This is indeed a high time to curb the increasing trend of caesarean section (CS) globally. This was shown in this excellent retrospective study by Cahill et al.

A recent report on CS trend in the United States revealed the overall CS rate to be 30.5%. A total of 31.5% of all nulliparous were delivered with CS, and prelabor repeat CS delivery because of a previous uterine scar accounted for 30.9% of all. Another study showed that 20% were at risk for labor arrest, which could further increase the CS rate. Researchers described preterm delivery to be higher in the male fetuses, which was due to increased incidence of spontaneous preterm labor and preterm premature rupture of the membranes. This was again repeatedly proven significantly in the present study.

In Table 1, the birthweight was significantly heavier in the male fetuses, which was contrary, and it was not concurrent with the findings of more medical problems in the mothers of female fetuses (MFF). In fact, the gestational diabetes was far more in these mothers compared with the mothers of the male fetus (MMF). We wonder how this could be explained because the risk of lighter fetuses (intrauterine growth retardation) was not really a big difference in those with maternal hypertension as seen in the MFF. Although not significant, MFF had a poorer cervical score to start with, needing more induction of labor (IOL) compared with the MMF. More augmentations were needed in the active process of labor in MMF (Table 1). Perhaps by having had more IOL, the cervical ripeness would have been better in MFF, resulting in better quality of contractions during progress of labor, which is in contrast to MMF and not just merely by gender factor alone, as claimed by the authors. Perhaps with reduced intervention with augmentation, resulting in fewer unnatural contractions, resulting in more vaginal deliveries observed in MFF compared with the number of operative delivery and CS in MMF. Thus, should sex alone be blamed for the arrest of the active phase of labor as seen in this observation (4.6 hours vs 4.0 hours; P = .002)?

In Figure 2, MMF with multiparity (second curve) was progressing faster than MFF with nulliparity (third curve). Thus, parity still played a more potential role in the labor progress if compared with sex, which was not highlighted in the observation.