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Severe childbirth injuries from forceps, vacuum ‘unacceptably high’ in Canada, research shows

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Canadian mothers face a high rate of severe, long-term injuries from the use of forceps or vacuum in childbirth, and urgent action is needed to reduce it, the authors of a new analysis paper say.

Operative vaginal delivery (OVD) refers to using forceps or vacuum in the second stage of labour when the cervix is fully dilated. Health-care professionals may need to use the instruments if labour stalls or if the fetus is at risk.

In an article published Thursday by medical journal BMJ, epidemiologist Giulia Muraca, an assistant professor in obstetrics and gynecology at McMaster University, and her co-authors note that Canada has the highest rate of maternal trauma during forceps- and vacuum-assisted deliveries out of 24 high-income countries. Canada’s injury rate was 16 per cent, compared to an average rate of 5 per cent for the group.

The paper says that of the more than 35,000 single infants born after OVD in Canada, one in four attempted forceps deliveries and one in eight attempted vacuum deliveries resulted in obstetric trauma — most commonly, obstetric anal sphincter injury, which involves severe tearing to the perineum.

Up to 15 per cent of deliveries in Canada include the use of forceps or vacuum.

“These rates of injuries are absurdly, unacceptably high,” Muraca said in an interview. “And there’s been … no concerted effort to reduce them. Perhaps even worse, we’re not even recognizing or talking about them.”

 

Births using forceps have ‘absurdly high’ injury rate in Canada, research shows

 

Featured VideoNew research finds that Canada has the highest rate among high-income countries of maternal trauma from the use of forceps and vacuum assistance during births. Experts say it’s a taboo topic that needs more transparency and education to prevent future injuries.

‘Worried that my son might die’

When Laura Ralph of Vancouver gave birth to her son seven years ago, she recalls it was a chaotic and anxiety-provoking experience. The doctors told her the fetal heart rate was falling and they needed to use forceps to deliver him quickly.

“At one point, I was worried that my son might die and that I might die,” Ralph said through tears.

Ralph needed a blood transfusion in the operating room. The forceps also contributed to pelvic prolapse, which happens when the pelvic floor muscles weaken, she said. In her case, her bladder fell into the vaginal wall.

Long after her son’s birth, Ralph said, she was dealing with lingering mental health issues, as well as the long-term effects of pelvic prolapse, including not being able to exercise as strenuously as she would have liked.

 

The Current19:43Hidden trauma of birth injuries in Canada

Featured VideoAs many as one in four births using forceps is leaving Canadian women with severe injuries, according to new research. Those injuries can have a long-lasting impact on quality of life, but it’s also a hidden trauma for many women, with little help available. Matt Galloway talks to medical experts about the risks women are facing and what needs to change.

When she later became pregnant with twins, she had a planned C-section.

Episiotomy and other options

Ralph contributed to the BMJ paper as a patient partner because she hoped it might prevent others from experiencing what she did, she said.

More severe perineal tears can lead to pelvic pain, sexual dysfunction and fecal and anal incontinence, which “can have devastating effects on social, psychological and physical wellbeing,” the paper says.

Other countries like the Netherlands, Finland and Sweden have zero per cent injury rates after they abandoned use of forceps altogether because of issues with maternal trauma, Muraca said.

Doctor seated in a hospital library.
Dr. Modupe Tunde-Byass, an obstetrician and gynecologist, says in trained hands, forceps and vacuum are safe. (CBC)

Dr. Modupe Tunde-Byass, an obstetrician and gynecologist focused on high-risk births at North York General Hospital, said health-care providers decide whether to use forceps or vacuum on a case-by-case basis.

In trained hands, they are still safe options, said Tunde-Byass, who was not involved in the paper. But she added that women should be empowered early in their pregnancy to learn about alternatives, including C-sections and episiotomy — a surgical cut made at the opening of the vagina during childbirth, to aid in a difficult delivery and prevent tearing.

However, Canada has moved away from episiotomy since a landmark clinical trial in 1992 found that having the procedure could cause just as much trauma as going without it for vaginal deliveries that happen after the natural onset of labour.

“It’s being demonized,” Tunde-Byass said. She added that many health-care providers will avoid performing episiotomies because they can negatively affect their quality improvement ratings.

However, both she and Muraca say that when providers correctly perform an episiotomy during operative vaginal delivery, many of the injuries are prevented.

More research from other countries is beginning to back that up, the BMJ paper says, showing less risk of obstetric anal sphincter injury when an episiotomy is performed at an angle that keeps the incision from extending into the sphincter.

Focusing on prevention

Muraca suggests Canada should take a page from the playbooks of Australia and the U.K., where lowering rates of maternal trauma is a national priority. In addition to their greater acceptance of episiotomy, they put more emphasis on prevention.

For example, she says, expectant mothers in the U.K. will receive a “bundle” of care that includes pelvic floor exercises they can do before childbirth.

Dr. Amanda Black, president of the Society of Obstetricians and Gynecologists of Canada, cautions against comparing countries as the BMJ paper did, saying the comparisons may not be fully apples-to-apples.

“Having said that, I don’t think we can discount the fact that there is some concern about the fact that our rates of obstetric sphincter injury may be higher than compared to our colleagues,” she said.

 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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