Fear of litigation and cesarean section rates

Semin Perinatol. 2012 Oct;36(5):390-4. doi: 10.1053/j.semperi.2012.04.025.


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.

Publication types

  • Review

MeSH terms

  • Cesarean Section / legislation & jurisprudence*
  • Cesarean Section / statistics & numerical data
  • Defensive Medicine*
  • Female
  • Humans
  • Malpractice / legislation & jurisprudence*
  • Obstetrics / legislation & jurisprudence*
  • Physicians / legislation & jurisprudence
  • Pregnancy
  • Risk