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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Mums have their say on the best hospitals to give birth at in the North East – see how yours fared – Chronicle Live

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Two North East hospitals have been voted among the best places in England to give birth as the region once again outperformed the rest of the country in a survey of new mothers.

The annual maternity services poll – which asked 17,151 women about their experiences of pregnancy and birth – found an improvement in the standard of care offered to new mothers on NHS wards nationally.

The poll, from the Care Quality Commission (CQC), showed many women saying positive things about their care during pregnancy and birth, but a poorer experience of care postnatally.

Results published on Tuesday, January 28, showed that a fifth of new mothers were not told how to access help if their mental health were to decline after giving birth and more than one in 10 (12%) were not warned about any changes they might experience to their mental health after having their baby.

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Sunderland Royal Hospital was the best performing nationally with the most positive responses to the survey (88%) when compared to all other trusts and a national average of 78%.

And the Newcastle upon Tyne upon Tyne Hospitals NHS Trust, which runs the Royal Victoria Infirmary, was the only trust to be rated ‘better than expected’ in all three main categories – labour and birth, staff during labour and birth, and care in hospital after the birth.

Gateshead, Northumbria Healthcare (which covers Northumberland and North Tyneside) and County Durham and Darlington trusts scored ‘about the same’ as other trusts overall.

There was no data available for South Tyneside due to the size of the maternity unit.

The poll was among women who gave birth in February 2019.

Sunderland Royal Hospital

High-scoring categories for City Hospitals Sunderland included 9.8/10 of women saying they were treated with respect and dignity during labour and birth and 9.8/10 who said they were spoken to during labour in a way they could understand.

Newcastle’s highest scoring categories for the Royal Victoria Infirmary were also ‘respect and dignity’ (9.8/10) and partners being involved as much as they wanted (9.8/10).

The Northumbria Healthcare NHS Foundation Trust, which runs the Northumbria Specialist Emergency Care Hospital in Cramlington, scored 9.7/10 for partners being as involved as they wanted and for clear communication.

QE Gateshead scored 9.9/10 for partner involvement and 9.3/10 for both skin to skin contact after birth, and the cleanliness of the ward.

County Durham and Darlington were rated ‘better’ than other trusts in the country for confidence and trust in staff (9.5/10) and receiving the information and explanations they needed after the birth (8.6/10).

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Stella Wilson, directorate manager for women’s services, at Newcastle Hospitals, said: “We’re delighted to see such wonderful feedback from the National Maternity Survey.

“Patient feedback is one of the best ways for us to measure the quality of our maternity services and in addition to these fantastic results and through our Maternity Voices Partnership, we actively seek the views of all women across Newcastle who have been in our care.”

Sheila Ford, head of midwifery at South Tyneside and Sunderland NHS Foundation Trust, said: “To be rated nationally as the best performing Trust in the whole country is absolutely fantastic news for the team and shows that local mams are receiving the very best maternity care right here in Sunderland.

“This is testament to the hard work of our maternity team and shows the level of care, dedication and compassion that our staff show to all of the families who choose to deliver with us and I am extremely proud to be part of such a wonderful team.

“There are, of course, areas where we must improve further and we will be looking at the results in detail, alongside other sources of feedback to the Trust, to make sure we continue to listen, learn and continue to develop the very best maternity services for local women in our area.”

Lesley Heelbeck head of midwifery at Gateshead Health said: “In Gateshead we have a really enthusiastic and committed team so it’s good to see such positive ratings from the CQC. Mothers and families are central to developing the services here at Gateshead so we’re always looking at ways we can improve.

“We’ve developed our maternity voices partnerships so that we can talk to local people and listen to their views more closely. Because we’re a smaller unit we aim to provide much more personal and individual care to everyone who comes here to give birth.

“We want as many local people as possible to come here and start their family with us and we aim to improve even further in the future.”

A spokesperson for County Durham and Darlington NHS Foundation Trust, said: “Pregnancy, labour and childbirth are one of the most important experiences women have and we’re delighted to have received this excellent feedback from women in the care of our maternity services.

Northumbria Specialist Emergency Care Hospital, in Cramlington, Northumberland

“In particular, we’re proud that in six categories our score was higher than for most trusts across the country.

“These include the number of women who said they had confidence and trust in those caring for them during labour and birth and the number of women who said their decisions about how they wanted to feed their baby were respected.

“We’re also delighted that we scored above the national average for the number of women reporting that a midwife or health visitor asked them about their mental health.”

Jenna Wall, head of midwifery at Northumbria Healthcare NHS Foundation Trust, said: “Providing our families with the best possible experience while having a baby with us is one of our top priorities and we welcome the feedback from the national maternity survey.

“We are pleased that during labour and birth women felt they were communicated with in a way they could understand, they were treated with respect and dignity and they had confidence and trust in the staff caring for them.

“It is also great that we have scored highly on facilitating skin to skin contact with the baby shortly after birth, involving partners and enabling them to stay as long as they want at our Northumbria hospital.

“These results are testament to our hard-working teams and I’d like to thank them for the dedication and compassion they show to women and their partners at this special time.

“We will, however, continually strive to do even better for our families and further improve the care during and after the birth of a baby.”

See how your trust scored here and how it compared nationally to other trusts:

City Hospitals Sunderland (South Tyneside & Sunderland)

Labour and birth – 9.2/10 – About the same

Staff – 9.3/10 – Better

Care in hospital after the birth – 9.0/10 – Better

County Durham and Darlington NHS Foundation Trust

Labour and birth – 8.9/10 – About the same

Staff – 8.8/10 – About the same

Care in hospital after the birth – 7.6/10 – About the same

Gateshead Health NHS Foundation Trust

Labour and birth – 8.8/10 – About the same

Staff – 8.6/10 – About the same

Care in hospital after the birth – 7.8/10 – About the same

Northumbria Healthcare NHS Foundation Trust

Labour and birth – 8.9/10 – About the same

Staff – 8.8/10 – About the same

Care in hospital after the birth – 7.8/10 – About the same

The Newcastle upon Tyne Hospitals NHS Foundation Trust

Labour and birth – 9.4/10 – Better

Staff – 9.3/10 – Better

Care in hospital after the birth – 8.5/10 – Better

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Worshippers at the Al Noor mosque photographed in terror threat | Stuff.co.nz

Worshippers at the Al Noor mosque in Christchurch were photographed in an apparent terror threat, two weeks before the first anniversary of the March 15 attack in which 51 worshippers were gunned down. 

The threat was issued on Sunday night on an encrypted messaging app, accompanied by a photo of a masked man sitting in a car outside the mosque. 

A police spokeswoman has confirmed an investigation into the threat is underway. 

Christchurch’s Al Noor was one of two mosques targeted in a racially motivated mass-shooting on March 15, 2019. The alleged terrorist, an Australian national, awaits a trial due to begin in June. 

Police and St John staff outside the Al-Noor mosque after the March 15, 2019 terror attack. (file photo)

Security Intelligence Service director Rebecca Kitteridge last month warned that some Kiwis have been inspired by the March 15 terror attack, and monitoring such people had been difficult.

The threat and accompanying photo was posted anonymously to more than 2000 followers on a messaging channel on the encrypted communication app Telegram.

Do you know more? Email thomas.manch@stuff.co.nz

The image shows a man wearing dark sunglasses and a balaclava printed with an image of a human skull. Through a car window the front of the Al Noor mosque can be seen. 

In the background, four people are visible at the entrance of the mosque. 

The message attached, written in both English and Russian, implies the people at the “same mosque” would be greeting each other for the “last time”. A gun emoji, or symbol, is also used in the message. 

The image was posted on a messaging channel dedicated to celebrating the March 15 terror attack. 

CHRISTEL YARDLEY/STUFF
Islamic Women’s Council national co-ordinator Anjum Rahman said police were already conducting enquiries into the threat.

Police were aware of the threat and enquiries were ongoing, a spokeswoman said.

Such threats to the community were taken “extremely seriously”. The spokeswoman declined to answer questions about security arrangements for the anniversary of the March 15 terror attacks. 

An SIS spokesman declined to comment on the specific threat.  

Islamic Women’s Council national co-ordinator Anjum Rahman​ said she was told of the threat early on Monday morning, and notified both mosque leaders and senior police officers. 

“[The police] were already aware and were looking into that threat,” she said. 

“There have been threats, more oblique threats, to other mosques in the last six to eight months or so. We know there is ongoing activity, I would just say the public should be vigilant and report anything that they see as suspicious.”

She said it would be helpful to have a visible police presence at the mosques as the anniversary of the attack approached.

Al Noor imam Gamal Fouda has been contacted for comment. 

In February, Kitteridge said New Zealand’s spy agencies were investigating some 30 to 50 people for a potential terror risk at any one time. 

She said it was challenging to monitor such people as they “tend to live in encrypted chat rooms” — such as Telegram. 

Kitteridge would not say if any specific terror plans had been intercepted.

Messages on the Telegram app first alerted the public to the arrest of a 27-year-old soldier connected to far-Right groups, in November 2019. 

The soldier now awaits a military trial, facing charges of accessing a computer system for a dishonest purpose and for disclosing information that prejudiced the security or defence of New Zealand. 

Authorities across western nations continue to grapple with the terror threat posed by adherents to far-Right and white supremacist ideologies. 

The director of the Australian Security Intelligence Organisation, Mike Burgess, last week told reporters that small cells of such extremists posed a growing and enduring threat.

Days earlier, in the United States, the New Jersey Office of Homeland Security increased the terror threat level regarding homegrown white supremacists to “high”. 

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Andrea Hayden Twins’ strength and conditioning coach | Minnesota Twins

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Except, well, Hayden thought she was missing something.

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

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

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

She remembers Kadish laughing.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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‘They saved my life’: Stabbing victim meets bystanders who came to her rescue | Stuff.co.nz

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A young Auckland woman who almost died after being stabbed by her ex-boyfriend more than 20 times has met the bystanders who “saved her life”.

In November 2018, Crystal Tupou was lured to Anzac Ave by ex-boyfriend Micah Santos who used a fake Facebook profile to invite her to lunch.

When she arrived at the meeting spot, Tupou said she came across the “one person I didn’t want to see”.

NZ POLICE
Crystal Tupou said she wanted to share her story to encourage other victims of domestic violence to seek help.

After arguing and threatening to kill her, Santos attacked Tupou, repeatedly stabbing her in the street.

In August 2019, Santos plead guilty to attempted murder and was jailed for six years.

NZ POLICE
Crystal Tupou was stabbed more than 20 times by her ex-boyfriend Micah Santos.

Now, Tupou has met with the three men, Steve Smith, Daniel Coombe and Walker Hunt, who ran to her aid and stopped Santos.

Detective Tim Johnston said Santos told police he only stopped stabbing Tupou after seeing the men.

“I believe if they did not do that, the victim may have got more serious injuries and may not have survived.”

NZ POLICE
Crystal Tupou embraces Steve Smith, the first person to come to her aid during the attack.

Johnston said the men didn’t hesitate to help Tupou and put their own lives at risk.

“Their actions were nothing short of heroic.”

In a video shared by police of Tupou meeting Smith, Coombe and Hunt, she was in tears as she embraced them.

NZ POLICE
Detective Tim Johnston said Crystal Tupou may not have survived the attack had the men not intervened.

Smith, who was the first to reach Tupou, was also in tears.

“It’s very emotional to see something like that,” he said, “breaks my heart”.

Coombe said what Tupou went through was “horrendous” but people aren’t powerless to change the outcome of events.

ALDEN WILLIAMS/STUFF
Police at the scene of the stabbing on Anzac Ave, central Auckland.

Tupou said she was “incredibly grateful” for the men who stepped in that day.

“They saved my life. There’s no way I’d ever be able to repay them but I hope a big thank you would be enough, and not only that but I want everyone to know that they’ve played a big part in getting me here, because if it wasn’t for them I wouldn’t be here and alive today.”

Santos took two knives from the kitchen of his Henderson home in a Louis Vuitton bag and caught the train to meet up with Tupou on the day of the attack.

CATRIN OWEN/STUFF
Micah Santos was jailed for six years after pleading guilty to attempted murder.

After the three men scared Santos off, he ran from the scene, dropping a knife and his bag.

He was arrested at Orakei train station after calling 111 and telling the phone operator what he had done.

By sharing her story, Tupou hoped it may help other women in controlling or abusive victims seek help.

“There were signs but I chose to see the good side of him. People would say bad things about him but I chose to ignore it.

“I knew that one day it would get out of hand, and I let it happen.”

Police encouraged anyone who was in, or knew someone who was in a harmful relationship to ask for help.

WHERE TO GET HELP

Women’s Refuge Centre 0800 773 843

Family Violence Line 0800 456 450

Shine National Helpline 0508 744 633

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Gunmen kill 24 people at protestant church in Burkina Faso | Daily Mail Online

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Gunmen have killed 24 people and wounded 18 in an attack on a Protestant church in a village in northern Burkina Faso where jihadists frequently target Christians.  

A group of ‘armed terrorists’ raided the village of Pansi, in Yagha province ‘and attacked the peaceful local population after having identified them and separated them from non-residents’, the governor, Colonel Salfo Kabore, said in a statement. 

The assault occurred on Sunday during a weekly service at a Protestant church, security officials said.

‘The provisional toll is 24 killed, including the pastor… 18 wounded and individuals who were kidnapped,’ Kabore said.

A resident of the nearby town of Sebba said Pansi villagers had fled there for safety. 

Both Christians and Muslims were killed before the church was set on fire, said a government security official in Dori who spoke on condition of anonymity because they weren’t authorized to speak to the media. 

A 2008 file photo shows a congregation worshipping at a church in the district of Toleha in Burkina Faso 

A Burkina Faso soldier patrols at a district that welcomes Internally Displaced People (IDP) from northern Burkina Faso, in Dori on February 3, 2020

Pictured: A locator map showing the village of Pansi in eastern Burkina Faso, where militants killed worshippers at a Protestant church 

The mayor of Boundore commune, Sihanri Osangola Brigadie, said roughly 20 attackers separated men from women close to a Protestant church. At least 18 other people were injured.

‘It hurt me when I saw the people,’ Brigadie said after visiting some of the victims in the hospital in Dori town, 110 miles from the attack. The gunmen looted oil and rice from shops and forced the three youth they kidnapped to help transport it on their motorbikes, he said.  

Christians and churches in northern provinces have become frequent targets by armed Islamists.

On 10 February, suspected jihadists in Sebba seized seven people at the home of a pastor. Five bodies were found three days later, including the pastor, according to the local governor.

One of the poorest countries in the world, Burkina Faso is on the front line of a jihadist insurgency advancing in the Sahel.

Since 2015, around 750 people have been killed in Burkina and around 600,000 people have fled their homes.

A picture taken on October 30, 2018 shows Burkinabe gendarmes sitting on their vehicle in the city of Ouhigouya in the north of the country

Also in the north of the country, five soldiers were killed on Sunday when their vehicle struck an improvised explosive device near Banh, in Loroum province, security sources said.

‘Three of the five were killed instantly and the two others died later from serious injuries,’ one of the sources said.

Thirty people in Burkina Faso have died in four attacks by highway bombs since the start of the year, according to a reported toll.

They include seven schoolchildren in the northwest of the country who were among 14 killed aboard a bus that had taken a road that had been banned because of the security risk.

According to UN figures, jihadist attacks in Burkina and neighbouring Mali and Niger left nearly 4,000 people dead last year.

A man drives past a church in the city of Ouahigouya, northern Bukina Faso, on October 30, 2018

Their armed forces are weak, struggling with poor equipment and lack of training and funding.

In Niger, a policeman was killed on Sunday at a police post near Ayorou, in the western region of Tillaberi, in the second attack in the area in a week, a security official said.    

Analysts are concerned that attacks against civilians, including against Christians, are increasing ‘at an alarming rate,’ said Corinne Dufka, West Africa director for Human Rights Watch. ‘Perpetrators use victims’ links to government or their faith to justify the killings, while others appear to be reprisal killings for killings by the government security forces,’ she said.

More than 1,300 civilians were killed in targeted attacks last year in Burkina Faso, more than seven times the previous year, according to Armed Conflict Location and Event Data Project, which collects and analyzes conflict information. 

Gunmen kill 24 people at protestant church in Burkina Faso

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The Devil Devours His Own – Crisis Magazine

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The sordid life of Jeffrey Epstein serves to highlight the decadence of the deplorable epoch in which we find ourselves, as do the suspicious circumstances surrounding his death. The web of vice and viciousness that he had spun was widespread, serving to entrap not only underage girls but also the rich and famous who preyed upon them. Using the allure of underage sex to lure his wealthy associates into his web, Epstein secretly filmed them in the act of sexually abusing minors, thereby turning his “associates” into his blackmail victims.

Epstein seems to have believed that the powerful people whom he’d entrapped in his “insurance policy” would have a vested interest in keeping him safe from the law, a strategy which worked for a while. In 2008, Epstein was convicted in Florida of sexually abusing a fourteen-year-old girl, receiving a scandalously light sentence, but due to a plea deal he was not charged with sexually abusing thirty-five other girls whom federal officials identified as having been abused by him.

After a further ten years in which Epstein masterminded the trafficking of young girls to satisfy the pornographic and pedophilic appetites of his powerful network of friends, he was finally charged in July of last year with the sex trafficking of minors in Florida and New York. A month later, he was found dead in his jail cell. Although the medical examiner originally recorded the death as being a case of suicide, there are so many anomalies and mysteries surrounding the circumstances of Epstein’s death that many people agree with Epstein’s lawyers that the death could not have been suicide.

One thing that is certain is that Epstein’s death removed the possibility of pursuing criminal charges. There would be no trial, and therefore Epstein’s powerful associates would not be exposed by their victims in a court of law. Seen in this light, or in the shadow of this possible cover-up, it is tempting to see Epstein’s “insurance policy” as his death warrant. He was too dangerous to be allowed to live when the lives of so many others depended on his timely death. It is no wonder that “Epstein didn’t kill himself” has become a hugely popular meme, nor that HBO, Sony TV, and Lifetime are planning to produce dramatic portrayals of Epstein’s life and death.

One aspect of Epstein’s life which is unlikely to be the focus of any TV drama is his obsession with transhumanism. For those who know little about this relatively recent phenomenon, transhumanism is usually defined as the movement in philosophy which advocates the transformation of humanity through the development of technologies which will re-shape humans intellectually and physiologically so that they transcend or supersede what is now considered “human.” At the prideful heart of this movement is a disdain for all that is authentically human and a sordid desire to replace human frailty with superhuman or transhuman strength.

Transhumanism rides roughshod over the dignity of the human person in its quest for the technologically “created” superman. Its spirit was encapsulated by David Bowie in the lyrics of one of his songs: “Homo sapiens have outgrown their use…. Gotta make way for the Homo superior.”

Most of Epstein’s so-called “philanthropy” was directed to the financing and promotion of transhumanism. The Jeffrey Epstein VI Foundation pledged $30 million to Harvard University to establish the Program for Evolutionary Dynamics. It also bankrolled the OpenCog project, which develops software “designed to give rise to human-equivalent artificial general intelligence.” Apart from his support for the cybernetic approach to transhumanism, Epstein was also fascinated with the possibility of creating the “superman” via the path of eugenics. He hoped to help in a practical way with plans to “seed the human race with his DNA” by impregnating up to twenty women at a time at a proposed “baby ranch” at his compound in New Mexico. He also supported the pseudo-science of cryonics, whereby human corpses and severed heads are frozen in the hope that technological advances will eventually make it possible to resurrect the dead. He had planned to have his own head and genitalia preserved in this way.

In addition to his bizarre association with the wilder fringes of technological atheism, Epstein also co-organized a conference with his friend, the militant atheist Al Seckel, known (among other things) as the creator of the so-called “Darwin Fish”—seen on bumper stickers and elsewhere, it depicts Darwin’s “superior” evolutionary fish eating the ichthys symbol, or “Jesus fish” of Christians. Seckel fled California after his life of deception and fraud began to catch up with him. He was found at the foot of a cliff in France, having apparently fallen to his death. Nobody seems to know whether he slipped, jumped, or was pushed.

Apart from his unhealthy interest in atheistic scientism, Jeffrey Epstein was also a major figure amongst the globalist elite. According to his lawyer, Gerald B. Lefcourt, he was “part of the original group that conceived the Clinton Global Initiative,” which forces underdeveloped countries around the world to conform to the values of the culture of death. Even more ominously, Epstein was a member of the Trilateral Commission and the Council on Foreign Relations, two of the key institutions responsible for fostering and engineering the globalist grip on the world’s resources.

As we ponder the sordid and squalid world of Jeffrey Epstein and his “associates,” we can’t help but see his life as a cautionary tale, the moral of which is all too obvious. It shows that pride precedes a fall and that it preys on the weak and the innocent. It shows that those who think they are better than their neighbors become worse than their neighbors. It shows how Nietzsche’s Übermensch morphs into Hitler’s Master Race and thence to the transhuman monster. It shows that those who admire the Superman become subhuman. It also shows that the subhuman is not bestial but demonic. It shows that those who believe that they are beyond good and evil become the evilest monsters of all.

Those of us who have been nurtured on cautionary tales such as Mary Shelley’s Frankenstein or C. S. Lewis’s That Hideous Strength will know that fiction often prefigures reality. We see that the real-life figure of Jeffrey Epstein is a latter-day Viktor Frankenstein, reaping destruction with his contempt for his fellow man and his faith in the power of scientism to deliver immortality to those who serve it. We can also see that the transhumanism which Epstein financed is a mirror image of the demonic scientism of the secretive National Institute of Coordinated Experiments in Lewis’s prophetic novel. We may even be grimly amused by the fact that the “leader” of the demonic scientistic forces in Lewis’s tale is a severed head which has apparently been brought back to life.

There is one final lesson that the pathetic life of Jeffrey Epstein teaches us. It shows us that the adage “the devil looks after his own” is not true. It’s a lie told by the devil himself. The devil hates his disciples as much as he hates the disciples of Christ. Once he has had his way with them, he disposes of them with callous and casual indifference, much as Jeffrey Epstein disposed of his victims.

Photo credit: Getty Images

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FGM doctor arrested in Egypt after girl, 12, bleeds to death | Global development | The Guardian

A doctor has been arrested after the death of a 12-year-old girl he had performed female genital mutilation (FGM) on.

Nada Hassan Abdel-Maqsoud bled to death at a private clinic in Manfalout, close to the city of Assiut, after her parents, uncle and aunt took her for the procedure.

Her parents and aunt were also arrested after reports of her death emerged.

The doctor, 70, carried out the procedure without anaesthesia, without a nurse present and without any qualifications as a surgeon, according to local prosecutors.

The surgeon, known only as “Ali AA” claimed the family brought the girl to him for “plastic surgery” on her genitals.

Family members reportedly admitted that they knew they were taking the child to undergo FGM, and that her mother and aunt had stayed in the room during the procedure.

FGM involves the removal of the clitoris and sometimes other external female genital organs. Tradition in some parts of rural Egypt demands that young women undergo FGM as a way of demonstrating sexual purity.

The police and officials carrying out investigations don’t care about domestic and sexual violence, including FGM

Egyptian authorities have struggled for years to eradicate the practice, despite a 2008 ban and new laws in 2016 criminalising parents and doctors who facilitate it. Under the new laws, anyone who performs FGM faces between three and 15 years in prison, while anyone accompanying girls or women to be cut faces up to three years in jail.

But campaigners warned at the time that the new laws were unlikely to combat the practice, given the lack of convictions of doctors and reliance on people to self-report. They also warned more girls could be taken to hospitals or other medical facilities to have the procedure, meaning that complications were less likely but so was public knowledge of the practice itself.

In 2013, 13-year-old Sohair al-Bata’a died as a result of FGM. Raslan Fadl was the first doctor to be convicted of FGM, serving three months of his sentence in a case considered a watershed in convincing Egyptian lawmakers to criminalise the practice.

Fadl was released after reconciling with the Bata’a family, a loophole in the law that campaigners say shields families and doctors from prosecution.

“FGM continues to occur because there is no desire from the political leadership to stop it. The state is tolerant of female genital mutilation despite the presence of law, and despite receiving funds and grants from abroad [to combat it],” said Reda El Danbouki, a lawyer and campaigner against FGM.

He said judges fail to apply the law because they “are affected by a culture which does not see FGM as a crime”.

He added: “The police and the officials carrying out investigations don’t care about domestic and sexual violence, including FGM.”

Danbouki criticised Egypt’s doctors’ syndicate for suspending convicted doctors rather than removing them permanently from the register.

According to Unicef, 87% of of females aged 15 to 49 have undergone FGM in Egypt. About 14% of girls under 14 have been cut.

An estimated 27.2 million Egyptian women and girls had been subjected to FGM in 2016, according to Unicef, out of a population of almost 100 million.

Rania Yehia, of Egypt’s National Council for Women, an initiative affiliated to the presidency, said that her organisation would continue to campaign to raise awareness.

Yehia maintained that the strength of tradition in rural Egypt makes the problem hard to combat, but blamed the persistence of the issue on external factors. “This habit comes from outside Egypt. It comes from elsewhere in the continent of Africa … not from north Africa,” she said.

Additional reporting by Adham Youssef

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Naira Marley soaring amidst controversies

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Naira Marley
Naira Marley

…Why he’s dominating Nigeria’s music scene

By BENJAMIN NJOKU

The Nigerian music scene in recent times has been saturated with lots of talented music stars, who are redefining the space and creating their own buzz. One of such wave-making stars is Azeez Adeshina Fashola, popularly known as Naira Marley.

Marley burst onto the country’s music space like ‘a colossus’ and suddenly stole the hearts and minds of many lovers of music in this part of the world. It still seems like the pop sensation dropped out of nowhere unto our collective music ears.

Before last year, not much was heard of the Agege-born rapper. Even after the release of his 2017 hit “Issa Goal”, which featured Olamide and Lil Kesh, Naira Marley was still not a name to be reckoned with in the Nigerian music scene. But it was after releasing his hit song, “Am I a Yahoo Boy” featuring popular musician Zlatan Ibile, where he alleged to have declared public support for internet fraud. Naira Marley became the name on everyone’s lips.

The Economic and Financial Crimes Commission,EFCC had arrested him alongside Zlatan and three other persons. They slammed an 11- count charge bordering on credit card fraud, car theft and Cybercrime against Naira Marley. Thus started a legal battle that culminated in his detention for 35 days. Many believe the EFCC arrested him because of his alleged support for internet fraud and his claim that cybercrime is a form of reparation of the wealth stolen from Africa. That was the beginning of his journey to stardom.

While the trial lasted, the controversial singer was busy creating buzz on social media. His fans were not deterred from protesting against his arrest outside the EFCC headquarters in Lagos.

READ ALSO: Davido is the king of African music – Miraboi

Marley was quoted to have said in an interview that their rage was understandable. “Because they know the system. They knew what [the EFCC was] trying to do and they followed what happened. They knew I shouldn’t be getting arrested for what I’m saying. Freedom of speech! I should be allowed to be saying what I’m saying. But the EFCC said I was supporting fraud, because I said I have no problem with these people.”

Today, Marley remains one of the hottest artistes that have dominated the mainstream music chart in Nigeria and diaspora. His fan base has continued to increase on daily basis, just as he’s not free from troubles. Recall that in November, Marley set social media agog when he tweeted that a lady with a big butt was better than one with a Master’s degree. Few days later, the lewd singer alongside his siblings and cousins landed into another trouble after they were accused of stealing a car. But unfortunately, the court early this year dismissed the theft case and the singer walked away a free man.

Marley is a phenomenal singer who has a lot going for him. His journey from prince of Peckham to cult figure in Lagos, represents his evolution into a bonafide intercontinental rock star: selling out shows across Africa, and trailed intently both online and off by his mass of obsessive followers, called the ‘Marlians’.

Named after the Nigerian currency and known for his anti-establishment spirit and viral dance crazes, Marley’s wave connects the West African diaspora to their roots as he delivers his lines in a syrupy mixture of Yoruba and English.

Like Eedris Abdulkareem, Terry G and Bobrisky before him, Marley has been able to traverse between public hatred and adoration. On social media, he’s the most talked about Nigerian singer at the moment. While he’s yet to break into the international scene, Marley is currently enjoying the buzz he’s creating with his music back home. He’s in a lane of his own that politely ignores the commercialism of Afro-pop. To many, Marley is using his music to promote immorality and a generation of valueless youths, while to others, his music is awesome.

RnB singer, Asa described Marley’s music as “awesome.” Just as some twitter users once called out the ‘Puta’ hit maker after he declared that his songs can cure depression. They complained that his songs are noisy and senseless and “the only thing his songs can do is that it can cause depression rather than cure it.”

Since he burst onto the UK music scene in 2014, with Marry Juana, a song he wrote with his friend Ma Twigz, the Agege-born, Marley has been banging out hit after hit. In November 2019, the controversial singer sold out the almost 5000 capacity 02 Arena for Marlian Fest in three minutes. Tickets for the Marlian Fest which held on 30 December 2019 at the Eko Convention Centre, Eko Hotels, Lagos also sold out. There was chaos at the venue as fans tried to gain entrance into the concert.

But believe it or not, Marley is a singer you will hate to love. At present, the rapper is not just the rave of the moment, he is arguably the most popular artiste in Nigeria today. But the negative influence of Marley’s songs on the youths is unimaginable. This Marlian fever, like the era of Makossa has taken over the streets of Lagos and everywhere you go, men, women, the young and the old, the affluent and the poor are quick to claim they are Marlians with glee; and the buzz word “I am a Marlian” hits you like an unforgettable dream.

The lewd singer currently has a huge fan base. They call themselves Marlians. His songs and dance steps are inspiring a new generation of morally debased youths, who follow him around. It seems the youth would be his followers for a long time, except something serious is done. They revel in being “outsiders’, and as a trademark, they are disrespectful of rules and agents of law enforcement.

From the dance step, ‘Soapy,’ that has popularised the habit of masturbation to his off and on life inside prison to his recent dance step called ‘Tesumole,’ Naira Marley has continuously been a source of controversy and confusion in the Nigerian music scene.

It’s not for nothing that a clergyman, Chris Omashola, early this year took to his Twitter page, where he shared a series of prophecies concerning Nigeria. He warned that Marley is a demon and his music is inspired by demons, to destroy the youths in Nigeria.

“In 2020, God told me, Naira Marley is A Demon, He is Satanic and should repent before it’s too late. His songs are demonically inspired to destroy the Destiny of The Youths of this generation, Nigerian youths should desist from calling themselves Marlians. #ACOProphecies2020,” he tweeted.

Marley’s fans have since dismissed the clergyman’s warning, as they sent him threat messages; while he himself reacted by sharing screenshots of the pastor’s leaked sex tapes with an interesting caption. “To all Naira Marley’s fans aka Marlian. Please what’s your final judgment on this #NairaMarley and Apostle Chris Omashola case.” . Then on another occasion he tweeted: “Jesus never went to church.”

That’s not all, a certain mother reportedly cried out on social media after her teenage daughter was suspended from school for being part of a Marlian cult. According to the woman, the school caught over 25 girls who were members of the cult, including her daughter.

The teacher had found underwear in one of the girls’ bags and when she was questioned, she revealed that she was part of a cult whose members do not wear underwear to school on certain days.

It was, however, ascertained that the girls don’t wear pants, while the Marlian boys don’t wear belts.

However, it’s said that being a marlian has its ups and downs, from the rumoured beltless trousers for boys and underwear free girls who all believe in the marlian philosophy. You suddenly behold a boy next door who identifies himself as a Marlian, and ready to dance his Marley’s latest dance steps , ‘ Shaku shaku and Soapy (a demonstration of someone pleasuring him or herself through dance) and you are taken aback.

Despite the legal battle and the backlash against him, Marley’s fan base continues to rise., just as the singer is not relenting on his resolve to rule his world. On December 30, 2019, Marlians thronged the Eko hotel venue of the maiden edition of his headlining show, ‘Marlian Fest’ to keep a date with their music idol. While performing at the show, the singer announced his new record label, Marlian Records and resident presented the four artistes who are signed to his music imprint. He equally won his first major award at the 2020 Soundcity MVP Awards, held at the Eko Convention Center, Lagos Nigeria.

The Marlian President beat Tiwa Savage (49-99), Chinko Ekun (Able God), Prince Kaybee (Banomoya), Shatta Wale (My Level), Burna Boy (On The Low), Rayvanny (Tetema), Zlatan (Zanku – Legwork) to clinch the award for Viewers’ Choice for his viral song Soapy. And it was a major boost to his music career. But one wonders how far Naira Marley can go in this journey?

The post Naira Marley soaring amidst controversies appeared first on Vanguard News.

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Drugs, death and stock trading – what became of the Goonies child stars | Buzz.ie

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Produced by Steven Spielberg, and directed by Richard Donner, The Goonies has become a Sunday afternoon TV classic – but 35 years on, what has become of its amazing cast?

Child stars may seem to have it all but the pressures – and dangerous opportunities – of fame can be a toxic mix when you’re at an impressionable age.

Adventure comedy classic The Goonies was released in 1985, and the past 35 years have been something of a rollercoaster ride for its young stars Sean Astin, Josh Brolin, Corey Feldman, Jeff Cohen, Jonathan Ke Quan, Kerri Green and Martha Plimpton.

And let’s not forget John Matuszak’s memorable turn as Sloth

Some Goonies alumni have managed to maintain steady showbiz careers, some have tasted the dark side of fame, and a few have turned their backs on show business altogether.

24 Martha Plimpton today is barely recognisable as the young girl who lost her glasses in the secret cave (Image: Dave Benett/Getty Images)

Sean Astin (Mikey)

Sean is a Hollywood baby, son of Valley of the Dolls star Patty Duke and adoptive son of her husband – Addams Family star John Astin.

The Goonies was Sean’s first film, and after that, he went on to appear in a string of movies, including War of the Roses, Memphis Belle and Toy Soldiers.

Abuse Sean Astin is still acting today (Image: Warner Bros.)

He achieved new levels of fame when he played Sam in Peter Jackson’s Lord of the Rings Trilogy forming a lasting bond with co-stars Elijah Wood and Billy Boyd.

Since Lord of the Rings, Sean’s main success has been in TV. He’s added a second string to his acting bow with a number of high-profile voice acting rifles in animated series as well as showing up in Stranger Things, Supergirl, 24 and The Big Bang Theory.

act Sean’s best known for his work in the Lord of the Rings saga (Image: FilmMagic)

Sean’s personal life seems to have been relatively trouble-free. he married former beauty queen Christine Harrell in 1992, taking her Lutheran Christian faith in 2013, and they have three daughters together.

While younger readers may have no idea what The Goonies even was, they’ll know Sean as the voice of Reginald from Minecraft.

Martha Plimpton (Stef)

Martha is another Goonies star who just kept going. As well as starring in hit US sitcom raising Hope she’s appeared in everything from The Good Wife to Frozen II.

She’s had her greatest successes on stage though, receiving three consecutive Tony Award nominations and starring in innumerable Broadway hits.

Like Goonies co-star Sean Astin, Martha also pops up as a character voice in Minecraft.

actor These days, Martha focuses on stage work (Image: Warner Bros)

Corey Feldman (Mouth)

Corey Feldman became an Eighties icon. Alongside his showbiz mate Corey Haim, he appeared in cult vampire movie The Lost Boys as well as its belated sequel The Tribe.

The pair also appeared together in a fictionalised reality show – The Two Coreys – where the pair pursued an Odd Couple relationship with Feldman coming across as relatively clean-living and Haim playing the slob.

age Corey Feldman struggled to cope with the pressures of child stardom (Image: Warner Bros)

Haim’s hedonistic lifestyle caught up with him in 2010 when he died aged just 38. Feldman too has had problems with booze and drugs. By the time he was 19, he’d been arrested three times for heroin.

Feldman has hinted, more than once that the reason he and Haim were driven to drink and drugs was a secret subculture of abuse in Hollywood.

All Corey says that dark forces in Hollywood are out to get him after he spoke out about a paedophile ring (Image: Getty Images)

In 2013, he told US TV’s The View (their equivalent of Loose Women) that a massive organised paedophile ring wielded massive power in the entertainment industry.

Feldman was also a close friend of Michael Jackson, who invited him to his Neverland estate and showered him with expensive gifts. But, he insists, the disgraced star never approached him sexually.

Josh Brolin (Brandon)

amazing Josh is the son of James Brolin, star of the original Westworld (Image: Warner Bros)

A Hollywood wild child, Josh Brolin ran with a rough crowd in his youth. He stole cars to pay for drugs, and had a flirtation with heroin.

He said: “I mean, I never got into it and I never died from it, which is a good thing. I’ve had 19 friends who died. Most of those guys I grew up with, they’re all dead now.”

avengers Josh Brolin grew up with a movie star dad, but had a troubled childhood before finding his feet as an actor (Image: Getty Images)

Brolin survived and went on to have a long and successful career in movies. Debuting in The Goonies he has appeared in No Country For Old Men, Sicario, Deadpool 2 and as Thanos in the massively successful Avengers series of films.

He also has a sideline trading in stocks and shares, and even considered giving up movies for the stock market at one point

Jonathan Ke Quan (Data)

Jonathan was already famous when The Goonies opened, having played Indiana Jones’s sidekick Short Round in the Temple of Doom.

While he continued to act for a while after Goonies, he increasingly used his martial arts knowledge to pick up work as a fight choreographer.

baby Jonathan was the highest-profile member of the Goonies gang when the film opened (Image: Warner Bros)

Kerri Green (Andy)

Kerri, like many of the Goonies stars, made her debut in Steven Spielberg’s treasure-hunting comedy thriller.

But, unlike some of her co-stars, she struggled to sustain her early success. She earned good reviews for her role in romcom Lucas, where she played opposite Cory Feldman’s partner in crime Corey Haim, but after that, the big roles dried up.

Beauty Kerri spends her time writing and directing these days (Image: Warner Bros)

She made a few appearances on TV shows such as Murder, She Wrote and ER, but hasn’t done much acting since the 1990s.

Kerri spends her time behind the camera these days, with her own production company and a series of writing and directing credits.

Jeff Cohen (Chunk)

Jeff was suffering from chickenpox when filing on The Goonies started but kept quiet about it to avoid being dropped from the production.

broadway Jeff worked hard to slim down after The Goonies (Image: Warner Bros)

After the film wrapped, Jeff got heavily into college football in a bid to shed some of Chunk’s weight. He made a few more movies but then, according to a 2014 profile, “puberty hit and forced Cohen into early retirement.”

He moved from acting to entertainment law. Partly, he says, “because I get to go to the parties but I don’t have to audition.”

business Today, Jeff is a hugely successful media lawyer (Image: Getty Images)

John Matuszak (Sloth)

Older than most of the other Goonies stars, Matuszak was already an established American Football player when the call came to play disfigured misfit Sloth in The Goonies.

camera John Matuszak (Sloth) Older than most of the other Goonies stars, Matuszak was already an established American Football player when the call came to play disfigured misfit Sloth in The Goonies.

The makeup, which took five hours to apply every day, disguised his appearance but Matuszak’s own face appeared in countless TV shows such as M*A*S*H, The Dukes of Hazzard, The A-Team and Miami Vice.

Tragically, Matuszak died young – succumbing to a mix of opioids and cocaine in 1989. He was 38.


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