Shoulder dystocia; NAPLAN scores

Dear Editor, Am I the only reader who notices the disparate quality of articles in ANZJOG? The most recent issue, October 2019, for example. The statistical analysis in the article by Hsieh et al1 is robust I am sure, but the conclusions drawn by the authors seem irrational. They briefly admit that children with major intellectual handicap would not have taken part in any NAPLAN testing, ‘our methodology may miss children with severe developmental impairments as they may not be attending school’. Yet the authors go on to claim their conclusion, that no intellectual harm is done by instrumental delivery, is unlikely to include any selection bias. Is ignoring this group of children, potentially those most affected, not a selection bias? Such an enormous selection bias makes it difficult to draw any conclusion at all from the study. At the other end of the spectrum is the article by Ansell et al.2 The study design is extremely simple and the results are probably poorly controlled for confounders. Yet to my mind, this is one of the best articles that the journal has published in years. I can only suspect the editors thought so too, having invited the editorial by Robson. Shoulder dystocia is an important clinical problem identified later in the same issue of ANZJOG by Sadler et al,3 as the second commonest peripartum cause of neonatal encephalopathy. The axillary traction technique promoted by Ansell could not be called novel, having been practised by many of us for decades. Still the authors, like whistle-blowers, draw our attention to an undocumented idea. I congratulate them on a very valuable clinical contribution to obstetrics and more than that I admire them. It takes courage to challenge the norms set by your peers.

[1]  L. Sadler,et al.  Contributory factors and potentially avoidable neonatal encephalopathy associated with acute peripartum events: An observational study , 2019, The Australian & New Zealand journal of obstetrics & gynaecology.

[2]  B. Mol,et al.  Implications of vaginal instrumental delivery for children's school achievement: A population‐based linked administrative data study , 2019, The Australian & New Zealand journal of obstetrics & gynaecology.

[3]  P. Larmer,et al.  Axillary traction: An effective method of resolving shoulder dystocia , 2019, The Australian & New Zealand journal of obstetrics & gynaecology.