Using databases to address important but neglected clinical questions.

The rate of cesarean sections has been increasing substantially over the last several decades, and, accounting for approximately 27.5% of deliveries in the general population in 2004, is much higher than the target rate of 15% established in 1991 as a United States health objective for the year 2000 [1, 2]. There are a number of intertwined medical and societal explanations for the increased rate of cesarean sections in the United States, but the overall pattern is admittedly not fully understood, nor is the most appropriate path to address the discrepancy between actual and goal cesarean delivery rates. One of the key first steps to determining optimal health care, as well as the reasons for falling short of health care goals, centers on understanding the extent and nature of the problem on many levels. Trends affecting the population as a whole – such as those related to preand perinatal care – naturally impact individuals and populations who are simultaneously affected by other conditions. As Revital Faro and colleagues point out in their important article entitled “Cesarean delivery rates in Down syndrome pregnancies,” the ramifications of general health trends are too often neglected in terms of the effects on certain subpopulations [1]. In the manuscript, Faro et al. state,