The authors reply regarding transparency, balance and perspective on intervention at full dilation.

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Date: Sept. 6, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 34)
Publisher: CMA Impact Inc.
Document Type: Letter to the editor
Length: 835 words
Lexile Measure: 1890L

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We are pleased Walker and colleagues (1) echo our sentiment (2) regarding the need for a balanced perspective on delivery options. We welcome the opportunity to clarify our methods, to reiterate that our conclusions do not suggest that any mode of delivery is superior to another and to underscore that dismissing the high rates of injuries associated with operative vaginal delivery (OVD) is inconsistent with a balanced perspective and signals a disregard for pregnant peoples' autonomy in making evidence-informed decisions regarding childbirth.

Walker and colleagues have questioned the quality of our data owing to "small-scale, noncontemporaneous, province-specific" validation studies. However, we cited a 2016 national reabstraction study that evaluated the accuracy of maternal trauma and found 97% agreement (95% confidence interval [CI] 95%-99%) with medical charts in hospitals across Canada. (3) Further, the aggregation of third- and fourth-degree perineal tears is the established definition of obstetric anal sphincter injury (OASI). (4) No evidence has suggested that 3A versus 3C and fourth-degree tears predict qualitatively different long-term outcomes. Although the article cited by Walker and colleagues provides no insight into long-term outcomes, the National Institute of Child Health and Human Development's Pelvic Floor Disorders Network showed that anal incontinence rates at 24 weeks postpartum after 3A and fourth-degree tears...

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Gale Document Number: GALE|A715979479