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August 17, 1994

Reducing the Rate of Cesarean DeliveriesAn Obtainable but Elusive Goal

Author Affiliations

From the Office of the Executive Director, American College of Obstetricians and Gynecologists, Washington, DC.

JAMA. 1994;272(7):558-559. doi:10.1001/jama.1994.03520070078043

The article by King and Lahiri,1 reported elsewhere in this issue of The Journal, attempts to quantify factors influencing the incidence of vaginal birth after a previous cesarean delivery (VBAC). From a retrospective analysis of data on 13944 births occurring in 1989 to New York State women with a history of cesarean delivery, the authors report small increases in the odds of VBAC for those women with higher levels of education, who delivered in hospitals with intensive and intermediate neonatal care facilities, and who were members of health maintenance organizations. They did not find any effect of professional liability factors on VBAC rates. King and Lahiri are to be commended for undertaking this difficult and arduous task. This report is especially timely following recent reports on the rates of unnecessary cesarean delivery. A scientifically based analysis of the reasons for and against repeat cesarean delivery is clearly needed. The

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