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The Business of BirthMalpractice and Maternity Care in the United States$
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Louise Marie Roth

Print publication date: 2021

Print ISBN-13: 9781479812257

Published to NYU Press Scholarship Online: September 2021

DOI: 10.18574/nyu/9781479812257.001.0001

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PRINTED FROM NYU Press SCHOLARSHIP ONLINE (www.nyu.universitypressscholarship.com). (c) Copyright University of NYU Press, 2022. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in NYSO for personal use.date: 17 May 2022

If in Doubt, Cut It Out

If in Doubt, Cut It Out

Malpractice and Cesareans

Chapter:
(p.150) 6 If in Doubt, Cut It Out
Source:
The Business of Birth
Author(s):

Louise Marie Roth

Publisher:
NYU Press
DOI:10.18574/nyu/9781479812257.003.0007

This chapter examines the effects of malpractice on cesarean deliveries in light of historical trends and changes in the standard of care. Nearly one third of births in the US involve a cesarean delivery, and cesareans are usually the first thing that people think about when they think about defensive obstetric medicine. While some popular accounts attribute the rise in cesareans to women’s requests, most maternity care providers and public health experts are skeptical of the idea that “choice” is driving the trend. This chapter highlights the ways that providers respond to three types of risk when they do cesarean deliveries: medical risk, iatrogenic risk, and legal risk. A culture of malpractice fear encourages obstetricians to prioritize legal risk, and they know that patients are more likely to sue them for not doing a cesarean than for doing an unnecessary one. Providers also described expedience, organizational efficiency, and changes in medical training as important causes of medically questionable cesareans. Analyses reveal that the odds of a cesarean are higher in states where providers face more liability risk, but the effect is extremely small. Professional guidelines, which changed over time, also mediate this effect.

Keywords:   Cesarean, VBAC, Risk, Malpractice, Defensive medicine

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