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Do Doctors Really Know Best? How Your OB/GYN's Fear of Malpractice Can Affect Your Healthcare
Do Doctors Really Know Best? How Your OB/GYN's Fear of Malpractice Can Affect Your Healthcare
their patients something blatantly untrue. And one major study reported that litigation pressure -that is, the thread of being sued -- does not make doctors deliver healthier babies.
What's even worse, in some cases, is that the threat actually prompts doctors to stop delivering
babies. In a survey of 5,644 OB/GYNs conducted by the American Congress of Obstetricians and
Gynecologists (ACOG), the largest professional organization of OB/GYNs in the United States, 8
percent had stopped practicing obstetrics in the past three years because of litigation fears, high
insurance premiums, or insurance unavailability. Though premium costs vary by region based on
state laws and litigation risk, they can be as much as $200,000 a year.
In 2006, after 36 years of practice, Jay Trabin, an OB/GYN based in West Palm Beach, Florida, gave
up his obstetrics practice to focus exclusively on gynecological services. "After a while, a doctor
starts saying to himself, 'Why am I doing this?'" he explains. "I loved obstetrics - I delivered well over
5,000 babies. But it became such that there was so much worry involved, and the malpractice
insurance was so expensive, I just couldn't do it anymore." It's not just individual doctors, either. In
2008, Long Island College Hospital, which is located several miles from my home in Brooklyn,
announced that it was closing its obstetrics ward because of prohibitively high insurance premiums.
The hospital was ultimately able to stay open only after a merger deal with SUNY Downstate
Medical Center.
Liability concerns and high insurance costs may also scare medical students away from choosing
obstetrics as a specialty. "It's definitely something that people consider when they're choosing what
field to go into," Keller says. Trabin agrees. "It's common to see young doctors, highly skilled, simply
opt not to do obstetrics for these reasons," he says.
The allure of surgery
In the 1960s, less than 5 percent of all U.S. births were by Cesarean section. In 2007, 31.8 percent
of them were. Yet "the U.S. doesn't have better outcomes than other countries that have lower Csection rates," says Janet Currie, Ph.D., director of the Center for Health and Well-Being at
Princeton University. American women are four times more likely to die during or immediately after
pregnancy than are women in Scandinavia, Japan, Ireland, and Slovakia, among other countries. So
why are doctors performing C-sections if they're not saving lives?
Related: 7 things you should NEVER say to the mom of a newborn
Fear of being sued may be part of it. Multiple studies, including one published in 2007 by
Northwestern University researchers, have reported that Cesarean rates are higher in states where
doctors face high malpractice pressure. In addition, 29 percent of OB/GYNs who completed the 2009
ACOG survey admitted that malpractice fears caused them to turn more frequently to surgery.
In some ways, it makes sense. Doctors can protect themselves in court by demonstrating that they
took action to save or protect a baby who was ultimately harmed. A lawyer or judge might ask, "Did
you do everything that you could have done? Did you err on the side of getting that baby out?"
explains Carol Sakala, PhD, MSPH, director of programs at Childbirth Connection, a non-profit
organization that promotes informed decision-making in maternity care. If doctors can show that
they took special action -- by, say, performing surgery -- they may ultimately escape blame.
According to a survey of 1,573 new mothers conducted by the Childbirth Connection in 2006, a
quarter of women who had C-sections felt pressured by their doctors to do so.
A routine blood draw early in my pregnancy revealed that I had low levels of a protein called
The problem, of course, is that repeat C-sections are often riskier than the alternative. "Many
doctors are afraid because of that very teeny-tiny percentage of women who have uterine ruptures,
so they go ahead and schedule another C-section," says Michele Deck, RN, a nurse and president of
Lamaze International, a non-profit organization that promotes a natural, healthy, and safe approach
to pregnancy. "But what they don't look at is the evidence of what that [surgery] does to a mother's
body and her uterus, and what risk that poses for her second, third, or fourth birth." For instance,
according to a 2006 study of 30,132 women published in Obstetrics and Gynecology, the risk of
hysterectomy, bowel injury, blood transfusion, and ICU admission all increase with each subsequent
C-section.
More than malpractice
C-sections are more common today for many reasons -- not just as a response to litigation pressure.
Women are having children later in life, when complications that ultimately require surgery are
more likely to occur. Some women actually ask for C-sections now because they can be scheduled.
And surgeries are convenient -- and lucrative -- for doctors, too: Not only do they take less time,
allowing OBs to deliver more babies in a year than they would vaginally, but most doctors are also
reimbursed at a higher rate for C-sections than they are for vaginal births.
The bottom line is that doctors' decisions are shaped by myriad factors, many of which align with
patients' best interests, but some of which may not. All obstetricians do ultimately want to deliver
safe and healthy babies, but the choices they make in pursuit of that goal may not always be the
most medically sound. I have suspicions -- particularly after talking to several other OBs -- that some
of the decisions my doctor made were defensive, but I know that ultimately, things turned out well.
In other words, I'm not really in a position to complain.
But there are things that can be done to improve the current situation. Read what Melinda suggests
on Babble.
http://www.huffingtonpost.com/babblecom/how-obgyns-fear-of-malpractice-can-affect-healthcare_b_1
590618.html