Comment & Controversy

“Medicine by protocol” overlooks many nuances

“RECOMMENDATIONS FOR PERINATAL CARE HAVE A TROUBLING PEDIGREE”
ROBERT L. BARBIERI, MD (EDITORIAL, APRIL 2009)

I appreciated Dr. Robert L. Barbieri’s thoughtful response to the rigid guidelines promulgated by the National Quality Forum (NQF). The source of much confusion about these guidelines, which advise against elective cesarean delivery prior to 39 weeks’ gestation, is the flawed, recent article in the New England Journal of Medicine regarding the alleged risks of elective term cesarean delivery.¹ As a faculty obstetrician for a high-risk, indigent, safety-net population, I have more than a passing interest in this topic. I must counsel and schedule these patients for “elective” repeat cesarean delivery on a routine basis.