Cesarean birth is recognized as a physical and psychological stressor for many women. Maternity practices during cesarean birth should meet women's needs, while maintaining safety, to optimize the experience. Family-centered cesarean birth is a package of interventions that encourages a woman to participate in choosing interventions that would be helpful when undergoing a planned or unplanned cesarean birth. Included in family-centered cesarean birth is implementation of skin-to-skin care in the operating room for neonates who appear term and healthy. The process of attempting to implement family-centered cesarean birth at one academic center is presented, including steps for implementation, benefits, challenges, and areas for continued improvement and research. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

LETTERS TO THE EDITOR 389 SANn( 1 0 ) To fhe Editor: -We very much enjoyed the two recent articles on clock drawing in Alzheimer's disease.'C2 However, we do have one concern with respect to this test, one that is not addressed by the authorsthat of a possible cohort effect. It is well known among gerontologists that cross-sectional studies can obscure true longitudinal changes.In addition, the clock drawing test is both time and culture-bound. It would certainly not work as a measure of dementia among preindustrial societies, the members of which tell time using methods other than the typical clock face. Even in our own relatively homogeneous western cultures, the clock drawing test, as described by Sunderland et al and Wolf-Klein et al, will in time become obsolete due to changing technologies.As the millennium approaches, we offer what we believe to be the appropriate clock drawing deterioration to be sought out among dementing baby boomers for the year 2025 and beyond (see Figure 1). We offer it to the research community in the form of a hypothesis and would be interested in any attempts to validate it.

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