Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section

Abstract

Background Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior aimed at reducing obstetricians’ exposure to malpractice litigation. Objective To estimate the effects of malpractice pressure on rates of VBAC and cesarean section. Research Design, Subjects, Measures We used state-level longitudinal mixed-effects regression models to examine data from the Natality Detail File on births in the United States (1991–2003). Malpractice pressure was measured by liability insurance premiums and tort reforms. Outcome measures were rates of VBAC, cesarean section, and primary cesarean section. Results Malpractice premiums were positively associated with rates of cesarean section (β = 0.15, P = 0.02) and primary cesarean section (β = 0.16, P = 0.009), and negatively associated with VBAC rates (β = −0.35, P = 0.01). These estimates imply that a $10,000 decrease in premiums for obstetrician-gynecologists would be associated with an increase of 0.35 percentage points (1.45%) in the VBAC rate and decreases of 0.15 and 0.16 percentage points (0.7% and 1.18%) in the rates of cesarean section and primary cesarean section, respectively; this would correspond to approximately 1600 more VBACs, 6000 fewer cesarean sections, and 3600 fewer primary cesarean sections nationwide in 2003. Two types of tort reform—caps on noneconomic damages and pretrial screening panels—were associated with lower rates of cesarean section and higher rates of VBAC. Conclusions The liability environment influences choice of delivery method in obstetrics. The effects are not large, but reduced litigation pressure would likely lead to decreases in the total number cesarean sections and total delivery costs.

A Check List to Reduce Misuse of Primary Cesarean Sections in Women with a Single Fetus in Cephalic Position

“…Nevertheless, to adequately compare this information, it is necessary to consider the risk structure of the pregnant women population cared for at each center [25]; for our figures, really there are not other reports to compare because the definition of group B has been generated for this report. In these sense, the indirect- Besides the improvement opportunities detected in this exercise, there are other equally necessary measures that have also shown their usefulness: changing the way in which health professionals and the general public perceive labor as something dangerous that makes both the mother and child suffer [8], a C-section as an innocuous procedure [4], the fear of legal repercussions from any apparently adverse outcome [34], and the type of economical or work benefit obtained by a C-section or vaginal birth, for professionals, institutions and health service payers [8] [35].…”

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“…Existen muy pocos trabajos que se hayan acercado a este tema con un interés científico por lo que la información que recibe el profesional puede ser incompleta, pero se considera suficiente para provocar cambios asistenciales 9,10 como por ejemplo el incremento en el número de partos por cesárea 11,12 .…”

Equivocal Court Cardiotocography Weighting in Cerebral Palsy Litigation

“…Internationally, obstetricians and gynecologists are sued more frequently than practitioners in most other specialties; with awards against them reaching massive amounts [2]. Such disabling awards, as well as the requisite insurance premiums required to fulfill medical practice requirements, have crippling effects,both at personal, as well national health levels.…”