text:
Sebastian Inlet facts for kids
Mouth of the Sebastian Inlet showing the North Jetty on the left and the South Jetty on the right.
Sebastian Inlet, located in Sebastian Inlet State Park in Brevard County, Florida and Indian River County, Florida, offers surfing and fishing opportunities. It is off State Road A1A just 12 miles north of Vero Beach. There are annual surf tournaments, professional and amateur. Visitors fish there, particularly for Snook and Redfish.
The first attempt by settlers to open an inlet at Sebastian took place in 1872. It was orchestrated by David Peter Gibson.
In the July 28, 1886 edition of the Florida Star letter writer G. W. Idner reports that talk was once again circulating about re-opening Gibson's Cut. Idner names some of those who worked on the first cut as "The Gibson and Houston boys ... and also Charley Creech and several others." Idner was an early settler of Tillman, now Palm Bay. He was also involved with Gibson's first efforts to open a cut. Discussion about opening Gibson's Cut in 1886 never amounted to anything more than just talk although a commonly held misconception has been that this was the year it was first dug.
When faced with foreclosure on the barrier island property that held his cut, he transferred title to his son, Quinn, but lost the property anyway.
At the time of D. P. Gibson's first effort the barrier island was about 260 feet (79 m) wide at the cut site. It widened considerably over the years as efforts to open an inlet continued.
During the summer of 1891 the second attempt to open an Inlet at Sebastian took place. By that time the barrier island had grown to be 450 feet (140 m) wide at the cut site. This would indicate that several other efforts had been mounted since 1872 although no records of these attempts have yet been found. Some of the folks involved with the 1891 effort were "Nesbitt...Harris and Williamson [of] Micco [along with] Knight, Gibson, Eason, Jacobs and Mitchell" all of Sebastian. They formed the St. Sebastian Inlet Association but they never succeeded in opening the inlet although they spent considerable money and time on the project.
An 1892 article read as follows: "Col. D. P. Gibson, the pioneer settler in this section, says he will cut an inlet through to the Atlantic, and as the distance is only about 120 yards, it will only take a short time to make this very valuable improvement, and it is the general opinion that Col. Gibson will make a success of it." There is no indication that any work actually went on at the cut site that year, or for the next five years for that matter.
In 1897 some winter residents of Brevard county made the third effort to open the inlet. It was the most ambitious so far. In that year The Roseland Inlet Corporation was formed to open an inlet to the sea at Gibson's Cut. The Corporation's Board of Directors included Alice P. Hudson, William W. Bissell, Henri J. Van Zelm, Harry Todd and Thomas S. Drake all of New Rochelle, New York. Bissell was a wealthy banker and all of the others were well-to-do friends and associates of his. Thomas S. Drake was a descendant of Sir Francis Drake. Harry Todd's father was James W. Todd who was a member of the Board of Directors at Bissell's bank. He purchased the entire Fleming Grant in 1892 for $5,050 ($119367.04 in 2021 dollars) when it was sold at a Sheriff's sale for taxes owed. There were 20,000 acres (8,100 ha). He paid 25 cents and acre($5.91 in 2021 dollars).
Todd broke the Fleming Grant up and sold tracts to his New Rochelle business acquaintances who then formed the Roseland Inlet Association. They saw the Inlet as an essential fixture for the drainage of their swampland and a convenient access to the Atlantic for their sailboats. Although the Roseland Inlet Corporation dug a partial cut across the island it was never completed.
The fourth attempt at opening Gibson's Cut began in 1899. Called "The Sebastian Inlet Association," it was organized at Eau Gallie, April 20, of that year "for the purpose of raising funds to cut a canal from Indian River to the ocean at Gibson's cut, opposite the Sebastian River,"
The fifth effort to open the inlet took place in 1901. A newspaper article read: "Another attempt is to be made to open the inlet at Gibson's cut." By Early October there had been enough rainfall to cause high water levels in the lagoon. High water in the lagoon was considered essential for opening the Inlet. Some locals went to work on the cut with shovels an explosive charge in an effort to try and open it.
By the start of the 20th century water quality in the entire Lagoon north of the narrows was diminishing. Algae blooms were killing the fish and the oysters population was disappearing.
History hasn't recorded exactly who was behind the sixth effort to open an inlet to the sea at Sebastian. A newspaper report mentions a dredge and a completion date prior to October 13, 1905.
In the same issue another article declared "The people in the vicinity of Sebastian succeeded yesterday in opening an inlet to the ocean, through the narrow peninsular opposite the mouth of the Sebastian river. Between 40 and 100 men have been engaged in the work all the week. The value of this inlet to the ocean to the people from the Narrows to Eau Gallie cannot be estimated in dollars and cents."
The following week's paper stated that "Water continues to run from the river to the ocean through the new inlet. There was apprehension that it would "cave" faster than the sand would be carried out." Their fear was well founded as the high sand banks at the cut site continually washed down into it. It wasn't long before the Inlet again filled with sand.
By 1909 population increases and numerous drainage projects had further degraded the Lagoon's water quality. Many residents saw the inlet as an answer to allow clean seawater in to flush out the filth. To accomplish this, funds were raised. The nearby success of Fort Pierce dredging encouraged the supporters. But it failed to raise sufficient support.
By 1914 the lagoon system was nearly a dead body of water. Some circulated a petition among their neighbors in the spring of 1914 asking for an appropriation of $1,200 to open the inlet. Over 100 names were gathered on the petition and a delegation of over 40 individuals from the South end of the county then presented it to the Brevard County Commissioner's at their April 1914 meeting. Among the delegation of 40 who spoke in favor of the Inlet were Roy Couch and Edson B. Arnold. It is likely that both of these men were instrumental in putting the petition drive together. The County Commissioners promised to "...give it their united attention, and look up the law on the matter...."
Memories of all the previous expensive failures were still too fresh. Some felt that there was a greater need for good roads than there was for an inlet which would "only benefit the fish business."
Hopes for an inlet were raised in 1914 when it became known that "Congressman L'Engle introduced a bill appropriating $5,000 to make a survey of several places including Sebastian, to open an inlet to aid the fishing industry. This reinforced the impression that inlet would benefit a select group while costing uninterested taxpayers money.
A lack of funds and essential permits required by the federal government prevented any actual work on the inlet from taking place during 1914.
By 1915 the Sebastian Inlet issue was a topic on which many county residents had developed an opinion. Residents in the northern portion of Brevard county were largely opposed. To dispose of their resistance some residents from the south Brevard tried to again split the county in thirds. These plans were submitted to the state legislature by some Brevardians who made an appearance at the capitol with petitions and maps detailing the split Their plan saw Brevard carved into three counties. Which would have been named, from north to south, Brevard, Hudson and Indian River. Titusville would have remained Brevard's county seat, Cocoa would have become the county seat for Hudson county, named in honor of the senator who was to sponsor the bill, and Melbourne was to be the county seat of Indian River county. This did not happen.
The United States Army Corps of Engineers objected to the idea of the Sebastian Inlet for several reasons. The chosen location presented the distinct possibility that once the cut was opened it would cause sand shoals to form in the Indian river and block the East Coast Canal. The Corps was obliged to maintain the East Coast Canal at that time and didn't want the extra expense of dredging out new shoals. Additionally they disagreed with the idea that the inlet would be dug, as had the East Coast Canal, using private funds which they viewed as a precursor to failure. The Corps insisted that for them to approve such a plan a local tax district would have to be created to raise funds for the inlets maintenance so that federal tax money wouldn't be needed.
Mainly because of the lack of a tax district the Corps continued to deny Inlet supporters their needed War Department permit all through 1915. The Inlet's supporters wouldn't take a "no" from the Army Corps and persisted with their efforts to be granted a permit to dig the Sebastian Inlet. They repeatedly petitioned the government and were granted several public hearings to discuss the inlet issue at greater length during that year.
Perhaps hoping to help persuade the Corps to grant a permit for digging to begin Jessie Goode volunteered to grant an easement across her barrier island property for the new cut. If her offer had been accepted the inlet would have been called "The Goode Sebastian Inlet" in honor of her late husband.
Two things important to the Sebastian Inlet plans occurred in 1916. The Corps agreed to grant a permit for a private consortium to proceed with work on the Inlet if they could post a $20,000 indemnity bond to cover the cost of the Corps repairing the East Coast Canal should the Inlet cause shoals to form and a wealthy physician, Dr. Hughlett, from Cocoa was elected to the state senate. Hughlett had been a friend of Couch's for some years and Couch knew his election meant that an ear sympathetic to the need for the Sebastian Inlet was in Tallahassee.
Several important events occurred in 1917 that concerned the Sebastian Inlet. One of these events was when Mrs. C. H. Holderman started another newspaper in Brevard county after selling the one she had published in Manatee county for some years. On March 22 the first edition of her new publication, the "Cocoa Tribune" hit the streets. Holderman was 1 of only 3 women in Florida who edited a newspaper at that time. She was an outspoken advocate of women's suffrage and unafraid of taking a stand on other controversial subjects as well. She exhibited an unrestrained disdain for burdensome taxation and used the pages of her publication to relay her feelings on the subject to her readers. Holderman's "Cocoa Tribune" came out every Thursday. In her 3rd edition, that of April 5, 1917 a large front page article appeared that openly called for the digging of several inlets along Brevard's coastline, including one at Sebastian.
Couch's lobbying, Holderman's editorial support and that of other editors in the area led Florida's legislature to draft, and pass, the Indian River Inlet Bill during its 1917 session. Known also as the Hughlett-Rodes inlet bill it called for a special election to let the voters in Brevard county decide whether or not to go ahead and allocate tax money for continued engineering studies of the inlets feasibility. The election was scheduled to be held on August 21, 1917.
Holderman's support for the Sebastian Inlet waned once she became aware of its dismal history. Subsequent issues of the Cocoa Tribune carried only criticism of the bill and the Inlets that would result if the bill became law. Most of the other newspaper editors in North Brevard also opposed the idea and let everyone know of their beliefs in no uncertain terms. Only one editor in the county's northern reaches, W. B. Dobson of the Cocoa Star, was very much in favor of the bill. No doubt this was because he was to become one of the three commissioners on the board should the inlet district become reality. The other two commissioners were going to be Couch and A. B. Tull.
As the August election drew close the inlet bill was a hotter, and more frequently discussed topic than was the 1st World War. Sections 6 and 7 of the bill were found particularly objectionable because they seemed to give the commissioners unlimited power to increase taxes and condemn land. When the election was held the bill lost. The majority of voters against it were in the north end of Brevard county. The bill would have succeeded had it only been up to the voters in the south end of the county.
As discouraging as this defeat must have been for Couch, it didn't keep him from continuing to push for the Sebastian Inlet. Fish were scarce and this scarcity combined with the food shortage caused by the War meant a lot of families in the Indian River area were going hungry.
On April 25, 1918 the Sebastian Inlet Association was created at a meeting held in Sebastian. Although it was a privately funded entity, its creation, and Roys perpetual lobbying, must have been good enough for the War Department because only 2 days later it finally granted a permit to dig the Sebastian Inlet. Stipulations listed on the permit included one demanding that if any shoaling should occur in the East Coast Canal as a result of the inlet the Association would have to remove the shoals. Even so, the permit still required a $10,000 bond be posted.
The seventh effort to open an inlet at Sebastian proceeded as rapidly as possible once the long awaited permit was granted.
There were several reasons to hurry and complete the project. Not only was it felt that high water in the Indian River was essential for the Inlet to be opened, but the War Department permit expired on December 31, 1918. High water levels usually were reached in late summer or early fall, only 5 or 6 months away.
An article that appeared in the May 1, 1918 issue of the Melbourne Times named the "officers of the Sebastian Inlet Association [as]: President, R.O. Couch, Grant; Secretary, Carl Schlichtinger, St. Lucie County; and Treasurer, Allen Campbell, Roseland.
This same article declared that no public money would be used in the effort, but only a few weeks had passed before Ernest Svedelius appeared before the County Commissioners of Brevard and St. Lucie counties to request that each of these bodies contribute $1,000 toward the inlet. No funds were forthcoming from either.
Because of the lack of funds in the Associations account Couch took it upon himself to build a 6 inches (150 mm) suction dredge at his marine ways in Grant. He also hired Charles W. Sembler to dredge out the cut.
No sooner was the inlet open in 1918 than it was again filled with sand and debris. There were a number of influential citizens in the area who were steadfastly opposed to opening the Sebastian Inlet. Among them were grove owners such as A. B. Michael of Orchid. Michael was opposed to it for several reasons. One, he saw opening an inlet to the ocean as something that would forever change the fragile ecology of the Indian River Lagoon. At that time it was almost a body of fresh water. He was also concerned that the influx of salt water would ruin the fresh water wells essential for his groves. Cattlemen on the mainland nearby also shared a fear that their fresh water wells would be ruined, but the most powerful opponent to the opening was by far Henry Flagler's Florida East Coast Rail Road that feared salt water in the lagoon would mean teredoes in the pilings of their rail road trestles that crossed the areas fresh water rivers. At any rate, it wasn't but a couple of days after the Sebastian Inlet was opened that someone organized several boatloads of men from the Narrows to Ft. Pierce into an Inlet destruction crew. One evening they loaded lanterns, shovels, saws, pick-axes, dynamite and chains, maybe even a mule or two, into boats and headed to the newly opened Sebastian Inlet. There they cut cabbage palms and any other tree they could find, dragged them into the cut and placed a lot of dynamite along the banks. Once the dynamite was set off it blew sand into the inlet sufficiently to plug it up.
Couch committed another dredge to the project and work continued through the winter, even past the December 31 expiration date of the permit. Before long word of the projects continuance past the permits expiration date reached the War Department and this agency was not amused. Every one of the Sebastian Inlet Association's board members and the dredge crews found themselves threatened with arrest if the work wasn't halted promptly. With the two dredges still at work Couch and some other influential citizens set out for Washington, D.C. where they approached Senator Duncan U. Fletcher and lobbied him to work on the War Department and obtain another permit.
After returning from Washington, Couch secured the able assistance of Capt. Robert Hardee and Frank Vickers and all three went to Tallahassee to push through a bill that was essentially identical to the failed Indian River Inlet Bill of the previous year. The biggest difference in the two was in the land area to be encompassed by the tax district. Because north Brevard county had defeated the previous bill it was left out and the districts boundaries encompassed only those precincts in Brevard and St. Lucie counties that had voted for the Indian River Inlet Bill. Couch, Hardee and Vickers stayed in Tallahassee until the bill was signed by Governor Catts.
The Sebastian Inlet Tax District came into being in 1919 after the new bill had been approved in an election and on August 31, 1920 this new agency was granted a permit to dig which would remain valid until December 31, 1923.
The Tax District's first $100,000 bond issue was delayed by court injunctions brought by some wealthy property owners and the F.E.C. but not even that delay stopped work on the inlet. Within several years the bond issue was approved, the inlet was opened sometime in June 1923 and several months later the Sebastian Inlet Tax District obtained permission from the land owner (Milton Hardee) to dig the inlet. It has been a continual struggle of man against the elements ever since just to keep the inlet open.
In 1924 jetties made of coquina rock were completed. They only lasted until the first big storm though when big waves rolled almost all the rocks away. Eventually granite, a much denser rock than coquina, was used and the jeeties became a permanent fixture.
The 1715 Spanish Treasure Fleet wrecked in this area. The site where the survivors camped was added to the U.S. National Register of Historic Places on August 12, 1970, under the title of Spanish Fleet Survivors and Salvors Camp Site. Today, the McLarty Treasure Museum (a part of the park) exhibits artifacts relating to the wreck.
In 2010, unwanted lionfish were found to have invaded local waters. They are a threat to native species.
Sebastian Inlet Facts for Kids. Kiddle Encyclopedia.


Handling Cocoa Notifications With Lua at Play With Lua!
This is less a "cool Lua trick" and more a "cool way to use Lua". What I'm doing is using Lua to write a Cocoa application. There are a couple tools to do this (Wax and LuaCore spring to mind) but they work on a different paradigm: they're like RubyCocoa in that they have a bridge where you can write Lua code that makes Cocoa objects, and write your whole app in Lua. I don't want to do that because I don't want to get in a race with Apple. Cocoa has a pretty good Objective C interface, including stuff like blocks and Interface Builder and CoreAnimation, and I'm perfectly happy to use it. I would just prefer to write the parts of my program that aren't tied to Cocoa objects in something a little more terse.
I'm going to go over what I did, conceptually, because last time having all the code made the post way too long.
To start, let's talk a little about the way you're supposed to architect Cocoa programs. Cocoa is an older model of OO programming than the C++ / Java model, and it really does draw a distinction between message passing and function calls. Not only can you have a function respond to arbitrary messages (like method_missing in Ruby) but you can broadcast a message to the world in general and let other objects decide whether they want to handle it. This is called a "notification" in Cocoa (it's a pretty common facility in GUI libraries but Cocoa uses it more than most), and you can use it not only to tie objects in your program together but actually as a form of IPC to have your program talk to other programs. It's a really powerful system.
So, the way you're supposed to design a Cocoa program is that nothing has a reference to anything else; you have a controller that (say) listens for a button press and then posts a notification, and some other objects that wait for a "saveDocument" notification and handle it. Everything is little self-contained objects created by a NIB file you made in Interface Builder, and they talk through notifications.
This struck me as a good way to embed Lua. Before, I had gotten bogged down trying to expose enough to Lua to let it drive the interface directly; that code was all simple but extremely repetitive. So instead, I made a LuaManager class that encapsulates a Lua state, and exposed two C functions to it that let Lua code post notifications and call Lua functions in response to notifications.
It took three or four hours and is incredibly simple; all I ever send across are numbers, strings, and tables, so no having to define userdata or anything. I create an instance of LuaManager in Interface Builder, tell it what Lua source file to run (stored in the app bundle), it sits there happily processing notifications. Lua objects stay in Lua (except strings and numbers, which are trivial to convert) and Cocoa objects stay in Objective C, nothing can directly talk to anything else so there's very little glue code to write.
If you'd like to look at it, here's the code. It's going to eventually be some kind of puzzle game. I'm thinking something like Chip's Challenge crossed with Pachinko; you drop a ball in and it falls through this machine, hitting switches and redirecting things and pushing things into other things.


Greeting's AOer's. This tutorial is going to be about Spyware/Adware and what it is, how to prevent yourself from getting it, detection/elimination, etc. So let's get started with a definition.
* A technology that assists in gathering information about a person or organization without their knowledge. On the Internet, "spyware is programming that is put in someone's computer to secretly gather information about the user and relay it to advertisers or other interested parties." As such, spyware is cause for public concern about privacy on the Internet.
* (From Noadware.com): Spyware and Adware is software made by publishers that allow them to snoop on your browsing activity, invade your privacy, and flood you with those horrible popups. If you are like most users on the internet, chances are you are probably infected with these applications. That is why we have designed our revolutionary product.
Where Can I Get Spyware?
Sadly, you can get these type of program's and application's from just about anwhere online. Where you would get trojan's and viruses, you would now get spyware as well. It could come from a simple e-mail attachment, to a popup from your browser or a website, to even your IM profile's. Thus said, spyware could be recieved in almost any matter a trojan or virus could be recieved.
What Can/Does Spyware Do To My System?
What Are Some Step's I Can Take To Protect Myself?
* Don't open e-mail attachment's from people you don't know, especially companies "offering" something that might catch your attention.
* Don't download a program/application unless it's from the vendor's direct site. Doing otherwise can risk having someone inject a spyware application (or a trojan/virus for that matter) into the program.
* Use a pop-up blocker when browsing the net.
* When on IM application's, do not click on link's that are given to you by people you don't know. Even if you know them, it could still be dangerous so be sure the link doesn't connect you to a malicious site.
* The old saying "If it sound's too good to be true, it probably is" applies in this category. Live by that rule.
* Don't trust p2p application's. This can be said for viruses/trojan's as well, but some p2p application's itself let alone the downloads are spyware app's.
What Are Some Tool's That Can Detect/Eliminate Spyware?
Well, that about wrap's this tutorial up. Hopefully some user's will now know/understand Spyware/Adware and will protect themselve's better from it. Anyway's, thanks for reading!
I hope this helps out people because the media, from all its "best efforts" have done nothing to really educate a home user about spyware, the true nature of cookies (remember when THAT was a big issue?), etc.
I live and die by Lavasoft's Ad-Aware and have been with them for the past 3+ years, back when they still had "games" on their main site.
Coupled with Ad-Aware (updated of course) and switching from IE to Firefox or Opera, I don't think an average home user would have 1/10th the normal spyware that infests their machine even with normal usage. When the google toolbar came out, it was great, but ONLY for those who used IE. Firefox and Opera both have default search engines set to Google and you can add more AND they have an integrated popup blocker (the best of which I think is Opera's because you can have "only requested" popups, which include login prompts, etc..just the way I like it!
Home users, take heed, hehe...unfortunately, in this day and age with no legislation against those that have spyware as part of their product (will someone PLEASE tell me where Gator/Claria is HQ'd?!) and with overseas servers hosting a plethora of crap that propogates regularly, it would be very wise and prudent to get very used to daily scans both AV and Spyware related.
Just a note about NoAdware, and with all due respect, it's not all that it has cracked up to be.
Otherwise, quite a nice tut.
Where's the credit to NemorY for givin you the idea for writing this ?
Hehe, oh come now, spyware tutorials shouldn't have to credit a single person for the "idea" of writing one...it's so prevalent, it's like antivirus, the word couldn't be spread around enough!
Heh, thanks. And yeah, that is kinda ironic, isn't it?
As do I. I think it's great and has detected many of application's I never would have thought as well as processes and whatnot. Very good at detecting spyware IMO and I think no user should be without it.
Aww, sorry if I forget the little people I step on to get to where I am haha, just kidding. Thanks for giving me the idea man. And thanks, even though it was more like 30 minute's.
Nice FAQ it helped with some of my questions.
Much of the rest is too poorly written to be plagerized (anwhere, linkn,recieved and poor grammar) the last 18 lines make sense though and are good advice.
I was merely copying out of my "Internet Glossary Handbook" which I used as a glossary to help define what it is. I stated that it came out of a glossary. Interestingly enough, the second link's information was also in the same Glossary, used as second reference. However a quick google search will show that it is from a couple of site's, therefore a few site's plagarized it as another's material. Mine came out of my handbook which I stated, as well as I stated the third reference.
Thanks My poor grammar must have gotten through though, as many have said I helped answer a few question's and helped them learn more. But sure.
the last 18 lines make sense though and are good advice.
Thank you, that I also did (go and search for it, geez seem's like your on a campaign against me, but k). Glad to hear it's good advice. Anyways, I understand I screwed up once and all and that was taken care of with MsMittens/Negative. However none of my tutorials (the three on AO) are plagarized. I quoted the source (however should have done so more directly in this one I suppose although it's origin was a book) but not directly .


text:
Cesarean complications rise in line with changes in mothers
A number of studies have been published recently, which, if read in the context and knowledge of other applicable studies, would inform women more accurately than many media reports have managed to do.
Take for example this week's highly publicized U.S. report, 'Severe Obstetric Morbidity in the United States: 1998-2005', by EV Kuklina et al. They found that the "prevalence of delivery hospitalizations (per 1,000) complicated by at least one severe obstetric complication increased from 0.64% (n=48,645) in 1998-1999 to 0.81% (n=68,433) in 2004-2005." And that
Perception of risk - actual increase versus percentage increase
Clearly, these numbers in real terms - especially when you consider that they take into account ALL delivery complications (including emergency cesareans) - are relatively small (less than 1%), but what many media reports concentrated on was the '% increase' number, which of course looks a lot higher - and riskier - when reported without the 'per 1000' figures.
For example, renal failure increased "by 21% (from 0.23 to 0.28), pulmonary embolism by 52% (0.12 to 0.18), adult respiratory distress syndrome by 26% (0.36 to 0.45), shock by 24% (0.15 to 0.19), blood transfusion by 92% (2.38 to 4.58), and ventilation by 21 % (0.47 to 0.57).
The authors conclude that: "Rates of severe obstetric complications increased from 1998-1999 to 2004-2005. For many of these complications, these increases were associated with the increasing rate of cesarean delivery.
But is cesarean surgery the reason for greater severe morbidity - or are other factors to blame?
Adding to a growing body of evidence on this subject, a Scottish review this month by A Poobalan et al, 'Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women - systematic review and meta-analysis of cohort studies' tells us that cesarean delivery "risk is increased by 50% in overweight women and is more than double for obese women compared with women with normal BMI."
And in 2003, KS Joseph et al's Canadian study, 'Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery', which set out to "estimate the contribution of changes in maternal characteristics (namely, age, parity, prepregnancy weight, weight gain in pregnancy, smoking status) and obstetric practice (namely, labor induction, epidural anesthesia, delivery by an obstetrician, midpelvic forceps delivery) to recent increases in primary cesarean delivery rates", concluded that "Recent increases in primary cesarean delivery rates are a consequence of changes in maternal characteristics. Obstetric practice, which has altered due to changes in maternal characteristics and concerns related to fetal and maternal safety, has also contributed to increases in primary cesarean delivery."
Specifically, the researchers noted a 14% increase in cesarean deliveries for dystocia, 24% for breech, 21% for suspected fetal distress, 47% for hypertension, and 73% for miscellaneous indications between 1988 and 2000. Importantly: "Adjustment for maternal characteristics reduced the temporal increase" in cesarean rates from 21% to 2% [and] Additional adjustment for obstetric practice factors further reduced period effects."
The future of cesarean rates
A review by Rebecca Simmons, MD., 'Perinatal Programming of Obesity', published in the U.S. in October 2008, reminds us that the prevalence of obesity "has risen dramatically over the last decade [and a] number of epidemiological studies have shown that there is a direct relationship between birth weight and BMI in childhood and in adult life." I would suggest that with no sign of a decline in obesity rates (in fact, quite the opposite) and with women continuing to have their babies later and later in life, we are not going to see any significant reduction in primary cesarean rates at all, and we need to be very careful about implementing strategies to drastically reduce them since this will result in greater morbidity and mortality for these women and their babies.
Labels: Risks for mothers, Table of Contents 2009
New research on cesarean surgery techniques
Hypotension and Nausea during surgey
When I saw this new study from Canada by M Tanaka et al, 'ED95 of phenylephrine to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery', it reminded me of my own experience during the birth of my daughter in 2007. The anesthetist had warned me prior to the start of surgery that I may experience some nausea, and to let him know if I did as he would be able to administer something for it. Well, I did, and he did, and in truth, I have no idea what the drug was, but I felt better almost immediately.
For those of who would like to be able to discuss this occurence of nausea and its treatment during your cesarean surgery in more detail (with your OBGYN or anesthetist), you might find this study interesting. It set out to "determine the 95% effective dose (ED95) of phenylephrine by intermittent i.v. bolus, to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery" and involved 50 patients undergoing elective cesarean delivery under spinal anesthesia.
The study results
"The ED95 of phenylephrine was estimated as 159 mug (95% confidence interval: 122-371 mug), although the largest dose given in the study was only 120 mug. Hypertension (systolic blood pressure >120% of baseline) was observed in 14 cases, immediately after intrathecal injection and prophylactic phenylephrine administration in all cases." The authors conclude that the "safety of this dose warrants further studies."
Blood loss following surgery
This second study from Iran, 'Efficacy of tranexamic acid in reducing blood loss after cesarean section' by L Sekhavat et al, was conducted on 90 primiparas divided into two groups who underwent cesarean delivery. "The study group, 45 women, received tranexamic acid immediately before CS, whereas the control group, 45 women received placebo" and then blood loss volume for each group was measured from the end of surgery to 2 hours postpartum.
Study conclusions
The authors conclude that: "Tranexamic acid statistically reduces blood loss from end to 2 h after CS and its use was not associated with any side effects or complications. Consequently, tranexamic acid can be used safely and effectively to reduce bleeding resulting from CS." My second baby is due shortly, and a cesarean delivery is planned, so I will certainly be asking my doctor about whether the findings in this study are relevant to my potential recovery experience.
Pelvic organ prolapse risk with vaginal delivery - are women made aware of it?
A new American study, Relation between vaginal birth and pelvic organ prolapse (by Eddie H. M. Sze and Gerry Hobbs), set out to "evaluate the relation between vaginal birth and pelvic organ prolapse quantification (POPQ) stages III and IV prolapse and whether each additional vaginal birth is associated with an increase in pelvic support defects."
The researchers conclude that "Vaginal birth is not associated with POPQ stages III and IV prolapse, but it is associated with an increase in POPQ stage II defect."
Birth risk/benefit analysis
This study demonstrates that there IS a link between vaginal delivery and subsequent pelvic organ prolapse (POP), and is in fact one of a number of studies to do so. Unfortunately, women planning vaginal deliveries are not always advised of this risk. In fact, in the U.S. December 2006 'Pelvic Organ Prolapse Topline Summary by ICR', an Ethicon Women's Health & Urology survey found that among the total female population age 21 and older, only 1 in 5 (19%) are even aware that such a female condition exists.
Furthermore, 2 out of 3 (68%) women diagnosed with POP were not aware of its existence before experiencing symptoms, and the majority (81%) of women who have given birth did not receive education about the relationship between a vaginal delivery and possible pelvic organ prolapse from their OB/GYN.
Are we truly informing women of the risks associated with vaginal delivery?
"Only 15% of women who have given birth report that their OB/GYN educated them about the relationship between a vaginal delivery and the condition [yet the] greatest risk factor for pelvic organ prolapse is a vaginal delivery, at any age."
Sze and Hobbs analyzed 458 nulliparas (first-time mothers) and 892 multiparas, including 272 with one, 299 with two and 321 with at least three term vaginal deliveries, and found that the "prevalence of POPQ stage II defect among nulliparas and multiparas that had one, two, and at least three term vaginal deliveries was 25% (119/458), 50% (137/272), 66% (198/299), and 69% (220/321), respectively (p<0.001), p="0.618)." style="font-weight: bold; color: rgb(0, 0, 102);">
Labels: Planned Cesarean Benefits, Table of Contents 2009
An article by Heather May in The Salt Lake Tribune on January 7th reports on a study in which "almost 4,000 Utah women suffered severe vaginal tears last year while giving birth after their doctors used forceps or vacuum devices to deliver the baby." This number translates to a reported "14% injury rate".
In releasing the figures, the Utah Department of Health is reported as saying that 14% is "lower than expected compared to national figures. But the tears can cause long lasting problems, including painful sex and fecal incontinence."
The article also cites comments from Ashley Nelson, a women's health physical therapist in Salt Lake City, who says: "It's hush, hush. Most people don't talk about this". She sees women seeking help to strengthen their pelvic floor muscles or who have irritated or damaged nerves because of scarring from tearing or subsequent care. "A lot of times they may sew them up too tight [and women experience] pain [from] penetration. Or just the way they've been sewn back up - it's irritated nerves and [they] constantly have pelvic pain," she said.
14% is the risk for SEVERE tears - many more women experience "minor tearing"
"...While minor tearing during delivery is common, the health department report focused on third and fourth-degree lacerations, which extend from the vagina to the anus. Using instruments increases the risk of severe tears. So does delivering large babies or having an episiotomy, a surgical cut between the vagina and anus. Doctors use instruments if the baby's heart beat drops dangerously or if the mother is worn out from pushing.
Some Utah hospitals have a 29% vaginal tear rate
"Utah hospitals' rate of vaginal tears range from 4.5 percent at Ogden Regional Medical Center to nearly 29 percent at Uintah Basin Medical Center in Roosevelt. "
The full report, '2007 Utah Hospital Comparison Report: Maternity and Newborns', can be accessed here.
Long-term benefits outweigh risks, says Malaysian doctor
You may have read my criticism of recent reports on the increased risk of asthma in children born by cesarean delivery, and how research in this area is still incomplete and inconsistent. Now the president of the Obstetrical and Gynaecological Society of Malaysia, Dr A. Baskaran, has criticized a media report by Datuk Dr Rajen M, titled 'C-Section babies risk becoming asthmatic'.
He says: "The article gives the impression that Caesarean section is detrimental to the health of the baby and should not be resorted to at all. Our greatest concern is that mothers may refuse to give consent when a Caesarean section is indicated in times of emergency after reading the article."
He continues: "In any operative delivery or, for that matter, in any operation, the benefits from the operation must be weighed against the short-term and long-term risks of the operation. Perhaps, one of the long-term risks to a baby born by Caesarean section may very well be a higher incidence of asthma but this must be balanced against the immediate and long-term risks to the baby when there is delay or no intervention by Caesarean section.
We do not want a baby to be forever mentally handicapped for fear of a higher risk of asthma.
The study quoted in the report, from the Dec 3 issue of the medical journal Thorax, showed that Dutch children born by Caesarean section were 80 per cent more likely to develop asthma by the time they are 8 years old. This study, together with another Norwegian study published in June last year in the Journal of Pediatrics, has shown an increased risk.
However, previous studies have shown conflicting evidence. More prospective, multi-central studies from many different countries need to be done before this risk is accepted into evidence-based practice. More importantly, other aspects such as failure to breast-feed a baby after a Caesarean section need to be considered.
Nevertheless, the increase in Caesarean section rates in the past couple of decades cannot be denied. It has always been an important and heavily debated topic of discussion in practically every obstetrics conference all over the world. The reason for this is complex and every attempt has been made by the fraternity to reduce this rate. But its judicious use has saved many a mother and baby."
I agree with a great deal of what Dr Baskaran says, but it would be interesting to learn more about his views on planned cesarean delivery with no medical indication. He does mention above that "every attempt has been made by the fraternity to reduce this [cesarean] rate" and it concerns me that women making legitimate decisions to choose one set of birth risks and benefits over another may be not be supported in Malaysia. I only hope that this is not the case.
More Women Choosing Birth Without Labor
Dr. Michael J. McGlynn of the Eden Medical Center in Castro Valley has written an article on the Castro Valley Forum this week, in which he comments on changes he's noticed in recent years. He says: "More and more pregnant women are requesting caesarean sections without labor. This is especially true for first-time mothers who are apprehensive about the pain associated with labor as well as injury to the birth canal with a vaginal birth. Many mothers also want a Csection to control the delivery date."
Dr. McGlynn makes the valid point that "information about choices to make as pregnant women enter into labor and delivery is not... straightforward." He says, "Questions about the birth process and whether to accept pain medication during labor or bypass labor altogether and have an elective caesarian section are very personal choices."
His advice?: "With so many decisions to make, pregnant women should be comfortable enough with their obstetricians to make sure they [are] even writing questions down in advance. After all, a healthy mom and a healthy baby is everyone's ultimate goal."
I completely agree with Dr. McGlynn's advice; in fact, this is exactly what I did ahead of my visits with my OBGYN. I read as many medical studies on cesarean risks and benefits as I could find, and was fortunate enough to have a doctor who was willing to answer all my questions and help me to understand my own individual health risks. Pregnancy and childbirth are not without risk, but understanding and feeling comfortable with the decisions you make has been shown in studies (10,11,13,15) to help increase women's likelihood of post-birth satisfaction.
Labels: Birth autonomy, Table of Contents 2009
Support for a cesarean/vaginal delivery comparative trial?
Australian Researchers Catherine Turner et al have recently published 'Willingness of pregnant women and clinicians to participate in a hypothetical randomised controlled trial comparing vaginal delivery and elective caesarean section', in which they conclude that a "randomised controlled trial comparing vaginal delivery and elective caesarean section may not be feasible due to low levels of willingness to participate, particularly among pregnant women."
This type of comparative trial has been criticized for being unethical and/or unfeasible in the past (by other researchers and doctors), but this latest research from Australia isn't all negative. The authors begin by stating that "Elective caesarean section is controversial in the absence of compelling evidence of the relative benefits and harms compared with vaginal delivery. A randomised trial of the two procedures to compare outcomes for women and babies would provide the best quality scientific evidence to confirm this debate but it is not known whether such a trial would be feasible."
They set out to ascertain what proportion of pregnant women and clinicians would participate in a hypothetical randomised controlled trial comparing the two delivery methods by asking pregnant women (via interviews) and midwives, obstetricians, urogynaecologists and colorectal surgeons (via a mailed, self-administered questionnaire).
How many support a hypothetical trial?
Out of 100 pregnant women, 84 midwives, 166 obstetricians, 12 urogynaecologists and 87 colorectal surgeons, 14% of pregnant women and 31% of clinicians indicated that they would participate in a randomised controlled trial.
Is this enough?
14% is a very low number, but I would be interested to learn whether the 100 women questioned already had a birth plan in mind, and also whether the hypothetical trial (as explained to them) meant that they would get to choose between each delivery or whether that delivery method would be allocated to them. These factors are crucial and could make a huge difference to the final percentage tally.
31% is almost a third of clinicians saying 'yes', and this is actually a sizeable proportion. If nothing else, it indicates that aversion to such a trial is no longer in the minority.
Trial alternatives?
The number of healthy women electing to have cesarean deliveries with no medical indication is reportedly low. However, these women do exist and their health outcome data is on record at hospitals (especially private hospitals) throughout the world. If we could gather the data available for some or all of these deliveries, this would go a long way to informing risk and benefit analysis as compared to planned vaginal deliveries in healthy women (the data of which is readily available at numerous large hospitals).
Trial fears?
In 2003, doctors in Australia asked the question 'Should obstetricians support a 'term cephalic trial'? (Robson S, Ellwood D. Aust N Z J Obstet Gynaecol. 2003 Oct;43(5):341-3.) In subsequent media reports, they were quoted as saying:
Dr Robson: 'What a disaster it would be if it was found elective cesarean was safer than vaginal birth.'
Dr Ellwood: 'There is an increasing trend towards elective cesareans, and there have been discussions over the last couple of years about mounting the so-called term-cephalic trial, which would be a randomised trial comparing cesarean versus planned vaginal birth for women having their first babies. We're concerned that the impact of such a trial could well be quite far reaching, and that it needs to be well thought through before such a trial is mounted.' [The reporter continued:] His fear is that if caesarean sections were found to be safer in such a trial, doctors and patients might feel compelled to go that way.
Labels: Research needed, Table of Contents 2009
When Childbirth Was Natural, and Deadly
This January 10th article by Druin Burch in Natural History Magazine concentrates on the history of diseases that were associated with deaths in childbirth, but if nothing else, it provides yet another reminder that while women may indeed have been giving birth since the beginning of time with bodies that were designed to do so, natural birth has always been inextricably associated with death too.
Pregnancy is risky; childbirth is risky. It is a woman's progagative to decide which set of delivery risks (vaginal or cesarean) is most tolerable to her.
Labels: Maternal deaths, Table of Contents 2009
0.5% risk of deep vein thrombosis with cesarean delivery
A new North American study by Winnie Siaa et al, 'The incidence of deep vein thrombosis in women undergoing cesarean delivery', set out to determine the incidence of deep vein thrombosis (DVT) post cesarean delivery since venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the United States and Canada, and cesarean delivery is a known risk factor.
The autors found an incidence proportion of DVT post cesarean delivery of 0.5% and say this is the largest study to date that uses Doppler compression ultrasound to diagnose DVT in women after cesarean deliveries.
Study highlights
The research is certainly worth a read, but I've highlighted some of the interesting points made by the researchers in the 'Comment' section of their presentation:
*A Swedish prospective study found an incidence of DVT post cesarean delivery at 1.8% using impedance plethysmography, which is known to have high false positive rate compared to Doppler ultrasound. However, four other studies using Doppler ultrasound did not find any DVT in their cesarean delivery population... [many more studies are cited]
*This incidence of post cesarean delivery DVT is much lower than that reported among general surgical patients... This disparity between general surgical patients and patients undergoing CD may be due to many factors. First, patients undergoing CD are generally younger. This is still true even though 20% of our population would be described as "advanced maternal age" for being over 35 years old. Age is both an independent risk factor of VTE and is associated with increased likelihood of co-morbidities. Second, most cesarean deliveries are now performed under regional anesthesia, which is known to have a lower risk of postoperative DVT compared with general anesthesia. Third, postpartum mothers are more likely to be out of bed early and frequently (because of the needs of their newborn) as compared to patients who have undergone other abdominal surgeries.
*It is interesting to note that while our study population appears to have few VTE risk factors, 78% would have warranted thromboprophylaxis after cesarean delivery per RCOG guideline. The preeclampsia rate of nearly 10% in our study is higher than that of the general obstetric population likely because preeclampsia increases the risk of cesarean delivery and our participants all had cesarean deliveries.
Epidural risk lower than thought
A BBC News article on the 12th January reports on a study by researchers at Bath's Royal United Hospital, which suggests that the "risk of epidurals and spinal anaesthetics to expectant mothers and patients undergoing surgery may be being overstated."
The researchers analysed the complications from the 700,000 pain-killing injections given each year and "found the risk of harm was at least as low as one in 23,000 - 10 times less than tends to be estimated. Experts said it was important patients were told about the true risk."
You can read the article in full here, but it continues: "Researchers said expectant mothers, in particular, should not be overly concerned as their risk of permanent harm was as low a one in 80,000."
Spinal anesthesia
Spinal anesthesia rather than an epidural is often used in planned cesarean deliveries today, but this research is worth being aware of for both cesarean and vaginal delivery risk information.
Rate of Unnecessary C-Sections Far Lower Than Thought
This December article by Serena Gordon of HealthDay News is a fascinating glimpse at what might be closer to the truth about cesarean delivery rates in the U.S: That the term 'unnecessary' may be being overused and based on inaccurate data.
Gordon reports that current estimates put the figure of unnecessary cesareans at nearly 60%, while the real number may be as low as 4%. Why the huge difference?
Mainly because of inaccuracies cited on birth certificates. When government experts analyzed birth certificates and hospital discharge data, they found the actual number of [unnecessary cesarean] deliveries was closer to 4%. The study author, Emily Kahn, an epidemiologist with the U.S. Centers for Disease Control and Prevention's division of reproductive health, explains that "You can't use the birth certificate alone to determine whether or not a woman is at risk for primary caesarean delivery."
"...The CDC researchers sifted through data on 565,767 births from women who were considered at low risk for needing a C-section. The women were all 37 weeks' to 41 weeks' pregnant when they went into labor and had singleton pregnancies. All of the women delivered in Georgia hospitals between 1999 and 2004. More than 70,000 of these women ended up having a Caesarean delivery, and almost 41,000 were listed on the birth certificate as having no risk factors. Yet, in the hospital discharge data, nearly 90 percent of these women had a risk factor listed. Overall, 58.3 percent of birth certificates suggested no risk factors. But when the researchers pooled the data and combined both birth certificate data and hospital discharge data, they found the rate of Caesareans with no reported risk factors at just 3.9 percent."
Doctors don't touch birth certificates
..."Kahn said there are several possible reasons for this discrepancy. One is that the main purpose of a birth certificate is simply to record the birth. Birth certificates aren't completed by physicians, but instead rely on worksheets filled out by the mother. And, she said, hospital discharge data is used to bill the insurance companies and doctors must be very detailed on these reports to get paid, which might make them more accurate. "Doctors don't touch birth certificates," said Dr. Miriam Greene, an obstetrician at New York University Langone Medical Center and author of the book Frankly Pregnant. "The person who writes up the birth certificate might not be knowledgeable about all the risk factors for C-section, and they see the baby is fine and may think there was no issue."
My view - U.S. birth data collation is unhelpful
The story above illustrates one disadvantage with the reliance on birth certificates for analyzing cesarean delivery occurence in the U.S., but I have long talked about another area for improvement. That is, separating the number of elective/planned cesarean deliveries and the number of emergency cesarean deliveries. Many European countries already separate these types of cesarean deliveries, and this has helped to inform research into the differences in risks between the two.
Even better would be to separate 'planned cesarean deliveries in healthy women with no medial indication' (since we now know they DO exist), as this would help us to compile actual outcome data of this group without waiting for agreement to a controversial clinical trial comparing planned vaginal and cesarean deliveries in healthy women.
On a positive note, the U.S. does separate primary and repeat cesarean deliveries, which has been useful for researching health risk outcomes in multiple deliveries. It now just needs to go a few steps further in order to ensure clarity and accuracy in its cesarean data collation.
Labels: Cesarean rates, Table of Contents 2009
Cesarean section rate growing in Czech Republic
The Prague Daily Monitor has reported that that in "2007, 114,632 children were born in the Czech Republic with one-fifth of them being born by cesarean section... According to the Institute of Medical Information and Statistics (UZIS), 22,428 women gave birth to their babies via cesarean section in 2007, which is 1.4 percent more than in 2006."
Interestlingly, the report state that according "to medical statistics, some doctors perform cesarean section at women's requests or when they need to ensure successful delivery, but some specialists disagree with the practice."
Other 2007 statistics cited
With 1.44 children per woman being born, this is a record high since 1993.
Women's average age at delivery has increased by 0.2% to 27.1 years at first delivery and 29.1 years in general.
39 is the magic number
It's been the recommended time of delivery for cesarean-born babies for many years now, but a new study has reiterated the importance of waiting until confirmed 39 weeks gestation before commencing surgery. Tita et al's American study, 'Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes', concludes that "Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes."
What the research found
The researchers "studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU)."
"Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5% at 38 weeks) and 49.1% at 39 weeks of gestation. One neonatal death occurred. As compared with births at 39 weeks, births at 37 weeks and at 38 weeks were associated with an increased risk of the primary outcome... The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks."
Obviously, some of these early deliveries are necessitated due to emerging or pre-existing medical conditions (either with the mother and/or the baby), but certainly wherever possible, doctors advise waiting until 39 weeks to deliver.
Labels: Risks for babies, Table of Contents 2009
Breathing difficulties are worse PRIOR TO 39 weeks gestation
This new study from Norway is a perfect example of how the risks associated with cesarean delivery are not necessarily relevant in a comparison of risks and benefits between planned vaginal delivery and planned cesarean delivery in healthy pregnancies with no medical indication in countries that follow the medical guidelines of waiting until 39 confirmed gestational weeks before performing surgery.
In Torkil et al's study, 'Cesarean section is associated with more frequent pneumothorax and respiratory problems in the neonate', the authors demonstrate that among 5,957 cesarean deliveries (20.3% of all 29,358 deliveries) between 2001 and 2005, "among the 26,664 neonates born at term (≥37th gestational week), 4,546 were delivered by CS (17.0%), of whom 0.5% by elective and 0.6% by emergency CS with NP [neonatal pneumothorax]. The incidence of diagnosed NP was significantly higher after CS than after vaginal delivery [0.6% vs. 0.10%]... In addition, the need for MV [mechanical ventilation] was significantly increased [0.41% vs. 0.19%] but use of CPAP [Continuous Positive Airways Pressure] was not [0.28%vs. 0.15%]."
This simply confirms recommendations by ACOG and the NIH (among others) to wait until confirmed 39 weeks getstaional age before scheduling planned cesarean deliveries. The respiratory outcomes for babies at 39 weeks are greatly improved and therefore this study should not be used as an argument against cesarean delivery on maternal request in healthy pregnancies.
Fear drives growth in cesareans in Australia
The article, 'Fear drives growth in caesareans' that appeared in Australia's The Age on the 6th January, describes Dr Jennifer Fenwick's opinion that "overblown fears about childbirth are a driver of Australia's rising rate of caesarean sections [and not] a case of women being 'too posh to push'."
She also believes that the country's national cesarean rate is "absolutely too high", and says that "women's fears and a culture of negative talk around vaginal birth - both in the medical profession and broader community - should be addressed." The article continues: "The messages are that birth is dangerous; you're better to have a caesarean section," says Dr Fenwick, who is Associate Professor of Midwifery at the University of Technology Sydney.
"What we haven't done is say (to women) 'let's talk about your fear .. Let's try and help you understand that birth is a really normal, healthy life event and your body is very good at having babies'."
As many readers of my website will know, I carried out research into this area myself, and it is true that women often cite 'fear of birth' and/or 'fear of vaginal delivery pain - during and after the birth' as reasons for choosing cesarean delivery. While I agree with Dr Fenwick that it can be helpful to try and address this fear in the case of some women, it should not be forgotten or dismissed that many women do not wish to go through counselling or therapy for fear, and have made a valid and measured decision to choose the risks and benefits associated with a planned cesarean delivery instead of those associated with a planned vaginal delivery.
Don't assume that fear can or needs to be overcome
Dr Fenwick may describe birth as a "normal, healthy life event and your body is very good at having babies" but the fact is that many planned vaginal deliveries result in adverse outcomes for mother and baby, and it is perfectly reasonable for women to make the decision to avoid these risks.
Cesarean complications rise in line with changes i...
Pelvic organ prolapse risk with vaginal delivery -...
Long-term benefits outweigh risks, says Malaysian ...
Support for a cesarean/vaginal delivery comparativ...
0.5% risk of deep vein thrombosis with cesarean de...
Rate of Unnecessary C-Sections Far Lower Than Thou...
Breathing difficulties are worse PRIOR TO 39 weeks...

redpajama_set_name: RedPajamaCommonCrawl


Pursuant to Andover Town Ordinance 61-01 there is no parking on the street during a period of snow fall or icy conditions. This parking ban is extended through the time after the snow fall or ice event until the roads are totally cleared. Please be sure to remove any objects like basketball hoops and place them at least 15 feet from the roadway. Items like this that are close to the road cause a serious hazard. Tickets will be issued to those who fail to comply.


The summer before my senior year in high school, I tried to read Wuthering Heights. I think I read the whole thing, but it was a struggle. The novel was too dark and complex for me at the time.
During the school year, a classmate recommended Jane Eyre. That I devoured. I was Jane. All of us plain, quiet girls were, and we loved dark and troubled men (or boys, at the time) like Mr. Rochester. I read the novel several times, and later her biography (not Elizabeth Gaskell's). I wrote about Jane Eyre for AP English (and got an A although I thought I was bullshitting). In college I watched the miniseries version with Timothy Dalton (or tried to, I wasn't into it) and I read Wide, Sargasso Sea.
So when my friend and I popped into the Morgan Library over the weekend as part of the Smithsonian's free museum day, I was over-the-moon to see their exhibit on Charlotte Bronte.
The exhibit marks the 200th anniversary Charlotte's birth. The Bronte children were born in Yorkshire to an Irish immigrant father and English mother. Charlotte had two older sisters, Maria and Elizabeth, who both died of tuberculosis at ages 11 and 10, respectively, and within a month of each other. Just a few years earlier, their mother died of uterine cancer. Left in the family besides Charlotte were her father Patrick, younger sisters Emily and Anne, younger brother Branwell, and their aunt Elizabeth who helped raise them after her younger sister's untimely death.
In the end, patriarch Patrick was the only Bronte to live to old age, outliving all of his children. Branwell and Emily died the same year, at 31 and 30, respectively, and, like their sisters Maria and Elizabeth, within months of each other and rom tuberculosis. Branwell was also an addict, and legend says that his failed romance with a married woman only worsened his condition.
Anne died the following year at 29, also of tuberculosis, and Charlotte, six years later at 38, from complications of pregnancy although it's speculated she might have also had typhus.
The exhibit focuses less on the tragic side of the family and more on the imaginative and whimsical. Included are the miniature replicas of books and magazines she and her siblings created for their toy soldiers, her teenage poems (one of which she bragged took her only an hour to write), her drawings and paintings, and of course her famous works.
My friend and I were fascinated by the teeny-tiny handwriting all the Bronte siblings used. It's said that they started out writing that way to match the size of their toy soldiers, but then it became a sort of secret code. I had heard of her "miniscule handwriting" before, but I hadn't realized it was that miniscule. The Morgan helpfully offers magnifying glasses so you can actually read it although they didn't really help my 40+ year old eyes.
— she had teeny-tiny hands that made writing so small easier.
In addition to her artworks, there's the famous family portrait by Branwell Bronte.
That's, from left to right, Anne, Emily and Charlotte. The portrait is usually housed at the National Portrait Gallery so I must have seen it during my two-week stay in London several years ago, but I don't remember. So seeing it in real life for what felt like the first time made me swoony.
Branwell had originally included himself in the portrait, but then painted himself out because he didn't want to "clutter" it. Now as the painting has gotten older, you can see the "ghost" of Branwell between Emily and Charlotte.
The exhibit's piece de resistance is a portion of Charlotte's original handwritten manuscript of Jane Eyre (written in regular size by the way). This is usually at the British Library so like the Bronte portrait, I must have seen it before, but again I don't remember so it felt new and just as swoon-worthy. Of course I wish I could have taken a picture of it, but, understandably, they don't allow pictures.
You'll have to go and see it for yourself. The exhibit is open through January 2.


text:
Hughenden may refer to:
Hughenden, Queensland, a town in Australia
Hughenden, Alberta, a village in central Alberta, Canada
Hughenden Valley, a village in Buckinghamshire, England
Hughenden Manor, a mansion in High Wycombe, Buckinghamshire, England, home of Benjamin Disraeli
Hughenden, Glasgow, a rugby stadium in Glasgow and former home of the Glasgow Warriors

redpajama_set_name: RedPajamaWikipedia


Tasting notes on the following beers accompanied "Blended to Perfection," which appeared in our September 2015 issue. These beers were tasted by Ken Weaver.
Tasting Notes: A barrel-aged mélange of six beers (lagers and ales). Some funkiness occurred, and the bottled result gushed out once the cap was popped. There's quite a bit to dig into here: ripe dark fruits, tartness that hints at raspberries and balsamic, and an underlying tannic structure that kept things well aloft on the palate. The full impact hints at chocolate-covered cherries and tart raspberry jam.
Tasting Notes: A pretty massive quad, with its core sweetness tempered by a combination of bourbon-barrel influences: Woodford Reserve, Elijah Craig and Four Roses. This also serves as a blending beer, specifically built to hit those rich caramel and toffee notes. There's an exceptional amount to engage with: dense dark malts, yeasty pepper and barrel-ness ranging from coconut to spice. Definitely a sipper, but one that doesn't fail to deliver in either depth or appeal.
Tasting Notes: This is arguably one of the strongest recent releases in Grand Teton's Cellar Reserve series. It's a blend of three distinct beers, starting with a saison base: One "thread" is fermented with a classic Belgian yeast strain, a second with what's often called Brettanomyces Trois, and the third with souring Lactobacillus. The result's exceptional, generous and smoothed out, with yeast aromatics ranging from peach to peppery, lemon to clove. A just-enough acidity gives this blend a softly lactic kick, while rounded notes of vanilla and almonds play out as well.
Tasting Notes: Fermented from Missouri-native wild yeasts and bacteria, the latest blend is from batches ranging from 3 to 6 months old. These are saisons aged in Chardonnay barrels, and the blend is such a nontrivial execution of combining beers. The aromatics offer hay, toasty crackers, a mélange of citrusy and grape-tinged tart fruits, and a hint of dill. Flavor follows suit, but with a vibrant lift of CO2, undercurrents of soft oak and apricotlike acidity in no short supply.


text:
The Stone Roses announce two secret gigs ahead of their Manchester concerts
Katie BaillieSaturday 4 Jun 2016 4:10 pm
(L-R) John Squire, Mani, Ian Brown and Reni – the lads are treating fans to some intimate gigs (Picture:Dave J Hogan/Getty Images)
Fans will have two extra chances to see the Stone Roses live when the group perform two intimate gigs.
Having just released their first single in 22 years, the lads are continuing to treat fans with the announcement that there'll be two shows being held just next week, one on June 7 at the Victoria Theatre in Halifax, and on June 8 at the Carlisle Sands Centre.
Tickets have gone on sale today for £25 each, and as each venue only holds around 1,500 revelers, they're likely to sell out fast.
Later this month they'll play the Etihad Stadium in Manchester to significantly larger audiences.
They announced the shows on their Facebook and there's a slight catch – tickets can ONLY be bought from the venues themselves and will only be sold to people with a Stone Roses album, t-shirt or previous gig ticket.
They'll also be strictly limited to two tickets per person.
Ian and the gang will play two surprise gigs (Picture: Rob Ball/WireImage)
Their single All For One received a mix response from fans who'd waited two decades for new music. While some branded it a 'banger' and 'a corker of a tune' others said it was 'disappointing' and complained 'it didn't blow me away'.
MORE : LISTEN: The Stone Roses release All For One, their first single in 22 years
MORE : Ian Brown confirms the Stone Roses are making 'glorious' new music
Stone RosesTickets


text:
< Insight
Craig Wightman
Chief Design Officer
Insights from innovation leaders: GIF 2019
At last year's event, the KD team framed a debate by posing "6 Big Questions for Innovation Today". This included questions on technology, the start-up scene, sustainability, changing demographics and the role of innovation within business. We used an interactive online tool (developed by the KD software team) to gain responses from the conference group which, although not a scientifically controlled study, provided a unique, real-time snapshot of innovation today, from a group of around 200 of the world's leading innovation practitioners and directors.
Amongst the key insights gathered, a few stood out:
A total of 64% agreed that sustainability is a driver for innovation with 36% stating that sustainability went hand-in-hand with innovation in their business.
A whopping 84% believed that their products and services will need to change "dramatically" or "significantly" to address the Millennials and Gen Z
A clear majority of 51% felt that amongst global trends, technology, in the form of AI, digital tools and the connected internet of things, would have the biggest impact on innovation in their businesses over the next 5 – 10 years
Amongst a range of responses relating to how innovation is used within business, including fuelling the pipeline of new ideas and providing a structure for progressing ideas through the business, 33% cited promoting a creative culture within their organisation as being its key role This chimes well with World Economic Forum's prediction that by 2022, creativity will rank as the 3rd most important skill required in the workplace, rising from 10th place in 2015. Similarly, a LinkedIn survey revealed creativity to be the number one soft skill companies need in 2019.
In response to our question about user-centred innovation, we found that, although the majority of businesses represented were engaging with end users to a "significant extent" and 22% stated that "everything we do is driven by and tested with end users", 41% were testing their products with users to a limited degree only. Astonishingly, in McKinsey's Business Value of Design report from October 2018, which evaluated the use of design within 300 publicly listed companies, over 40 percent of the companies surveyed were found to be not talking to their end users during development. Clearly, the GIF audience represents an enlightened group when it comes to the management of creativity!
84% of innovation leaders believe that their products and services will need to change dramatically or significantly to address millennials and Gen Z audiences
Reflecting on the questions and themes of the debate from last year, and on how things have developed during 2019, it's clear that these themes are still relevant as we head towards 2020. At KD, our work with clients in 2019 has included a growing and significant focus on sustainability, connected technology, changing demographics, the understanding of new user behaviours, and the application, education and learning power of creativity. The ability to synthesise these wide-ranging influences has never been more important to delivering user-centred innovation and successful new products and experiences.
On top of the big questions we asked last year, we're delighted that the theme of this year's GIF is around aligning creativity with purpose – a theme that's close to our hearts and one that's reflective of the interests of many of our clients today. We'll be hosting a panel discussion on "Designing a Better World" where we'll be joined by leaders from diverse fields including healthcare, banking and charity. We look forward to exploring issues of diversity, inclusivity, empathy and human-centeredness, and to defining how doing good and having a positive impact also equals good business.
Craig's article, Insights from Innovation Leaders, was originally featured on LinkedIn here.
To discuss how
Podcast >
Designing a better world
Kinneir Dufort 5 Host Street, Bristol, BS1 5BU +44 (0)117 901 4000
© 2021 Kinneir Dufort KD and Kinneir Dufort are trading names of Kinneir Dufort Design Limited, registered in England and Wales, company no.1311968 Registered office 5 Host Street, Bristol, BS1 5BU --- VAT: UK 302560502
Terms and Conditions > Privacy Notice >