Cesarean section: An answer to the House of Horne

Kenneth J. Leveno, F. Gary Cunningham, Jack A. Pritchard

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


The incidence of cesarean delivery in the United States has at least tripled in the past 20 years, and this has generated a great deal of concern within the profession, by the government, and by the consumer. Recent data from the National Maternity Hospital in Dublin, Ireland, from which a stable 5% cesarean section rate was reported, have led those investigators to conclude that more frequent delivery by cesarean section in the United States was due in part to less aggressive management of labor in nulliparous patients. In this report, we compare obstetric practices and outcomes during 1983 for Parkland Memorial Hospital with those of the National Maternity Hospital. The overall cesarean delivery rate was 18% in Dallas and 6% in Dublin, and racial population differences along with an increased number of nulliparous patients likely account for a higher incidence of primary cesarean sections for dystocia in Dallas. Importantly, when we compared the results in Dublin with our own, more liberal use of cesarean delivery for presumed fetal jeopardy in Dallas was associated with a sevenfold decreased incidence of intrapartum fetal death and a twofold decrease in infants with seizures. From these data, we advise caution before one attempts to emulate, on faith alone, someone else's low and seemingly safe cesarean delivery rate.

Original languageEnglish (US)
Pages (from-to)838-844
Number of pages7
JournalAmerican journal of obstetrics and gynecology
Issue number8
StatePublished - Dec 15 1985


  • Cesarean section
  • Dublin, Ireland
  • intrapartum fetal death
  • seizures

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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