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Dr Iffy's letter misinterprets our conclusion. We did not say that "the National Institute of Child Health and Human Development—sponsored Consensus Development Conference on Cesarean Childbirth failed to affect the increasing rates of abdominal deliveries." We stated that "substantial increases have been observed in the rates of trial of labor and vaginal births after a previous cesarean delivery. However, these changes have not been sufficient to stem the rising cesarean delivery rates." There is a difference between these two conclusions. We believe that although cesarean delivery rates are still rising, the rates would be substantially higher without the recent trend toward trial of labor and VBAC. Dr Iffy also cites operating-room availability as a factor possibly limiting adoption of VBAC. On the contrary, crowding of operating facilities might be reducible if more VBACs were done.Dr Poma's letter discusses several factors that may contribute to the increasing cesarean
Shiono PH, McNellis D, Rhoads GG, Fielden JG, Pearse WH. Cesarean Births and Trial of Labor Rates-Reply. JAMA. 1987;257(20):2758-2759. doi:10.1001/jama.1987.03390200097019