This study is a nice example of how we can track secular trends through publicly accreted data. As we have children later in life it may well be that we are running against some biological limits that Obstetric surgery allows us to overcome. As we instrument the healthcare enterprise using informatics technologies, more and more such testable hypotheses are going to be generated. Will we have the governance in place throughout our healthcare systems to test these hypotheses in a timely and responsible manner? Do we have the expertise and tools in place?