The editorial, “Decision to incision: time to reconsider,” provides a realistic and timely perspective. The accompanying article in this same issue showed the difficulty for a hospital to be compliant with the described standard.

Aside from the lack of evidence supporting this 30-minute rule as having an impact on perinatal morbidity/mortality, there may be difficulty with the definition of fetal intolerance to labor (sometimes referred to as “fetal distress”). The use of having this standard, with its acceptance by hospital organizations to gather the necessary resources to accomplish compliance, is well-articulated in the editorial.

It should be recognized, however, that there is a spectrum of conditions that might lead to the need for an immediate delivery, with varying acuity, from an umbilical cord prolapse (in the extreme) to a flattening of the fetal heart rate (the extreme at the other end of this same continuum). What may confound the measurement of this Decision-to-Incision Time (DIT) is the difficulty of assigning the precise “Decision Time” (not often well-documented), unlike the specific detail of the “Incision Time” (commonly entered into the digitized or nondigitized Medical Record).

Nonetheless, I support the proposed modification of this accepted standard (the “30-minute rule”), to be applied to very specific situations indicating the need for an immediate perinatal delivery, properly defining those relevant clinical situations that may be most commonly encountered. Perhaps national compliance with this will then be improved on.