The Risks of Lowering the Cesarean-Delivery Rate

To the Editor: Sachs et al. (Jan. 7 issue)¹ are incorrect in their assumption that programs designed to reduce the rate of cesarean delivery center on increasing the number of operative vaginal deliveries (the use of forceps and vacuum extractors). Quite to the contrary, we have found that physicians who perform fewer cesarean sections tend to perform fewer operative vaginal deliveries (14.9 percent, as compared with a rate of 20.7 percent among those who perform more cesarean sections).² These same physicians also have lower rates of use of epidural analgesia and induction of labor, but they more often monitor the . . .