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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Andrea Hayden Twins’ strength and conditioning coach | Minnesota Twins

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FORT MYERS, Fla. — Andrea Hayden isn’t too accustomed to having Twins players upset with her. But she was thrilled about it.

Several players had seen Hayden featured in a television segment that highlighted her as the first female strength and conditioning coach in Major League Baseball, and they approached her in the weight room, aghast that they hadn’t already been aware of Hayden’s place in league history.

“How did we not know?” they asked her.

“I wear that as a badge because you’re not supposed to know,” Hayden said. “‘Good. I’m doing my job, because you shouldn’t be aware. You need to focus on what we’re doing and where we’re headed as an organization.'”

Hayden officially became a member of the Twins’ coaching staff last November, when strength and conditioning director Ian Kadish promoted her to assistant coach following a year-long fellowship during the 2019 season. Nobody was really aware of it at the time, but that made her not only the first female strength and conditioning coach in MLB history, but also the first full-time female member of a Major League staff.

It was only later on that Kadish and Hayden got curious and looked through the MLB staff directory to see if there was anyone else. There wasn’t. (Gabe Kapler and the San Francisco Giants have since hired Alyssa Nakken to their Major League staff.)

“OK, cool,” Hayden told Kadish. “Let’s move on. We have work to do.”

That workmanlike attitude defines how both Hayden and the Twins’ organization have approached this move. Kadish offered her the job because he saw her personality as a great fit on his staff and he felt a strong connection to her working philosophy. Kadish considers Hayden to be more of an expert than himself in Olympic lifts and has given her a lead role in the Twins’ performance-testing initiatives.

Hayden is here to contribute her knowledge to the championship push of a 101-win team, and that’s a responsibility she takes very seriously.

“She’s got a great personality, she’s got great knowledge in her field, and she’s adapted to the Major League clubhouse, it feels like effortlessly,” Twins manager Rocco Baldelli said. “It didn’t take very long for a lot of our players to come forward and say that they really enjoyed working with her, and it was a pretty straightforward, pretty easy decision for us to want to have her here and have her here full-time and do her thing, which is great.”

Hayden laughs as she reflects on what her life was like just one year ago, when she was very happy in her role as an athletic performance coach at Lindenwood University, near her hometown of St. Louis. Even without considering her budding Major League career, she’s the first to admit that her professional career has been anything but traditional.

Her interest in the field stemmed in part from her own experiences of looking for any competitive advantage when she played basketball, softball and soccer when she was young. (“I’m five-two-and-a-half with shoes on,” she says with a laugh.) Academics didn’t come easily to her, so she started her career as an 18-year-old as a physical trainer and managed some gyms around the St. Louis area until she “got burnt out of training soccer moms.”

That gave her important, hands-on experience with developing people skills and sharing her knowledge with a wide variety of people. When she found that she needed the scientific background to bring out her full potential in the field, she went to college at age 24 and emerged with degrees in exercise science and human performance. Her career has since seen stops at EXOS, the University of Louisville, USA Hockey and Team China Women’s Hockey.

“I think it’s just a love of what the weight room means and the power that it can have in the culture that is kind of driven out of that, where we work hard and we see the benefits of it on the field,” Hayden said. “And not to say that that’s everything, but it is something really powerful.”

One day last February, a former colleague, Aaron Rhodes, told her on the phone that a friend had an opportunity in baseball. He asked her to call and just to listen to what the friend had to offer. That friend was Kadish, and he and Hayden immediately had a strong connection as the pair discussed an opportunity with the Major League team.

Except, well, Hayden thought she was missing something.

“I remember being like, a third of the way into our conversation, he hadn’t brought up one time that I was a girl,” Hayden remembers. “And I’m like, ‘Does he not know?'”

“So, do you have any more questions?” Kadish asked at the end of the call.

“Yeah, like, I’m female,” Hayden recalls. “Where do you see that as being an issue or a problem?”

She remembers Kadish laughing.

“Look. Your job is the same as my job,” Kadish told her. “The only way it’s going to be difficult is if you do it differently than I do it. I’m not viewing it at all any differently than what I have to do.”

“He never once flinched at it,” Hayden said. “It never was an option. Like, it never was a disadvantage because of being a female. He only saw it as an advantage.”

Five days later, Hayden was in her car, driving down to Spring Training in Fort Myers. She left a full-time job with benefits and her hometown behind when she left Lindenwood for the fellowship with Kadish and the Twins.

“A personal motto is ‘courage over comfort,’ and choosing the things that maybe are unknown and scary and taking that leap,” Hayden said. “It’s always paid off. And I’m really fortunate that it has.”

It’s a reflection of Hayden’s personality and the seriousness with which she takes her role on a winning team that she’s never really looked to carry herself as any sort of figurehead — and there’s nothing about her day-to-day life that really makes her feel the need to do so. She calls the players her “brothers” and gives and takes friendly jabs with the best of them as she works the weight room.

She jokes that the only difference is that all of her team shirts are in men’s sizes.

“She wants to be low-key,” Kadish said. “She wants to lay low and do her job to the best of her ability and let her work speak for itself. I commend her for that in every aspect. I have no problem blowing her tires up and bumping her up, because she deserves it.”

“I think my success in my career, it’s secondary to [the players] and our success as a team, and I feel that I’m part of them,” Hayden said. “So I’d never want to make myself feel as if I have an individual platform. I have a platform with the Twins. And I really take that seriously. So every win, every loss, I wear that.”

Whether fairly or not, she knows the expectations for her — at least, looking from the outside in — might be higher than they would be for others in her position. She is aware that her success and how she carries herself in this position could open or close the door for other women to follow.

With that in mind, Hayden also said she feels that Kadish, Baldelli, the Twins’ organization and her network also deserve the acknowledgment for putting her in this position and giving her the well-deserved opportunity.

“I attribute a lot of it to a really powerful network of people,” Hayden said. “I’m so humbled that they put their name on me. I say I wear a jersey with a lot of people’s names on my back that have taken a risk on me, whether that was when I was 18 or currently in the big leagues. People have taken a risk to allow me to do what I love, and so I take that really seriously.”

Still, she’s careful to acknowledge the fact that other women around the industry may not have the strong base of support and understanding to facilitate such an easy transition into the industry. Hayden understands that there could be uphill battles and double standards for others in her position.

But that’s not the path she’s forged in the Twins’ organization. And for that, she remains encouraged — and grateful.

“It’s a direction that is obviously needed in the game, and one that nobody sits and stops, and really, it’s what times have evolved into, for the better,” said veteran starter Rich Hill.

“My story has just been awesome,” Hayden said. “And it’s so good and so supportive and being with all these dudes is awesome, and I wouldn’t trade it for anything. So that’s honestly the best part.”

Do-Hyoung Park covers the Twins for MLB.com. Follow him on Twitter at @dohyoungpark and on Instagram at dohyoung.park.

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4 reasons you must embrace push notifications to increase revenue – Best in Australia

Photo: Cristian Dina, Pexels.

You think of expanding your business, suddenly one idea sparks in your mind and that is none other than the mobile app technology and you want to adapt it since you want your business to excel and you don’t want a single stone to remain unturned for the sake of your success. 

But after getting a mobile app you realize that it is turning out to be a hard task for you to retain users.

When the question of app’s success comes the very segment which describes the success of a mobile app is the number of active users on your mobile app, and something which takes this journey one step ahead is the app retention on your mobile app. 

Push notifications can be a tool for the user retention, but only if you decided to proceed with certain tactics, which are mentioned herewith in this blog. Let’s read ahead and experience the difference

App retention is one of the greatest concerns every app has to deal with and needs to find out the best ways out of it in order to make your app survive the app chaos elegantly. 

Indeed there are certain aspects which must be integrated into the app during the app development process, so the app can fit in the requirements of the business and falls as an absolute fit for the users’ expectations as well.

But with so many features, functionalities, it gets more confusing for the app owners to pick the right strategy for the mobile app, which can help the mobile app from getting doomed, so to avoid the cloud of confusion, we have brought this post today, which clearly speaks that how a simple feature in your app, can help your mobile app to survive the game of the app retention…this feature is none other than the Push Notification.

Motivates users to buy products

When a customer plans to buy something from your app, but adds them in the cart and forgets to buy the product, in such scenario when you send a push notification reminder to your targeted audience so they can complete their purchase.

So with a help of simple push notification, you trigger your audience and help them to stay hooked to your services only.

Offers personalized notification

Your users have a different choices, and the different demand from the users, often lead the users to visit the competitor’s mobile app, since they feel the existing app doesn’t have anything new to serve them, so with a push notification you can easily eradicate this possibility by continuously updating your users, about any new feature or the new update which would suit their taste.

With this, you would help your users to stay engaged with your mobile app only and you can experience a much-engaging user experience.

Works on users’ psychology

When you wake up in the morning, and find a notification on your mobile app, telling you the weather forecast, you would definitely feel touched and would start to notice the app. 

This same strategy is integrated by the Facebook as well, wherein on opening the app or the web page in the morning, you are notified by a beautiful message, which states, Hi XXX, today weather will remain clear in Australia, you can enjoy the sunshine!!!, these small notifications which stay on top of your mobile app, keep reminding the users to about your app.

Now the question comes, that how to make the push notification a successful strategy???

Unfortunately push notification can be a deal-breaker or the maker for your app if you skip following the rules. The rules are quite simple and state:

Keep the content simple

When you decide to proceed further with the push notification then you must remember that your users don’t have much time to understand and act on your notification, so the very first strategy suggests, that more your content would be simple, more it would be preferred by the users. So keep the notification content simple yet engaging with some magic words, like ‘ Grab the deal’ or ‘ (name) you should not miss this deal’, by integrating the words like this, you would allow your users to use your app.

Push platform

The selection of the right platform to send the push platform is also mandatory for the successful push notification strategy. There are many push platforms in the market, such as PushWoosh and Parse to name a few, but you need to pick the most appropriate option as per your business needs.

Notifications must have the frequency

You need to understand a very common and most significant fact, that every user has a personal life as well, and you cannot disturb it with your push messages, so you need to understand that your push notification must not turn out to be an irritating factor for your mobile app, so by keeping this in mind you must set a frequency of your push messages.

Switch on/off option

When it comes to push notification, the more you allow your users to use it as per their convenience they would prefer to use it further. To make this happen, you must let the On/Off option in your mobile app, which would allow the users to set the notification-receiving as per their convenience.

Indeed push-notifications can help your mobile app to retain the users, but only if it is planned and managed with the right strategies to yield the best result out of it and can help you to make your app development a cherishing experience for your business goals.

Also, one another fact which equally matters in the success of a mobile app, and cannot be given a miss at any given cost, is the selection of the right mobile app development company for your app.

I know there are many app development companies in the app development market, and which keep on confusing you further, but you need to be sure of picking a right app development partner, which has the impressive technical experience and the technical exposure to handle your app requirements effortlessly.

If you are finding it hard to find such company for your app concept, then you must get in touch with experienced app builder such as Techugo, which has every bit of these requirements coupled with the renowned clientele list, and help your app to grow immensely.

Jason is a senior Android developer in Australia. He holds great expertise in latest and advanced Android technologies, and ensures to integrate his skills into the mobile app development process.

What do you think about it?

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Apostle Who Predicted Pastor Adeboye’s Death Reveals Fresh Prophecy On Buhari

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President Muhammadu Buhari

Apostle Paul Okikijesu of the Christ Apostolic Miracle Ministry has revealed what God told him about President Muhammadu Buhari.

In a series of 2020 prophecy he released to DAILY POST on Saturday, he said God has asked Buhari not to rely solely on his wisdom.

He said Buhari must have a meeting with religious leaders, including his religious advisers in order for his government to be meaningful.

He said, “Thus says the Lord: Tell the President of this country to seek advice from those that I established as my ambassador and representatives that are telling the truth, and not the gluttons.

“The gluttons did not allow Buhari to listen to the truth and he did not count Christianity as something valuable, because the acts/behaviors of Christian leaders are different from what he thought.

“He should think deeply concerning his administration because the messages which I sent to him, he carried out some of my instructions and left the rest, that was the reason that his tenure was in this precarious state.

“Send these messages to him the third time that I want the fear of I the Lord in the heart of this man, and he should not see himself as the president. He should realize that God alone is the President of the world.

“Thus says the Lord: I have sent these messages to him in the past to give these three arms of the government the power to work effectively.

“These arms of the government are the executive, the judiciary and the law enforcement.

“This judicial arm includes the human rights advocates and I instructed him to give them free hand to operate; these are the things which I requested from him, and this is what can make his regime to be meaningful.

“I send this message to him the second time that he should invite the ex-presidents, and he must not commonize anyone if he wants his government to be peaceful.

“According to My previous messages, he complied partly but not fully. I instructed him to invite and have meeting with the banking sector, stock exchange sector, the oil and gas sector and the foreign exchange sector for the growth of the nation.

“He should then present the outcome of the meetings to the spiritual people for advice.

Thus says the Lord; remember that those I installed as rulers during the ancient period did not use only their wisdom, but they asked for direction from I the Lord.

“It is when he calls these people that his regime will be meaningful and he will have a successful tenure. If he uses power to do things, some people will be sabotaging his government.

“The executive that I said are the ex-presidents, he should call them and have meeting with them; then get the opinions/advice of the people in his administration separately.

“It is the wisdom derived from these meetings that will cause growth/development in Nigeria. He must have meeting with the business community including the expatriates, these are the steps that will make the economy of Nigeria to rise and grow.

“He should have meeting with ex-ministers, ex-senators, ex-presidents, and ex-governors, the outcome of the meeting will have positive effect on the economy and restore the economy to a buoyant position.

“He should have a meeting with judicial personnel, including the attorney general to find way that will make the law of the country to be effective.

“If Buhari can take these steps and have meeting with religious leaders, including his religious advisers, his government will be meaningful for good.

“Thus says the Lord; Buhari should have meeting with ex-party leaders and the current party leaders concerning the issues of Nigeria and how she can progress.

“These steps are the things that can make him to be successful and prolong his life, so that I will halt the judgment hand that I intend to use in year 2020.”

In his last prophecy, Okikijesu had declared that God told him that Pastor Enoch Adeboye of the Redeemed Christian Church of God, RCCG; Pastor W.F Kumuyi of Deeper Life Bible Church and Bishop Oyedepo of the Living Faith Church, will die soon and would not make heaven. 

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Kenyan Mum, Connie Muuru, Advises Women As She Marks 4 Years Since Her Daughter Was Battered To Death By Boyfriend – Motherhood In-Style Magazine

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Yesterday, January 14, marked the fourth anniversary of the death of a young Kenyan woman, Sharon Muuru who was killed by her boyfriend, Salim Kipruto Seem. The deceased’s mother, Mrs Connie Muuru, a Nairobi businesswoman took to Facebook to mourn and warn victims of domestic violence as she always does since the untimely loss of her daughter, who was a single mum.

Connie, who has started a project that would empower victims of domestic violence, says her daughter’s experience has made her cognizant of the morbid experiences people in violent relationships go through. She narrated that Salim made a habit of getting violent with the deceased even though he was jobless, lived in her daughter’s house and was fended for by Sharon.

The deceased was also not married to her killer and her only child was from a previous relationship according to Connie, who only got to know of how serious her child’s travails had been, only after the young mum had passed.

She narrated to eDaily what transpired until her daughter died.

”If someone shows you little elements of violence, walk out. Don?t wait to be beaten to death ? this applies to members of both genders.

Let the wrangling couple, whose relationship is marred by violence, to separate and solve their differences when not living under the same roof.

They can come back together later after their problems are solved amicably. For instance, my daughter knew her partner Serem was not a good person because she was beaten severally. She shouldn?t have waited until she was killed.

I am not against families, I am not against marriages. But when it comes to death, nothing can be compared.

My daughter thought since she was the one providing and paying the rent, then the man was the one to leave.

But that shouldn?t be the case. If you are the one providing and your partner becomes violent, please leave him or her. You can get another house and other properties, but not another life.”

Read Connie’s Facebook post from yesterday below:

Baby girl I wish there’s anything I can do to bring you back… It’s exactly 4 years today, since you left us.
January 14th will remain dark and sad day all my life!

It’s more painful to remember the man you cared and loved, decided to kill you.
Sadly you allowed him to continue staying in your house, even after many nights of violence.

You were kind… brilliant…considerate and selfless… maybe that’s why he took advantage of you.

But it’s doesn’t matter now though…I only hope that you made to heaven child

Continue resting with Angels, because you are one of them!

Your beautiful memories are with me daily and have consciously, refused to forget you.
IN MEMORY OF MY DAUGHTER SHARON MUURU, I CONTINUE SAYING NO TO DOMESTIC VIOLENCE!

If your spouse can’t solve problems without a fight just part ways, while you are alive.Remember you have only one life… once you lose it, it’s forever!

MAY THE BEAUTIFUL SOUL OF MY DAUGHTER SHARON MUURU REST IN PEACE

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Cleric to Nigerians: Turning cemeteries to refuse dump sites, disrespect for death – Daily Nigerian

A cleric, Yohanna Buru says most Nigerians lacked respect for the dead, as cemeteries have been turned to refuse dump sites and were often covered with pet bottles.

Mr Buru, a pastor of Christ Intercessory Fellowship, Sabon Tasha, Kaduna, said this while briefing newsmen after a tour of some cemeteries in Kaduna.

According to him, it is unfortunate that citizens have stopped respecting the serenity of the graveyards which supposed to be a clean and sacred environment and not dump site.

“Citizens should be God fearing and remember that, they are all going back to the cemeteries one day.

“Many cemeteries in Nigeria are in poor and bizarre conditions as most of them have turned out to be latrines, refuse dumps, hideouts for criminals and ritualists among other atrocities.

“The environment in some graveyards is not looking good due to the large number of pet bottles within and outside the premises.

“A graveyard must be properly secured and fenced to avoid trespass or encroachment to the premises, it is not a grazing site for animals or a place of smoking Indian hemp,” he said.

Mr Buru added: “The surrounding of most of the cemeteries are not good looking due to lack of sanitation by those in charge of the places.

“We must respect the dead more so when cemeteries hold great significance to communities across the country.”

He said that the cemeteries should be cleaned, adding that State and Local Government authorities must ensure that cemeteries were not turned into permanent refuse dump sites .

Mr Buru thanked the African Climate reporters on its selfless service toward raising public awareness on the dangers of throwing trash into sacred places like cemeteries.

He called on environmental officers to start creating public awareness on the cleaning of sacred places and the environment.

Gambo Abdullahi, a Muslim scholar, also condemned those using cemeteries as toilet grounds and asked them to stop the habit.

Mr Abdullahi, a member of Peace Revival and Reconciliation Foundation of Nigeria, a Non Governmental Organisation, NGO, said that there was need to carry out regular cleaning of cemeteries to keep them clean.

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Trending: Fat church rats sting Pastor Oyedepo | P.M. News

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Oyedepo: stung by church rats

Presiding Bishop of the Winners Chapel, Dr. David Oyedepo, is in the news after his shock revelation that some top officials of his church had looted the church’s treasury.

He made the revelation at the empowerment summit organised for ordained workers of the church on Saturday, with the story going viral since then.

Oyedepo said the officials, the fat church rats, mainly accountants have been sacked. He did not however say whether the church would seek retributive justice in the court of the land.

“Can you imagine accountants perpetrating fraud in the house of God?”, the angry bishop said.

“We had no choice but to dismiss them. You can imagine top church officials engaging in doubling figures and other dubious practices.

“Even after we dismissed them, we discovered more fraud.

“Those who should discover the fraud were the ones involved in it. One of them refused to confess until the last minute.”

He admonished the church members against employing the dismissed officials. He said he had to tell everyone present because he knew the dismissed officials “will come to you for employment.”

“Don’t employ them and don’t sympathise with them. Whoever sympathises with the wicked is wicked himself.”

Dead silence fell on the gathering as the Bishop reiterated: “Don’t sympathise with any perpetrator of fraud, otherwise you are a partaker of the evil act.”

Oyedepo did not disclose the volume of money stolen by the church rats, but newspaper reports assumed it must be in millions to provoke his anger.

However, his critic, Daddy Freeze, is not shedding any tear for him. In an Instagram post, Freeze refers Oyedepo to the scriptures, asking if the missing money came from the sweat of Oyedepo or whether it is a donation.

“This to me, is nothing more than a daunting cocktail of scriptural misinterpretation, misplaced priorities and misdirected resources, making this seem like it’s an odd in between compromise amidst a church and a business enterprise.

“For starters, the church building is NOT the house of God (the scriptures in acts 17:24 clearly tell us so)!

“Is money they stole money you worked for from your personal business enterprises? If yes they should face the wrath of the law.

“However, If it came from donations, let Acts 4:32 guide you. According to the aforementioned verse, the disciples shared everything equally, so there was no lack. Could it be that you haven’t been giving them their share and they now took it by force?🙄

“Remember, the offertory the early church received was shared equally among ALL believers, maybe if you practice that, you won’t fret over accountants pilfering.

Acts 17:24 New Living Translation:“He is the God who made the world and everything in it. Since he is Lord of heaven and earth, he doesn’t live in man-made temples,

Acts 7:48 New Living Translation: However, the Most High doesn’t live in temples made by human hands. As the prophet says,

2 Corinthians 5:1 New International Version: For we know that if the earthly tent we live in is destroyed, we have a building from God, an eternal house in heaven, not built by human hands.

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Death, Diarrhea and Late Night Sackings: The Inside Story of an Unfolding Staff Nightmare at UBA and Dangote

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Last November, thousands of Lagosians including hundreds of UBA Bank employees attended what was billed as the ‘party of the year’ at the Lekki Special Events Centre on Admiralty Way.

The UBA RedTV Rave had everyone from Wizkid to Olamide to Jidenna to Burna Boy thrilling the festive crowd as UBA chairman Tony Elumelu and CEO Kennedy Uzoka mingled with the artists and guests.

On the surface, this was the best of times, as a bank that was clearly in rude health celebrated a successful year with thousands of employees, friends and family. The bank had also recently concluded a recruitment exercise that would add nearly 4,000 new employees to its staff strength, so the year ahead looked to be a promising one for most employees present. 

Unknown to them, while senior executives danced with Wizkid in the VIP area, one of the most brutal staff layoffs in Nigerian banking history was just around the corner. They partied well into the night and then showed up for work the following week as usual. A week went by. Two weeks. Four weeks. Then right at the start of the new year – a shocker.

Closed at 5.30PM, Terminated at 10.30PM

Ifunanya (name has been changed) was asked to wait behind at work on Friday January 3. As a 12-year UBA veteran including a long stint in her role as a Branch Operations Manager at a branch in Ojodu, Lagos, this was not an unusual request to receive. She was even used to working weekends so that the ATMs could remain functional and she could troubleshoot other onsite customer-facing issues. This time however, was different. 

Along with other staff members at the branch, she was asked to wait for a board meeting. By 10.30PM, the assembled staff were informed that their services were no longer required. They were then told verbally to write out their resignation letters on the spot and leave voluntarily or be forced out. At this point, her security pass was taken, and along with the other affected staff, her profile was unceremoniously deactivated from the bank’s internal system. She was reminded to drop her work ID on the way out, and thus ended a 12-year association with the bank.

When a relative of hers reached out to tell the story, he was keen to make the point that she was not an agency employee, but a full UBA employee on a monthly salary of N153,000. He could not understand why the bank would treat her that way. I heard similar stories from two other sources who insisted that they were coerced into resigning after being told that their services were no longer required right at the start of the new year.

Shocking and callous as these stories may have sounded, one of the first things you are taught in any professional journalism program is to always balance the story. So I sought an alternate account of what transpired, with the goal of putting the picture together to tell a complete story. There were conflicting accounts of the events of January 3 flying around, with some accounts describing a recruitment and promotion exercise without mentioning any firings, while others reported a purported “restructuring” at UBA, which is a well-known euphemism for “mass sack.”

I managed to establish contact with a current senior employee at UBA who asked to remain anonymous because he is not authorised to speak about such matters. This was his account of what happened at UBA bank at the start of this year:

“Usually when anyone joins UBA with a Bachelor’s degree, they are put on a GT1 level (N80,000). After one year, they are promoted to GT2 (N100,000), then after another year ET1 (N140,000) which is where a lot of people get stuck on. If you are lucky, you get to ET2 (N165,000). So what UBA did was to meld those 4 levels into one (ET) so any one who was on GT1 and GT2 gets automatically promoted to ET2. Those that were on ET1 and ET2 got promoted to SET (Senior Executive Trainee). 

So it was a promotion of sorts, but honestly it was long overdue because compared to other banks, N80,000 for entry level staff is quite low. About the layoffs: I only know 4 people personally who got affected. The people affected were on manager grades and worked at the head office, they all reportedly got 6 months arrears.”

According to this source, he was not personally aware of the fate of any branch staff or what he termed ‘OND staff.’ He did however say that in his opinion, the bank handled the situation poorly and that Nigeria does need stronger labour laws to protect young graduates fresh out of school from exploitation for cheap labor at the hands of corporates like UBA. He also mentioned that he knows current UBA staff have not had a salary increase in ten years – a remarkable situation for workers in a country whose currency has declined 195 percent over the same period.

As it later emerged, more than 2,000 staff were affected by the shocking late-night cull at UBA. It also became increasingly clear that the firings had nothing to do with a harsh operating environment or decreased profitability. The bank which had brought together Nigeria’s most expensive music stars to perform at its end of year shindig was anything but struggling – it actually hired more people than if fired. What the sackings did though, was clear out a number of people in roles that the bank considered obsolete, particularly within branch operations.

It can definitely be argued that such restructuring is inevitable in the face of rapidly changing technology, which is hardly a terrible thing. What is also true however, is that the bank that paid huge sums of money to bring Burna Boy and Jidenna to an annual vanity event that adds nothing to its bottom line could also afford to retrain its redundant staff to fit into new roles –  instead of just sacking them and instantly bringing in thousands of readymade replacements.

Yet again, the actions of a Nigerian corporate made the point that Nigerian labour law, in addition to be being poorly enforced is also woefully inadequate and unfit for purpose. If after 12 years of useful service to a bank, Ifunanya could be dumped out onto the street without even a few hours of notice – and no regulatory action was forthcoming – then clearly, Nigerian employees working for Nigerian companies have a problem on their hands.

As much as the UBA situation made that point, nothing could have prepared me for what I was about to unearth about another Nigerian corporate behemoth.

Diarrhea in India, Death in Ibeju-Lekki: The Unbelievable Story of Dangote Refinery

While senior executives at UBA House were going over the finer points of their plan to log 2,000 employees out of their work systems and force them to resign on the spot, a different level of labour exploitation was entering its fourth year about 73KM east of the Marina. There, at the site of the Dangote Refinery at the Free Trade Zone in Ibeju-Lekki, Lagos, the refinery was taking delivery of the world’s largest crude oil refining tower.

While this was predictably being celebrated across local and foreign media as the start of a glorious new chapter in Nigeria’s industrial history, I was speaking to a whistleblower with close and detailed knowledge of the project. What he had to say about the refinery project, the Indian project managers, the company’s internal culture and its much-publicised trainee program left me absolutely floored. Naturally I reached out to Dangote Group for a comment, but at press time I have received no response or acknowledgment.

My source, whom I shall call “Mukhtar” worked in and around the refinery project between 2016 and 2018, and what I found most distressing amidst everything he said was the revelation that deaths due to onsite accidents are not just known to happen at the refinery site, but are effectively covered up by Dangote. This he said, is because the people who die are mostly site labourers who are hired through staffing agencies instead of directly. When they die, it becomes the staffing company’s problem and the Dangote brand distances itself from it – even though the site owner is legally responsible for all safety-related incidents onsite.

Something else that struck me was that he implied that – contrary to all its public posturing – the company actually has no intention of using Nigerian engineers to run the refinery anytime soon. The trainee program that sent dozens of Engineering graduates for a one-year training program in India? “Strictly PR,” he said.

Accidents
The first batch of Dangote Refinery trainees head off to India in March 2016

For full effect, I have decided to reproduce the full and unredacted transcript of our conversation instead of using quotes and reported speech. Here is the conversation below:

ME: When we started this conversation, you mentioned that Dangote Refinery is exempt from Nigerian labour laws. What were you referencing?

Mukhtar: Because the refinery is in the FTZ, it is not subject to certain laws like local content laws. As such, even mundane jobs are given to non-Nigerian companies. Even the refinery’s fence wall was handled by a Chinese company. This didn’t stop long stretches of the fence from collapsing sometime in 2017. The FTZ affects Labour laws too. The company is not really under any obligation to employ Nigerians. They do so mostly for PR. All key decision makers are Indians (say 98%).

ME: There have been several horror stories about Indian-run businesses in Nigeria. Was this one of them?

Mukhtar: Yes, the Indians are quite racist. Some even demand to be referred to as “master”. To be fair, when this is reported, the HR unit makes a show of cautioning them. But I dont think anyone has ever been dismissed for it or seriously punished. Most of workers who meet their death on site are labourers. So their names might be known to many staff. I’ll see what I can get. It happens. It’s kept under wraps but it happens.

ME: Now you mentioned onsite deaths earlier. I want to know all about this. Why haven’t we heard anything about this?

Mukhtar: The refinery site is not really the best place to work. Mortality rate on site is quite high. People falling from heights or getting crushed by heavy vehicles/machines is quite common. These numbers are not reported because most staff are contract staff (or outsourced) so the company gets to wash its hands off such cases. But safety on site is the ultimate responsibility of the owner of the project. The construction site has a board that is supposed to display the safety statistics but it is never displays the truth. According to that board, there has never been a fatality on site. But in reality, I think 2018 had about 5 fatalities between January and March. If I were to guess, I’d say there have been over 25 fatalities since construction started in 2016/17.

ME: Now you said earlier that the trainee program was a washout and a disappointment. Fill me in on that.

Mukhtar: I was one of the first batch of engineers sent to India for training in 2016. In my opinion, the whole scheme was either poorly thought out or the company was somehow compelled to do it, and did so for PR. Our salaries were being paid into our accounts in Nigeria, so we were using our debit cards to access our Nigerian accounts for expenses over there) Around July 2016 when the naira went from around 160 per dollar to nearly double that number, our spending power was effectively halved.

ME: I also remember that there was a forex shortage crisis in 2016 and Nigerian bank cards stopped working outside the country.

Mukhtar: So when the banks eventually stopped all cards from functioning abroad, we were stranded. The company resorted to selling us dollars or rupees at the black market rate.They deducted the money from our salaries. We had accommodation (two adults per room) and feeding (Indian food which many of us did not like). Some of had to buy intercontinental dishes regularly, because Indian food is really not nice if you’re not into many smelly spices. It was crazy. Meanwhile we were told categorically that we would have Nigerian food and Nigerian cooks. It was a blatant lie by the Indian HR director.

Also, no arrangement was made for our medical care. Those who fell ill had to treat themselves from their pockets. During the currency crisis, those who fell ill had to rely on the rest of us to put together our spare change to pay for their treatment. The company promised to refund medical expenses, but this shouldn’t have been the situation in the first place.

ME: Tell me about the training program. What was the course content and the experience like? Was it what you were expecting?

Mukhtar: The training itself was a mess too. We were supposed to be trained to operate the refinery (at the time, it was said that it will be completed by mid 2017), but we were sent to a design company. These (designing a refinery and operating it) are two very, very different things. The trainers did not want us there in the first place. It was not a part of their initial contract with Dangote. Plus, they didn’t know what to teach us because designers are not operators. They were confused, several times, they asked us what we wanted to learn. But we could not know what we wanted to learn cos we knew nothing about the entire business. In the end, they reluctantly settled for teaching us design (skills we were/are unlikely to use cos the refinery was already 90% designed). 

ME: If you say that the refinery was “already 90% designed,” and you were learning design in India, that sounds like your presence was superfluous. Was the company really serious about sending you to learn skills to run a refinery?

Mukhtar: Indians will run the refinery. It will take many many many years before that refinery will be populated by just Nigerians. It was strictly PR. Anyways, the training with that design company was suddenly terminated on December 31st. Apparently, Dangote had not paid them a dime for all the months were were being taught design. They didn’t want to send us back to Nigeria so they moved us to the Dangote office in India. The office housed the Indian engineers (around 150 – 200 in number) who were supervising the design work being done by the design company. Now, it is interesting that these guys were working and earning as expatriates within their own country.

But realising that the “training” was a blunder, the company sent back some engineers to train in an actual refinery. So what was supposed to be a 1 year training became 2 years.

ME: Since returning to Nigeria, is there anything else you have noticed about the project that worries or disturbs you?

Mukhtar: Yes. So we have only the refinery at the FTZ, but the company gets to import things meant for other branches of the company duty-free. As a matter of fact, with the Dangote jetty in place and a customs office right there, the company no longer needs to clear stuff at Apapa. Dangote empire effectively has its own customs and port, because we cannot assume that the custom officers stationed at Dangote’s jetty/FTZ are extremely meticulous in checking what comes in and goes out. Personally, I find this disturbing. No non-military entity should be able to import stuff that easily into any country. This is bigger than just skipping custom duty payment.

–Ends–

Between bank staff being fired at 10.30PM and refinery site labourers being killed by workplace accidents without accountability, the sheer grimness of the picture facing Nigerian workers comes into stark relief. It is afterall, an employer’s market, with several thousand qualified people jostling for every job opening, which creates the possibility and incentive to treat staff like battery animals.

Whether the Labour Ministry is willing or able to do anything about such blatant labour exploitation is anybody’s guess. Nigeria’s government is increasingly weak and unable to impose its will on the country even territorially. In the event that the government did take interest, there is a valid fear that it would go to the other extreme and adopt a lazy anti-business Hugo Chavez approach, as it so often does. The real solution if there is to be one, must come from Nigerian labour having a stronger bargaining position through an improved economy. Anything else as it stands, is little more than a sticking plaster.

As Mukhtar mentioned, even inside the ridiculous situation of being financially stranded in a foreign country at the behest of an irresponsible and insincere Nigerian corporate, the vast majority of the group chose to suffer in silence. They did so because spending a year abroad learning useless information, suffering deprivation and experiencing diarrhea after being forced to eat unfamiliar food was still preferable to whatever alternative was at home.

Ultimately, that is the biggest problem facing Nigerian labour. 

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Son stabs father to death, lands in trouble in Lagos — Daily Times Nigeria

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A man identified as Nelson has been arraigned before the Lagos State High Court sitting in Ikeja for stabbing his father, Sunday Oamen, to death with a broken bottle.

Patience Oamen, a hairdresser, on Tuesday told the court how his brother stabbed their father.

The suspect is facing one count of murder contrary to Section 221 of the Criminal Law of Lagos, 2011, before Justice Hakeem Oshodi.

The Prosecutor, M. T. Adewoye, told the court that Nelson was 33-year-old when he committed the offence on September 18, 2015, at their residence, Block 272, Flat 4, Abesan Estate, Lagos State.

Patience while speaking in the court noted that though Nelson had a good relationship with their father the relationship went sour because their father denied Nelson money on Sunday.

The hairdresser further stated that his brother’s clothes had bloodstain on it on the day of the incident before he ran out of the house.

Patience said, “On the day of the incident, our mother, who sells foodstuffs, was downstairs with me and between noon and 1 p.m., while we were still downstairs, I saw my brother hurriedly coming downstairs with his clothes stained with blood. I called his name but he ran away.”

“The door to the house was locked and I was wondering how he opened the door. I took the keys, opened the door and saw a pool of blood and immediately ran downstairs to call our mother and we both ran upstairs to check on our father and noticed that he had been stabbed.

“He had been stabbed all over his stomach and neck with a broken bottle.”

“We reported the case to the police and three days later, Nelson came to the police station to confess that he stabbed our father to death.”

Patience further stated that Nelson smokes Indian hemp and had once stolen the prepaid meter in the house.

Patience, while being cross-examined by the defence counsel, E. B. Ogogo, reiterated that though she was not in the room when the incident happened, she knew that her brother committed the crime because his clothes were stained with blood.

She added, “I saw him that day but I forgot to put it down in my statement. I was not myself that day because of the shock; that was why I did not remember to write it in my statement.”

“My brother said our father’s spirit was haunting him and that was why he went to the police station to confess.”

The case was adjourned 

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Nathan Miller obituary, death: Nathan Miller Chocolate Chambersburg

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Nathan Miller obituary, death: Nathan Miller Chocolate Chambersburg

Nathan Miller obituary, death: Beloved Nathan Miller Chambersburg chocolatier has passed away.

He is the proprietor and chocolatier at Nathan Miller Chocolate.

Please say a prayer for his grieving family mourning his death as you read the tributes below:

Please cover Deb and Rick Miller in love and prayers for comfort. They lost their beloved son Nathan and he will be greatly missed by so many.

I just remember him with this amazing dry sense of humor that brought joy to our lives as my sons middle school and highschool friend. Wrestling, soccer, cross country and many sleep overs at our house. Nate had an explorer’s spirit and wasn’t afraid to take risks like my son.

Looking back I never would have dreamed they both would have been business owners. Nate became a chocolatier in Chambersburg after studying abroad and here, all types of culinary skills. Nathan’s chocolates in Chambersburg made the best chocolate.

Nathan was a true example of an overcomer and showed the world that with faith and hard work you can find your dreams. You will be dearly missed and thankyou for the wonderful day I got to come down and have a tour.

Rest in Peace Nate until we meet again. Love and prayers

The Chambersburg community has a lost a real one. I’ll always remember going to $5 punk shows in the event space attached to the coffeehouse, buying bags of my favorite Little Amps coffee, having the best brownie I’ve ever tasted, and tearing up with hometown pride when seeing Nathan’s factory on national TV while on a flight home. Thank you Nathan Miller. Rest Easy.

Nathan Miller obituary

Nathan Miller I met you in the darkest part of my life. You took me under your wing. You told me your dreams of being a chocolatier, I knew you would not only make that a reality, but take it to the highest level.

You were in your twenties, with all your friends, drawn to your house almost nightly, and Sunday barbecues. You were all so smart, fun, creative and welcoming- to an older woman divorcee even though I never felt like the outsider I was.

Your gatherings, many which involved karaoke and music- your go to Karaoke was vintage Pink Floyd and David Bowie. We enjoyed art, the outdoors, our views of spirituality, of course gorgeous food, and a lot of laughter. Then when I was trying to make it as a realtor, you trusted me and hired me, giving me work. You referred your friends and your wonderful uncle Doug Walter.

You grew my business. As time went on your family, Deb Walter Miller with Doug, made me feel welcome, just as you had, with your friends.

When you trusted me to sell your home, I saw you off to go back to Chambersburg to pursue and conquer your dreams. We didn’t stay in touch. I didn’t visit you when your work brought you to Denver. And I didn’t support through your health battle. I never reciprocated any of the joy and generosity you naturally shared with me. I deeply regret that.

My heart is heavy and I pray your heart and soul have been set free. I miss you, and I’m so grateful for all the love and life you showed me.

Nathan Miller obituary, death: Nathan Miller Chocolate Chambersburg

Nathan was a kind, gentle person. He believed in us and helped us get started. He always gave us good advice and held great conversations over his amazing coffee and chocolates. He will be missed and we will think of him every time we take a bite of chocolate. May he rest in peace.

Our downtown mourns. We mourn the loss of Nathan Miller, proprietor and chocolatier at Nathan Miller Chocolate. Nathan provided encouragement and advice to many businesses with our downtown. He collaborated with GearHouse Brewing Co on a chocolate porter and crafted a product known world wide. We offer our condolences and prayers to the Nathan’s family and friends.

📸 – Nathan Miller Chocolate

Saddened to hear about the passing of Nathan Miller of Nathan Miller Chocolate. His dedication to his craft and his effort to revitalize Chambersburg’s Grant-Street-warehouse area were major inspirations for my own business ventures in this town.

“Made with ❤️ from bean to bar then handwrapped by our team. Come visit our factory at 140 North Third Street in Chambersburg, Pennsylvania.”

[from the packaging – this bar was a gift to Rach and I from Alex and Moriah].

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