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June 15, 1994

Factors Influencing Primary Cesarean Rates-Reply

Author Affiliations

University of Washington Seattle

JAMA. 1994;271(23):1829-1830. doi:10.1001/jama.1994.03510470033027

In Reply.  —We are pleased that Ms Taffel and colleagues, using a national data set, have confirmed our statewide findings concerning the impact of demographic changes on cesarean rates. Birth weight and plurality were not important components of the change in cesarean rates in their analysis because these distributions have not changed dramatically during the past two decades in the United States. However, birth weight may be an important confounder in international comparisons, if countries vary widely in low-birth-weight rates. We found that primiparous women delivering lowbirth-weight infants had twice the risk of cesarean delivery of those delivering infants weighing 2500 to 3499 g, while among multiparous women the risk was more than fivefold.We appreciate the utility of the approach by Taffel et al, using nationally compiled vital records data. However, we believe that one strength of our study lay in the accuracy with which we were able to

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