Dr. Barbieri observed that “numerous advances in the clinical science of obstetrics have expanded the indications for cesarean section.” I would disagree. Rather, research is finally being done that demonstrates the cesarean section rate was appropriate in the mid 1980s—when we were urged to reduce such deliveries significantly. In my opinion, the current cesarean delivery rate of 26.1% is a complete vindication of the practice of obstetrics in that era. As for the need to establish a new rate of 30%: I believe American Ob/Gyns have already voted with their scalpels, making such a goal superfluous.
I also believe the quixotic quest in the 1990s to achieve a 15% cesarean rate is—at least in part— directly responsible for the rise in litigation against Ob/Gyns.
David C. Walters, MD
Mount Vernon, Ill