Change in cesarean section rate as a reflection of the present malpractice crisis

To examine the potential effect of the malpractice crisis on the cesarean section rates of practicing obstetricians.

We reviewed the medical records of primagravid women, from both clinic and private practice settings, having singleton deliveries at Hartford Hospital from 1994 to 2003. The records of cesarean sections due to fetal distress and cephalopelvic disproportion (CPD) were further analyzed for three different two-year periods; 1994-1995, 1999-2000, and 2002-2003. Cases with accepted indications for elective cesarean sections were excluded. These included breech position, HIV, herpes, preeclampsia, placenta previa, and abruptio placenta.

The private cesarean rate in 1994-1995 was 15.6%, 1999-2000 15.7%, and in 2002-2003 24.8%, a 58% increase. This is a significant increase that was not equally seen in the clinic population during the same period.

The private, primagravid cesarean section rate has increased significantly in the last two years. A concurrent rise in medical malpractice actions and malpractice insurance premiums, without other attributable explanations, suggests this may be a major factor.