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.
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