The Cesarean Section Rate-Reply

In Reply.—  A premise of my review was that further increases in cesarean section rates are not warranted. Dr Overhulse's call for the universal adoption of cesarean section contradicts this prevailing consensus¹ and perhaps illustrates why there is so frequently a tenuous connection between clinical practice and the medical literature.Although maternal mortality is now rare, cesarean section nevertheless carries an increased risk of death compared with vaginal delivery, even for planned cesarean sections.² In addition, postcesarean infection occurs in approximately 15% of cesarean deliveries even with antibiotic prophylaxis.³ Hospital stays are twice as long following cesarean section compared with vaginal delivery. Although the physical and emotional hardships of laboring women cannot be minimized, the statement that "the mortality and morbidity rates of planned cesarean section... are as low as those of vaginal delivery" is not supported by the literature. Dr Overhulse's implication that late pelvic relaxation