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Randall S. Stafford, PhD
University of California at San Francisco School of Medicine

JAMA. 1991;265(5):595-596.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

My original article¹ in JAMA outlined strategies proposed to control rising cesarean section rates. That article, as well as my response² to a letter advocating the universal application of cesarean section, suggested that further increases in cesarean section use contradict a consensus of research. This body of research, despite occasional limitations, should help obstetricians confront the clinical dilemmas mentioned by Dr Peach.

There is little controversy that adverse maternal outcomes are more common following cesarean section. Women undergoing cesarean section have higher mortality, higher rates of postpartum infection, longer hospital stays, and longer recovery periods. Although data specifically addressing the outcome of elective cesarean section are limited, adverse maternal outcomes are more common with cesarean section both before and after the onset of labor.

The review article³ cited in my letter concluded that a conservative estimate of the risk of maternal mortality from a cesarean . . . [Full Text PDF of this Article]

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