Hi Everybody: I have obtained the loan of a manuscript entitle "Coming to Term...Innovaions in Safely Reducing Cesarean Section Rates" The three major areas of focus are "broadening physicain accountability, enlisting the patient, and restaffing the hospital" This is a fabulous report and belongs in the hands of doula organizations and childbirth educators. I believe LCs and those of us working with breastfeeding will benefit from it as well, for this report clearly states in many ways that there is a direct correlation between epidural use (particularly when given early in labor) and cesarean section. And breastfeeding workers sure have an uphill battle to get mother and baby together well when there is either of these events. It can be obtained from the Medical Leadership Council, (FAX) 202-672-5700 or 1-800-673-1756. Ask for publication #MLC-000-001. It is intended for broad dissemination among OBs, administrators and L&D unit staff members. A number of folks have reviewed this report, including Bruce Flamm, Penny Simkin, and John Kennel. The tables and charts and research are amazing...I can't post the whole thing, although I'd love to. There is one pie-graph showing that 20% of cesareans are influenced by patient demand: 9% from epidural-related dystocia, and 11% from women refusing a trial of labor. It also shows how the jury is still out on the Active Management of Labor...that recent research hasn't supported a significant difference. (Is this because active management of labor in the US leaves out the one factor determined by meta-analysis that makes the difference, i.e. one-to-one support?) Whatever....I hope we can all get copies. Warmly, Nikki