Cesarean section: the House of Horne revisited

In 1983, obstetricians from Dublin, Ireland, alleged that the perinatal mortality rate in the United States could be achieved with a cesarean section rate of approximately 5%. We responded in 1985 that population and infant outcome differences precluded such a low rate of cesarean sections at Parkland Memorial Hospital. The Dublin obstetricians responded 3 years later that it was unfair to compare obstetric services for only 1 year (1983). We respond again.