Do malpractice threats, real or imagined, lead to more C-sections?
Tom Smart, Deseret News
Worries about malpractice lawsuits have led doctors to increase the number of repeat cesarean sections, even when vaginal delivery is possible and sometimes a safer option.
Obstetricians face more lawsuits and have higher insurance premiums than nearly any other medical specialty, except for neurosurgeons, according to a report from the National Institutes of Health. A fear of litigation causes some doctors to choose a C-section as the legally safe option, rather than allow the mother to choose her own method of delivery, which infringes on the rights of the mother and possibly puts her in danger, according to the New York Post.
The ratio of C-sections increased from 5 percent of all births in 1970 to 31 percent in 2007, according to an article on the American Congress of Obstetricians and Gynecologists website. While repeat C-sections are sometimes necessary to prevent serious harm to the mother or child, a vaginal birth after C-section (VBAC) "avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery," the article says.
"Indeed," wrote Naomi Schafer Riley in the New York Post, "there’s universal agreement in the medical community that too many C-sections are taking place, but the fact is that doctors don’t have much choice."
Another study from the National Institutes of Health found that a $10,000 decrease in the premiums obstetricians must pay when faced with a malpractice lawsuit would lead to "approximately 1,600 more VBACs per year, 3,600 fewer primary cesarean sections, and 6,000 fewer cesarean sections overall," using the numbers from 2003.
The rising number of C-sections, however, does not correlate with a rising number of malpractice lawsuits over VBACs, wrote Louise Marie Roth, an associate professor of sociology at the University of Arizona, on the website KevinMD.
Instead, the fear alone is what prompts many hospitals to adopt strict policies limiting the number of VBACs performed, Roth says. "Moreover, these fears do not justify subjecting millions of women to unnecessary surgery, which violates medical ethics and pregnant women’s human rights."
Immediately defaulting to a C-section doesn't even necessarily ensure that the doctor is protected.
Rinat Dray, a mother of three, is currently suing a New York hospital for forcing her to have a C-section in July 2011 for the birth of her third child, according to the New York Times. After two previous C-sections, she was determined to deliver the child nonsurgically and hired a doula to help. She labored for several hours before the doctor decided she needed to have a C-section.
The Times reported that Dray's bladder was cut during the procedure, and the doctor did not respect her rights as a mother.
Both C-sections and VBACs have medical risks, the most likely risk for VBACs being uterine rupture, which occurs in 1 out of 500 women who attempt the trial of labor, according to the ACOG. Still, the procedure is successful for 60 to 80 percent of eligible candidates and saves the mother from going through another surgery.
ACOG issued guidelines in 2010 that would enable more hospitals to safely allow VBACs if the mother chose, but the threat of malpractice suits still hang over the heads of many doctors. To combat this, ACOG included in its guidelines a clause that allows doctors to send patients to another physician if they don't feel comfortable performing a VBAC.
Emily Hales is an intern on the national team, covering issues facing families in the United States. She is a communications major at Brigham Young University.
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