Ellen Catalinotto's July Viewpoint, "Medically Unnecessary Cesarean Sections," was long overdue. We need accurate data on the rates of maternal and neonatal mortality by birth method and on the long-term effects of cesareans on mothers and infants. Even 25 years ago when I worked in labor and delivery, I noticed too many cesareans and too few obstetricians who could handle difficult vaginal births. I suspect that number is even smaller today. Support for vaginal deliveries, especially those without anesthesia, is also limited because epidural anesthesia generates money. I have seen obstetricians deliberately do rough vaginal examinations to induce hard contractions and then ask the woman if she wanted an epidural. Once the epidural has been given, the patient is flat in bed and ready for a cesarean. We need more midwives. Physicians, a well-organized group with lots of money at stake, don't take the time for vaginal births. One hospital in Cleveland fired its midwives because insurance paid more for deliveries performed by obstetricians.

How can we send a new mother home after major surgery and expect her to cope with all the tasks of motherhood with minimal support? What problems will develop in 10 or 20 years from adhesions and other sequelae of abdominal surgery? Do women with health insurance have a higher rate of cesarean delivery than women who get treated at clinics? Does Medicaid pay the same rate as private insurance? Why do the insurance companies let this happen without any protest?

Linda Q. Thede, PhD, RN-BC

Aurora, OH