MONDAY,OCTOBER21,2019 | THEGLOBEANDMAIL O NEWS | A
While U.S. President Donald
Trump insists he’s bringing
home U.S. troops from “endless
wars” in the Mideast, his Penta-
gon chief says all U.S. forces leav-
ing Syria will go to western Iraq
and the United States will con-
tinue operations against the Is-
lamic State group.
They aren’t coming home and
the U.S. isn’t leaving the turbu-
lent Middle East, according to
current plans outlined by U.S.
Defence Secretary Mark Esper
before he arrived in Afghanistan
on Sunday. The fight in Syria
against Islamic State forces, once
spearheaded by U.S.-allied Syrian
Kurds, who have been cast aside
by Mr. Trump, will be undertak-
en by U.S. forces, possibly from
neighbouring Iraq.
Mr. Esper did not rule out the
idea that U.S. forces would con-
duct counterterrorism missions
from Iraq into Syria. But he told
reporters travelling with him
that those details will be worked
out over time.
Mr. Trump nonetheless tweet-
ed: “USA soldiers are not in com-
bat or ceasefire zones. We have
secured the Oil. Bringing soldiers
home!”
The President declared this
past week that Washington had
no stake in defending the Kur-
dish fighters who died by the
thousands as partners of the
United States fighting in Syria
against Islamic State extremists.
Turkey conducted a weeklong of-
fensive into northeastern Syria
against the Kurdish fighters be-
fore a military pause.
“It’s time for us to come
home,” Mr. Trump said, defend-
ing his removal of U.S. troops
from that part of Syria and prais-
ing his decision to send more
troops and military equipment
to Saudi Arabia to help the king-
dom defend itself against Iran.
Mr. Esper’s comments to re-
porters travelling with him were
the first to specifically lay out
where U.S. troops will go as they
shift from Syria and what the
counter-IS fight could look like.
Mr. Esper said he has spoken to
his Iraqi counterpart about the
plan to shift about 1,000 troops
from Syria into western Iraq.
Mr. Trump’s top aide, asked
about the fact that the troops
were not coming home as the
President claimed they would,
said, “Well, they will eventually.”
Acting chief of staff Mick Mul-
vaney toldFox News Sundaythat
“the quickest way to get them
out of danger was to get them
into Iraq.”
As Mr. Esper left Washington
on Saturday, U.S. troops were
continuing to pull out of north-
ern Syria after Turkey’s invasion
of the border region. Reports of
sporadic clashes continued be-
tween Turkish-backed fighters
and the Syria Kurdish forces, de-
spite a five-day ceasefire agree-
ment hammered out Thursday
between U.S. and Turkish lead-
ers.
The Turkish military’s death
toll has risen to seven soldiers
since it launched its offensive on
Oct. 9.
Mr. Trump ordered the bulk of
the approximately 1,000 U.S.
troops in Syria to withdraw after
Turkish President Recep Tayyip
Erdogan made it clear in a phone
call that his forces were about to
invade Syria to push back Kur-dish forces Turkey considers ter-
rorists.
The pullout largely abandons
Kurdish allies who have fought
IS alongside U.S. troops for sever-
al years. Between 200 and 300
U.S. troops will remain at the
southern Syrian outpost of Al-
Tanf.
Mr. Esper said the troops go-
ing into Iraq will have two mis-
sions.
“One is to help defend Iraq
and two is to perform a counter-
ISIS mission as we sort through
the next steps,” he said. “Things
could change between now and
whenever we complete the with-
drawal, but that’s the game plan
right now.”
The U.S. currently has more
than 5,000 military personnel in
Iraq, under an agreement be-
tween the two countries. The
U.S. pulled its troops out of Iraq
in 2011 when combat operations
there ended, but they went back
in after IS began to take over
large swaths of the country in- The number of U.S. forces
in Iraq has remained small be-
cause of political sensitivities in
the country, after years of what
some Iraqis consider U.S. occu-
pation during the war that began
in 2003.
Mr. Esper said he will talk with
other allies at a NATO meeting in
the coming week to discuss the
way ahead for the counter-IS
mission.
Asked if U.S. special oper-
ations forces will conduct unilat-
eral military operations into Sy-
ria to go after IS, Mr. Esper said
that is an option that will be dis-
cussed with allies over time.
He said one of his top con-
cerns is what the next phase of
the counter-IS missions looks
like, “but we have to work
through those details.” He said
that if U.S. ground forces do go
in, they would be protected by
U.S. military aircraft.
While he acknowledged re-
ports of intermittent fighting de-
spite the ceasefire agreement, he
said that over all it “generally
seems to be holding. We see a
stability of the lines, if you will,
on the ground.”
He also said that, so far, the
Syrian Democratic Forces that
partnered with the U.S. to fight IS
have maintained control of the
prisons in Syria where they are
still present. The Turks, he said,
have indicated they have control
of the IS prisons in their areas.
“I can’t assess whether that’s
true or not without having peo-
ple on the ground,” said Mr. Esp-
er.
He added that the U.S. with-
drawal will be deliberate and
safe, and it will take “weeks not
days.”
According to a U.S. official, a
couple hundred troops have left
Syria so far. The U.S. forces have
been largely consolidated in one
location in the west and a few
locations in the east.
The official, who spoke on
condition of anonymity to dis-
cuss continuing operations, said
the U.S. military is not closely
monitoring the effectiveness of
the ceasefire, but is aware of spo-
radic fighting and violations of
the agreement. The official said
it will still take a couple of weeks
to get forces out of Syria.
Also on Sunday, U.S. House
Speaker Nancy Pelosi led a group
of U.S. lawmakers on a visit to
Jordan to discuss “the deepening
crisis” in Syria.
Jordan’s state news agency Pe-
tra said that King Abdullah II, in
a meeting with the U.S. delega-
tion, stressed the importance of
safeguarding Syria’s territorial
integrity and guarantees for the
“safe and voluntary” return of
refugees.ASSOCIATED PRESSU.S.troopstocontinuefightfromIraq
DespiteTrump’sclaim
of‘bringingsoldiers
home,’counterterrorism
missionsagainstISin
Syriawillstillgoon,
DefenceSecretarysays
LOLITABALDORKABUL
U.S.militaryforcesdrive
througheasternSyriaon
Sundayafterpullingout
oftheirbase.President
DonaldTrumpordered
mostofthe
approximately1,
U.S.troopsinSyriato
withdrawafterTurkish
PresidentRecepTayyip
Erdogansaidthathis
forceswereaboutto
invadethecountry.
DELILSOULEIMAN/
AFP/GETTYIMAGESThe use of episiotomies has been
declining for years, but the con-
troversial procedure during
childbirth may help more than it
harms in certain deliveries, a
new study suggests.
The study, published in the
Canadian Medical Association
Journal on Monday, looked at
more than 2.5 million childbirths
in Canada over a 13-year period
and found an increase in anal
-sphincter injuries associated
with vaginal deliveries involving
instruments such as forceps and
vacuums.
The study also found, during
the same period, a decrease in
the use of episiotomies, which
are vaginal incisions used to aid
difficult childbirths.
Invasive episiotomy proce-
dures have been found to have
little medical benefit when per-
formed during births without in-
strumentation.
This has led to a significant re-
duction in the practice over the
past two decades. “It’s been a tri-
umph for women’s health,” said
Giulia Muraca, who co-authored
the study.
The problem, according to the
study authors, is that episioto-
mies are becoming less frequent
in all types of vaginal births, in-
cluding those aided by forceps.
“The downside of this is that
it’s kind of creeped into these de-
liveries with the assistance of in-
struments, and our research is
showing that that is to the detri-
ment of women’s health,” said
Dr. Muraca, a postdoctoral fellow
at the reproductive epidemiolo-
gy clinic of the Karolinska Insti-
tute in Sweden and the depart-
ment of obstetrics and gynecol-
ogy at the University of British
Columbia.
Researchers studied all vagi-
nal deliveries with gestation pe-
riods lasting between 37 and 41
weeks in Canada between 2004
and 2017.
The study did not include data
from Quebec and only included
deliveries where a single baby
was delivered.
According to the study, nearly
20 per cent of all operative vagi-
nal deliveries resulted in anal in-
juries in 2017.
The study also noted that op-
erative vaginal deliveries make
up just more than 10 per cent of
all deliveries in Canada, accord-
ing to statistics from 2012.The study also showed that
two-thirds of women who had
never given birth to a baby vagi-
nally before did not receive epi-
siotomies during deliveries in-
volving the use of forceps.
That statistic is alarming, said
John Kingdom, a staff obstetri-
cian at Mount Sinai Hospital in
Toronto who was not involved in
the study.
“You really should never do a
forceps delivery without an epi-
siotomy,” said Dr. Kingdom.
“That’s precisely why episiotomy
was invented.”
He added that, if done proper-
ly, the procedure of a forceps de-
livery compounded with an epi-
siotomy should not result in any
lasting injury.
Data from the study show that
forceps deliveries make up about
one-quarter of all operative vagi-
nal deliveries in Canada.
The authors of the study
recommended more specific gui-
delines on the use of episioto-mies in an effort to reduce the
number of anal sphincter inju-
ries.
The Society of Obstetricians
and Gynaecologists of Canada
recommends that episiotomies
be used “restrictively” during op-
erative vaginal deliveries, ac-
cording to the most recent edi-
tion of their clinical practice gui-
deline.
“The guidelines around epi-
siotomy and the use of instru-
ments in vaginal delivery need
to be more receptive of the cur-
rent evidence,” Dr. Muraca said.
“My prescription would be that
the SOGC guidelines reflect the
evidence and not be up to inter-
pretation.”
However, Dr. Kingdom said
the guideline is grounded in
practical clinical experience and
is clear on when to use episioto-
mies during operative vaginal
deliveries.
“[The SOGC guideline] states
clearly that forceps are an ac-
ceptable, safe choice for delivery
of a baby, and should be done
with an episiotomy,” said Dr.
Kingdom.
The guideline states that the
decision to perform episiotomies
“must be made by the treating
clinician.”
In an e-mailed statement,
SOGC chief executive officer Jen-
nifer Blake said her organization
reviews its guidelines “when new
research is available, but there
may be many reasons and many
possible recommendations.”
Dr. Blake added that the SOGC
has not yet seen the study and
therefore could not “properly
comment.”
Dr. Muraca said she hopes the
study will help reduce the num-
ber of childbirth-related anal
sphincter injuries.
“It’s always been dismissed or
explained away as a natural side
effect of childbirth,” said Dr. Mu-
raca.
“It’s my mission to make this
not a necessary part of child-
birth.”Episiotomymayhelpreduceinjuries
tiedtoforceps-aidedchildbirths:study
KCHOARD
TheSocietyof
Obstetriciansand
Gynaecologistsof
Canadarecommends
thatepisiotomiesbe
used‘restrictively’
duringoperativevaginal
deliveries,accordingto
themostrecentedition
of their clinical practice
guideline.Hong Kong streets descended into chaotic scenes after an
unauthorized pro-democracy rally Sunday, as protesters set
up roadblocks and torched businesses, and police respon-
ded with tear gas and a water cannon.
Protesters tossed firebombs and took their anger out on
shops with mainland Chinese ties as they skirmished late
into the evening with riot police, who unleashed numerous
tear-gas rounds on short notice, angering residents and pas-
sers-by.
Police had beefed up security measures ahead of the rally,
for which they refused to give permission, the latest chapter
in the unrest that has disrupted life in the financial hub
since early June.
Some 24 people were hurt and treated at hospitals, in-
cluding six with serious injuries, the Hospital Authority
said.
Police did not give an arrest figure. One person was seen
being handcuffed and taken away to a police van.
As the rally march set off, protest leaders carried a black
banner that read, “Five main demands, not one less,” as
they pressed their calls for police accountability and politi-
cal rights in the semi-autonomous Chinese territory.
Supporters sang the protestmovement’santhem,waved
colonial and U.S. flags, and held up placards depicting the
Chinese flag as a Nazi swastika.
Many protesters wore masks in defiance of a recently
introduced ban on face coverings at public gatherings, and
volunteers handed more out to the crowd.
Some front-line protesters barricaded streets at multiple
locations in Kowloon, where the city’s subway operator re-
stricted passenger access.
They tore up stones from the sidewalk and scattered
them on the road, commandeered plastic safety barriers
and unscrewed metal railings to form makeshift roadblocks.
A water-cannon truck and armoured car led a column of
dozens of police vans up and down Nathan Road, a major
artery lined with shops, to spray a stinging blue-dyed liquid
as police moved to clear the road of protesters and barri-
cades.
At one point, the water cannon sprayed a handful of
people standing outside a mosque. Local broadcaster RTHK
reported that the people hit were guarding the mosque and
few protesters were nearby. The Hong Kong police force said
it was an “unintended impact” of its operation to disperse
protesters, and later sent a representative to meet the
mosque’s imam.
As night fell, protesters returned to the streets, setting
trash on fire at intersections.
Residents jeered riot police, cursing at them and telling
them to leave. The officers, in turn, warned people that they
were part of an illegal assembly and told them to leave, and
unleashed tear gas to disperse the crowds.REUTERSShopsravaged,about
twodozeninjuredinlatest
HongKongshowdown
KELVINCHANHONGKONG