Fear of litigation and cesarean section rates

Both the rates of cesarean section and the rates and payouts from obstetrical malpractice suits have risen in past decades, albeit not always in tandem. A great deal of evidence suggests that physicians practice defensive medicine, and many obstetricians acknowledge that a more liberal recourse to cesarean section is one such behavior in which they sometimes engage. However the degree to which fear of litigation actually is a contributor to, or perhaps even a driver of, the rising cesarean section rate is not as clearly known. In this article I will discuss the research that has been performed that attempts to epidemiologically assess the link between lawsuits, malpractice premiums and cesarean section rates. I will also consider factors beyond dollars and cents (e.g., cognitive biases, changing risk tolerance of doctors and patients) that may lie at the base of the relationship. Finally I will offer a brief discussion of how professional ethics should inform the actions that physicians take in these difficult circumstances.