By Dr. Mercola

Most people are aware that you should not swallow your toothpaste, and many even know this is because of the fluoride it contains. But when it comes to fluoride in drinking water, many are either unaware that it is there, or they trust their government to know―and do―what’s best for them.

Detox Protocol

by Suzanne Humphries

The CDC announced on June 8th that they are almost at the finish line of global polio eradication. They’ve not had a case of wild polio since January 13, 2011. Whoopee! But they still have plenty of paralysis. In fact they have more and more every year. AND …children with non-polio Acute Flaccid Paralysis (AFP), the new name for polio, are at more than twice the risk of dying than those with wild polio infection! In fact, more oral polio vaccine has correlated strongly with "non-polio" AFP. One must wonder what exactly the WHO, UNICEF, Rotary International and the Bill and Melinda Gates Foundation are really going for.

Vaccine Protocol

Many believe that a disease called "polio" has been eradicated in the Western hemisphere. Most everyone thinks that "polio" was eradicated by vaccination. To fully understand where polio went, one must understand what polio was. When one understands what polio was, it becomes clear that it is impossible to eradicate it with a vaccine. But that never stops vaccination interests from launching full- scale propaganda misinformation campaigns in order to vaccinate the children of the world, even though they fail in eliminating paralysis. "Wild" poliovirus may be gone from vaccinated countries, but what was once called "polio," and frightened the wits out of parents world-wide, is still ubiquitous.

The term "poliomyelitis" is a description of spinal pathology. The meaning of the word comes from Greek:

polios= gray, and muelos =marrow, itis=inflammation; meaning "inflammation of the gray matter of the spinal cord."

All poliomyelitis means is that the gray matter of the spinal cord is inflamed. This can occur anywhere from the brainstem to the end of the spinal cord, and it has always had many causes, the least of which is a virus that lives in intestines of healthy people.

The result of this inflammation, whether chemical or viral, leads to certain characteristic muscular symptoms that have been conditioned into the minds of several generations of people to appear as the classic atrophied limbs, iron lungs and other horrifying images.

By definition and by historical documentation, these infamous images of polio should by no means be blamed solely on a specific wild-type (naturally occurring) virus. Environmental toxins, other infections, and laboratory-derived vaccine viruses were all implicated in paralytic polio over the years. Yet wild virus, even though it is said to be asymptomatic in 95% of infected, and only causes paralysis in a small amount of infected is the excuse for world-wide polio vaccination with live viruses that are known to cause their own outbreaks of polio in China, Nigeria and India.

Naturally existing polio is thought to have been a normal bowel commensal for hundreds of years before paralytic polio emerged as an epidemic disease, beginning in white populations. For instance, an in-depth study of a remote Indian tribe in the Rio das Mortes in the State of Mato Grosso, Brazil demonstrated the presence of the virus with consistent and high levels of immunity – and no disease.

Native populations are known to have harbored polioviruses of all three strains with no poliomyelitis whatsoever.

Any thinking person would have to wonder what changed to make the natives and the non-natives become paralyzed from an otherwise completely innocent viral bowel commensal. Dr Loyd Aycock, in 1942 said "

This statement was prophetic and unfortunately largely ignored. Some of the "added circumstances" that are known by polio scientists and well documented in medical literature to be highly correlated with paralytic forms of polio include tonsillectomy, intramuscular injections of any sort, vaccines, DDT, arsenic, misdiagnosed syphilis, coxsackie virus, other enteroviruses just to name a few.

Tonsillectomy was at its peak in 1959 at 1.4 million surgeries and declined drastically in years following. DDT was outlawed in the USA but is still found all over India. Arsenic is no longer commonly used as an intramuscular injection up to 100 times in a single person to treat syphilis like it was in the 1940’s – but there is an abundance of unnecessary intramuscular injections in India. Differential diagnoses now exist for paralysis unlike the old days of polio epidemics before the hailed Salk vaccine came to be, when all that became numb or transiently paralyzed was "polio."

History is about to repeat itself in India, Pakistan, and Nigeria. In the USA there was a similar campaign and renaming- after the vaccine was accepted- just like occurs today in India. During a Detroit epidemic in 1958, four years into the Salk vaccine campaign, it was determined that nearly half of the cases of "polio" were not poliovirus-associated and were given other designations than polio.

Today in India, "polio" is a well-publicized problem, and DDT can be found on the shelves just about everywhere. India is the only country that still manufactures DDT, and remains the chemical’s largest consumer.

DDT enhances the release and intracellular multiplication of poliovirus.[6] Thus it likely contributes to creating a monster out of a normally benign gut virus. Additionally, exposure to DDT induces symptoms that can be completely indistinguishable from poliomyelitis – even in the absence of a virus.[7] Here is a description of DDT poisoning, which is indistinguishable clinically from poliomyelitis.

Despite the known dangers of oral polio vaccines, that paralysis is on the rise, and that many other entities enhance the virulence of poliovirus, multi-billion dollar polio eradication campaigns march on, often vaccinating a single child 15 times (or more) with live vaccine by their 5th year of life.

It didn’t eliminate infection, and in fact more oral polio vaccine has correlated strongly with "non-polio acute flaccid paralysis." The response by WHO and GAVI is to ramp up the current oral polio vaccination campaigns in recent years. Now some children are reported to have received 32 vaccines in one day.

Here is a picture of what is happening in India, the country that hasn’t had a polio case since January 13, 2011:

In India today, as the World Health Organization tracks polio during the vaccination campaigns, it seems that "polio" has declined while "acute flaccid paralysis" (AFP) has increased annually, reaching 60,000 new cases in 2011.
The causes of AFP that have been identified are as follows:

As a result of the unrelenting OPV campaigns in India, there has been an exponential rise in "acute flaccid paralysis" while the number of documented cases of "polio" has declined."

Image may be subject to copyright

What is clear from the above graph is that massive "pulse" vaccination campaigns have done nothing to eliminate paralysis, and in fact there is evidence pointing to the likelihood that vaccination is related to the rise in AFP. Isn’t the vaccination really about eliminating paralysis…or is it simply to replace wild virus with a vaccine virus no matter the outcome?

Why doesn’t the World Health Organization notice the medical literature that points to the truth that paralysis has increased with pulse vaccination campaigns in India? How could they possibly explain the intensification of a failed and harmful vaccine campaign where a deadly form of non-polio AFP increases exponentially in children heavily vaccinated with oral polio vaccines?

by Sayer Ji, founder

If you visit the World Health Organization’s website, or that of the Centers for Disease Control and Prevention, the information presented there on vaccines is so clearly one-dimensional, repeating the age-old pro-vaccine mantra: "safe"—"effective"—"safe"—"effective" ad nauseam, that before long, you either become lulled into complacency, or stray off into less officially sanctioned sources of information, such as the many anti-vaccine sites on the internet, where discussion of the abject failure of vaccines repeats the same mantra, but recorded backwards like a Beatles record: "unsafe"—"ineffective"—"unsafe"—"ineffective."  

Vaccine Protocol

So, where should one go for the absolute truth on the matter?

According to the dominant medical system, as represented by organizations like the CDC, FDA and WHO, peer-reviewed and published research is the holy grail, without which, claims against vaccines are merely anecdotal, superstitious and/or irrational polemic.  

But, what happens when published scientific research freely available on the National Library of Medicine’s public domain bibliographic database known as Medline, contradicts the pro-vaccine party line?  

A recent review published in April in the journal Expert Review of Vaccines titled, "Review of the risks and benefits of yellow fever vaccination including some new analyses," revealed a surprising fact about yellow fever vaccines:  

Say what?

So, according to this review, if you add up the net harm done by yellow fever vaccines over the past 22 years of their tracked use in travelers versus their net good, your chance of getting sick from the vaccine is 5 times higher, and getting killed at least 12 times higher, than taking your chances unvaccinated.

While surprising, this is not the only case where a so-called "vaccine-preventable diseases" has been found to be less destructive than the vaccines being used to "prevent" them. Increasingly, the truth about vaccine-induced injuries and death are coming to light through the very organizations and research institutions that have championed their use, and fashioned their image into modern medicine’s most successful technological innovation against infectious disease. 

Case in point…

The Polio Global Eradication Initiative (PGEI), founded in 1988 by the World Health Organization, Rotary International, UNICEF, and the U.S. Centers for Disease Control and Prevention, holds up India as a prime example of its success at eradicating polio, stating on its website (Jan. 11 2012) that "India has made unprecedented progress against polio in the last two years and on 13 January, 2012, India will reach a major milestone – a 12-month period without any case of polio being recorded."

This report, however, is highly misleading, as an estimated 100-180 Indian children are diagnosed with vaccine-associated polio paralysis (VAPP) each year. In fact, the clinical presentation of the disease, including paralysis, caused by VAPP is indistinguishable from that caused by wild polioviruses, making the PGEI's pronouncements all the more suspect.²

According to the Polio Global Eradication Initiative's own statistics³ there were 42 cases of wild-type polio (WPV) reported in India in 2010, indicating that vaccine-induced cases of polio paralysis (100-180 annually) outnumber wild-type cases by a factor of 3-4. Even if we put aside the important question of whether or not the PGEI is accurately differentiating between wild and vaccine-associated polio cases in their statistics, we still must ask ourselves: should not the real-world effects of immunization, both good and bad, be included in PGEI's measurement of success?

For the dozens of Indian children who develop vaccine-induced paralysis every year, the PGEI's recent declaration of India as nearing "polio free" status, is not only disingenuous, but could be considered an attempt to minimize their obvious liability in having transformed polio from a natural disease vector into a manmade (iatrogenic) one.

VAPP is, in fact, the predominant form of the disease in developed countries like the US since 1973.⁴ The problem of vaccine-induced polio paralysis was so severe that the The United States moved to the inactivated poliovirus vaccine (IPV) in 2000, after the Advisory Committee on Immunization Practices (ACIP) recommended altogether eliminating the live-virus oral polio vaccine (OPV), which is still used throughout the third world, despite the known risks.

Things, however, may be be far worse than reported…

A highly concerning paper published in the April-June issue of the Indian Journal of Medical Ethics discusses the possibility that the 47,500 new cases of "non-polio acute flaccid paralysis (NPAFP)" in children reported in 2011, which is clinically indistinguishable from polio paralysis but twice as deadly, were directly proportional [i.e. casually linked] to doses of oral polio received.  According to the authors of this paper: "Though this data was collected within the polio surveillance system, it was not investigated. The principle of primum-non-nocere [First, do no harm] was violated." In other words, instead of acknowledging the high prevalence of vaccine-associated polio paralysis (VAPP), those administering the vaccines and doing surveillance on adverse events simply reclassified the symptoms of injury from polio vaccine to non-vaccine related by coining a new disease terminology, i.e. "non-polio acute flaccid paralysis (NPAFP)," which describes essentially the same symptoms. When one considers the scale of Indian eradication campaign, 47,500 cases of NPAFP, while immense, are within the realm of feasibility. According to the article:

If the 47,500 case figure for NPAFP is correct, the actual scale of vaccine-related adverse effects associated with oral polio vaccine are probably 2-3 orders of magnitude higher than officially reported by the governmental and non-governmental agencies promoting their use, and by those agencies who are responsible for monitoring and reporting their adverse effects.

Cases like this illustrate how important it is that we all take a critical look at the first-hand vaccine statistics and research itself, reading between the lines when the lines have been intentionally manipulated and the truth obfuscated. For several years, our ongoing project has dedicated itself to providing the research community an alternative medical and toxicological resource for ascertaining the true risks and/or unintended consequences of conventional medical interventions such as vaccinations.

by Rob Waugh

Many people brush more than the recommended number of times per day – especially after a rich meal.

Detox Protocol

by: Larry Malerba, DO

(NaturalNews) Contemporary scientific culture has fed us the mantra that depression is the result of a chemical imbalance for so long now that the premise is rarely questioned by the general public. On the other hand, there are many in the alternative health community who have been aware of this for a long time (1).

SAMe
Lithium Orotate

by: Ethan A. Huff

(NaturalNews) June 6, 2012, was a very strange day for northern Indiana and southern Michigan, where a series of strange explosions and a subsequent nuclear radiation spike left local residents combing for answers. And though there are still many missing pieces to the puzzle, it has become clear that some type of nuclear cover-up is taking place in the region, which is further evidenced by numerous eyewitness accounts of intense shaking and loud booms, audio recordings of inexplicable explosions, and pictures of unmarked aircraft flying during and after the incident.

Radiation Protocol

BISMARCK, N.D. — Since Californians shrank their property taxes more than three decades ago by passing Proposition 13, people around the nation have echoed their dismay over such levies, putting forth plans to even them, simplify them, cap them, slash them. In an election here on Tuesday, residents of North Dakota will consider a measure that reaches far beyond any of that — one that abolishes the property tax entirely.

“I would like to be able to know that my home, no matter what happens to my income or my life, is not going to be taken away from me because I can’t pay a tax,” said Susan Beehler, one in a group of North Dakotans who have pressed for an amendment to the state’s Constitution to end the property tax. They argue that the tax is unpredictable, inconsistent, counter to the concept of property ownership and needless in a state that, thanks in part to wildly successful oil drilling, finds itself in the rare circumstance of carrying budget reserves.

“When,” Ms. Beehler asked, “did we come to believe that government should get rich and we should get poor?”

An unusual coalition of forces, including the North Dakota Chamber of Commerce and the state’s largest public employees’ unions, vehemently oppose the idea, arguing that such a ban would upend this quiet capital. Some big unanswered questions, the opponents say, include precisely how lawmakers would make up some $812 million in annual property tax revenue; what effect the change would have on hundreds of other state laws and regulations that allude to the more than century-old property tax; and what decisions would be left for North Dakota’s cities, counties and other governing boards if, say, they wanted to build a new school, hire more police, open a new park.

“This is a plan without a plan,” said Andy Peterson, president and chairman of the North Dakota Chamber of Commerce, who acknowledged that property taxes have climbed in some parts of the state and that North Dakota’s political leaders need to tackle the issue. “But this solution is a little like giving a barber a razor-sharp butcher knife — and by the way, this barber is blind — and asking him or her to give you a haircut. You’ll get the job done, but you might be missing an ear or an eye.”

Polls conducted last month and last week suggest that voters here overwhelmingly oppose the ballot measure to ban the property tax.

Still, even if the measure here fails on Tuesday, the notion is picking up steam in some Republican circles in other states, including North Carolina, Texas and Pennsylvania.

“No tax should have the power to leave you homeless,” said Jim Cox, a state representative in Pennsylvania who has proposed legislation to eliminate the school property tax in the state where, he said, such taxes have led to residents’ losing homes to sheriff’s sales, entering into reverse mortgages or simply moving away.

In a way, North Dakota, though 48th in population among the states, was a logical place for such a movement to brew. While the state’s property tax collections per capita generally fall near the middle among states, the surge in oil production over the past five years, mainly in the western portion of the state, has seen its effects ripple through other parts of life here. The state’s coffers are full, overflowing even. Assessments of home values, especially in some areas, have risen drastically too.

The political mood here, too, leans toward Republicans (who dominate Bismarck), small government, little intrusion and fiscal conservatism. Though opponents to the property tax here received a $12,000 donation in 2010 from the American Tax Reduction Movement, a sister group to the Howard Jarvis Taxpayers Association, which grew out of California’s Proposition 13, members say the efforts here were largely organic, the result of unhappy property taxpayers getting fed up.

“The same problem kept coming up,” said Charlene Nelson, a homemaker who became a leader of the effort to amend the Constitution, pointing to what she deems the underlying problem with the property tax. “It means all of us are renters — none of us are homeowners.”

In recent years, state officials sent more money to localities to pay for schools in an effort to lower property tax bills. But opponents of the property tax said those efforts did not go nearly far enough, and collected nearly 30,000 signatures on petitions to bring the matter to the ballot.

Those who want to keep the property tax have vastly outraised the opponents, gathering more than $500,000, campaign finance reports show. Though the question is among four on ballots here on Tuesday — including the highly contentious question of whether the University of North Dakota should give up its Fighting Sioux nickname — residents here said they had been deluged with information about the property tax measure, on signs, in radio talk shows and through months of debates in school gymnasiums and recreation halls in small towns like Edgeley and Bowman.

For his part, Gov. Jack Dalrymple, a Republican, said he opposed the property tax ban. “It’s mind-boggling, really,” he said, in an interview, of the effects of such a ban. “We’d be changing everything, frankly.”

The notion, he said, that the state has enough surplus to replace property taxes for localities around the state without raising other taxes is false. For starters, he said, much of the state’s benefits from the oil boom are already dedicated legally to particular funds and cannot simply be transferred to support schools, counties, towns, park districts and the like.

Even if the ban fails, North Dakota lawmakers now seem all but certain to tackle broader solutions to the property tax question as early as next year.

“I have to say that we totally understand that North Dakotans are very concerned about their property tax payments,” Mr. Dalrymple said. “You have a tension there, and people say this can’t keep on.”

by Pat Robinson

• Dietary supplementation with flaxseed oil lowers blood pressure in dyslipidaemic patients.

  Flax Oil

Omega 3 fatty acids improve the cardiovascular risk profile of subjects with metabolic syndrome, including markers of inflammation and auto-immunity.

• Omega-3 in modest doses reduces cardiac deaths, and in high doses reduces nonfatal cardiovascular events.
• Dietary supplementation with omega-3 fatty acids reduces the incidence of sudden cardiac death in patients with myocardial infarction.
• Omega-3 fatty acid reduce the total mortality and sudden death in patients with left ventricular systolic dysfunction.
• Raising blood levels of omega-3 fatty acid levels may be 8 times effective than distributing automated external defibrillators (AEDs), and 2 times more effective than implanting implanting cardioverter defibrillators (ICDs) in preventing sudden death
• Omega-3 fatty acid supplementation reduces total mortality and sudden death in patients who have already had a heart attack.
• Consuming small quantities of fish is associated with a reduction in coronary heart disease.
• Omega-3 fatty acids and vitamin D supplementation results in a substantial reduction in coronary calcium scores and slowed plaque growth.
• Omega-3 fatty acids improve macro- and microvascular function in subjects with type 2 diabetes mellitus.
• Fish oil improves tubular dysfunction, lipid profiles and oxidative stress in patients with IgA nephropathy.
• In patients with stable coronary artery disease, an independent and inverse association exists between n-3 fatty acid levels and inflammatory biomarkers.
• Omega-3 fatty acids improve endothelial function in peripheral arterial disease.
• Fish oil has a beneficial effect on blood viscosity in peripheral vascular disease.
• Fish oil supplementation improves walking distance in peripheral arterial disease.
• The omega-3 fatty acid docosapentaenoic acid (DPA)reduces the risk of peripheral arterial disease associated with smoking.
• Fish and long-chain omega-3 fatty acid intake reduce the risk of coronary heart disease and total mortality in diabetic women.
• Higher plasma concentrations of EPA and DPA are associated with a lower risk of nonfatal myocardial infarction among women.
• Omega-3 fatty acid consumption is inversely associated with incidence of hypertension.
• Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction.
• The consumption of fish reduces the risk of ischemic stroke in elderly individuals.
• Fish consumption reduces the risk of ischemic stroke in men.
• Eicosapentaenoic acid (EPA) may have a therapeutic role in attenuating pulmonary hypertension.

by Dr. Richard Schulze

The growing trend over the last few decades seems to be the almost endless selling by owners of their small companies to huge international corporations. I wouldn't mind this trend, if I thought it was in the customers’ best interest, and furthermore, if what I experienced was that the products got better. Instead, what I almost always see is that the products get worse. This trend is usually NOT in the consumers’ best interest at all.

by Judy Cohain, CNM

Abstract: Case controlled studies show no benefit to inducing for postdates. Routinely inducing for postdates is based on 3 uncontrolled, retrospective studies showing 1/1000 less stillbirths while ignoring possible increases in brain damage to newborns as a result of induction. Induction or Elective cesarean for Precious pregnancies is justifiable.

Membrane Complex
Magnesium Oil

There is a low risk of stillbirth at ≥42 weeks in the US although it is even lower in Europe.  Once you get to term, the chance of a healthy woman delivering a live baby is 99.95% in Europe and 99.90% in the US. If post-term induction were to be shown in the future to have the capability of preventing stillbirth without increasing brain damage and perinatal mortality, about 2,000 healthy, low risk women would have to be induced at 40 weeks to prevent one stillbirth.

Stillbirth and Neonatal death happen throughout pregnancy (1,2).

Term stillbirth and perinatal mortality rates: European rates in red , US rates in blue

It is expected that 98% of women do NOT deliver on their due date, but rather 49% before and 49% after their due date, and only 2% on their due date. Since first births on average deliver a week after the due date, about 75% of first births deliver after their due date.  Data from 2002-2008 in the US showed  11.4% of low risk first births and 6.4% of low risk multiparous births that attempted vaginal birth were induced for the reason of  'postdates’ and a total of 45% of births, that were not elective cesareans, were induced.

Inducing for postdates originated from an uncontrolled, non-randomized observational study from 1999 showing a drop of 1/1000 in the stillbirth rate at several hospitals, occurring serendipitously during the same time frame as an increase in the induction and cesarean rates in Canada.  The drop in stillbirths in this type of research can be explained by a change in many other possible variables that took place during the same time period. This result has never been shown by case controlled trials. The best quality evidence says that induction for postdates does NOT reduce the number of stillbirths or improve perinatal mortality rates.

Documented Drawbacks of routine induction: High induction rates are associated with an increase in premature births between 34–36 weeks, increased births of problematic babies that need intensive care,  higher cesarean rates and 1 in 3000 maternal deaths due to cesarean, a possible increase in brachial palsy due to undo force of induced contractions, and two fold increase in amniotic fluid embolism.

There is some logic behind a desire to deliver In Vitro Fertilization (IVF) pregnancies at 40 weeks to avoid the rare cases of stillbirth that take place after 40 weeks. Since you know when fertilization took place, you know when the fetus is fully developed.  IVF babies are particularly precious since they may not be replaceable. There is some logic behind delivering uncontrolled diabetics early to avoid stillbirth for similar reasons. 

The same cannot be said for non-IVF pregnancies. Ultrasound dating is only accurate to the nearest 2 -4 weeks. A woman who thinks she is 40 weeks by 10 week ultrasound, might only be 36 weeks and if induced, the fetus may need intensive care, and therefore would be more vulnerable to problems such as infection.  About  90% of pregnancies currently defined as post term would not be so if instead of rounding out pregnancy to 40 weeks (280 days) it was counted as 284 days.  When 284 days are used to define pregnancy instead of 280, less than 1% spontaneously deliver ≥2 weeks late, rather than 10%. 

If a prenatal test could predict which pregnancies would end in third trimester stillbirth, then doctors could do the test and induce those pregnancies. But, no prenatal test has been shown to predict stillbirth, therefore doctors are only left with the option of inducing all postdate births or none of them.   

First births on average deliver at 41+0 weeks or 287 days.  In the absence of any other explanation for delayed birth in primiparous women, this phenomenon appears to be explained by the increased level of anxiety of women on their first pregnancies. Women who want to finish a doctoral thesis, attend a wedding, or an important event are well known to deliver after their desired action is finished. Women who go past 42 weeks either have incorrect dating, a wedding they don’t want to miss etc., or fears directly or indirectly related to the birth, family or mothering that have not been dealt with.

Having warm care providers available helps prevent prolonged pregnancy and therefore stillbirth. Having one-on-one midwifery model ongoing support in which fears are expressed and dealt with, the mother starts birth informed and knowing that the person they want will be available and attending the birth, and the same stillbirth rates and perinatal mortality are obtained with much lower cesarean rates, as with medical management with routine induction at 41 or 42 weeks.

What is the research evidence

Postdate induction is based on unreliable ultrasound dating. Pregnancy is about 284 days not 280.

The only pregnancies in which the approximate time of fertilization is known are In Vitro Fertilization (IVF) pregnancies.  The fertilization of IVF pregnancies is known to take place somewhere within 18 hours of combining egg and sperm in the Petri dish. This knowledge of fertilization has been used in studies to see how accurate first trimester ultrasound is in establishing due date.

Ultrasound specialists, blind to conception date of IVF pregnancies, were only able to estimate the age of the IVF pregnancies within -15 days and +14 days of the actual known due date in the first trimester. (4)  Among accurately dated IVF pregnancies, if ≥284 days were used to define pregnancy, instead of ≥280 days, in the absence of induction, post term pregnancies would account for less than 1% of pregnancies (4).  That means that if pregnancy is considered 284 days instead of 280 days, less than 1% of women would go beyond 42 weeks, instead of about 10%.

According to the 1980 edition of Williams Obstetrics Textbook, published before the widespread use of labor induction for postdates, 10% of pregnancies persist for 42 weeks or more. In a large study done with the intent to reduce post term pregnancy using ultrasound, the post term rate was reduced to 2.5%(5). However, in a 2010 study from Sweden using a population of over 1,175,000 singleton births from gestational week ≥37, for which 95% had first trimester ultrasounds, 9% of pregnancies still persisted for 42 weeks or more (6).

In a study of 17,000 Finnish women from 1993–98 trying to prove the usefulness of ultrasound dating between weeks 8 and 16, 10% of women went post term. (7). When two days were added to the length of pregnancy from LMP, only 6% of deliveries were post term(7). This is the only study of first trimester ultrasound that also looked at outcomes, and it found no increase in perinatal mortality among deliveries after 42 weeks. 

Research comparing induction to waiting

Stillbirth and perinatal death occur at every week of pregnancy.  BUT induction of labor at any week has not been shown to decrease stillbirth or overall perinatal mortality and may increase maternal and newborn morbidity. The stillbirth rate after 40 weeks is 1/2000 pregnancies(8). Does inducing 2000 women at 40 weeks prevent one stillbirth?  Systematic reviews say NO. Systematic Reviews of the research which were large enough to study perinatal outcomes have found no significant difference in perinatal mortality including stillbirths between induction and expectant management groups(1,9,10*, , and 11).

The studies supporting induction at 41 weeks are 3 low quality observational studies. The first is co-authored by Mary E. Hannah, author of Breech Trial, who persistently presents "data with serious concerns as far as study design, methods, and conclusions with frequent lack of adherence to the inclusion criteria."(12). Hannah’s 1999 article promoting induction for post term linked two things that may not be related: the stillbirth rates in Canada as a whole and the induction rates reported at Canadian hospitals close to where she lives, between 1980–1995(13). Perinatal mortality rates were not examined during the period. Stillbirth rates went down from 3/1000 to 2/1000.

This could have been the result of greater availability of abortion on demand, improved hospital protocols, prenatal care, nutrition, and/or less smoking or other unknowns. During the 15-year study period, induction rates increased or decreased at different rates in each place, but in general increased from 12% to 16%. Cesarean rates also increased. It is not made clear by how much; only small samples of cesarean rates at 40 and 41 weeks in the years 1986, 1992 and 1995 are given (13). Hannah’s study compares induction in one place to stillbirth rates at different places during the same time period. The studies neglect to report on perinatal mortality, and withhold known cases of babies who were permanently injured directly as a result of postdates induction protocol. (14)

The second study is by a group of five Canadian academics who chose to study American, not Canadian, birth certificate data from 1991–1997 (2). Birth certificate data is known to be unreliable. The birth certificate data used shows no indication of why labor induction was used and the authors admit the data includes inductions for an already dead fetus and for a fetus that was already compromised. Therefore, the outcomes of actual inductions involving a live fetus is unknown. Like the other studies, this study compares stillbirth rates (not perinatal mortality) to approximate induction rates during a six-year period in which induction increased from 10% to 20%.

A third study is again retrospective research using birth certificate data reporting a 1/1000 decrease in stillbirths associated with induction.(15)  Again, the data is birth certificate data. Again important variables that affect stillbirth rates are not controlled for.  This study shows that induction is associated with a significantly higher rate of problematic babies that need intensive care though no long term follow up was made to know if this results in a significantly higher rate of long term brain damage.

All 3 studies admit that it is impossible to draw conclusions or base protocol on their findings since so many factors could lower the stillbirth rate. Nevertheless, those studies are all the evidence there is to support a policy of induction at 41 weeks.

Many doctors are opposed to postdate induction protocols

 "The induction of labour between 41 and 42 weeks is a very crude strategy for reducing term and post-term stillbirth rates. Although the risk of fetal death is increased after 42 weeks, many more fetuses die in utero between 37 and 42 weeks than die in the post-term period. It appears that smaller term fetuses run a far greater risk than their larger counterparts, and that current methods of antepartum assessment of the term fetus are still inadequate" (16).   Difficulty in identifying at-risk fetuses is what has led to routine inductions and better methods are needed(17).

Prenatal testing cannot predict stillbirth or perinatal mortality

As much as we would like a prenatal test and subsequent intervention that would prevent postdate stillbirth, there is none. Risk screening and prenatal tests have many false positive results and the majority of adverse outcomes occur in the larger population of women identified as low-risk. "There is no effective screening test that has clearly shown a reduction in stillbirth rates in the general population"(18,19). Tests that do NOT decrease stillbirth and perinatal mortality compared to control group (19) are:

Macrosomia

In addition to supposed avoidable stillbirth, another false justification for inducing labor postdates is based on the fact that the healthy fetus continues to gain weight in utero and larger babies may suffer damage on the way out. The 2011 Cochrane Review found three trials involving 372 women rigorous enough to draw conclusions. The evidence shows that induction of labor for suspected fetal macrosomia in non-diabetic women has not been shown to alter the risk of maternal or neonatal morbidity (20).

In countries with relatively low induction rates of 15% (Denmark and Sweden), where 8% of births take place ≥42 weeks, 4% of babies weigh 4500 g or more at birth. In countries like Austria and Belgium, where 40% of pregnancies are induced, only 0.5% of births take place ≥42 weeks, and 1% of babies weigh 4500 g or more at birth(1). Induction results in lower birth weights but not better newborn outcomes. 

Brachial palsy (OBPP) is palsy of the newborn’s upper arm muscles that resolves itself within the first year in about 80% of cases. (shoulderdystociainfo.com) It is caused by damage to nerves in the neck while struggling to deliver a large head in breech birth or stuck shoulders. There is no perfectly accurate way to predict birth weight and even if you could, half the cases of shoulder dystocia (21)  happen when the birth weight is less than 4000 g.

Infants delivered by caesarean section have a lower risk of brachial plexus injury but between 1 and 4% of OBPP cases accompany cesarean surgery.  500 cesarean deliveries would have to be performed to prevent one case of OBPP. More experienced practitioners have a lower incidence of OBPP because the risks may be less if there is no panic, pressure on the fundus, lateral traction or pivoting of the head at the neck or rotational movement of the head in an attempt to rotate the shoulders.

Placental insufficiency

As long as the baby keeps growing, the placenta is obviously functioning well, which indicates that the fetus should be able to tolerate spontaneous labor. Where the baby is thought to have stopped or slowed down its growing, a genetic defect is suspected.

Placental dysfunction is blamed as the cause of miscarriage and stillbirth but there is no evidence to support this theory. Consecutive measurement of the height of the uterine fundus with a tape measure by the same caregiver has been shown effective at picking up the fetus that is not gaining weight. Abdominal measurements facilitate a relationship between a woman and her baby, and educate couples about nutrition, which contributes to better outcomes.

When a fetus is suspected to be small-for-dates, the antenatal care provider can focus on behavioral, social and environmental influences that could be mitigated, including smoking and poor nutrition. Induction has not been shown to improve outcomes perhaps because diagnosis of IUGR is most often wrong and real IUGR babies are probably not good candidates for the difficult labor associated with induction.

Oligohydramnios

Oligohydramnios diagnosed after birth is associated with poorer outcomes, but inducing based on Amniotic Fluid Index (AFI) has never been shown to prevent poor outcomes.  Research comparing AFI in the summer and winter has proven that AFI directly reflects the amount of fluid the mother is drinking and how much she is sweating(22). 

In a 2004 study, scientists failed to find poor outcomes associated with an AFI ≤5 cm measured within seven days of delivery in the third trimester(23). They found no difference in umbilical arterial pH or base excess, even in small-for-gestational-age (SGA) infants, including those with suspected placental insufficiency. There was no difference in the number of SGA neonates, 5-minute Apgar <7, respiratory distress syndrome, necrotizing enterocolitis or neurologic morbidity from matched controls with normal AFI.

"Amniotic fluid stems from the baby’s urine, and the urine results from good blood flow, so if we see low fluid, the assumption is that there is not good blood flow and the fetus is compromised. This study shows the amniotic fluid index is not as good as we thought, and there is no reason to deliver the baby early if other tests are normal"(25).

In a prospective study of 3050 pregnancies, AFI failed to predict lack of fetal well-being and had "no prognostic significance"(24). Cochrane review found "the use of the amniotic fluid index increases the rate of diagnosis of oligohydramnios and the rate of induction of labor without improvement in peripartum outcomes"(25). A 2007 article found that single deepest pocket (SDP) measurement is as useless as AFI (26).

Meconium Aspiration Syndrome

Women are told they need to be induced at 41 weeks to decrease the risk of meconium aspiration. Meconium is not the cause of meconium aspiration. A 2009 review of randomized control trials found pulmonary hypertension and asphyxia, not the presence of meconium, to be the important risk factors for MAS(27). It is likely that perinatal distress and aspiration of meconium occur earlier in the pregnancy, not at birth, which is why suctioning or cesarean delivery does not improve outcomes.

Universal intrapartum suction of infants with meconium stained amniotic fluid has proven useless. Instead, endotracheal intubation and suctioning are currently recommended only for nonvigorous infants. Respiratory failure in infants with MAS is initially treated with mechanical ventilation and surfactant administration.

Suctioning of the hypopharynx is associated with delay in onset of resuscitation, damage to the mouth and hypopharynx, and cardiac arrhythmias secondary to vagal stimulation. A 2009 study concluded, "Routine suctioning is more likely to cause harm than good and should therefore be abandoned as a routine procedure"(27).

A 2009 systematic review (1966–2007) suggests elective induction of labor ≥41 weeks is associated with a decreased risk of meconium stained amniotic fluid, but the lack of quality studies shows a lack of evidence that this translates into better outcomes. Therefore, more research is required before induction can be justified(28).

Drawbacks of Elective Induction for Post term

Elective induction has been shown to increase cesarean rates by 5%(29) Elective cesarean at term has 3X the perinatal mortality of vaginal birth(30). United States statistics show a 13% increase in premature singleton births for the years 1991–2006, the increase occurring among births between 34–36 weeks, with no change in the earlier weeks of prematurity(30). During this period induced labor doubled from 8% to 16%, suggesting "that the increase in the preterm birth rate was related to increases in obstetrical interventions" without any improvement in US infant and fetal mortality rates. 

The rate of amniotic fluid embolism (AFE) is increasing from previous rates of 1/120,000 and occurred in 1/50,000 births from 2005–07 in the United Kingdom(31). Among the 60 cases of AFE reported, half were labor inductions. A 2010 Australian study found the same recent increase in AFE associated with induction (32). Consider this case, of a typical, routine induction: a 40-year-old woman with an unremarkable obstetric or medical history admitted at 41+ weeks for induction due to reduced fetal movement; fetal head down; estimated fetal weight 3600g; cervix not effaced or dilated.

The woman was induced with three prostaglandin E (PGE) doses over 16 hours. Epidural analgesia was administered. At 7 cm membranes were artificially ruptured. Ten minutes later the cervix was fully dilated and the patient started pushing. Respiratory distress appeared and the patient was ventilated and intubated, then died of amniotic fluid embolism (33).