Litigation in obstetrics: does defensive medicine contribute to increases in cesarean delivery?
OBJECTIVE
Obstetrics is one of the most sued subspecialties in the US. This study aimed to examine clinicians' medical-legal experience and its association with recommending cesarean delivery.


METHODS
Cross-sectional convenience survey.


METHODS
This is a survey study of clinicians in the US.


METHODS
Survey included eight common obstetric clinical vignettes and 27 questions regarding clinicians' practice environment. Chi-square test, multivariable logistic regression models were used for statistical comparisons.


METHODS
Likelihood of recommending cesarean delivery.


RESULTS
There were 1486 clinicians who completed the survey. Clinicians were categorized based on answers to clinical vignettes. Having had lawsuits and daily worry of suits were associated with higher likelihood of recommending cesarean, compared to those without lawsuits (17.2 versus 11.3%, respectively; p = 0.008) as was frequent worry of lawsuits (every day, 20.3% more likely; every week/month, 12.3%; few times a year/never, 11.4%, p < 0.001).


CONCLUSIONS
Obstetric malpractice lawsuit and frequent worry about lawsuit are associated with higher propensity of recommending cesarean delivery in common obstetric settings.
Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California , San Francisco, CA , USA .
Yvonne W
YW
Cheng
Jonathan M
JM
Snowden
Stephanie J
SJ
Handler
Ira B
IB
Tager
Alan E
AE
Hubbard
Aaron B
AB
Caughey
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003675:Defensive Medicine / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D055815:Young Adult
Cesarean; clinician characteristics; litigation