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Cesarean Section Rates in the United States

Leslie Iffy, MD
JAMA. 1985;253(22):3247-3248. doi:10.1001/jama.1985.03350460043006.
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To the Editor.—  Dr Norbert Gleicher1 frankly addresses the fact that while in high-risk centers the cesarean section rate leveled out at 12% to 15%, it continued rising to 30% to 35% in surburban hospitals. He correctly comments, "Only the media noted the difference. Medical organizations never did." Nonetheless, some of his suggestions are not beyond dispute.In the 1960s, peer review committees blindly adhered to the prevailing misconception that the rate of cesarean sections should not exceed 4% to 5%. Progress came through the effort of those physicians who dared to defy the authorities of the time.I do not consider fetal scalp blood sampling helpful in reducing cesarean section rates since it is relatively inaccurate,2 exposes the fetus to infection,3 and serves as a relative contraindication to the use of the vacuum extractor,4 which in our service is the


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