Cesarean Births and Trial of Labor Rates

Sylvain Fribourg, MD
JAMA. 1987;257(20):2758. doi:10.1001/jama.1987.03390200097018.
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To the Editor.—  The report by Shiono et al1 entitled "Recent Trends in Cesarean Birth and Trial of Labor Rates in the United States" is a fine preliminary report on the subject, indicating the need for further study if we are in fact truly to understand the crude overall rise in cesarean births and attempt either to stem the rise or to reverse it.The authors state that "53% of the rise in cesarean deliveries from 1980 to 1983 was due to dystocia." Dystocia includes at least three different diagnostic possibilities: either abnormal or weak uterine forces, contraction of the maternal pelvis, or fetal malpresentation. The imprecision of the diagnosis of dystocia, for example, the diagnosis of maternal pelvic anatomic contraction, is repeatedly demonstrated when a vaginal birth after cesarean results in a larger newborn than the newborn delivered by cesarean section, even when both were documented to have


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