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Cesarean Births and Trial of Labor Rates

Pedro A. Poma, MD
JAMA. 1987;257(20):2757-2758. doi:10.1001/jama.1987.03390200097017.
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To the Editor.—  In spite of our profession's concerns, the number of cesarean deliveries continues to increase, as was well demonstrated in the nationwide survey by Shiono et al.1 This increase in abdominal deliveries does not directly correlate with the obstetric risks of the mother, nor with an improvement in perinatal morbidity and mortality. In fact, cesarean deliveries have a higher maternal and perinatal morbidity and mortality rate than vaginal deliveries.2 Today, there is a higher proportion of nulliparas in obstetric services, and today's women have fewer children and at an older age (in 1985, 30.7% of women aged 35 years and older underwent cesarean delivery vs 16.1% of those younger than 20 years)3; these factors tend to increase abdominal deliveries, but there is also a higher expectation of perfect results.Traditionally, a good measure of patience (allowing nature to take its course) has been considered a


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