The effect of medical and social conditions on the mode of delivery: a prospective questionnaire-based study applied to 404 Turkish obstetricians

Behavioural factors associated with fear of litigation as a driver for the increased use of caesarean sections: a scoping review

“…The legal environment and how it influences maternity care were the focus of 24 studies 13 14 21 22 33–38 41 43 46 47 49 50 52 54 62 63 76–79. While laws, legal norms and procedures differ by context, we identified common themes across different studies.…”

“…The second theme illustrates the lack of clear demarcation within legal systems between malpractice and unavoidable adverse events. 54 Providers in some of the included studies perceived that judges, jurors and expert witnesses assign fault based on empathy with the families’ suffering a loss or disability following birth, rather than looking at whether or not this negative outcome was a result of negligence. 34 This perception could be reinforced in contexts where limited social or financial support to families and children with disabilities existed, and hence the legal environment seeks to place blame as a way to help the family with the resulting settlement.…”

“…Ambiguity, in the form of uncertainty of length and outcome of vaginal birth (VB), was a justification for preferring CS to avoid litigation consequences in 16 studies 13 14 32 34 48–59. This tendency to avoid ambiguity is what leads professionals to perform CS, especially in the context of caesarean delivery on maternal request (CDMR)58 or vaginal birth after CS (VBAC) or risk of uterine rupture 34 57…”

“…This ambiguity also may lead providers to shift the responsibility of decision making to the women and their families, rather than giving their professional opinion, as a means of avoiding litigation in case of complications; a CS becomes a sort of insurance policy 58. Some authors note that this behaviour is reinforced by the fact that women and their families are increasingly perceiving adverse events in maternity care as unacceptable 13 54 57…”

“…Seven studies explicitly discussed providers’ beliefs around the relative safety of CS 37 41 51 54 60–62. The inclination to perform CS to avoid litigation risk can be motivated by providers’ belief that CS is a safer option than VB, and that CS guarantees the best outcome for mother and child 63.…”