the tightened lap belt can cause direct injury to the fetus without severely injuring the pregnant woman.5

6The net result is that car crashes are the leading cause of traumatic fetal death. 82% of all traumatic fetal deaths are caused by motor vehicle crashes.

To help understand why this is happening, we only need to look at the anatomy of the pregnant woman.

This a picture ofa 16 week pregnancy. The swollen uterus is clearly visible in the pelvic cradle. At this point in the pregnancy, the babys head is usually up, and the front of the uterus has expanded outward beyond the front of the pelvis iliac as shown in the next slide.7

Here is a side view of the seated pregnant Mom.8

The fundus is at the very top of the uterus,9

And the placenta is usually located in the fundus. Its just above the top of the moms legs.10

The lap belt sits on top of the moms legs, in a direct lime with the fundus and placenta. The intended path of the lap belt in a severe crash penetrates directly into the moms belly toward the pelvis iliac crests, right through the fundus and placenta.

Please not that this is the belt possible location for the belt. If it is either higher or lower, it will penetrate even farther back into the baby. This is the lap belt at its best.11. ...the seat belt should not be placed over the fundus,Placental Abruption Is The Most Frequently Cited Cause Of Fetal Death

Is it any wonder that placental injury is the most frequently cited cause of traumatic fetal death? Over 40 years ago the first researchers to study this problem reported that, the belt should not be worn over the fundus. During much of the 2nd trimester, the Mom cant avoid wearing to belt directly over the fundus

12

IliacCrests2 Inches

Later in the pregnancy, the lap belt is directly in front of the babys body at varying levels as the baby grows. The belt is intended to be lined up with the pelvic iliac crests as shown, and in a crash it is intended that the belt will penetrate straight back and engage the iliac crests. There is only about 2 inches between the iliac crests and the spine. Now watch what happens in a 30 MPH frontal crash.13

In the next slide we can see both the original and the deformed shape of the abdomen superimposed.23

Now lets slow things down even more so we can compare the original shape of the belly with what happens in a crash.24

As the crash starts, everything is in the normal position.25

As the Mom starts to slide forward on the seat, the belt pulls tight and starts to penetrate.26

Now we can see the penetration of the belly compared with the undeformed state.27

As the crash progresses, the upper part of the abdomen starts distending forward. This is caused by both the penetration of the belt and the crash accelerations that build up as the mom tries to keep moving forward as the car stops. 28

Note that at this point the upper portion of the abdomen is distending much farther forward than portion below the belt. This is because the legs are preventing the belly going under the belt, and the uterus and baby are squeezing out over the top.29

31

At this point the acceleration is increasing rapidly, and the pressure in the lower abdomen start to separate the legs and pushes farther forward.32

33

As the belt finally reaches the iliac crests, the pelvis is forced to an immediate stop. At this point the force of the lap belt is on the order of 2000 pounds, and the deceleration loads on the abdomen are extreme.

Its impossible to know exactly what happens to the baby, but its not good.34

35Lest there be any doubt about the authenticity of these animations, here is the image of an actual third trimester pregnancy with the legs and belt positions added. During the 2nd and 3rd trimesters, there is no way the mother can prevent the lap belt from crushing.Pregnant women not wearing a seatbelt 3times more likely to experience fetal deathHyde et al (ObGyn, 2003): Effect of motor vehicle crashes on birth & fetal outcomes in Utah

36NHTSA says that the chances of fetal death are reduced by 3 to 1 if the mom wears the belts, but thats because the belt is keeping the mom alive. It is not because the belts are protecting the baby.

At the end of the day, pregnant women must wear the seat belts because its required by law, and because the mother is safer, which in turn makes the baby somewhat safer. But the baby is still at extreme risk of injury or death caused by the belts.

This leaves the Mom with only two choices

1.Stay out of the car altogether, or

2. Put their new baby at extreme risk of injury or death.

Umpire Pad (US 349589) ?

Crotch Strap (US5005865)INADEQUATE

Crotch Strap #1www.tummyshield.comINADEQUATE

PiXie Pregnancy Harnesswww.pregnancyseatbeltharness.com, INADEQUATE

Partial Shell (US 4610463)DANGEROUS

Partial Shell (US 5213366-2)DANGEROUS

Gravida Protection (JP, H-40060, U)DANGEROUS

Full Shell (US 8070184 B2)www.jimhof.comNOTAVAILABLEThe Technology Exists To Fix This Problem

We have known how to solve this problem for a long time. Many people have designed restraint systems for pregnant women. Most of these devices are inadequate, and some of them are downright dangers to both the Mom and her baby, and there is no safety standard to separate the good from the bad.

The best ones are not available in the United States because in the absence of a Federal Standard, the cost of product liability protection for a device like this is prohibitive.37In the early 1970, research showed that:

The high rate of fetal and placental injury in this study indicates that additional restraint may necessary to reduce the snubbing action of the lap belt.

*(1972). Effects of Lap Belt and Three Point Restraints on Pregnant Baboons Subjected to Deceleration. Fifteenth Stapp Crash Conference Proceedings, SAE #710850, 68-83.]* [Crosby, Snyder, Snow, Hanson, (1968) Impact Studies in Pregnancy, Experimental Studies, Civil Aeromedica Inst. Oklahoma City Okla.]

NHTSA has been aware of his problem for over 40 years, and they have still not done anything to help pregnant women keep their babies safe. Instead they falsely tell them that if they wear the lap belt low, or under the belly, both the mom and baby will be protected.

As we have seen, that is absolutely not true.38There Is No Excuse For

NHTSAS FAILURE

to correct this situation

There is no excuse for NHTSAs failure to correct this problem, and I am petitioning them to do something about it.39I Am Demanding That NHTSA Issue A

Federal Motor Vehicle Safety StandardOn Restraints For Pregnant Women

Properly Advise Pregnant Women About The Risks Of Driving Or Riding In A Car When They Are Pregnant, And

Assure That Only Safe And Effective Systems Are Offered For Sale In The United States.

I am demanding that NHTSA to do two things. 1. Provide correct information to pregnant women regarding the risks of riding in a car when they are pregnant.2. Establish a Federal Safety Standard for restraints for pregnant women, similar to the standards for infant and child restraints.

This does not include a mandatory use requirement for these devices. It will simply give pregnant moms the information they need to know which devices will protect their babies. Its their choice to use it or not.

40Please Help Submit Your Petition For Rulemaking To:Mr. David L. Strickland, AdministratorNational Highway Traffic Safety Administration1200 New Jersey Avenue, SEWest BuildingWashington, DC 20590

Label It Petition For RulemakingUse USPS (Snail Mail)

www.jimhof.comAs we all know, getting the people in Washington to actually do something is very difficult. Im asking for your help in prodding NHTSA into action.

Im asking you to submit a supporting petition directly to David Strickland, the Administrator of NHTSA. He has the authority and responsibility to make this happen.

Unlike a suggestion, or request, which NHTSA can summarily ignore, Mr. Strickland must acknowledge you petition, and give you a substantive response within 120 days of your submittal.

Your petition should be sent directly to the Administrator, Mr. David Stricklane, in regular, USPS (SNAIL) mail at this address. It should be clearly labeled, Petition For Rulemaking.

Downloadable petition forms are available at www.jimhof.com along with much more information.

And please share this information with everyone you know who cares enough to help keep these babies alive. Dont forget the MDs you know, especially ObGyns, and send copies to your senators and congressmen as well.

Thank you for listening.41

Traumatic Fetal DeathsBy MechanismSelected States, 1995-1997
Weiss et al , JAMA, 2001, October 17;286(15):1862-1868

Hank Weiss, Center for Injury Research & Control

This study, the first summarizing traumatic fetal mortality on a multi-state basis, showed that motor vehicle crashes accounted for 80% of the known listed causes of traumatic fetal death.