I got mail from the American Congress of Obstetricians and Gynecologists (ACOG) today. I get a lot of mail from them. Together we are responsible for much deforestation. For example, I would be happy NOT to get a print version of the Green Journal as they promptly go into a pile from whence they will never return. I read the articles I want on line.
But I digress.
Today’s mail was different. A puffy package with the bubble wrap. A press package. Yes, that’s right, according to ACOG I am now a journalist (see the Dear Journalist picture for proof).
The press package had a nifty little book with 2011 stats and facts for women’s health. I flipped through it and was stunned at the malpractice information. We talk about the ever increasing rate of c-sections (31% of deliveries!!!) and all the different reason why this happens. Tort reform is always tossed around, but no one ever seems to do anything about it (maybe because Washington is run by, I don’t know, LAWYERS?).
So here are the sad stats. Truly, I was blown away.
- > 90% of OB/GYNs have been sued at least once during their career
- The average number of times an OB/GYN is sued is 2.7
- 30.5% of obstetrics claims involve a neurologically impaired infant and 49% of these claims are lost (meaning money was paid). FYI, losing a claim does not necessarily mean anything was done incorrectly.
- 63% of OB/GYNs change their practice in some way because of risk of fear of litigation
And for those of you wondering about the specific effect of malpractice on c-sections…in 2009:
- 26% of OB/GYNs stopped offering/performing VBACs because of malpractice concerns
- 29% increased the number of c-sections because of malpractice concerns
- 8% stopped doing obstetrics because of malpractice concerns
In 2009 in 17 states liability premiums for OB/GYNs were more than $100,000 a year. In one state OB/GYNs pay > $200,000/year for malpractice insurance.
I have blogged before about how lawyers impact the c-section rate. How great men like *cough* honest John Edwards have made hundreds of millions of dollars from obsterics lawsuits.
I don’t know how to fix this. I don’t.
But it needs to be fixed.
Lawyers are changing the practice of medicine, and it’s wrong.
How do we fix it? Educating women on what biologically normal birth really looks like. Stop indoctrinating women into the idea that birth is a medical crisis waiting to happen. Demand access to (and coverage for) trained doulas and midwives. Start making midwives and OBs a continuum of care, not a rivalry.
Posted by C.Hamilton | August 14, 2011, 6:24 amthank you. Really great reply.
Posted by Laurie Donovan, LMFT, LCSW | November 10, 2011, 8:01 pma biologically normal birth looks like maternal death in 1-1.5% of all pregnancies, and many more poor fetal or neonatal outcomes.
Posted by GH | January 19, 2012, 9:14 pmNo, the maternal death rate with a vaginal delivery is not 1-1.5%.
Posted by Dr. Jen Gunter | January 21, 2012, 12:08 pmI think GH meant “normal” as in “in nature, without docs or technology”. THIS is what many NCB advocates talk about when they bag the drum of “normal”- not a VB, but a VB with zero tech, meds, etc.
Posted by Stacey Jw | February 12, 2012, 10:13 amYes, the WHO says that the “natural” maternal mortality rate is 1-1.5%. http://www.who.int/whr/2005/chap4-en.pdf
Posted by Becky | September 2, 2012, 7:12 pmWhy would I want a midwife when I can have an OB?
YOU might like MWs, but many moms don’t want them. They aren’t any more likely to make you deliver VB than not, it just seems that way because they are limited to low risk moms!
I’m tired of hearing that docs don’t see, or understand “normal” birth. Maybe it’s the natural childbirth advocates that really don’t get it.
Posted by Stacey Jw | February 12, 2012, 10:11 amHoly crap… I’ve known for a while that c-section rates were influenced by fear of litigation, but this is the first time I’ve seen numbers with direct links like this. It’s just scary…. Thanks for sharing.
Posted by Marcy | November 10, 2011, 6:38 pmIt’s a long time since the original post, but here’s another perspective. In my country (Slovakia), the rate of C-sections is up to 38% (March 2012), BUT doctor litigation is nearly unheard of. People see courts as ineffective against any personal injury and may go other routes (administrative complaints), but I have not heard of a single case when an OB/GYN was successfully sued for money. Another reason being, of course, that a majority of births take place in (state-owned) hospitals, so you’d basically have to go against the state.
The driving factor behind the high rate of C-sections is probably the women themselves. The assumptions are that they give birth at a higher age and so want to increase the chance that their (probably only) baby will be healthy; that they are afraid of the pain; and fear the risks associated with natural assisted birth, etc.
I know second hand, my wife gave birth by C-section because she assumed from the very start that she would have a “medical condition” for it. If you wish it hard enough, it becomes truth, especially when doctors are sympathetic.
I would have much rather tried it the natural way, but since I was not the one giving birth I backed down. I would not be surprised if this was the same case with many other women.
Sometimes I think that the struggle for perfection is crippling our society – we want everything to be perfect, but it just costs so much energy.
Posted by Tomas | June 24, 2012, 11:37 pmDr. Jen, great article. This is a poster for defensive medicine that is more than just a monetary cost. There’s no easy solution – though I have proposed a complete change in how the issue of malpractice is dealt with. I’m curious about Kaiser’s c-section rates, since Docs are shielded more from the lawsuits. Does a relative degree of malpractice protection affect rates?
–Dr. B
Posted by Dr. Brennuh (@irb123) | November 10, 2011, 6:57 pmHi, I’ve only just found your blog and this post, it’s very interesting how different things are in the US to here in the UK. 26% of obs won’t offer VBAC ! In the UK VBAC is very strongly pushed (excuse the pun) by most Obs and midwives (most people will see far more of midwives than doctors). After an emergency C-section I was told I’d be expected to try VBAC if I have another and would have to argue my case for an elective CS with the departments Psychiatrist on mental health grounds if I really wanted to go down that route.
I blogged about this recently and was speculating just today if the difference in opinion in the US v UK had anything to do with higher litigation rates in the US – I’ll link to this post!
Posted by Southwarkbelle (@SouthwarkBelle) | March 22, 2012, 8:27 am