Abstract
The magnitude of cesarean section rates in the United States has been of increasing public concern. A consensus development conference in 1980 formulated recommendations that were expected to lead to a decrease in national cesarean section rates. A review of cesarean section patterns for the last five years in many representative states revealed, contrary to expectations, a continuing increase in cesarean section delivery rates even after the conference. A review of underlying causes for these developments suggests that only a more efficient peer review process, involving individual physicians as well as institutions, will lead to a decline of unacceptably high cesarean section rates in this country. (JAMA1984;252:3273-3276)