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Author Ellen Catalinotto responds: Fear of malpractice litigation influences the way obstetrics is practiced. But that alone does not account for the 46% increase in cesareans during the last decade. The high rate of inductions, the many (often unproven) interventions to which women are subjected, as well as the efficiency (for the institution and provider) of a 30-minute surgery instead of hours of labor are part of the picture. Unnecessary cesareans are being marketed to women as safe and convenient, despite mounting evidence showing that they are more dangerous to mothers and babies than vaginal delivery.