EBB 117 – The Evidence on Inducing for Due Dates – Evidence Based Birth®

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Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing labor for going past your due date.

Welcome to the Evidence Based Birth podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing versus waiting for labor when you’re going past your due date. I’m going to be joined by Anna Bertone, MPH, our Research Editor at Evidence Based Birth to talk about this topic.

Before we get started, I have a quick announcement, and that is next week we are hosting free webinars for the public all about the Evidence Based Birth Childbirth Class. On Monday, March 2, we’ll host a special webinar just for parents. We’ll give you a peek behind the scenes at what it’s like to take our Evidence Based Birth Childbirth Class. Then on Tuesday, March 3, we’ll have a special webinar just for birth professionals to give you a tour of the Evidence Based Birth Childbirth Class so that you can decide if it’s something you’d like to recommend to your clients or not. You can register for these free webinars at evidencebasedbirth.com/childbirthclasswebinar. That’s all one word /childbirthclasswebinar.

All right, now back to the topic at hand, inducing labor for going past your due dates. Now before we begin, I do want to give a brief trigger warning. In our discussion about the research evidence on this topic, we will be talking about stillbirth and newborn death. So there has been a ton of new research on the evidence on induction versus waiting for labor when you go past your due date. So much research, in fact, that we have decided to separate our Signature Article on due dates into two separate articles.

So we still have the original article, The Evidence on Due Dates, which you can find at ebbirth.com/duedates. And although we updated that article a little bit, it’s remained very similar to previous additions. It talks about the length of a normal pregnancy, factors that can make you more or less likely to have a long pregnancy, et cetera. But then we separated out the research on induction into a new article that you can find at ebbirth.com/inducingduedates. This is a peer-reviewed article that covers all of the research on induction versus something called “expectant management” for going past your due date. And in today’s podcast, we’re going to update you on the latest info that we found for that article.

Just a heads up, we will not be covering the research evidence on inducing at 39 weeks. We already covered the ARRIVE study, a randomized trial that looked at induction versus expectant management for 39 weeks of pregnancy in episode 10 of the Evidence Based Birth podcasts. And just a tip, if you’re having trouble finding any of our earlier episodes of this podcast, iTunes has stopped showing the earliest podcasts, but they’re still out there and you can find them on Spotify and any other podcasting app. You can also find info about the ARRIVE study at ebbirth.com/arrive.

So we’re not going to talk about induction at 39 weeks. Instead, we’re going to be focusing on the evidence on induction versus waiting for labor once you reach 41 weeks. And to do so, we’re going to talk with our Research Editor, Anna. So welcome, Anna, to the Evidence Based Birth podcasts.

Anna Bertone:   Thank you! I’m glad to be on the podcast again.

So I want to start by explaining to our audience a little bit kind of about the background of why this topic is important. Inductions for non-medical reasons have been on the rise in the United States and all around the world for the past 30 years. And increasingly, more people who are pregnant are being induced for reaching their estimated due date. So we really want to cover the benefits and risks of elective induction for going past your estimated due date. And we’ll also talk about whether or not your goals and preferences for your birth matter, which of course they do, but that kind of plays a role as well.

So how often are people induced for going past their due date? Well, we don’t know for sure because this hasn’t been measured recently. But according to the 2013 Listening to Mothers III survey, which was now published about seven years ago, more than 4 out of 10 mothers in the U.S. said that their care provider tried to induce labor. Inducing labor for going past your due date was one of the most common reasons for an induction. Out of everyone who had an induction in this study, 44% said they were induced because their baby was full term and it was close to the due date. Another 18% said that they were induced because the healthcare provider was concerned that the mother was overdue.

The Centers for Disease Control in the U.S. also reported in 2018 that about 27% of people had their labor induced, but we think that number is probably low and that the percentage of people who have labor induced is under-reported in the Vital Statistics Program in the United States. So Anna, can you talk a little bit about why there’s so much controversy over this concept of electively inducing labor once you go past your due date?

Anna Bertone:   So why is there so much controversy about elective induction? Elective inductions by definition are labor inductions that do not have a clear medical reason for taking place. They occur for social reasons, like the provider wanting the mother to give birth before the provider goes out of town or for other non-medical reasons like the pregnancy getting uncomfortable and for the mother’s convenience. But there’s also a gray zone about what constitutes an elective induction. Many providers only consider an induction to be “elective” when the mother is healthy, pregnant with a single baby, and less than 41 weeks pregnant. The gray zone is that sometimes when the pregnancy goes past 41 weeks, some providers consider that to be a medically indicated induction rather than an elective induction. But in general, inductions are considered medically indicated when there are accepted medical problems or complications with the pregnancy that make it less safe to continue the pregnancy.

For many years, and I remember when I first entered the birth world in 2012, a lot of people talked about the fact that if you have an induction it doubles your chance of cesarean. And then all of a sudden there were people saying that wasn’t true. So can you talk a little bit about that controversy?

Anna Bertone:   So for many years, the common belief was that elective induction doubles the cesarean rate, especially in first-time mothers. But researchers nowadays consider those earlier studies to be flawed. In the earlier studies, what they would do is they would compare people assigned to elective induction to people who went into spontaneous labor. Nowadays, they don’t compare those two groups anymore. They compare people assigned to elective induction to the people assigned to what’s called expectant management, or in other words waiting for labor. And in that group, the person could either go into spontaneous labor or they could require an induction for medical reasons (so that would be a medically indicated induction), or they could choose elective induction further along in the pregnancy.

So that’s a subtle difference but an important one because in the earlier studies they compared elective induction to spontaneous labor. But you don’t have the choice to go into spontaneous labor today. Your choice is to be induced today or to wait for labor to start. And sometimes during that waiting period you might develop complications that require an induction, or you might change your mind and decide to have an elective induction, or you might go into spontaneous labor.

Anna Bertone:   Right. So nowadays, we compare a group assigned to elective induction to a group assigned to expectant management. One example of this was the ARRIVE trial.

The ARRIVE trial was a study comparing elective induction at 39 weeks versus expectant management. We’re not going to go into that trial in detail because we already covered it in detail in episode 10 of the Evidence Based Birth podcasts. But they actually found a lower risk of cesarean in the elective induction group. Researchers think that had to do with the fact that of the people in the expectant management group, more of them developed problems with blood pressure that required medical inductions and increased risk for complications. So again, that just kind of goes to show you that it does make a difference when you compare elective induction to expectant management.

Although, one thing you have to keep in mind with the ARRIVE study is that they had a very low cesarean rate in both groups compared to some settings. The cesarean rate was 19% in the elective induction group versus 22% in the expectant management group. So those research results cannot probably be generalized to settings with extremely high cesarean rates or high cesarean rates with inductions. We have some, for example, some professional members at Evidence Based Birth who talked to us about where they’re practicing and how high the cesarean rates are with the elective inductions there. So I think you have to be careful how you generalize or apply that data from the ARRIVE study, and we talk more about that in episode 10 of the podcast.

Which leads me to another point, and that is some cautions about the evidence. When I say generalize, that means taking research from a research study, and seeing if you can apply that to where people are giving birth in your community. So it’s important to understand that there are some major drawbacks to some of the research that we’re going to be talking about. Many of the studies are carried out in countries or time periods where there are low cesarean rates. So when that happens, when a study is carried out in a setting where culturally there’s low C-section rates, that might not apply to a hospital with high cesarean rates. If your hospital has high rates of “failed inductions” and strict time limits on the length of labor, then the evidence in these studies may not apply to you because induction might be more risky in your community hospital.

Also, another disclaimer about the evidence, in these trials, people are randomly assigned to induction or expectant management. And it’s important to remember that the people assigned to expectant management do not always go into labor spontaneously. There’s a mix of people in that group. Some of them do have a spontaneous labor. Others have an elective induction later on, and others have a medical induction for complications.

Also, you have to look at what they’re doing for fetal testing in the studies. In some studies there’s lots of fetal testing going on in the expectant management group. However, we’re going to talk about one of the studies where they were not doing any standard fetal monitoring during expected management. So those results might not apply to your community if your community does the fetal monitoring, and the study did not have fetal monitoring.

Finally, another disclaimer about the research evidence is that the induction protocols vary from study to study, and even within studies themselves. So knowing what the protocol was for induction in that study can be very helpful to decide if this is going to apply to your unique situation in your local community or not.

So with all of those disclaimers being said, there’s been quite a lot of new research in the past year about induction at 41 weeks. So Anna, can you talk about one of the most recent studies? Let’s talk about the INDEX trial from the Netherlands. There were two trials that came out in 2019, two large randomized control trials. Let’s talk about the INDEX one first.

Anna Bertone:   Sure. So the INDEX trial was from the Netherlands. INDEX stands for induction at 41 weeks, expectant management until 42 weeks. This was a large multicenter trial. It was conducted at 123 midwifery practices and 45 hospitals. Most of these pregnancies were managed by midwives.

…So this was the midwifery-led model of care-

Anna Bertone:   Exactly.

… which is very different than in the United States which is typically an obstetrician-led care model.

Anna Bertone:   The researchers randomly assigned a total of 1,801 pregnant people to either induction at 41 weeks and zero to one days or to wait for labor until 42 weeks and zero days, which is called expectant management. The reason they were able to conduct this study in the Netherlands and got ethical approval for it is because it was standard practice for them to not induce labor before 42 weeks with an uncomplicated pregnancy.

…Whereas in the U.S. it’s rare to see someone go to 42 weeks, in the Netherlands, they typically won’t induce you unless there’s medical reasons until you get to 42 weeks – 

Anna Bertone:   Exactly. So the mothers were enrolled in the study between 2012 and 2016. Everyone had to be healthy, and pregnant with single, head-down babies. The gestational ages were estimated with ultrasound before 16 weeks of pregnancy. They excluded people with a prior cesarean, with high blood pressure disorders, with expected problems with the baby’s growth, abnormal fetal heart rate, or known fetal malformations (congenital anomalies). In both groups, cervical ripening and induction methods depended on local protocol. It’s like what Rebecca was talking about earlier. There wasn’t a standard protocol to apply to both groups in this study when it came to cervical ripening and induction. It was based on local protocol. And this is an important weakness of the study because the providers might’ve managed labor inductions differently based on whether someone was being electively induced or was assigned to the expectant management group. It also limits the study’s generalizability, which means our ability to apply the results of this study to the population at large because providers don’t have an induction protocol that they can replicate.

…So we can learn from what happened in this study, but it’s difficult for us to apply it to across the board because there’s no specific induction protocol that could be followed – 

Anna Bertone:   Yeah. What happened was in the elective induction group, 29% of the participants went into labor before their induction and 71% were induced. Then in the expectant management group, 74% of the participants went into labor spontaneously before their planned induction and 26% were induced.

…And before we talk about how long the pregnancies were, I think it’s important for people to understand that when you have a randomized controlled trial like this the researchers do something called intent to treat analysis. So it doesn’t matter what type of birth they had, whether it was a spontaneous labor or a medical induction, the data were analyzed depending on which group you were originally assigned to. So if you were assigned to an elective induction but you happen to just quick go into labor on your own before the induction, you were still grouped with everyone in the elective induction group and vice versa. So that’s just an important distinction for people to understand. – 

Anna Bertone:   Yes. What happened with these results is that the median pregnancy was only two days shorter in the elective induction group compared to the expectant management group. This is interesting because they still found a difference between these two groups, but-

…And this is important because a lot of people ask us like, “Well, I only want to wait one more day, or two more days, or three or four more days,” but they’re saying by decreasing the length of the pregnancy by two days they found significant results. So what did they find in the INDEX trial? – 

Anna Bertone:   So for mothers, they found that there was no difference in the cesarean rates. This was taking place in a country with low cesarean rates. It was a midwifery model of care and the rates were very low in both groups (11%). 

They only had an 11% cesarean rate then?

Anna Bertone:   Yeah. They also had an outcome called a composite outcome, which is a combined outcome for mothers, and there was no difference in that measure either. They were looking for things like excessive bleeding after birth, manual removal of the placenta, severe tears, intensive care admission, and maternal death, and they didn’t find a difference in those things. There were no maternal deaths in either group. So as far as the bad outcomes for the mothers, there were about 11% to 14% in both groups, but not different.

…And what about for the babies then? – 

Anna Bertone:   And then for the babies, the babies in the elective induction group had a lower composite outcome rate. And in this composite outcome, what they were looking at was perinatal death, Apgar score less than seven at five minutes, low pH, meconium aspiration syndrome, nerve injury, brain bleeds, or admission to a NICU. And here they found a lower composite adverse outcome rate with the babies in the elective induction group (1.7% versus 3.1%). 

And why do they think that outcome was better with the elective induction group?

Anna Bertone:   They think that it was mostly due to the lower rate of Apgar scores less than seven at five minutes, and that probably contributed the most to having a lower adverse outcome rate with the babies in the elective induction group. The author’s note that there was no difference in rates of Apgar score less than four at five minutes, but they found that the combined outcome was still lower in the elective induction group if they used an Apgar score of less than four at five minutes and excluded fetal malformations. So basically, the babies in the elective induction group had better Apgar scores overall.

…And what about stillbirths? Because that’s like the main reason they’re doing these kinds of elective inductions, is to lower the risk of stillbirth. – 

Anna Bertone:   Yep. And they did not find a difference in stillbirth in this study. There was one stillbirth that occurred in the elective induction group. It was at 40 weeks and six days, before the mother was induced. Then, there were two stillbirths that occurred in the expectant management group while the mothers were waiting for labor.

Anna Bertone:   I looked for a few more details about those stillbirths because I was interested in that. Of the two stillbirths that occurred in the expectant management group, one was a small for gestational age baby at 41 weeks and three days to a first-time mother. The other one was to a mother with a prior birth, and that was at 41 weeks and four days. The mother’s placenta showed signs of infection (infection of the membranes). Then, the one stillbirth that occurred at in the elective induction group at 41 weeks was to an experienced mother (someone who had already had given birth before), and that was at 40 weeks and six days, and there was no explanation for that one. But with two versus one, they didn’t find a significant differences in stillbirths between those groups.

And what was the protocol for fetal monitoring in that study?

Anna Bertone:   There was no protocol for fetal monitoring. It depended on local guidelines, just like the induction and cervical ripening protocol. But the study authors say that fetal monitoring and assessment of amniotic fluid levels was typically done between 41 and 42 weeks. 

So how would you sum up the results of this INDEX study then?

Anna Bertone:   They found that elective induction at 41 weeks resulted in similar cesarean rates and less overall bad outcomes for babies compared to waiting for labor until 42 weeks. However, they say that the absolute risk of a bad outcome happening was low in both groups. It was 1.7% in the elective induction group versus 3.1% in the expectant management group (the group that waited until 42 weeks).

All right. Well, the next study we wanted to talk about was the SWEPIS trial from Sweden, also published in 2019, also coming out of Europe. It’s S-W-E-P-I-S, and it stands for the Swedish post-term induction study, or SWEPIS. It got a lot of media attention with headlines like … There was one that said, “Post-term pregnancy research canceled after six babies died.” And it is true that this study was ended early after deaths in the study. The researchers intended to enroll 10,000 mothers from multiple centers across Sweden, but they ended up stopping the study with about 1,380 people in each group after their data safety and monitoring board found a significant difference in perinatal death between the groups.

Data safety and monitoring boards are basically a board that keeps track of what’s going on in the study. They get interim reports. And if they see any concerning safety issues, they have the power to stop the studies. That’s a standard part of a lot of randomized controlled trials is to have one of these safety boards.

Similar to the INDEX trial in the Netherlands, in Sweden, labor is typically not induced before 42 weeks if you have an uncomplicated pregnancy. Also similar to the Netherlands, in Sweden, midwives manage most of the pregnancies and births. It’s a midwifery-led model of care.

The purpose of the SWEPIS study was to compare elective induction at 41 weeks and zero to two days versus expectant management and induction at 42 weeks and zero to one day if the mother hadn’t gone into labor by that point. The study was carried out in the years 2015 to 2018. The researchers enrolled healthy mothers with single babies in head-first position. They had accurate gestational ages. They excluded people with a prior cesarean, diabetes, and other complications such as high blood pressure, small for gestational age, or known fetal malformations.

There is a pretty low stillbirth rate in Sweden, so they thought they would need about 10,000 people to see a difference between groups, but they ended up not needing nearly that many people to find a difference in stillbirth rates. One of the big strengths of the SWEPIS trial is that in contrast to the INDEX trial, in the SWEPIS trial they defined an induction protocol and they used that same protocol with everyone in the elective induction group and everyone in the expected management group who had an induction. The protocol was basically if the mother’s cervix was already ripe, they simply broke her water and gave her oxytocin as needed by IV. If the mother’s cervix was not ripe or the baby’s head was not engaged, they used mechanical methods or Misoprostol, or prostaglandins, or oxytocin, but they did cervical ripening first.

In the elective induction group, most of the people were induced. 86% had their labor induced. 14% went into labor spontaneously before the induction. In the expectant management group, 67% of them went into labor spontaneously and 33% ended up with an induction. Similar to the INDEX trial, there was a really tiny difference in the length of pregnancy between groups. Pregnancy in the elective induction group was in general only three days shorter than pregnancy in the expectant management group, but yet they did go on to find significant differences.

So what the SWEPIS trial found was that for babies – this is why this study was stopped early – there were five stillbirths and one early newborn deaths in the expectant management group out of 1,379 participants for a death rate of 4.4 deaths per 1,000 women. There were zero deaths in the elective induction group out of 1,381 participants. All five stillbirths in the expectant management group happened between 41 weeks, two days and 41 weeks, six days. Three of the stillbirths had no known explanation. One was for a baby that was small for gestational age. The other was with a baby who had a heart defect. There was one newborn death that occurred four days after birth due to multiple organ failure in a baby that was large for gestational age.

The authors mentioned that when complications are present at the end of pregnancy, such as problems of the placenta, or the umbilical cord, or fetal growth, these problems may become increasingly important as each day of pregnancy progresses, which they believe is why they found a higher death rate with expectant management past 41 weeks.

Another key finding of the study was that all of these deaths occurred to first-time mothers, which suggests that 41-week induction may be especially beneficial for babies of first-time mothers. They found that it only took 230 inductions at 41 weeks to prevent one death for a baby, and this was a much lower number than previously thought. If you remember, though, as Anna was saying, the INDEX trial did not find a significant difference in death between the induction group and the expectant management group. We think the reason the SWEPIS study found a difference was because it was a larger study, it was better able to detect differences in rare outcomes like death. Also, with the SWEPIS study, there might not have been as good fetal monitoring. So it’s possible that the better fetal monitoring of participants between 41 weeks and 42 weeks in the INDEX trial might’ve been protective, leading to fewer perinatal deaths. We can’t be certain though because there were no fetal monitoring protocols in either trial.

Another thing to note is that participants in the SWEPIS expectant management group tended to give a birth a little later than the participants in the INDEX expectant management group. That might help explain the higher perinatal death rate in the expectant management group in SWEPIS. They did not find a difference in what they call the composite adverse perinatal outcome, which included death, low Apgar scores, low pH, brain bleeds, brain injury, seizures, and several other major complications, but there was that significant difference in perinatal death (either having a stillbirth or newborn death).

Also, the elective induction babies were less likely to have an admission to intensive care, 4% versus 5.9%. They had fewer cases of jaundice, 1.2% versus 2.3%, and fewer of them were big babies, 4.9% versus 8.3%.

For mothers, the outcomes were overall pretty good. There were no differences in cesarean rates similar to the other trial. The cesarean rate in this study in both groups was about 10% to 11%. More mothers in the elective induction group had an inflammation of the inner lining of the uterus called endometritis, 1.3% versus 0.4%. And on the other hand, more mothers in the expected management group developed high blood pressure, 3% versus 1.4%. They also interviewed the women in both groups and they found that the mothers in the expectant management group really struggled with negative thoughts. They described feeling in limbo while they waited to go into labor. So Anna, can you talk a little bit about the fetal monitoring in this study and how it may have differed from the other study?

Anna Bertone:   Sure. Fetal monitoring in this study was done per local guidelines. So there was no study protocol for fetal monitoring during the 41st week of pregnancy. However, the mothers recruited from one region of Sweden, called the Stockholm region, which made up about half the people in the study, had ultrasound measurements of their amniotic fluid volume and abdominal diameter at 41 weeks, whereas the people that came from the other areas of Sweden in the study did not receive these assessments regularly. None of the six deaths that occurred in this study occurred in the Stockholm region of Sweden where they received this type of fetal monitoring, which leaves us with the question of how important was this fetal monitoring. Could it have made the difference between the Stockholm region participants not experiencing fetal deaths whereas participants from other regions did?

Anna Bertone:   So that’s just an important thing to keep in mind with this study is that the fetal monitoring may have made a difference as far as the perinatal outcomes. It also means that the results of the SWEPIS study might not apply equally to mothers who receive fetal monitoring at the end of pregnancy, specifically during that 41st week of pregnancy which seems to be the really critical time period. Another thing, all of the perinatal deaths in this study occurred to first-time mothers, which tells us that the results might not apply equally to mothers who have already given birth before.

…So in the SWEPIS study, out of the mothers in the study who had already given birth before and were having a subsequent baby, none of them experienced this stillbirth or newborn death, correct?

Anna Bertone:   Correct. Yes.

Okay. So all of the perinatal deaths occurred to first-time mothers.

Anna Bertone:   And the first-time mothers, by the way, they only made up about half of the participants in the sample, so it was about a 50/50 split.

So all of the fetal and newborn deaths from this study came from first-time mothers who lived in the areas of Sweden that did not do any prescribed fetal monitoring during that 41st week of pregnancy.

Anna Bertone:   That’s my understanding. Correct.

Okay. So those are the two big randomized trials that came out in 2019. Before they were published, there was a 2018 Cochrane meta-analysis. Anna, I was wondering if you could talk a little bit about that. This study did not include the SWEPIS and the INDEX trials, but we still wanted to talk about it in our article. So can you explain to our listeners a little bit about this Cochrane review?

Anna Bertone:   Sure. There was a 2018 Cochrane review and meta-analysis by Middleton. Unlike these randomized control trials that we were just talking about, they didn’t focus specifically on the 41st week of pregnancy versus the 42nd week of pregnancy. It was much more broad than that. What they did was they looked at people who were electively induced at some point, and compared them to people who waited for labor to start on its own until some point. So there was a much more broad range of gestational ages there. But they included 30 randomized control trials with over 12,000 mothers, and they compared a policy of induction at or beyond term versus expectant management. All of the trials took place in Norway, China, Thailand, the U.S., Austria, Turkey, Canada, the UK, India, Tunisia, Finland, Spain, Sweden, and the Netherlands.

So it’s quite a global sample.

Anna Bertone:   Yes. But one study in this meta-analysis really dominated and accounted for about 75% of the data, and that was the Hannah post-term trial that I think Rebecca is going to be talking about soon. Because that one trial dominated this meta-analysis so much, most of the data was on giving birth at 41 weeks or later.

And they did not include the ARRIVE trial in this meta-analysis.

Anna Bertone:   Right. They didn’t include the ARRIVE, INDEX, or SWEPIS trials. So in its next update, it’s going to be updated with those three randomized control trials. But they did include 30 other randomized control trials. What they found was that a policy of induction at term or beyond term was linked to 67% fewer perinatal deaths compared to expectant management. So that was two deaths with induction at or beyond term versus 16 deaths in the people assigned to expected management.

Anna Bertone:   The Hannah post-term trial excluded deaths due to fetal malformations, but some of the smaller trials that were included in the Cochrane meta-analysis did not. So if we exclude the three deaths from severe fetal malformations, then the final count is one death in the induction group and 14 in the expectant management group. So it doesn’t change the results too much overall to exclude fetal malformations. Overall, they found that the number needed to treat was 426 people with induction at or beyond term to prevent one perinatal death. Specifically, there were fewer stillbirths with a policy of induction at or beyond term.

Which was a different number needed to treat than the SWEPIS trial, which found only took 230 inductions at 41 weeks to prevent one perinatal death.

Anna Bertone:   Yeah. I think part of the reason the SWEPIS trial was so groundbreaking and got so much media attention is because it did find a lower number needed to treat than had been found previously. So the absolute risk of perinatal death was 3.2 per 1,000 births with the policy of expected management versus 0.4 deaths per 1,000 births with the policy of induction at or beyond term. They found that a policy of induction was linked to slightly fewer cesareans compared to expectant management, 16.3% versus 18.4%.

Anna Bertone:   Fewer babies assigned to induction had Apgar scores less than seven at five minutes compared to those assigned to expectant management. They didn’t find any differences between the groups with the rate of forceps or vacuum assistance at birth, perinatal trauma, excessive bleeding after birth, total length of hospital stay for the mother, newborn intensive care admissions, or newborn trauma. The authors concluded that individualized counseling might help pregnant people choose between elective induction at or beyond term or continuing to wait for labor. They stress that providers should honor the values and preferences of the mothers.

We need more research to know who would or would not benefit from elective induction. And the optimal time for induction is still not clear from the research, which is what they said in 2018. I think Rebecca’s going to talk about the famous Hannah post-term study that accounted for 75% of the data in that meta-analysis.

Yeah, so we’re kind of working backwards through time. We started with the 2019 randomized trials, then the 2018 meta-analysis where they said the optimal time for induction is not clear, but they stated that before the two new randomized trials came out. Then even before then going back in time is the 1992 Hannah post-term study, which is one of the most important studies on inducing for going past your due date and it was the largest randomized trial ever done on this topic, larger even than INDEX or SWEPIS. And it controls most of the findings in that Cochrane meta-analysis that Anna just described.

So let’s look at what happened in this study because it plays so much of a role in the meta-analysis. It was carried out between the years 1985 and 1990 when a group of researchers enrolled 3,407 low-risk pregnant people from six different hospitals in Canada into the study. Women could be included if they were pregnant with a live single fetus, and they were excluded if they were already dilating, if they had a prior cesarean, pre-labor rupture membranes, or a medical reason for induction.

This study had a much different expectant management protocol than INDEX or SWEPIS because unlike those studies where the longest you would go was 42 weeks and zero to one or two days, in the Hannah post-term study, the people assigned expectant management were monitored for as long as 44 weeks pregnancy before they were induced, so up to a month past your due date, which is almost unheard of today. At around 41 weeks, people who agreed to be in the study were either randomly assigned to have an induction of labor or fetal monitoring with expectant management.

In the induction group, labor was induced within four days of entering the study, usually about 41 weeks and four days. If the cervix was not ripe and if the fetal heart rate was normal, they were given a prostaglandin E2 gel to ripen the cervix. They used a maximum of three doses of gel every six hours. If this did not induce labor or if they did not need the gel, people were given IV oxytocin, had their waters broken, or both. And they could not receive oxytocin until at least 12 hours after the last prostaglandin dose.

So one strength of this study is that it had a defined induction protocol that providers could replicate. But the big weakness of this study is that the expectant management group did not have that same induction protocol. In the monitored or expected management group, people were taught how to do kick counts every day and they had a non-stress tests three times per week. They also had their amniotic fluid levels checked by ultrasound two to three times per week. And labor was induced if there were concerning results in the non-stress test, or if there was low amniotic fluid, or if the mother developed complications, or if the person did not go into labor on their own by 44 weeks. And if doctors decided the baby needed to be born, mothers in expectant management group did not receive any cervical ripening. Instead, they either had their water broken and/or IV oxytocin, or they just went straight to a cesarean without labor. So Anna, do you want to talk a little bit about what the researchers found in the study?

Anna Bertone:   What the researchers found in the Hannah post-term study is that in the induction group, 66% of the people were induced and 34% went into labor on their own before induction. And in the expectant management group, 33% were induced and 67% went into labor on their own. There were two stillbirths in the group assigned to wait for labor and zero in the group assigned to induction. This difference was not considered to be statistically significant, which means we don’t know if it happened by chance or if it was a true difference between the groups. The more interesting outcome to look at with the Hannah post-term trial are the findings on cesarean rates because they differ depending on what numbers you look at. You can either look at the outcomes for the two original groups, which were the people randomly assigned to induction and then those assigned to expectant management, or you can look at the breakdown of what actually happened to the people in the two groups, in other words what happened to the people who were actually induced or who actually went into spontaneous labor.

Anna Bertone:   So what happened in the original randomly assigned groups? If you look at the two original groups, the overall cesarean rate was lower in the induction group. It was 21.2% versus 24.5%. That was even after taking into account factors like the mother’s age, whether or not it was her first baby, and cervical dilation at the time of study entry. Or you could look at what happened with the people who were actually induced or who actually went into labor on their own. And if you look at that, you see two very interesting things. You see that people who went into spontaneous labor, regardless of which group they were assigned to, they had a cesarean rate of only 25.7%. But if people in the monitoring group had an induction, their cesarean rate was much higher than all the other groups. It was 42%. The same was true for both first-time mothers and for mothers who had given birth before.

Anna Bertone:   So what does this mean? It means that only the people who were expectantly managed but then had an induction had a really high cesarean rate. The people who were expectantly managed and then went into labor spontaneously did not have a higher cesarean rate. One possible reason for this, for the highest cesarean rate seen in the people who were assigned to expectant management but then ended up getting an induction, is that the people in this group might’ve been higher risk to begin with since a medical complication could have led to their induction. The people that were assigned to expectant management and never developed a complication requiring an induction, those were the lower risk people, which means they were the ones less likely to end up giving birth by cesarean.

Anna Bertone:   Then, another important factor that I know Rebecca has discussed previously is that doctors might’ve been quicker to call for a cesarean when assisting the labors of people with medical inductions if their pregnancies were beyond 42 weeks. They may have been less patient waiting for labor.

…Or more easily worried about the course of the labor, big baby, etc. – 

Anna Bertone:   Yes. More worried.

So basically, it seems like from the Hannah post-term trial, one of the benefits of considering expectant management is that if you do have spontaneous labor, your chance of cesarean is pretty low. But the risk is that you’ll develop medical complications and need an induction, in which case an induction at 42 weeks is going to be riskier than an induction at 41 weeks. So what do you think? We have all this research from all over the world, from the Hannah post-term trial, to the 2018 meta-analysis, to two trials out in 2019. Do you still feel like routine induction at 41 weeks is still going to be controversial or not?

Anna Bertone:   I think it’s definitely still controversial, and I think everybody’s still processing the results from the INDEX trial and the SWEPIS trial. Rebecca and I reached out to Dr. Wennerholm who conducted the SWEPIS trial in Sweden, and she said she’s currently working on secondary analysis of the data. They’re talking about the economic implications of the findings in Sweden and what it means for Swedish national policy. So I think it’s still controversial. People are still talking about what to make of these findings.

Anna Bertone:   There was another systematic review from 2019 by Riedel. This one came out too early to include the SWEPIS and the INDEX trials, but it’s still interesting to look at. Because unlike the Middleton Cochrane review, these authors were specifically interested in induction during the 41st week of pregnancy versus during the 42nd week of pregnancy. So in their analysis, they restricted the studies only to people having a routine induction at 41 weeks and zero to six days versus routine induction at 42 weeks and zero to six days. If you remember, the Cochrane review was much broader than that. They also only looked at studies published within the last 20 years. They only looked at studies with low-risk participants, and they ended up with three observational studies, two randomized controlled trials, and two studies that they called “quasi experimental studies”, which they grouped with the randomized controlled trials even though these studies weren’t truly randomized.

Anna Bertone:   What they found was one perinatal death in the 41 week induction group and six deaths in the 42 week induction group. That was a rate of 0.4 versus 2.4 per 1,000. This finding was not statistically significant. In other words, we don’t have strong enough evidence that this couldn’t have happened by chance. These same studies, those two randomized controlled trials and the two quasi experimental studies, they showed no difference in cesarean rates between groups also. But the authors did report that one observational study found an increase in the cesarean rate with the 41 week induction group. So basically, they’re saying if you look much more narrowly at the evidence of induction during the 41st week versus the 42nd week, then there might not be a significant difference in the death rate.

But that Riedel study from 2019 is already outdated because that was before the two big randomized trials came out.

Anna Bertone:   Yes. We need to see a systematic review and meta-analysis that includes those two randomized controlled trials and see if that changes. These authors also expressed concerns about the cesarean rate possibly rising with 41-week induction because both the SWEPIS trial and the INDEX trial took place in countries with very low cesarean rates. So we just don’t really know at this point whether there would be a difference in cesarean rates if they took place in countries with higher rates of cesarean, such as the U.S.

Anna Bertone:   So I think it is still controversial. There’s also countries that are changing their policies about induction and going back and looking at whether that policy change led to any difference in outcomes. One such country is Denmark. They just published a study where they compared birth outcomes from 2000 to 2010 versus 2012 to 2016. And in that time period there was a change in policy from recommending induction at 42 weeks and zero days to 41 weeks and three to five days. They included over 150,000 births in the dataset. And when they looked back, they didn’t see any difference in stillbirths, or perinatal deaths, or low Apgar scores when they compared the period before versus after the policy change. The perinatal death rate was already declining before the policy change in 2011, and it just continued going down without any additional impact from the 2011 policy change. There was also no impact on the rate of Cesareans with the policy to switch from 42 weeks to 41 weeks.

Anna Bertone:   That’s just an example of how this is still controversial. Countries are implementing new policies, and Sweden and the Netherlands may implement new policies based on the INDEX and the SWEPIS studies. Then they’ll probably conduct a study the same way that Denmark did to see if that policy change had any real impact on the population.

I think it’s important to mention, though, that with the Denmark national policy, they switched from 42 weeks and zero days to 41 weeks and three to five days, and that might not have been early enough to make an impact on the stillbirth rate because the studies that we were looking at from 2019, SWEPIS and INDEX, were looking at inductions happening at 41 weeks and zero to one or two days and it was that couple of days difference that made the difference between low stillbirth rate and a higher stillbirth rate.

Anna Bertone:   Right. Exactly. I think that future researchers shouldn’t group 41 weeks and zero to six days together in one grouping because there seems to be differences between the earlier part of the 41st week and the later part of the 41st week because, like you said, SWEPIS and INDEX found that waiting even just two or three days make a difference in outcomes during that week.

So let’s just sum up the pros and cons of induction at 41 weeks versus continuing to wait for labor since that’s what we have the bulk of the evidence on now. I would say that the research shows that the pros of inducing labor at 41 weeks include a lower risk of stillbirth, especially among those with risk factors for stillbirths such as being pregnant with your first baby. In our article, we have a table of the pros and cons. The absolute risk of stillbirth is 4 out of 10,000 pregnancies at 39 weeks, 7 out of 10,000 pregnancies at 40 weeks, 17 out of 10,000 pregnancies at 41 weeks, and 32 stillbirths out of 10,000 pregnancies at 42 weeks. Research also shows a lower risk of the baby receiving intensive care with an elective induction at 41 weeks, lower risk of the baby having jaundice, lower risk of the baby being large for gestational age, and lower risk of needing a cesarean, although that finding may depend on your practice setting. There is a lower risk of mother developing a high blood pressure disorder. at the end of pregnancy. And for some people, they may find an elective induction at 41 weeks convenient and it could help them end an uncomfortable pregnancy.

Also, in our article, we reference one study that found some cognitive benefits for babies. It suggests that the cognitive benefits for the baby from the mom remaining pregnant appear to increase until about 40 to 41 weeks after which there’s no cognitive benefits to the baby’s brain development for continuing to remain pregnant. So Anna, can you share the cons of elective induction at 41 weeks?

Anna Bertone:   Yeah. One of the cons of being induced at 41 weeks instead of continuing to wait and see if you go into labor is the potential for medicalization of birth. One example of this is continuous fetal monitoring may occur if you have the induction, whereas you might not get continuous fetal monitoring if you go into labor on your own spontaneously during that 41st week. 

Anna Bertone:   Another con would be a potential for failed induction leading to a cesarean. That also depends a lot on your practice setting. Another con is the potential for uterine tachysystole, which is defined as more than five contractions in 10 minutes averaged over 30-minute window. There’s a potential increase in the risk of uterine rupture with medical induction. That is especially important among people with a previous cesarean having a VBAC.

Anna Bertone:   Another con is missing the hormonal benefits of spontaneous labor. Another con is increased risk of mother getting inflammation of the inner lining of the uterus, endometritis. One study found that as a possible risk of induction 41 weeks. Then, lastly, medically-induced contractions might increase pain and make epidural use more likely.

We also have a section in the article where we talk about whether there are any benefits to going past your due date. That table we just took you through was comparing the benefits and risks of elective induction. In terms of benefits of going past your due date, one of the major benefits of awaiting for spontaneous labor are the hormonal benefits, which Anna briefly mentioned. In our article, we link to the book Hormonal Physiology of Childbearing by Dr. Sarah Buckley, which talks about the physiologic understandings and the physiology of spontaneous labor. So that is something to keep in mind, and that’s one reason why some people prefer to wait for spontaneous labor. So Anna, if someone wants to wait for labor to begin on its own and they’re talking with their care provider about expectant management, what’s kind of the bottom line about that?

Anna Bertone:   I think the bottom line about that is it all needs to be very individualized. When someone goes past their estimated due date, they could talk to their care provider about the benefits and the risks of elective induction versus continuing to wait for labor and how those benefits and risks apply to them personally. Most research articles and guidelines say that because there are benefits and risks to both options, the pregnant person’s values, goals, and preferences should play a part in the decision-making process.

Anna Bertone:   It’s important for expectant families to be aware of the growing research evidence showing that there could be worse health outcomes for those who wait for labor after 41 weeks of pregnancy instead of being induced at 41 weeks, especially among first-time mothers and those with additional risk factors for stillbirth. But ultimately, after receiving accurate evidence-based information and having conversations with their care providers, pregnant people have the right to decide whether they prefer to induce labor or wait for spontaneous labor with appropriate fetal monitoring.

I want to also let people know about a couple more resources that are in this article at evidencebasedbirth.com/inducingduedates. We have a section all about how people and their care providers can talk about the risk of stillbirth with some sample scripts that healthcare providers can use when they’re talking about risks of stillbirth. We also have links to different guidelines from different organizations about induction at 41 weeks. Then we also have our section called The Bottom Line. So what would you say are some of the bottom lines, Anna, about elective induction at 41 weeks and zero to two days?

Anna Bertone:   I think the bottom line is that elective induction at 41 weeks and zero to two days could help to reduce stillbirths and poor health outcomes for babies without increasing harm, like the risk of Cesarean for mothers. We’re getting that from those two large randomized controlled trials published in 2019 that both found benefits to elective induction at 41 weeks instead of continuing to wait for labor until 42 weeks. One of those studies, as we mentioned, found less perinatal death with 41 week induction and the other found fewer poor health outcomes for babies like intensive care unit admission and low Apgar scores with 41 week induction. Neither of those trials found an increase in the risk of Cesarean during birth with 41 induction compared to continuing to wait for labor until 42 weeks. However, both of those trials took place in countries that follow the midwifery model of care and the overall Cesarean rates were very low. So I think it remains to be seen how that will translate into countries like the U.S. that have higher Cesarean rates. 

So I hope you all found this podcast helpful in looking at the recent research on induction at 41 weeks versus expectant management. Make sure you check out the blog article that goes along with this podcast episode for all of the resources, links, research references. We also have a free one-page handout you can download that summarizes the results of this research. Just go to evidencebasedbirth.com/inducingduedates to download that new article. Thank you so much, Anna, for joining us to help our listeners understand the evidence.

Anna Bertone:   Happy to do it, Rebecca. Thank you.

Today’s podcast was brought to you by the PDF library inside the Evidence Based Birth Professional Membership. The free articles that we provide to the public at evidencebasedbirth.com and this free podcast as well as other resources are supported by our Professional Membership program. Everyone who joins our professional membership gets access to a library with all our printer-friendly PDFs. Each signature article that we publish online has been turned into a professionally-designed, easy-to-print PDF so that our members can print and share evidence-based info with their clients, other parents, or other professionals. To learn how you can become a member today, visit ebbirth.com/membership.

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‘Queen of Suspense’ Mary Higgins Clark dies aged 92 | Books | The Guardian

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Mary Higgins Clark, the “Queen of Suspense” who topped charts with each of her 56 novels, has died at the age of 92.

Simon & Schuster president Carolyn Reidy said that Higgins Clark died on 31 January in Naples, Florida, from complications of old age. The author published her first novel, Where Are the Children? in 1975, going on to sell more than 100m copies of her compulsive suspense novels in the US alone. She published her most recent thriller, Kiss the Girls and Make Them Cry, about a journalist investigating sexual misconduct at a television news network, in November.

Crime author Alafair Burke, who collaborated with Higgins Clark on the Under Suspicion series, said she would “miss my friend and co-author, but consider myself one of the luckiest people around to have had the chance to tell stories with one of my favourite writers, the Queen of Suspense.

“Through it all, I marvelled at Mary’s kindness, loyalty, and utter devotion to the work of being a writer. She could write me under the table, insisting we could get a few more pages in when I felt a snack break coming,” said Burke on Twitter. “When we went to an outdoor book festival in August, I kept sneaking off to the air-conditioned ladies’ room, but Mary stayed at the table and posed in the heat for selfies long after the books had sold out.”

Higgins Clark’s fellow authors spoke of her generosity, especially to new writers. Harlan Coben said he was heartbroken to learn of Higgins Clark’s death, describing her as “a generous mentor, hero, colleague, and friend” who “taught me so much”. Laura Lippman called her a trailblazer, adding that “so many of us owe our careers to her”. Scott Turow said she was “an extraordinarily gracious person, unpretentious and remarkably generous in a hundred ways”.

In her memoir, Kitchen Privileges, Higgins Clark wrote of “aching, yearning, burning” to write when she was young. It was an achievement made in the face of heavy odds. Her father died when she was 11, and she went to secretarial school after graduating from high school in the Bronx in New York. She went on to work as an air stewardess. After flying for a year, she married Warren Clark, who she had known since she was 16. She sold her first short story in 1956, for $100. After Clark died in 1964, she began writing radio scripts for a living, while also trying her hand as a novelist. She would write from 5am to 7am, before getting her five children ready for school.




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“My mother’s belief in me kept alive my dream to be a writer. My father’s early death left her with three young children to support. A generation later my husband’s early death left me in exactly that position, except that I had five children,” she wrote.

“Mother supported us by renting rooms, allowing our paying guests to have the privilege of preparing light meals in the kitchen. I supported my family by writing radio shows. Very early in the morning I put my typewriter on the kitchen table before I went to work in Manhattan and spent a few privileged and priceless hours working on my first novel.”

She sold Where Are the Children? when she was 47. Telling of a young mother who has fled her original life after the death of her first two children, only for her next two to disappear, it was a huge hit. David Foster Wallace taught it in his college classes, and Coben recalled a letter from the Infinite Jest author, in which he called it “one of the scariest fucking books I’ve ever read”. (“Sorry about the language, Mary!” Coben added.)

She wrote, she told the Guardian in 2015, about “very nice people whose lives are invaded”. In 1988, she struck what the New York Times reported was “the first eight-figure agreement involving a single author”, with a multi-book contract that guaranteed her at least $10.1m. Given the Authors Guild Foundation award for Distinguished Services to the Literary Community in 2018, she was the recipient of numerous awards and 21 honorary doctorates, and saw many of her books adapted for film and television.

“Let others decide whether or not I’m a good writer. I know I’m a good Irish storyteller,” she said, when she was the grand marshal of the St Patrick’s Day parade in Manhattan in 2011.

Michael Corda, her editor at Simon & Schuster since 1975, said: “She always set out to end each chapter on a note of suspense, so you just had to keep reading. It was a gift, but also the result of hard work … She was unique. Nobody ever bonded more completely with her readers; she understood them as if they were members of her own family. She was always absolutely sure of what they wanted to read – and, perhaps more important, what they didn’t want to read – and yet she managed to surprise them with every book.”

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Stephen King quits Facebook over false claims in political ads | Books | The Guardian

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Stephen King has quit Facebook, saying that he is not comfortable with the “flood of false information allowed in its political advertising”.

The bestselling horror novelist, a prolific user of social media, also said he was not “confident in [Facebook’s] ability to protect its users’ privacy”. King made the announcement on Twitter, where he has 5.6m followers. His Facebook page has been deleted.

The social network has faced backlash over its decision not to factcheck political ads, with chief executive Mark Zuckerberg arguing that “political speech is important” and should not be censored. Facebook said last month that while it had considered limiting the targeting of political ads, it felt that “people should be able to hear from those who wish to lead them, warts and all, and that what they say should be scrutinised and debated in public”.

Last October, the company came under fire for airing a 30-second video from the Trump campaign that falsely claimed that Joe Biden “promised Ukraine a billion dollars if they fired the prosecutor investigating his son’s company”. CNN declined to run the ad, saying that it “makes assertions that have been proven demonstrably false by various news outlets”. When the Biden campaign complained about the ad, Facebook invoked its “fundamental belief in free expression, respect for the democratic process, and belief that, in mature democracies with a free press, political speech is already arguably the most scrutinised speech there is”.

Writing for the New York Times last week, the billionaire philanthropist George Soros said: “I believe that Mr Trump and Facebook’s chief executive, Mark Zuckerberg, realise that their interests are aligned – the president’s in winning elections, Mr Zuckerberg’s in making money.” Facebook, Soros wrote, “follow[s] only one guiding principle: maximise profits irrespective of the consequences”.

Twitter, where King made his announcement, has banned all political advertising. King has long used the site as a way to air his political opinions, most recently using it to announce his support for Elizabeth Warren. “I’ll support and work for any Democrat who wins the nomination, but I’m pulling for Elizabeth Warren,” he wrote. “I’d love to see her open a large can of whup-ass on Trump in the debates.”

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Facebook keeps policy protecting political ads | ABS-CBN News

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Facebook logos are seen on a screen in this picture illustration taken Dec. 2, 2019. Johanna Geron, Reuters/file

SAN FRANCISCO — Defying pressure from Congress, Facebook said on Thursday that it would continue to allow political campaigns to use the site to target advertisements to particular slices of the electorate and that it would not police the truthfulness of the messages sent out.

The stance put Facebook, the most important digital platform for political ads, at odds with some of the other large tech companies, which have begun to put new limits on political ads.

Facebook’s decision, telegraphed in recent months by executives, is likely to harden criticism of the company heading into this year’s presidential election.

Political advertising cuts to the heart of Facebook’s outsize role in society, and the company has found itself squeezed between liberal critics, who want it to do a better job of policing its various social media platforms, and conservatives, who say their views are being unfairly muzzled.

The issue has raised important questions regarding how heavy a hand technology companies like Facebook — which also owns Instagram and the messaging app WhatsApp — and Google should exert when deciding what types of political content they will and will not permit.

By maintaining a status quo, Facebook executives are essentially saying they are doing the best they can without government guidance and see little benefit to the company or the public in changing.

In a blog post, a company official echoed Facebook’s earlier calls for lawmakers to set firm rules.

“In the absence of regulation, Facebook and other companies are left to design their own policies,” Rob Leathern, Facebook’s director of product management overseeing the advertising integrity division, said in the post. “We have based ours on the principle that people should be able to hear from those who wish to lead them, warts and all, and that what they say should be scrutinized and debated in public.”

Other social media companies have decided otherwise, and some had hoped Facebook would quietly follow their lead. In late October, Twitter’s chief executive, Jack Dorsey, banned all political advertising from his network, citing the challenges that novel digital systems present to civic discourse. Google quickly followed suit with limits on political ads across some of its properties, though narrower in scope.

Reaction to Facebook’s policy broke down largely along party lines.

The Trump campaign, which has been highly critical of any attempts by technology companies to regulate political advertising and has already spent more than $27 million on the platform, largely supported Facebook’s decision not to interfere in targeting ads or to set fact-checking standards.

“Our ads are always accurate so it’s good that Facebook won’t limit political messages because it encourages more Americans to be involved in the process,” said Tim Murtaugh, a spokesman for the Trump campaign. “This is much better than the approaches from Twitter and Google, which will lead to voter suppression.”

Democratic presidential candidates and outside groups decried the decision.

“Facebook is paying for its own glowing fake news coverage, so it’s not surprising they’re standing their ground on letting political figures lie to you,” Sen. Elizabeth Warren said on Twitter.

Warren, who has been among the most critical of Facebook and regularly calls for major tech companies to be broken up, reiterated her stance that the social media company should face tougher policies.

The Biden campaign was similarly critical. The campaign has confronted Facebook over an ad run by President Donald Trump’s campaign that attacked Joe Biden’s record on Ukraine.

“Donald Trump’s campaign can (and will) still lie in political ads,” Bill Russo, the deputy communications director for Biden, said in a statement. “Facebook can (and will) still profit off it. Today’s announcement is more window dressing around their decision to allow paid misinformation.”

But many Democratic groups willing to criticize Facebook had to walk a fine line; they have pushed for more regulation when it comes to fact-checking political ads, but they have been adamantly opposed to any changes to the ad-targeting features.

On Thursday, some Democratic outside groups welcomed Facebook’s decision not to limit micro-targeting, but still thought the policy fell short.

“These changes read to us mostly as a cover for not making the change that is most vital: ensuring politicians are not allowed to use Facebook as a tool to lie to and manipulate voters,” said Madeline Kriger, who oversees digital ad buying at Priorities USA, a Democratic super PAC.

Other groups, however, said Facebook had been more thoughtful about political ads than its industry peers.

“Facebook opted against limiting ad targeting, because doing so would have unnecessarily restricted a valuable tool that campaigns of all sizes rely on for fundraising, registering voters, building crowds and organizing volunteers,” said Tara McGowan, chief executive of Acronym, a non-profit group that works on voter organization and progressive causes.

Facebook has played down the business opportunity in political ads, saying the vast majority of its revenue came from commercial, not political, ads. But lawmakers have noted that Facebook ads could be a focal point of Trump’s campaign as well as those of top Democrats.

Facebook’s hands-off ad policy has already allowed for misleading advertisements. In October, a Facebook ad from the Trump campaign made false accusations about Biden and his son, Hunter Biden. The ad quickly went viral and was viewed by millions. After the Biden campaign asked Facebook to take down the ad, the company refused.

“Our approach is grounded in Facebook’s fundamental belief in free expression, respect for the democratic process and the belief that, in mature democracies with a free press, political speech is already arguably the most scrutinized speech there is,” Facebook’s head of global elections policy, Katie Harbath, wrote in the letter to the Biden campaign.

In an attempt to provoke Facebook, Warren’s presidential campaign ran an ad falsely claiming that the company’s chief executive, Mark Zuckerberg, was backing the reelection of Trump. Facebook did not take the ad down.

Criticism seemed to stiffen Zuckerberg’s resolve. Company officials said he and Sheryl Sandberg, Facebook’s president, had ultimately made the decision to stand firm.

In a strongly worded speech at Georgetown University in October, Zuckerberg said he believed in the power of unfettered speech, including in paid advertising, and did not want to be in the position to police what politicians could and could not say to constituents. Facebook’s users, he said, should be allowed to make those decisions for themselves.

“People having the power to express themselves at scale is a new kind of force in the world — a Fifth Estate alongside the other power structures of society,” he said.

Facebook officials have repeatedly said significant changes to its rules for political or issue ads could harm the ability of smaller, less well-funded organizations to raise money and organize across the network.

Instead of overhauling its policies, Facebook has made small tweaks. Leathern said Facebook would add greater transparency features to its library of political advertising in the coming months, a resource for journalists and outside researchers to scrutinize the types of ads run by the campaigns.

Facebook also will add a feature that allows users to see fewer campaign and political issue ads in their news feeds, something the company has said many users have requested.

There was considerable debate inside Facebook about whether it should change. Late last year, hundreds of employees supported an internal memo that called on Zuckerberg to limit the abilities of Facebook’s political advertising products.

On Dec. 30, Andrew Bosworth, the head of Facebook’s virtual and augmented reality division, wrote on his internal Facebook page that, as a liberal, he found himself wanting to use the social network’s powerful platform against Trump.

But Bosworth said that even though keeping the current policies in place “very well may lead to” Trump’s reelection, it was the right decision. Dozens of Facebook employees pushed back on Bosworth’s conclusions, arguing in the comments section below his post that politicians should be held to the same standard that applies to other Facebook users.

For now, Facebook appears willing to risk disinformation in support of unfettered speech.

“Ultimately, we don’t think decisions about political ads should be made by private companies,” Leathern said. “Frankly, we believe the sooner Facebook and other companies are subject to democratically accountable rules on this, the better.”

2020 The New York Times Company

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Buhari replies CAN, says ‘I won’t tolerate politicisation of religion’ – Daily Nigerian

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President Muhammadu Buhari has said that his administration would never tolerate politicization of religion in whatever form.

The President stated this in reaction to the Christian Association of Nigeria, CAN, call to deploy every available resources for the rescue of all Christian hostages by the Boko Haram and Islamic State of West African Province, ISWAP, terrorists.

A statement by the Senior Special Assistant on Media and Publicity to the President, Garba Shehu said the security agencies are working hard to rescue people held hostage by the Boko Haram insurgents and reunite them with their families.

“The security forces of Nigeria are working continuously to return those taken hostage by Boko Haram to their families, friends, and communities. In doing this, the government has full confidence in their ability to accomplish the task.

“On its own part, the government has condemned some of the appalling acts of terror, especially following the festive period.  Yet, to continue to see these happenings solely in religious terms – removed from social, economic and environmental factors – simplifies complexities that must be heeded.

“Not seeing them as they should be is exactly what the terrorists and groups wish: they want Nigerians to see their beliefs as a reason to turn against one another.

“On the contrary, Christians and Muslims alike are united in their opposition to Boko Haram and the hatred for decency that the infamous group stands for.

“Nigerians must continue to be united in ensuring that they do not subscribe to the terrorists’ message of division. Unfortunately, some leaders and politicians seek to make political capital from our religious differences.

“As we fight Boko Haram on the ground, so too must we tackle their beliefs: stability and unity in face of their hatred is itself a rejection of their worldview.

“This government shall never tolerate religious intolerance. We clearly and unambiguously restate our support for the freedom to practice whichever belief you wish. The politicisation of religion – as forbidden by the constitution – has no place in Nigeria,” the statement added.

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Facebook Users Share Their Worst Sex Experience. What’s Yours? | DeeDee’s Blog

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King Ibrahim Omoniyi My gf requested for anal sex and I refused it blatantly for the first time cos my religious belief would not allow me but the second time I just had anal sex with her. Although I enjoyed the anal sex but am never gonna have it again cos it’s not worth it jawe.

Adebukola Omo Ade Me that say make I position well receive better prick, before I position finish, brother don cum..

That thing pain me ehn

Uwem Udoh That is how I was chopping hanty pussy from behind. It was sweeting her and I was just enjoying pussyjuice that had strawberry flavour.

Small time, hanty was shouting, Uwem am cumming…. Uwem am cumming.

And me feeling fly. I put in effort.

Chop pussy majestically, whilst I insert a finger inside for added pleasure.

Na so hanty cum. Hanty piss. Hanty squirt at the same time.

All the water just rush enter my mouth…

Have been traumatized since then.

Arewa Comfort Olorunmbe Crushing on uncle for a while due to long-distance when I finally see brother after long talk on life, sex and everything just small kiss and suck uncle don cum like ocean was like is that all, brother was dressing saying we should be going I was like what will happen to me he said I will be fine, till date I no talk to him again…

Tayo Fasuan What the? Have I told you about my first affair with a virgin who also doubled as an asthmatic person? I spent the entire night cleaning her up, petting her and silmutaneouldy resuscitating her from the land of the dead. That’s my first and the last time with either a virgin or an asthmatic person. I cannot can. Ever again.

Liasu Oluwabukunmi My own is if you know you’re 30secs man biko don’t act as if you can grind and drill…abi which one is you making me cum on chat…like i was looking forward to all the different styles we’ve talked about, only for us to see and 30 secs everywhere don burst… Haaa…I no fit cry,like what sort of waste of sin be this bayii?

Lord Jesse Had this terrible separation with my gf while in Uni… now ex though. I saw her during those their stupid night class seated on the pavement of a dried gutter kissing this guy she claimed was just her friend. She lived with me as at then. What haunted me was that this guy and I used to play PS2 o. Thank God say I dey always trash am that year…funny enough,the guy’s name is Thankgod.

I was haunted by this feeling for weeks and it drove me into the arms of one of my friends that had terrible crush on me. Since seeing my gf every time I come back home is irritating,I spent more time with Patience the one that had a crush on me. She knew what happened and persuaded we date. I told her I would eventually get back with my gf that it will hurt her so it’s needless. She still refused. Most night Patience will beg me to sleep in her house and I will just pity the girl and sleep…severally she will make advances at me but I refused. This has continued for more than 3months until one day…

One night after we were back from the club, this girl brought out juice from her fridge and gave to me, I drank and started feeling weak. My whole bones couldn’t even do anything. My eyes were wild open but drowning bit by bit…she pulled off my clothes, started sucking Jr…that idiot wasn’t weak at all, he was smiling all through. Patience had her way sha…the girl use me turn like this. When I finally woke up the next morning, I quietly wore my clothes, she was feeling bad at this moment. I grabbed my wallet and straight away, went to make up with my gf. Shame won kill me say girl rape me.

Oluwabusola ArikeAde Nwosu Got to his place to pass the night,uncle was only kissing,no smooching,no licking,the next thing he poured on my body choi, I cleaned up and kukuma face wall. In the morning, he just did shukeshuke that doesn’t even last 25 seconds tueh.since that day I stopped picking his calls.

Adegoke Ahmed Possible I met this babe on 2go room during my 100level days in school I asked her out and she agreed.

Fortunately for me, Asuu announced their strike and I called my 2go lover that I would come and visit her in Oshogbo where she stays, where I also have cousins.My plan was just to romance her and go as per Novice wey I be, I was still a virgin as at then so when I got to her house I met her and her younger sister. After I finished the delicious food she cooked for me, she sent her sister to go and buy something from a far distance I noticed from the girl’s reaction. She was ranting, that the place s too far anty bla bla bla.

Immediately the girl left, my babe just dragged me to her mummy’s room. She pulled me on the bed with one finger, I just fell like a mango tree.

Na so this babe climbed me, she didn’t allow me to even do any missionary.
She started fvcking me, I was just breathing like a frog under her.

This babe is a professional I swear, Me that I have never had any major sex before, if you see how this girl ride and rough handled me, it was like rape. I was begging her I want to go home. She too was begging me to allow her to cum, she was going up and down on the local man.

I struggled under her for like 10 minutes, she screamed and I forcefully pulled her on the bed.

I ran out to the sitting room!! She ran after me and pulled me again on the 3 sitter-chair in the sitting room. Local man still fell yakata, she said I was so sweet that I should sleep over her mum has travelled to pH to take care of her sister that just gave birth.

I pulled her away and told her my cousins are expecting me to come home !! I ran out of the house last-last it was a sweet and terrible experience I have ever had.

Tayo Fasuan Oh my gawd! I was 18 or 19. A neighbor’s daughter came to spend the night at our place. When everyone had slept, she sneaked over into my room as pre-planned. What she didn’t tell me was that she just used her hand to prepare pepper.

Small handjob, my little man was on fire. She licked, licked and licked to no avail. At a point, I legit asked God to forgive me my sin because I didn’t know what else to do.

Merry Ta I and my boyfriend, now Ex After 2years of not seeing each other, we finally met.

We did foreplay and finally to the main deal, Only for this dude to cum just as he inserted his dick.
I felt twas because of the excitement and gave him another opportunity to prove himself.
Same thing happened.

I avoid him afterwards, in fact that was what finally ended the relationship.
Mtchew! I cannot be wasting fornication.

Fatayo Williams I used to have this thing for thick girls, the last one before I entered my ‘never again’ mode wanted to kill me.

We just finished 69 when aunty said she enjoyed my part that she wants to sit on my face and ride my face,fam, I wish I said no

Na so we start, initially she wasn’t resting all her weight on my face, but as the thing begin dey sweet her, I could feel all her weight grinding back and forth on my face, I was gasping for air, I was trying to scream, but it was like aunty was getting another sweet feeling from my mouth opening and closing under her as I tried to scream.

I legit summoned the last strength within me and pushed her away to save my life, weyrey olomu nla yen o lohun o pa mi.

That was the last time I had anything intimate with any thick girl……Mi o le wa ku.

Lexy Oluwafisayomi Oshiga Out of excitement for the first time,plus it was meant to be a quickie, he mistakenly rushed and entered my butthole

I screamed the building down.

He was just there begging sorry sorry

That shit was really painful..how you people have anal sex is really unbelievable

He left for work, came back, I was still there

I can’t even remember how I got home..but I wasn’t normal for days.

Akinyemi Mr-Knyght Johnson So I was forming big boy when I met this babe in my area in Egbeda (I hope Dipo won’t see this cos I cannot cry again abeg).

It was in 2008, we used to hang out just for fun until her sailor dad went to work and she was home alone. I sha saw that every time I go there to spend the night, I come home feeling sad because by the time I do my hard work for like one hour, she will still be like, please don’t stop I haven’t cum enough.

So, one day I just felt so empowered in my spirit and I decided to go for her. One of my friends took me to one herb joint and I got a solid dose. On my way back, I branch chemist again, buy Vega 100. But over excitement made me forget food.

By the time I saw my juicy bursty babes in boxers and singlet, my zoom-zoom went up for the race. My village people were really after me, I didn’t cum my erection didn’t come down so she was happy and kept turning and turning, banging with all the energy in her but I was losing energy small small. After a whole hour of non-stop had core s** I was panting and then I pushed her off, dashed to the bathroom.

Bros, she burst follow me in tears o. She said I was punishing her and being stingy. I asked for garri, she no get, I asked for bread, e no dey, how do I revive my energy cos my eyes were already turning.

My sister, na pursue she pursue me around the room till 4:00am. At the sound of the first bike, I tear race comot.

I got back home to my padi and I couldn’t narrate my ordeal until 1:00pm, after a bowl of chilled water garri and very long sleep.

As I dey tell Dipo he dey laugh me so stupidly. Then he broke my jaw when he said, Vivian is in the sitting room since 10:30, say he forgot something with you.

I don’t even know where the babe is anymore.

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Meet the Nigerian developer that runs free online digital skills training on Facebook and Slack

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Martha (not real name) had no choice but to stay with her sick mum in hospital, but this didn’t mean much until it was clear her stay would run into a year. For Martha, it meant placing her life on hold as she wouldn’t have time to do anything else.

However, this changed when she came across Tech Skills Hack (TSH), an open Facebook group where people get free training on diverse digital skills ranging from graphic design to data analysis to content creation.

Martha joined the group, attended training religiously, and soon discovered she could become a certified digital skills expert running her personal creative agency.

Iniobong Udoh, the brain behind TSH, would be overwhelmed by a sense of fulfillment hearing this testimonial because it is clearly fulfilling the startup’s mission.

“Tech Skills Hack is a platform dedicated to equipping Nigerians with the in-demand and futuristic digital skills to curb unemployment and help businesses scale free of charge,” she says.

Demystifying digital literacy

There is a belief that people in the tech space are a bunch of code-writing geeks. However, Udoh thinks it’s only a myth.

“The tech ecosystem is a large community that includes all digital skills, ranging from graphic design, data analysis, content creation, that has nothing to do with writing code.”

Her mission was clear; to bridge the gap that exists between employers of labour and applicants without basic skills. And she does this by compiling curated digital skills resources and sharing on the various training platforms used.

To her, “Digital skills literacy means possessing skills you need to live, learn, and work in a society where communication and access to information is [sic] increasing through digital technologies like the online platforms, social media, and mobile devices.”

If anything, Udoh’s experience as a Google Certified Android developer and a certified UX expert came in handy as she brought the startup to life in February 2019 — a year after she got the idea but was held back by funds to either rent a hub or acquire equipment for physical training.

“I had to use the available platform and it was Facebook for me. Aside from programming, we train undergraduates on basic or foundational skills like Excel, PowerPoint, Canva, Google Sheets, and social media usage.”

TSH’s offering is twofold: solving the challenge of affordable training and acquiring the basic equipment to practise – a laptop. The aim is to assist young people to acquire relevant digital skill sets via their smartphones at no fee at all. Unfortunately, it wasn’t an encouraging first outing for her.

“I felt bad when we sent out the ad inviting people to learn and the response wasn’t impressive as thought [sic], but 50 people responding to our ad was fair.”

To build trust, Udoh made the platform open for interested individuals to join instead of adding people randomly. With time, the platform would have a good number of open-minded, willing, consistent, and determined members.

Apart from Udoh who is the founder, TSH’s team includes Nzaki Ekere who doubles as the CTO and in-house developer who takes web development classes and Anthony Eyo as the digital marketer. Extra help for on-site training also comes from volunteers, some of who have gone through training on the platform.

A social enterprise

“Tech Skills Hack is a non-profit venture. We’ve been running this for 9 months and it’s been self-funded. It is not too capital intensive because I use a free platform (Facebook) and get free volunteers. I get to search top-notch courses from organisations like Google, Udemy, and Coursera for free, so we don’t pay for these courses, except with our time, because I need to go through every course before sharing them on our platform,” Udoh explains.

With no change of business model in view, Udoh affirms that TSH will retain its non-profit social enterprise status for the next two years, but it will need as much help as it can get.

“Our aim is to equip every Nigerian with a digital skill at no cost or low cost, and we would appreciate support from people to achieve that.”

In over 9 months of operation, the startup boasts of more than 1000 users on both Facebook and Slack. It has also assisted 30 budding Small and Medium-scale Enterprises (SMEs) to design logos and business cards for free. Lately, it conducted two free offline trainings in two Nigeria cities, Lagos and Uyo, in partnership with a Ghanaian tech hub, iSpace; and Directorate of Microfinance and Enterprise Development, Akwa Ibom State, respectively.

At a point when incorporating offline training is needed because online classes do not fully capture the startup addressable market, the founder admits that TSH is greatly in need of funds.

“We would appreciate financial and hub support. We need founders to allow us to use their hubs and gadgets for our trainings. We’ll also love free publicity so that more people can hear about what we are doing and get to join.”

Undeterred by challenges

Apart from funding, Udoh names trust issues as another challenge some people have because the belief is that with free trainings, the quality of content is usually bad.

She said they may not be able to change this perception, but the reviews, testimonials, and feedback received from students, who have gone ahead to get their certifications and even begin their own creative agencies, are enough motivation for the TSH team.

“I’ve lost count of the reviews and tags we get once a student learns a skill. Not only the testimonials but students using the skills they’ve learnt to better their lives and also pass down this knowledge to others is also what we use to measure our success and this we’ve been able to achieve in a short span of our existence.”

With another physical training program in the offing, the team is presently working on integrating an eLearning site with better and friendly learning features to further expand coverage.

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Sorry Will Ferrell, Elf is the most overrated Christmas film of all time

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Elf is one of the most overrated Christmas films of all time

Elf is one of the most overrated Christmas films of all time (Picture: New Line)

It’s Christmas, which means that normal TV is thankfully replaced by an abundance of festive fun. Home Alone 1 and 2, Miracle On 34th Street, Die Hard, Jingle All The Way, I’m ready to watch it all. But, before we all start commanding the remote control, we need to talk about how Elf is the most overrated Christmas film – and maybe just overall movie – of all time. And, instead of spewing me with gifs, telling me that I sit on a throne of lies etc, just take a breath and hear me out.

Buddy the Elf is probably one of the most annoying characters to appear on the big screen. He just is. And that’s no disrespect to Will Ferrell, but a grown man in an Elf costume who eats cotton balls, shouts all the time, breaks into song and bounces around like a high-as-a-kite Tigger is not fun, endearing or cute. Imagine when Christmas is over and he’s still… there.

Also his back story is the most ridiculous thing. I know it’s a film, and it’s Christmas so we should suspend belief just a touch more, but seriously guys… Newborn Buddy is left in an orphanage, then climbs into Santa’s sack undetected, with no one realising at any point that they’re missing a literal baby. And how does Santa not clock there is a child in his bag until he gets back to the North Pole? He presumably has to open said sack to give other people their presents, but he just failed to see a baby? Not buying it.

Editorial use only. No book cover usage. Mandatory Credit: Photo by Alan Markfield/New Line Prods/Kobal/REX (5884647n) Will Ferrell Elf - 2003 Director: Jon Favreau New Line Productions USA Scene Still Elfe

Buddy the Elf is the most annoying character ever (Picture: New Line)

Instead of the elves checking his address in their all-knowing records, they let Buddy build a life for himself in the North Pole, beavering away and making crap Christmas presents. But, in all that time, did no one also stop and suggest to build him some grown-up furniture so he didn’t have to constantly crouch? They’re all elves, building is what they do. The man doesn’t even have a toilet he can fit on.

When he’s eventually told about his parents – after what seems like 30 years as an elf – he just swans off to New York, floating away from his adopted dad on an ice ledge and armed with nothing but a snow globe of the Empire State Building. How did he get there? How does he know the way? How are his clothes not dirty from the journey? Why didn’t he just take Santa’s sleigh? So. Many. Questions.

Suddenly, Buddy is just handed a job at a swanky department store as part of their Christmas display. No CRB, no checks, just letting a grown man off the street – dressed as an elf – in a job where he interacts with children. Police would shut Gimbels down in a hot minute, but it’s a festive film so no one bats an eyelid. While there, he locks eyes on Zooey Deschanel’s character, who is also dressed as an elf (for work) and they have precisely five seconds of banter before she moves on, because Buddy is someone you would swipe past on Tinder, or ghost after precisely three messages. He then walks in on her in the shower, tells her that she makes his tongue swell up (absolutely a euphemism) and takes her on a date to a revolving door. And she still falls madly in love with him. This is how low the bar is for men.

Editorial use only. No book cover usage. Mandatory Credit: Photo by Moviestore/REX (1566358a) Elf, Zooey Deschanel Film and Television

Zooey Deschanel, you’re better than this. (Picture: New Line)

Also, you’re better than this, Zooey Deschanel, and don’t let an overgrown man child dressed like an elf tell you differently.

Buddy’s dad Walter (James Caan) is also a horrible human being. He’s rude, entitled, mean to nuns, has all his priorities in exactly the wrong order, and knowingly shipped a bunch of books out with missing pages like an absolute monster. Yes, this is probably his biggest crime of all. He quite clearly doesn’t want to spend any time with Buddy – or his other son, Michael – as we’ve spent most of the movie seeing.

But then, in a blink-and-you-miss-it character arc, he then becomes a nice guy who remembers he should love his family. All of a sudden, he’s ready to roll up his sleeves and save Christmas. Where the hell did that even come from? In the space of 30 seconds, Walter has gone from the meanest man on the planet to quitting his very good job for a son who puts syrup on their pasta.

Nope, sorry, I do not buy it. Count me out. I honestly love Christmas more than most other people, for me it is the happiest time of the year, but Buddy the Elf and his terrible taste in pasta does nothing for me.

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Proponents of death penalty for Hate Speech are real harbinger of hate speech -Gani Adams — Daily Times Nigeria

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The Aare Onakakanfo of Yorubaland, Iba Gani Abiodun Adams, has described those behind the controversial hate speech bill as pretenders.

Speaking during the 2019 edition of Ajagunmale Festival in Lekki, Lagos, Adams said though the National Assembly had bowed to pressures from Nigerians to remove the death clause for violators of hate speech, there is need for public enlightenment and education in order to change the narrative on the issue.

The Aareonakakanfo admitted also that many Nigerians are ignorant of issues relating to media information gathering and literacy, insisting that the law must be flexible to accommodate other people’s interests.

“It is a cheering news that the National Assembly and proponents of death penalty for violators of hate speech has bowed to pressures from Nigerians, but in a gathering like this, it is not out of place to raise and discuss issues that affect us holistically.

“The political game that had been playing out on the issue of hate speech and a death penalty for violators needed to be considered with utmost importance.

“I must confess truly, that I have been monitoring the reactions of eminent Nigerians on the issue, and I think those reactions are commendable. Those that spoke said death penalty for a violator of hate speech was barbaric and unacceptable.

“Actually hate speech can incite violence and damage relationships in a society, but we need to understand and protect the individuals’ rights to express their opinions freely and peacefully. It is also a fact that freedom of speech is an integral component of a free society. Therefore, imposing death penalty on violators is uncultured, barbaric, and not acceptable in our society,” he explained.

The Yoruba generalissimo flayed those behind the bill, saying politicians that are also the chief promoters of this bill are the harbinger of hate speech, describing them as products of hate speech, especially, during campaigns.

“Many of our politicians today are pretenders. During their campaigns, they promised you heaven on earth, and shortly after they are elected, you hear a different story entirely. I feel sad sometimes whenever I look back and see how Nigeria has drifted from its original ideals of our forefathers, but I always take solace in the belief that  one day, whether now or in the nearest future, we shall find our feet and get back on the right track”

In his remarks, Executive Chairman, Lekki Local Council Development Area (LCDA), Hon. Ogidan Mukadasi, said his administration will continue to support the Oodua Peoples’ Congress (OPC) and the Olokun Festival Foundation (OFF) on  ideas and projects that can launch the community positively to the world, adding that the huge attendance of guests at this year’s edition of Ajagunmale festival has really helped in boosting the tourism potentials of the community.

“It is our duty and responsibility to sustain this laudable programme, therefore, as a government, we will continue to play our role. We will continue to support the Olokun Festival Foundation to ensure that this festival becomes one of the most celebrated festivals in the state,” he said.

The Guest lecturer, Associate Professor Adams Kolade, from the Lagos state University (LASU) Ojo, spoke on the need to embrace the core values, culture and tradition of the Yoruba race.

He noted that Yoruba race is a gifted race with potentials to be the best, declaring that efforts should be made to sustain and promote the Yoruba cultural identity through festivals like this. He applauded the Aareonakakanfo of Yoruba land for the courage to sustain the laudable ideal of the organisation.

 “Language is an integral part of our culture. All over the world, the Yoruba tradition and heritage are next to none. As a race that have been so blessed with all these potentials, there is need for us to sustain all these and one of the best ways to sustain our cultural identities is to cultivate a new habit which will be directed at promoting what is truly ours,” he said.

The Onilekki of Lekki, Oba Olumuyiwa Ogunbekun, expressed delight at the success of the event, saying Ajagunmale Festival has come to stay in the area.

 He charged all members of the Oodua Peoples’ Congress not to relent in their efforts, declaring that the traditional institution across the South West will continue to support the foundation.

Meanwhile, Iba Gani Adams, said with the celebration of Ajagunmale Festival, Lekki will soon become a top investment destination in Lagos State.

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Turkey Converts Historic Church Building into Mosque

The Turkish Council of State has approved the conversion of a historic Greek Orthodox Church into a place of Islamic worship.

The Byzantine-era “Chora” Church was originally built in the early 4th century as a monastery complex outside the walls of Constantinople. It was later converted to a mosque after the Ottoman invasion of Istanbul.

In 1945, the church was restored and preserved as the “Kariye Museum.” Despite its conversion back to a symbol of Christianity, a lawsuit was later filed by the Association of Permanent Foundations and Service to Historical Artifacts and Environment claiming that the building was a mosque and thus belonged to the Fatih Sultan Mehmet Foundation.

The recent decision by the Council of State backs this belief and clears the way for the building to be converted into a functioning mosque, according to International Christian Concern.

“The Kariye mosque… is one of the public immovables belonging to the Fatih Sultan Mehmet Foundation,” the council said in a statement, reports the Greek City Times.

Belief

Princeton University describes more about the church’s storied history and religious significance:

Great Revival Sweeping Through Iran As Hundreds Of Thousands Come To Jesus Christ

“Described by Osterhaut as ‘second in renown only to Hagia Sophia among the Byzantine churches of Istanbul’, Kariye Camii [Mosque] attracts much attention because of its rich mosaics and frescoes. The original structure was built by the Holy Theodus in 534 in the reign of Justinian. In the 11th and 12th centuries, it was rebuilt by the Comnenus family and dedicated to Christ (thus the name, Christ in Chora). The structure suffered the great earthquake of 1296 and was later converted into a mosque in 1511 after the Turks conquered Istanbul. Since 1948, the building has been the Kariye Museum, a popular tourist attraction.”

In March of this year, Turkish President Recep Erdogan declared that the iconic Hagia Sophia cathedral, which is also being preserved as a museum transformed into a place of Islamic worship.

“As you know, the mosque was converted to a museum in 1935, as a reflection of the (Republican People’s Party) CHP mentality. We may as well take a step and change that,” Erdogan was quoted as saying, according to the Greek Reporter, prompting outrage from the Christian community.

Many believe that this latest announcement will speed up the process of converting the Hagia Sophia to a full-fledged mosque.

CBN

Historian Dr. Vassilios Meichanetsidis told the Greek Times that the mosque conversions are “a sign of Islamic conquest and supremacy” that have their roots in the Ottoman period and the brutal islamization of the region.

“It was widely practised in the times of conquest and throughout the Ottoman period and thus most of the truly superb Byzantine churches were converted into mosques and suffered serious damages,” assilios added.

“In many ways, the conversions of churches into mosques or museums area part of a genocidal process in which a physical genocide of human beings (Greeks, Armenians and Assyrians/Arameans) has turned into a cultural genocide.”

Offering her analysis of the situation to Faithwire, International Christian Concern’s Regional Manager for the Middle East, Claire Evans said:

“When reading the New Testament, it is apparent that the history of the Church is built upon the soil of Turkey. The country was first Christian, but the invasion of the Ottomans was followed by the steady erasure of this land’s Christian history. Although modern-day Turkey is constitutionally secular, the current political environment is increasingly Islamic.

The environment reinforces the belief that Christianity is a foreign religion to Turkey, and thus a threat to the nation. Indeed, President Erdogan has built his base around concepts that polarize and deepens an “us versus them” mentality. Historic churches prove a difficult concept for Turkey; many do not realize that their country was first Christian, and that Islam is actually the foreign religion. Turning historic churches, now functioning as museums, into mosques scores political points for a government that finds its identity in the country’s Ottoman history.

CBN

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