‘Runner’ film tells story of refugee turned Olympian. Watch now

Watch: Inspirational documentary ‘Runner’ tells story of refugee who becomes Olympian

Detroit Free Press
Published 7:40 AM EDT Jun 20, 2020

Here’s a chance to watch a documentary that will get your heart racing. 

“Runner” tells the story of Guor Mading Maker, who escaped captivity in his native, war-torn Sudan, where eight of his nine siblings were killed in that country’s civil war. He eventually landed in the U.S., where he began running for his high school track team and later competed in college. Maker (formerly known as Guor Marial) then went on to qualify for the 2012 Olympics — but not without further setbacks and challenges.

“Runner” details Maker’s journey from refugee to world-renowned athlete, using interviews, animated flashbacks and dramatic footage from his racing career. There’s also an emotional reunion with his mother in Sudan after two decades apart.

Anyone interested in viewing the film can rent it for $12 in the screen near the bottom of this page. 

The film won several awards in a festival run in 2019 and early 2020, including the best of fest audience award at Woods Hole Film Festival, the audience award and best documentary jury prize at Naples International Film Festival, the human spirit award at BreckFilmFest and best documentary at Fairhope Film Festival. 

“Runner” tells the story of Guor Mading Maker (formally known as Guor Marial), who ran from captivity in war-torn Sudan to seek safety in the U.S. Maker joined his high school track and field team and eventually qualified for the 2012 Olympics.
“Runner”

Freep Film Festival (the documentary film festival produced by the Detroit Free Press) and Detroit Free Press/TCF Bank Marathon are both presenting partners on the film’s virtual release. Revenues from the rental of the film through this page will be shared with the festival and marathon. The film is also being hosted by more than 120 film festivals, theaters, races and refugee advocacy groups around the country.

Two members of the film’s distribution team, Jenny Feterovich and Steve Bannatyne, were producers on two of the most notable documentaries to have played Freep Film Festival: “The Russian Five” and “Boy Howdy! The Story of Creem Magazine.”

Watch ‘Runner’ documentary here

To watch “Runner,” follow these steps:

1) Press the “Rent $12” icon on the screen above. (Pressing the Play icon will start the film’s trailer.)

2) It’s $12 to watch the film. You’ll be prompted to input your email to create an account, and then enter your credit card. Payments are processed securely via Stripe, a PCI Service Provider Level 1, the most stringent level of certification available. 

3) Once you purchase “Runner,” the film will be available for viewing for 72 hours.

4) Those who rent the film will be sent a link to watch a live Q&A at 9 p.m. Saturday featuring the film’s subject and director. 

4) The link to purchase the film will be available at freep.com through June 25.

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After Trump’s St. John’s photo-op, church leader says “I am now a force to be reckoned with.”

Episcopalian church leaders responded to President Donald Trump’s use of St. John’s Episcopal Church for a photo-op Monday evening, forcibly clearing what was by all accounts a peaceful protest outside the White House with flashbangs, tear gas, and brute force. “I am outraged,” Right Rev. Mariann Budde, the Episcopal bishop of Washington, told the Washington Post, in the immediate aftermath of the staged spectacle. Budde told the Post that the church was unaware of Trump’s intention to use the place of worship for what was essentially a photo shoot with a Bible and that the church does not condone the president’s conduct. “Everything he has said and done is to inflame violence,” Budde said. “We need moral leadership, and he’s done everything to divide us.” The head of the Episcopal church in the U.S., Presiding Bishop Michael Curry, accused the president of using “a church building and the Holy Bible for partisan political purposes.”

“He did not pray,” Budde said of Trump’s publicity stunt in an interview with the New York Times. “He did not mention George Floyd, he did not mention the agony of people who have been subjected to this kind of horrific expression of racism and white supremacy for hundreds of years. We need a president who can unify and heal. He has done the opposite of that, and we are left to pick up the pieces.”

The Bible teaches us to love God and our neighbor; that all people are beloved children of God; that we are to do justice and love kindness. The President used our sacred text as a symbol of division.

— Mariann Budde (@Mebudde)

Bishop Mariann Edgar Budde, who oversees St. John Episcopal Church, reacts to Pres. Trump’s visit and says police using tear gas to clear out peaceful protestors is “antithetical to the the teachings of Jesus.” https://t.co/F4NBSBmfRU pic.twitter.com/p5Mbi8Ogt2

— Good Morning America (@GMA)

The rector of St. John’s, Gini Gerbasi, recounted in a Facebook post Monday night the moments that led up to the presidential publicity stunt.

The police in their riot gear were literally walking onto the St. John’s, Lafayette Square patio with these metal shields, pushing people off the patio and driving them back. People were running at us as the police advanced toward us from the other side of the patio… We were literally DRIVEN OFF of the St. John’s, Lafayette Square patio with tear gas and concussion grenades and police in full riot gear. We were pushed back 20 feet, and then eventually – with SO MANY concussion grenades – back to K street. By the time I got back to my car, around 7, I was getting texts from people saying that Trump was outside of St. John’s, Lafayette Square. I literally COULD NOT believe it. WE WERE DRIVEN OFF OF THE PATIO AT ST. JOHN’S – a place of peace and respite and medical care throughout the day – SO THAT MAN COULD HAVE A PHOTO OPPORTUNITY IN FRONT OF THE CHURCH!!! PEOPLE WERE HURT SO THAT HE COULD POSE IN FRONT OF THE CHURCH WITH A BIBLE! HE WOULD HAVE HAD TO STEP OVER THE MEDICAL SUPPLIES WE LEFT BEHIND BECAUSE WE WERE BEING TEAR GASSED!!!!

 I am deeply shaken. I did not see any protestors throw anything until the tear gas and concussion grenades started, and then it was mostly water bottles. I am shaken, not so much by the taste of tear gas and the bit of a cough I still have, but by the fact that that show of force was for a PHOTO OPPORTUNITY. The patio of St. John’s, Lafayette square had been HOLY GROUND today. A place of respite and laughter and water and granola bars and fruit snacks. But that man turned it into a BATTLE GROUND first, and a cheap political stunt second.

“I am DEEPLY OFFENDED on behalf of every protestor, every Christian, the people of St. John’s, Lafayette square, every decent person there, and the BLM medics who stayed with just a single box of supplies and a backpack, even when I got too scared and had to leave. I am ok,” Gerbasi concluded. “But I am now a force to be reckoned with.”

*This post was updated with additional comments from Right Rev. Mariann Budde after it was published.

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Minneapolis death of George Floyd: Protests escalate; Trump vs Twitter

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Minneapolis protests escalate as police precinct set on fire, CNN reporter arrested; Trump lashes out at looters on Twitter: What we know

Ryan W. Miller, Jordan Culver, Joel Shannon and Erick Smith
USA TODAY
Published 7:45 AM EDT May 29, 2020

A Minneapolis police precinct was torched late Thursday night as protests intensified following the death of George Floyd, a black man who died in police custody this week after a white officer pinned him to the ground under his knee.

Amid the escalating violence, President Donald Trump criticized the city’s mayor and called protesters “thugs.” Twitter later put a public interest notice on that tweet.

Elsewhere in the deeply shaken city, thousands of peaceful demonstrators marched through the streets calling for justice.

There were protests and rallies across the country, too – including New York City, Chicago and Denver. In Louisville, Kentucky, a protest to demand justice for Breonna Taylor, the 26-year-old Louisville ER tech shot and killed by police in March, turned violent. Seven people were shot.

Here’s what we know Friday:

State police, national guard clear streets Friday morning

Early Friday, patrols of local and state police and the national guard were clearing the streets around Minneapolis Police’s 3rd Precinct as smoke from the overnight fires billowed.

Video of police and the guard in riot gear and with shields were seen holding lines and marching through the street to push people back.

The heavy police presence came after hours of protests and looting overnight during which little to no police were seen in Minneapolis.

CNN reporter and crew arrested

A CNN reporter and crew were arrested early Friday as state police advanced down a street near the 3rd Precinct.

Correspondent Omar Jimenez was reporting live on “New Day” when police advanced toward him and his crew. Jimenez told police that he was a reporter, showed his credentials and asked where they would like him and the crew to stand so they could continue reporting and be out of their way.

“Put us back where you want us. We are getting out of your way,” Jimenez said. “Wherever you want us, we will go. We were just getting out of your way when you were advancing through the intersection.”

A response by police could not be heard as Jimenez explained the scene. An officer then told Jimenez he was under arrest. Jimenez asked why he was under arrest, but was taken from the scene. The rest of the crew was then arrested as the live shot continued with the camera on the ground.

CNN said later Friday that Jimenez had been released and that Minnesota Gov. Tim Walz apologized for his arrest.

George Floyd video adds to trauma: ‘When is the last time you saw a white person killed online?’

Fires, protesters overtake 3rd precinct

Hours after hundreds of protesters flooded Minneapolis streets – shouting “I can’t breathe” and “no justice, no peace; prosecute the police” – a group of demonstrators overran MPD’s 3rd Precinct, setting “several fires” and forcing officers to evacuate “in the interest of the safety,” according to a police statement.

Protesters celebrated – cheering, honking car horns and setting off fireworks – as fires scorched at the precinct. For hours, police ceded the area to the protesters as windows were smashed, fires lit and buildings looted.

Protesters could be seen setting fire to a Minneapolis Police Department jacket, according to the Associated Press.

Video from Minnesota Public Radio reporter Max Nesterak shared on Twitter showed large crowds around the precinct with rubble and debris thrown about. Nesterak tweeted that Postal Service vehicles were being hijacked.

Follow the George Floyd story: Get USA TODAY’s Daily Briefing in your inbox

Trump calls Mayor Jacob Frey ‘weak,’ Twitter responds with notice

As the city was erupting, President Donald Trump lashed out on Twitter, calling the city’s mayor “very weak” and saying that “thugs are dishonoring the memory of George Floyd.” 

In a tweet just before 1 a.m. ET, Trump said he couldn’t “stand back & watch this happen to a great American City.”

“A total lack of leadership,” Trump tweeted. “Either the very weak Radical Left Mayor, Jacob Frey, get his act together and bring the City under control, or I will send in the National Guard & get the job done right.”

Twitter later put a public interest notice on that tweet.

“This Tweet violated the Twitter Rules about glorifying violence. However, Twitter has determined that it may be in the public’s interest for the Tweet to remain accessible,” the social media company posted.

Trump’s social media order: Rule means agencies can review whether Twitter, Facebook can be sued for content

National Guard activated

Minnesota Gov. Tim Walz earlier Thursday activated the National Guard at the Minneapolis mayor’s request. The Guard tweeted minutes after the precinct burned that it had activated more than 500 soldiers across the metro area.

Photos and video on social media showed the National Guard moving through the streets around the precinct early Friday.

Target closes 24 stores in Minneapolis-St. Paul area ‘until further notice’ 

After multiple videos of looters causing chaos inside a Target store circulated on social media Wednesday night, the Minneapolis-based retailers on Thursday announced closures for 24 of its stores in the Minneapolis-St. Paul area. 

All of the closures are “until further notice,” Target said in a statement. 

“We are heartbroken by the death of George Floyd and the pain it is causing our community,” the company said. “At this time, we have made the decision to close a number of our stores until further notice. Our focus will remain on our team members’ safety and helping our community heal.”

Earlier Thursday, dozens of businesses across the Twin Cities boarded up their windows and doors in an effort to prevent looting.

Minneapolis police at center of George Floyd’s death had a history of complaints

Derek Chauvin, the officer fired for kneeling on Floyd’s neck, and officer Tou Thao, who is seen on the video of Floyd’s arrest standing by, have histories of complaints from the public.

Since December 2012, the officers drew a combined 13 complaints. Minneapolis settled at least one lawsuit against Thao. Since 2006, Chauvin has been reviewed for three shootings. 

They were repeatedly accused of treating victims of crimes with callousness or indifference, failing to file a report when a crime was alleged and, in at least one case, using an unnecessary amount of force in making an arrest.

– Kelley Benham French, Kevin Crowe and Katie Wedell

More news on the police death of George Floyd

How did we get here: What happened to George Floyd

Floyd, a 46-year-old black man, was pinned down by a white police officer who held his knee to Floyd’s neck. The incident was recorded on cellphone video that went viral, sparking outrage nationwide.

Floyd died after pleading with officer Derek Chauvin to remove his knee from Floyd’s neck while police were investigating the use of a counterfeit bill at a corner store. Chauvin and the three others officers involved were fired Tuesday.

– Tyler J. Davis

Rev. Jesse Jackson calls for nationwide protests

“The protests must continue, but around the country … protest until something happens,” the Rev. Jesse Jackson said in a visit to Minneapolis, where he called for murder charges over Floyd’s death. He said protests should respect social distancing protocols to prevent the spread of COVID-19. 

The Rev. Al Sharpton and Gwen Carr, the mother of Eric Garner who was killed by an NYPD officer, also came to Minneapolis to speak to protesters. 

Protesters should continue to take action until charges are announced, Jackson said. He said black people have been “brutalized without consequence” for decades. 

– Tyler J. Davis

State and federal authorities promise to investigate Floyd’s death

“That video is graphic and horrific and terrible and no person should do that,” Hennepin County Attorney Mike Freeman said at a press conference. He said investigators needed time to determine if the video showed a criminal offense: “We have to do this right.”

Investigators took an unusual step in announcing an in-progress federal investigation, U.S. Attorney Erica MacDonald said. She joined Freeman and other officials in offering condolences to Floyd’s family and pleading for peaceful protests.

Calling Floyd’s death a “disturbing” loss of life, MacDonald promised a “a robust and meticulous investigation” and said the Department of Justice is making the case a “top priority.”

Contributing: Associated Press; Trevor Hughes, Cara Richardson and Steve Kiggins, USA TODAY.

Read more about George Floyd, the shooting and other news

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COVID-19: 15 Nigerians employed by the US Health Agencies – Leonard

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U.S Ambassador to Nigeria, Mary Beth Leonard, speaks on the efforts towards curbing the spread of Coronavirus pandemic across the world.

#COVID19 #Pandemic #Coronavirus

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This content was originally published here.

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Coronavirus live updates: U.S. death toll nears 55,000

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The U.S. coronavirus death toll neared 55,000 early Monday, with more than 972,000 confirmed cases, according to NBC News’ tally.

The grim milestone comes as the White House coronavirus task force coordinator Dr. Deborah Birx warned that many of the social distancing measures that have upended American life will be a fixture through the summer.

To get a more accurate picture of the virus’ spread, the U.S. needs a “breakthrough” on coronavirus testing, she said on NBC News’ “Meet the Press” Sunday.

Meanwhile in Italy, Europe’s hardest hit country, the prime minister laid out plans for a phased end to restrictions, including the opening of restaurants and libraries in mid-May.

Download the NBC News app for latest updates on the coronavirus outbreak.

45m ago / 12:13 PM UTC

British Grand Prix could take place behind closed doors, French race cancelled

The British Grand Prix and French Grand Prix are the latest global sporting events to be affected by coronavirus.

France has called off its event altogether, while Britain’s race might take place without fans this year as the U.K. government continues to ban large gatherings to prevent the spread of coronavirus.

Silverstone, the track that has hosted the race since 1952, said it was discussing with the government a plan to show the event on TV for free instead. Silverstone said it would give health care workers tickets for the 2021 event.

✍️An update from our Managing Director, Stuart Pringle about the Formula 1 Pirelli British Grand Prix 2020. pic.twitter.com/APIXq8F2OS

— Silverstone (@SilverstoneUK)

Nursing home industry pushes for immunity from lawsuits during coronavirus emergency

As the COVID-19 death toll at nursing homes climbs to nearly 12,000, the nursing home industry is pushing states to provide immunity from lawsuits to the owners and employees of the nation’s 15,600 nursing homes.

So far at least six states have provided explicit immunity from coronavirus lawsuits for nursing homes, and six more have granted some form of immunity to health care providers, which legal experts say could likely be interpreted to include nursing homes.

Patient advocates worry that nursing homes accused of extreme neglect could avoid liability.

“I can’t even believe this is a topic of discussion,” said Anny Figueroa, whose 55-year-old mother was a resident at Andover Subacute & Rehab Center in New Jersey, where law enforcement discovered 17 bodies in a makeshift morgue this month.

1h ago / 11:52 AM UTC

Italian expat in Sweden shows off country’s lack of restrictions

An Italian PhD candidate living in Sweden has documented the “parallel universe” of daily life in Sweden, a country where the government has not enforced strict social distancing measures amid Covid-19.

Alessandra Palusco, 28, who is studying at the University of Orebro, posted several videos on social media showing life in Sweden and the difference with countries living under lockdown. Palusco told NBC News via text message that she lied to her family back in Italy to reassure them that locals are wearing masks in public,”otherwise they would go crazy.”

Sweden’s Foreign Minister Anne Linde denied in a news conference on April 17 that “life goes on as normal in Sweden,” but Palusco believes that the Swedish government has not taken firm enough action on the virus. “I really don’t understand, if they implement certain measures, it means that they basically know that the situation is dangerous,” Palusco told NBC News.

“Masks do very little, if anything at all”. We wont forget the way you misinformed people, and this is the result 👏👏👏 @Folkhalsomynd #COVID19 #COVID19sverige #covid19swed pic.twitter.com/BaUEDro1J4

— Alessandra • 桑德拉 (@alex_paiusco)

1h ago / 11:37 AM UTC

Salons, florists and garden centers allowed to reopen in Switzerland

Hospitals in Switzerland reopened for outpatient and non-urgent procedures on Monday as the country began easing measures put in place to contain the coronavirus outbreak. 

Beauty salons, DIY stores, garden centers and florists were also permitted to reopen, the government announced as it laid out its staged plans to lift the lockdown. On May 11th, elementary schools and other shops will be allowed to reopen “if the situation allows,” the government said in a statement. Then in June, high schools, zoos and libraries will be allowed to open their doors.

Switzerland has nearly 30,000 confirmed cases of COVID-19 and 1,600 deaths since the pandemic began.

2h ago / 11:19 AM UTC

Two funeral home workers in Harlem, N.Y. said they are turning away families whose loved ones have died because there are more bodies than they can handle.

“We want to be able to help everyone,” manager Alisha Narvaez told “Kasie DC” Sunday evening, adding that they often have to tell families to call back because they have no room. Both women, who work at International Funeral and Cremation Services, said the emotional toll of helping the families weighs heavily on them.

“Just today I had a family call because they’re pretty much at the cut-off time for the hospital to hold their loved one. And out of desperation, she cried to us and she begged,” said funeral director Nicole Warring, adding the woman was fearful her father would end up buried in an unmarked grave. “It’s tough when we just don’t have the capacity.”

Iran to open mosques in areas with few coronavirus cases

Iran plans to loosen restrictions in some parts of the country by classifying regions as either white, yellow or red based on the spread of the coronavirus, President Hassan Rouhani has said.

Iran has been one of the Middle East’s worst hit countries with more than 91,000 cases of coronavirus recorded as of Monday, as well as around 5,800 deaths.

2h ago / 10:37 AM UTC

Nearly 2 million people download Australia tracking app

More than 1.8 million people downloaded a new tracking app released by the Australian Government that claims to “speed up contacting people exposed to coronavirus,” according to the country’s Health Department.

COVIDSafe is available to all Australian residents, though participation is not mandatory. It tracks the movement and interaction of residents with the aim of quickly locating and informing anyone that may have been in contact with someone who has tested positive for COVID-19. If a user tests positive, the other users of the app that have been in close proximity to that initial user will be informed so they can get tested and isolate themselves. Health officials will not name the person who was infected.

Officials have said 40 percent of the population will need to download the app for it to work effectively. Australia has been one of the most successful countries in fighting the coronavirus pandemic, recording just 83 deaths and 6,700 cases.

3h ago / 9:53 AM UTC

Italy’s prime minister lays out plan to slowly reopen in May

Construction workers and factories will restart in Italy on May 4, Prime Minister Giuseppe Conte said as he laid out plans for a phased end to the country’s strict nationwide lockdown. 

Public parks will reopen then as will restaurant takeout and delivery services. “We will live with the virus and we will have to adopt every precaution possible,” Conte said Sunday evening. Shops, museums, exhibitions and public libraries will reopen on May 18, and hairdressers, bars and restaurants will be open from June 1. Schools however, will remain closed until September.

The announcement comes a week after the country reported its first decline in the number of people sick with coronavirus since the virus hit. The country has recorded 26,384 coronavirus deaths and 195,351 confirmed cases.

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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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Colorado ‘Psychic Kay’ killer files murder case appeal

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‘Psychic Kay’ killer files appeal claiming attorneys failed to inform him of plea offer


Sady Swanson


Fort Collins Coloradoan
Published 11:25 PM EST Jan 31, 2020
John Marks Jr. (right) is serving 48 years to life in prison after a jury found him guilty of murdering his wife of 20 years, Kathy Adams, 57, in 2010.
Fort Collins Coloradoan archive

The man sentenced to prison for the murder of the 57-year-old Fort Collins woman known as “Psychic Kay” has filed an appeal claiming his attorneys failed to properly advise him of potential plea agreements.

John Marks Jr., now 57, was found guilty of second-degree murder and sexual assault in the 2010 death of his wife, Kathy Adams, known as “Psychic Kay.” He was sentenced to 48 years to life in 2012 and is currently serving his sentence at the Fremont Correctional Facility in Canon City. 

Adams’ body was recovered from a ravine off U.S. Highway 36 near the Boulder-Larimer County line in October 2010, according to Coloradoan archives. Marks was arrested on suspicion of second-degree murder about two weeks after her body was found. Initial arrest documents indicated that Marks was abusive and Adams had planned to escape to Atlanta and live with family before she was killed.

Marks pleaded not guilty in his initial case and has maintained his innocence, according to his previous defense attorney. 

Online court records indicate documents were filed to reopen the case in 2015, and the first petition was filed May 2017. The appeal was filed under Colorado criminal procedure that allows for a request for post-conviction relief if attorneys provided ineffective counsel during a criminal case. If approved, the judge could order a new trial or a modified sentence. 

Cold cases: There are 1,700 cold cases in Colorado. Could genealogy sites be the key to cracking them?

On Friday afternoon, Marks appeared in a Larimer County courtroom, where his attorney argued to 20th Judicial District Judge Nancy Salomone that Marks’ criminal defense attorneys failed to properly inform him of an offered plea agreement during his 2012 trial.

During Friday’s hearing, the defense attorneys and prosecutors from the 2012 trial denied the assertion that a midtrial plea offer — or that any formal plea offer — was made in the case. 

Defense attorney Derek Samuelson was appointed to be Marks’ attorney about a year into the case — in fall 2011 — after the public defender’s office removed themselves due to a conflict of interest, Samuelson testified Friday. 

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After his appointment, Samuelson said he reached out to now Second Assistant District Attorney Emily Humphrey, the lead prosecutor on Marks’ case, to suggest a potential plea offer of manslaughter instead of second-degree murder. Humphrey refused the suggestion, Samuelson said.

Shortly after that exchange, Samuelson said he met Humphrey and now Larimer County District Attorney Cliff Riedel, Humphrey’s supervisor at the time, at a coffee shop in September 2011 to discuss the potential for a plea offer.

An email sent after that meeting from Samuelson to another defense attorney assisting with the case — Lisabeth Castle — said the district attorney suggested they may be open to an offer involving Marks’ pleading guilty to second-degree murder in a heat of passion, which could have led to a lesser sentence.

The discussion was not an official offer, Samuelson said.

Per the district attorney’s office policy, according to testimony by Humphrey and Riedel on Friday, to minimize harm to the victims or the family in a sexual assault or murder case, prosecutors might tell a defense attorney what they might consider a fair plea offer first. Then, if the defendant comes back with interest in taking a plea offer similar to what they discussed, that’s when the prosecution would bring the idea of a plea agreement to the victim or the victim’s family, not before that point. 

“There was absolutely no formal offer made to (Samuelson),” Humphrey testified Friday.

After having the initial discussion with Humphrey and Riedel, Samuelson said he went to the Larimer County Jail to speak with Marks. Because pleading guilty to second-degree murder in a heat of passion would still likely mean decades in prison, Samuelson said Marks declined to move further with it.

“What he told me was motivating him was innocence,” Samuelson said.

Hey Google, what’s the news in Fort Collins? You asked Google. We answered. Find it all in the free NoCoAsks newsletter. Sign up today! 

Castle also testified that no midtrial offer was conveyed to her, and she was not aware of one being conveyed to Samuelson or directly to Marks. 

“And (if we did receive a midtrial offer) I think that’s something we would’ve encouraged him to take,” Castle testified.

The appeal hearing was initially scheduled to finish Friday afternoon, but attorneys and the judge agreed that a second day of testimony is necessary. Because of scheduling conflicts, a date for the second day of the hearing has not yet been scheduled. 

Samuelson, who was not able to finish testifying Friday afternoon, will resume his testimony at that hearing.

Sady Swanson covers crime, courts, public safety and more throughout Northern Colorado. You can send your story ideas to her at sswanson@coloradoan.com or on Twitter at @sadyswan. Support our work and local journalism with a digital subscription at Coloradoan.com/subscribe.

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US will no longer issue Visas to foreigners for birth purpose

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Nigeria News | Laila’s Blog
US will no longer issue Visas to foreigners for birth purpose

The United States Government under Donald Trump administration on on Thursday says it will no longer issue visas to foreigners who want to give birth in the country.

The new United State Visa rules restricts “birth tourism,” in which women travel to the U.S. to give birth so their children can have a coveted U.S. passport. Henceforth, applicants will be denied tourist visas if they are determined by consular officers to be coming to the U.S. primarily to give birth, according to the rules in the Federal Register.

Foreigners who want to gets visas to give birth in the United States will now have to prove that they are traveling to the U.S. because they have a medical need and not just because they want to give birth there and must prove they have the money to pay for it — including transportation and living expenses.

According to a statement released by the office of the press secretary, the rule will be effective from Friday, January 24.

The statement reads;

Beginning January 24, 2020, the State Department will no longer issue temporary visitor (B-1/B-2) visas to aliens seeking to enter the United States for “birth tourism” – the practice of traveling to the United States to secure automatic and permanent American citizenship for their children by giving birth on American soil.  This rule change is necessary to enhance public safety, national security, and the integrity of our immigration system.  The birth tourism industry threatens to overburden valuable hospital resources and is rife with criminal activity, as reflected in Federal prosecutions. Closing this glaring immigration loophole will combat these endemic abuses and ultimately protect the United States from the national security risks created by this practice.  It will also defend American taxpayers from having their hard-earned dollars siphoned away to finance the direct and downstream costs associated with birth tourism.  The integrity of American citizenship must be protected.

This is coming amidst speculation that the US government is planning to place Nigeria and some other countries on ‘travel ban list‘.

Follow us on Facebook – @Lailasnews; Twitter – @LailaIjeoma for updates

US will no longer issue Visas to foreigners for birth purpose
Damilola Ismail

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Persecution of Muslims in China and India Reveals Important Facts About Religion and Geopolitics

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India, China and Myanmar are three Asian countries currently engrossed in carrying out physical and cultural genocides on their Muslim populations. While the plight of Rohingya Muslims and Uighur Muslims is well known, the recent introduction of a new law expressly aimed at dispossessing Muslims of Indian citizenship has alerted many to the reality that India’s ruling BJP government sees itself as Hindu first and foremost.

Questions such as “Why aren’t the rich Arab countries saying anything?” have come up, with the implicit inference that Muslim-dominated countries are supposed to stick up for Muslims everywhere in the world. Others have pointed out that despite suffering oppression in some parts of the world, Muslims are also responsible for brutal acts of oppression against other minority groups elsewhere, which allegedly negates the sufferings of the prior group.

In this article, I will pick through these questions and viewpoints with a goal of isolating some useful truths about how religion, geopolitics and human nature constantly interplay and produce much of the world around us.

Oppression is a Matter of Perspective

Which religion is the most oppressed? I like to troll my Christian friends with the image below whenever the topic comes up about some religion or the other allegedly imposing its will at their expense.

The truth is however, that this image could apply to just about every religion on earth. As a general rule of thumb, the only limiting factor on whether or not a religion functions as an oppressive tyranny in a particular jurisdiction is the proportion of the population that practises it there. Similarly, the only thing stopping any religion from being an oppressed and downtrodden identity is whether it is a small enough minority for that to be possible.

While Muslims in India, Myanmar and China are going through untold degrees of horror because of their religious identities, Muslims in places like Bangladesh, Indonesia, Afghanistan, Malaysia and Northern Nigeria are simultaneously visiting very similar horrors on Bah’ai, Shia Muslims, Christians, Budhists and other minorities in those areas. It turns out that the mere fact of belonging to a religious identity does not in fact, confer unrestricted global victimhood.

This point is important because it disproves the notion held by every major religion that its adherents follow a single set of standards and do things in the manner of a global “brotherhood.” In reality, Islam according to a Rohingya Muslim hiding from the Burmese military, and the same religion according to an itinerant herder in Kogi State bear almost no similarity to each other save for the most basic tenets. Environmental factors in fact have a bigger influence on how religions are practised than their own holy books. 

The current antics of India’s ruling BJP and its Hindu fundamentalist support base provide an important case in point as to how this works. Looking at the evolution of Hinduism from a passive philosophy into an openly militant ideology gives an important insight into how religion is in fact, a thoroughly contrived and amorphous set of ideas that can be changed, adjusted, aligned and revised at a moment’s notice in justification of anything at all. 

Hinduism traditionally sees itself as a religion of thoughtful, considered spirituality as against the angry dogmas of its Abrahamic neighbours, but something interesting is happening. Some argue that it started in the days of Gandhi, and some ascribe it to current Prime Minister Nanendra Modi, but whoever started it is a side note. The key point to note is that based on political factors, i.e anticolonial senitment against the British and anti-Muslim sentiment fueled by India’s national rivalry with Pakistan, Hinduism has somehow been coopted into the narrative of a jingoistic, monotheistic, mono-ethnic state which is  historical nonsense.

India has always been a pointedly pluralistic society, and in fact the geographical area now known as “India” does not even cover the geographical area of the India of antiquity. That India was a place of Hindus, Budhists, Muslims, Zoroastrians and everything in between. Hinduism never saw a problem with pluralism because Hinduism itself is a very plural religion – it has at least 13 major deities. The conversion of the Hindu identity into a political identity movement is a recent and contrived phenomenon first exploited by Gandhi as a means of opposing British colonialism, and now by Modi to oppose the Pakistanis/Muslims – it is a historical falsity.

The creation of Hindu fundamentalist movements like the RSS (which PM Modi belongs to) is something done in response to environmental factors. Spectacles like the RSS march below are evidence of yet another religion undergoing constant and ongoing evolution into whatever suits its purposes.

Something similar happened when medieval Europe turned into colonial Europe and European Christianity transitioned into a peaceful and pacifist ideology after centuries of being a bloodthirsty doctrine. The environmental factors that created the Crusades, the Spanish Inquisition, book burnings and witch hunts went away with the introduction of an industrial society, and thus the religion too transitioned.

In plain English, what all this means is that nobody actually practises a religion in the pure sense they imagine they do. Everyone who subscribes to a religion merely practises a version of it that is subject to the culture and circumstances of their environment and era. This is directly connected to the next major insight raised by these events.

Geopolitics is all About Self-Interest…Everyone Gets it Except Africa

While anti-Muslim violence has continued apace for years in China, Mynammar and India, the question has often been asked: “Why are the wealthy Arab nations not saying anything?” There is a perception that since the Arabian peninsula is the birthplace of Islam and Arabs – particularly Saudis – are viewed as the global gatekeepers of the faith, they must be at the forefront of promoting the interests of Muslims worldwide.

To many, the fabulous wealth and international influence that Saudi Arabia, Kuwait, Qatar and the UAE enjoy, in addition to the presence of two of Islam’s holiest cities – Mecca and Meddinah – in Saudi Arabia, means that they have a responsibility to speak for the global Muslim Ummah and stand up for them when they are unfairly targeted and mistreated. Unfortunately for such people, the wealthy nations of the Arab Gulf region tend to respond to such questions with little more than an irritated silence – and with good reason.

To begin with, these countries are not democracies led by the wishes of their almost uniformly Muslim populations. They are autocracies led by royal families who came to power in the colonially-influenced 20th century scramble for power and influence. Saudi Arabia, which houses Islam’s holiest sites, is named after the House of Saud, its royal family which came into power in its current form at the turn of the 19th century. The priority of the regimes in these countries first and foremost is self-preservation.

Self-preservation means that before throwing their significant diplomatic and economic weight behind any attempt to help out fellow Muslims, the first consideration is how doing so will benefit them. India for example, is a country that has close diplomatic ties with the UAE, and supplies most of their cheap labour for construction and low-skilled functions. India has even coordinated with UAE special forces to repatriate the dissident Princess Latika when she made an audacious escape attempt in 2018.

What does the UAE stand to gain if it napalms its diplomatic relationship with India by criticising Modi’s blatantly anti-Muslim policy direction? It might win a few brownie points with Islamic hardliners and possibly buy some goodwill among poor Muslims in South Asia, but how much is that worth? The regime and nation’s self-interest is best served by looking the other way, so that is exactly what they will do.

The Saudis make a similar calculation. At a time when they are investing heavily in military hardware to keep up with their eternal rivals Turkey and Iran, and simultaneously preparing for the end of oil by liberalising their society and economy, does it pay them to jump into an issue in India that does not particularly affect them? As the status of their diplomatic relationship with the U.S. remains unclear following the Jamal Khasshoggi incident, are they going to risk pissing off the Chinese because of Uighur Muslims?

In fact self-interest like that mentioned here is the basis of the considerations that underpin all international relations. Well I say “all,” but what I really meant to say was “all except African countries.” It is only African countries that take diplomatic decisions based on little more than flimsy emotions and feelings of religious affinity. Gambia for example, has dragged Myanmar before the UN and filed a genocide case against it on behalf of the Rohingya Muslims.

This would be commendable and great were it not that Gambia itself is hardly a human rights luminary, and generally has little business fighting an Asian battle when its own worse African battles lie unfought. The only thing Gambia stands to gain from fighting a diplomatic war that the rest of the world seems unwilling to touch is the temporary goodwill of a few Muslims in Asia and around the world – goodwill that cannot translate into something tangible for it.

To coin an aphorism from social media lingo, you could call it ”diplomatic clout chasing.’

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‘Death to America’: We will take hard and definitive revenge ― Iranians chant

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Iran is considering 13 scenarios to avenge the killing of a top Iranian military commander in Iraq by a U.S. drone attack, a senior Tehran official said on Tuesday as the general’s body was brought to his hometown for burial.

In Washington, the U.S. defense secretary denied reports the U.S. military was preparing to withdraw from Iraq, where Tehran has vied with Washington for influence over nearly two decades of war and unrest.

The killing of General Qassem Soleimani, who was responsible for building up Tehran’s network of proxy forces across the Middle East, has prompted mass mourning in Iran.

U.S. and Iranian warnings of new strikes and retaliation have also stoked concerns about a broader Middle East conflict and led to calls in the U.S. Congress for legislation to stop U.S. President Donald Trump going to war with Iran.

“We will take revenge, hard and definitive revenge,” the head of Iran’s Revolutionary Guards, General Hossein Salami, told tens of thousands of mourners in Soleimani’s hometown of Kerman.

Many chanted “Death to America” and waved the Iranian flag.

READ ALSO: Iran threatens to ‘unleash Hezbollah’ in Israel and Dubai

Soleimani’s body has been taken through Iraqi and Iranian cities since Friday’s strike, with huge crowds of mourners filling the streets.

Iran’s Supreme Leader Ayatollah Ali Khamenei and military commanders have said Iranian retaliation for the U.S. action on Friday would match the scale of Soleimani’s killing but that it would be at a time and place of Tehran’s choosing.

Ali Shamkhani, secretary of the Supreme National Security Council, said 13 “revenge scenarios” were being considered, Fars news agency reported. Even the weakest option would prove “a historic nightmare for the Americans,” he said.

Iran, whose southern coast stretches along a Gulf oil shipping route that includes the narrow Stait of Hormuz, has allied forces across the Middle East through which it could act. Representatives from those forces, including the Palestinian group Hamas and Lebanon’s Hezbollah movement, attended the funeral.

Despite its strident rhetoric, analysts say Iran will want to avoid any conventional conflict with the United States but assymetric strikes, such as sabotage or other more limited military actions, are more likely.

Trump has promised strikes on 52 Iranian targets, including cultural sites, if Iran retaliates, although U.S. officials sought to downplay his reference to cultural targets.

Reuters and other media reported on Monday that the U.S. military had sent a letter to Iraqi officials informing them that U.S. troops would be repositioned in preparation to leave.

“In order to conduct this test, Coalition Forces are required to take certain measures to ensure that the movement out of Iraq is conducted in a safe and efficient manner,” it said.

U.S. Defense Secretary Mark Esper said there had been no decision whatsoever to leave Iraq.

“I don’t know what that letter is,” he said.

U.S. Army General Mark Milley, chairman of the Joint Chiefs of Staff, said the letter was a “poorly worded” draft document meant only to underscore increased movement by U.S. forces.

The letter, addressed to the Iraqi Defence Ministry’s Combined Joint Operations and confirmed as authentic by an Iraqi military source, had caused confusion about the future of the roughly 5,000 U.S. troops still in Iraq, where there has been a U.S. military presence since Saddam Hussein was toppled in a 2003 invasion.

On Sunday, Iraq’s parliament, dominated by lawmakers representing Muslim Shi’ite groups, passed a resolution calling for all foreign troops to leave the country.

Iraq’s caretaker Prime Minister Abdel Abdul Mahdi told the U.S. ambassador to Baghdad on Monday that both sides needed to work together to implement the parliamentary resolution.

Friction between Iran and the United States has risen since Washington withdrew in 2018 from a nuclear deal between Tehran and other world powers.

The United States has imposed economic sanctions on Iran and Tehran said on Sunday it was dropping all limitations on uranium enrichment, its latest step back from commitments under the deal.

The U.S. administration has denied a visa to allow Iranian Foreign Minister Mohammad Javad Zarif to attend a U.N. Security Council meeting in New York on Thursday, a U.S. official said.

“The United States will get the decisive, definite answer for its arrogance at the time and place when it will feel the most pain,” Zarif said in a speech broadcast on state television.

Trump’s U.S. political rivals have challenged his decision to order the killing of Soleimani and its timing in a U.S. election year. His administration said Soleimani was planning new attacks on U.S. interests but has offered no evidence.

U.S. general Milley said the threat from Soleimani was imminent. “We would have been culpably negligent to the American people had we not made the decision we made,” he said.

Trump administration officials will provide a classified briefing for U.S. senators on Wednesday on events in Iraq after some lawmakers accused the White House of risking a broad conflict without a strategy.

Reuters/NAN

The post ‘Death to America’: We will take hard and definitive revenge ― Iranians chant appeared first on Vanguard News.

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