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Many doctors will tell you that they are afraid of lawsuits and practice something called “defensive medicine.” Many believe that this fear causes doctors to perform more cesarean section deliveries than they otherwise should. A cesarean is a faster way to get a baby out of the womb, and should only be used when the baby is in danger, or a vaginal delivery is unwise.
At its core, defensive medicine occurs when doctors provide unnecessary medical care because they are scared of being sued. Perhaps this is true to a degree, but the safest course is always when doctors act according the standard of care that is set out by medical schools, professional associations and good, common practice.
Acting outside the standard of care by practicing defensive medicine can be worse malpractice than the lawsuit a doctor seeks to avoid. One recent article reports that “[w]orries 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.” It doesn’t make any sense—if vaginal delivery is safer, a doctor should permit a vaginal delivery. Failure to perform the safer option is usually malpractice.
Performing unnecessary procedures is also typically insurance fraud. A doctor or hospital that accepts payment from an insurance company for a procedure that is not medically indicated is likely breaching the terms of the agreement with the paying insurance company.
In an effort to badmouth victims of medical malpractice and to disparage lawyers, the article states that fear of lawsuits encourages cesarean sections, which infringes on the rights of the mother to choose the method of delivery. Under all states’ informed consent laws, a mother can refuse any medical treatment, including cesarean section. If a doctor is telling them a cesarean is safer, and if that statement is a lie, then informed consent has been breached even if the patient agrees to the procedure—this would be misinformed consent.
The real questions are whether vaginal deliveries are on the rise, and whether that rise is related to a fear of medical malpractice lawsuits. Certainly, most would agree that cesarean rates have increased over the years. The American College of Obstetricians and Gynecologists (ACOG), a professional organization of doctors, calculated that from 1970 to 2007, the rates of cesarean section increased from 5% to 31%. That’s a big jump.
But what other causes are there? Perhaps lawsuit avoidance is one cause, but medicine has changed a great deal in 37 years. Largely thanks to infertility treatments, birth of twins has jumped 76% from 1980 to 2009, and that says nothing about the numbers for triplets and higher multiple gestations (triplets and more). Women are having children later in life than they did in the 1970s, and as a result, there are more medical problems necessitating cesarean sections. Additionally, medicine is so advanced that many babies which might not make it to term are being nurtured and a cesarean may be the best means for delivery. Finally, electronic fetal monitoring is more advanced, and our understanding is such that, in many cases, a cesarean section is simply the right choice for the baby’s health, whereas in the 1970s, doctors did not have the same level of information.
Doctors performing more cesarean sections because of a concern about lawsuits are simply reacting to incomplete information, often propounded by insurance companies and anti-lawsuit groups. The reality is that, though cesarean sections have increased over the past 40 years, there is no indication that the great majority of these surgeries are unnecessary. If you have questions about whether a doctor should have ordered a cesarean section for you, call us at (440) 252-4399 or online for a free consultation.
