Myth of the ideal cesarean section rate: commentary and historic perspective

Attempts to define, or enforce, an "ideal" cesarean section rate are futile, and should be abandoned. The cesarean rate is a consequence of individual value-laden clinical decisions, and is not amenable to the methods of evidence-based medicine. The influence of academic authority figures on the cesarean rate in the US is placed in historic context. Like other population health indices, the cesarean section rate is an indirect result of American public policy during the last century. Without major changes in the way health and maternity care are delivered in the US, the rate will continue to increase without improving population outcomes.