C-section rates and its association with lawsuits

The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news.

Why is the C-section rate sky high?

The pervasive nature of the increase may hold some clues. The increase has been remarkably consistent across all possible variables. The C-section rate increased among all races. It increased in all maternal age groups. It increased at every gestational age, and it increased in all 50 states. The global nature of the increase suggests that it is due to a global factor, rather than the increase in a particular diagnosis a dramatic change in specific risk factors. Like many obstetricians, I suspect that the rising C-section rate is driven by liability concerns.

It’s true that there is no correlation between numbers of lawsuits and the C-section rate. In addition, there is no correlation between the size of monetary awards and the C-section rate. There is a correlation between malpractice premiums and the C-section rate, but the association is not dramatic. So how could the C-section rate be tied to liability concerns?

The assumption behind searching for a correlation between C-section rate and malpractice lawsuits or monetary awards is that as the rate or payout of lawsuits rises, obstetricians will be reminded that they are at risk of being sued. However, if every obstetrician expects to be sued, the increasing rate of suits or payouts will be irrelevant. At this point, every obstetrician expects to be sued at least once in a professional lifetime.

According to Victoria Green, MD, JD author of the chapter Liability in Obstetrics and Gynecology in the textbook Legal Medicine:

Nearly 77% of obstetrician/gynecologists have been sued at least once in their career and almost half have been sued three or more times. Moreover, virtually one-third of residents will be sued during their residency. Fear of malpractice, in general, may cause physicians to order more tests than medically necessary, refer patients to specialists, and suggest invasive procedures to confirm diagnoses more often than needed. Nearly 40% may prescribe more medications than medically necessary due to concerns of legal liability. The public has responded by escalating the “punishment” associated with malpractice claims where multimillion-dollar jury awards are commonplace.

When obstetricians expect to be sued, it no longer matters how many other suits are filed, how high the monetary judgments are, or even whether malpractice premiums are rising. The only consideration when a lawsuit is inevitable is how to successfully defend oneself.

Consider the most common reasons for an obstetrics lawsuit. The paper Liability in High Risk Obstetrics explains the most common causes. Although the paper concentrates on high risk obstetrics (perinatology), the results appear to be generalizable to obstetrics as a whole. According to the paper’s author James L. Schwayder, MD, JD, obstetric lawsuits center on errors of omission or commission. The most common alleged errors are:

1. Errors or omission in antenatal screening and diagnosis
2. Errors in ultrasound diagnosis
3. The neurologically impaired infant
4. Neonatal encephalopathy
5. Stillborn or neonatal death
6. Shoulder dystocia, with either brachial plexus injury or hypoxic injury
7. Vaginal birth after cesarean section
8. Operative vaginal delivery
9. Training programs (Resident supervision markedly impacts litigation exposure. Increased used of nurse midwives and nurse practitioners may increase ones liability exposure.)

Of the 9 most common reasons for obstetric malpractice suits, 6 (#3-#8) allege failure to perform a C-section or failure to perform a C-section sooner. In other words, performing a C-section when there is any doubt about the baby’s health, or even before there is any doubt, will virtually eliminate the chance of being sued successfully in connection with the delivery; it might even make a lawsuit less likely if the plaintiff cannot argue that a C-section should have been performed.

Most of these potential complications are equally distributed across maternal age, maternal race, gestational age, and state of residence, leading to a rising C-section rate across all demographics. The skyrocketing rate is being driven by an attempt to defend or potentially avoid lawsuits, since the majority of lawsuits allege failure to perform a C-section or to perform a C-section sooner. An ever increasing C-section rate is the inevitable result.

The C-section rate is skyrocketing primarily for non-medical reasons. While doctors blame the tort system as the proximate cause, the fundamental cause rests with patients, not lawyers or insurance companies. The fundamental cause is an inability to tolerate any risk to a newborn. In the current legal climate, there is no possible justification for not doing a C-section, regardless of how tiny the risk posed by vaginal delivery may be. Unless and until people stop penalizing doctors for not doing C-sections, they will continue to do them in ever increasing numbers. They really have no choice. You cannot say to obstetricians, “Give me a perfect baby or I will sue you for failure to perform a C-section” and then express shock and dismay that obstetricians will perform C-sections in order to guarantee that you will have a perfect baby.

The sky high C-section rate all too predictable result of parental expectations. As long as parents continue to sue for failure to perform a C-section, the C-section rate will continue to rise.

Amy Tuteur is an obstetrician-gynecologist who blogs at The Skeptical OB.

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  • jsmith

    Well said Dr. Tuteur. My wife had two C-sections with two perfect babies being the outcome. We have no complaints about the C-sections.
    Parental/societal expectations are driving the C-section rates. I for one don’t worry about the sections. You want perfect babies, you pay the price.
    Putting the obstetricians in a Catch 22 is an absurd yet entirely typical course of action in the US of A. And of course the ones who might benefit from lower rates are perfectly happy to put all the risk on you all.
    At bottom, society gets from its docs what its actions, not its words, tell us to do. In this case society has made its decision.

  • Chris

    YES!!!!!!!!!!!!!!
    I am a practicing Ob/Gyn.
    I could not agree with you more. You summed it up perfectly….
    You cannot say to obstetricians, “Give me a perfect baby or I will sue you for failure to perform a C-section” and then express shock and dismay that obstetricians will perform C-sections in order to guarantee that you will have a perfect baby

  • PJT

    >>The global nature of the increase suggests that it is due to a global factor, rather than the increase in a particular diagnosis a dramatic change in specific risk factors.>>

    Sure. I’ll agree with that.

    >>Like many obstetricians, I suspect that the rising C-section rate is driven by liability concerns.>>

    That’s one theory, but liability concerns are far from the only global factor possibly responsible.

    >>It’s true that there is no correlation between numbers of lawsuits and the C-section rate. In addition, there is no correlation between the size of monetary awards and the C-section rate.>>

    Unless I misunderstand, the C-section rate may be based on fear of lawsuits, which have actually neither increased in numbers nor in size of monetary awards, correct?

    Fear is an emotional response, and it’s not always entirely based in fact – as in this case. Perhaps the rising C-section rate as a result of fear of lawsuits is actually due to a rise in the proportion of female OB/GYNs currently working in the field? After all, women in general (though certainly not all) are far more likely than men in general to respond to threatening situations emotionally, rather than logically.

    Just a thought.

  • http://www.skepticalob.com Amy Tuteur, MD

    “Unless I misunderstand, the C-section rate may be based on fear of lawsuits, which have actually neither increased in numbers nor in size of monetary awards, correct?”

    No, I’m not referring to the overall US rate of lawsuits or the overall size of American legal awards. I’m talking about the studies that have looked at the differences between particular states.

    The studies that have looked at the impact of numbers of lawsuits or size of awards find no correlation between the lawsuit profile in a particular state and its C-section rate. The theory behind such studies is that fear of lawsuits is correlated with what is going on in the obstetrician’s state. The unstated assumption is that obstetricians judge their risk of being sued based on the rate of lawsuits in their state.

    That assumption is wrong because most obstetricians believe that their lifetime risk of being sued is 100%. So the rate in their particular state is irrelevant. The average size of awards is entirely irrelevant because they fear being sued, not losing the suit, and not the size of the judgment.

  • Clare

    One can obtain quality care and reduce the risk of a c-section by choosing a midwife for delivery.

  • http://blog.jayparkinsonmd.com Jay Parkinson

    Another question…have successful birth outcomes improved 50% since 1996?

  • Chris

    PJT,
    Just to be clear, are you for real with your last paragraph?
    Increased c-section rate due to increasing number of female physicians?

    Just want to be sure you meant that before addressing how insane that statement is.

    BTW I’m a male.

  • http://blog.jayparkinsonmd.com Jay Parkinson

    Excellent post. However, the other side of the argument is missing. OB/GYNs are paid more for C-sections.

    As physicians, we’re going to have to be up front with the general public about the conflict of interest we’re in– the more we do, the more we get paid. Is this a moral business model that maximizes “do no harm” and one we’d like to embrace? Or is this the business model that’s always existed? Shouldn’t we advocate for a new business model to get paid for doing what’s right for our patients, not what’s best for our profitability?

    None of these issues will change unless both doctors and patients want them to change.

  • http://www.litigationandtrial.com Max Kennerly

    Your argument presumes that the past rate of C-sections was the appropriate rate and that any higher rate is inherently too high.

    Isn’t it equally plausible that, in the past, too few C-sections were performed?

  • Dr. Jerry

    Insightful. Thank you. Some might say that it is shocking that physicians in the U.S. have not been convinced by the lawyers and parents, that the appropriate way to “virtually eliminate the chance of being sued successfully in connection with the delivery” is to have a hospital CS rate of 100%.

  • http://www.skepticalob.com Amy Tuteur, MD

    “Isn’t it equally plausible that, in the past, too few C-sections were performed?”

    Not likely.

    We would expect that C-sections, like any intervention intended to save lives, would adhere to the law of diminishing returns. In the case of Cesarean sections, the law of diminishing returns would predict that there will be a point beyond which each addition increase in C-section rate yields smaller and smaller decreases in neonatal mortality rate.

    At low C-section rates (1-5%) virtually every C-section is lifesaving. Above that rate, some C-sections will turn out to be unnecessary, but only in retrospect. The fact is that as the C-section rate rises to approximately 20%, the perinatal mortality rate falls in concert. However, going from a C-section rate of 5% to 6% yields a larger decrease in perinatal mortality than going from a C-section rate of 19% to 20%. As the law of diminishing returns implies, as the C-section rate rises, the perinatal mortality rate will asymptotically approach zero. Indeed, if you graph the American C-section rate against maternal mortality, you will find that the C-section rate has risen dramatically since 1995 with virtually no decrease in the neonatal mortality rate.

    The law of diminishing returns predicts that as we approach zero perinatal mortality, we will do more and more unnecessary (in retrospect) C-sections for each life that we save. At some point, the risks to the mother from surgery will begin to exceed the chance of saving a perinatal life.

    I suspect that we are rapidly approaching, or have already exceed a C-section rate that saves the maximum number of perinatal lives while at the same time minimizing serious maternal morbidity or even death.

    Yet our legal system takes none of this into account. The only consideration in a lawsuit is whether a C-section in this particular case MIGHT have saved a baby’s life.

    • Jerry

      Brazilian studies may not apply, but they have reported CS rates of 85% without a measurable effect on maternal mortality. The private patients get elective CS and the uninsured patients get vaginal births, so it is a skewed statistic. The private patients also do not tend to have large families, so the issue with repeat CS complications that enter into the picture when 3 or 4 previous CS have been performed, do not apply.

      What I have not been able to find is anything that demonstrates a difference in Brazilian law suits for performing an elective or elective repeat CS.

    • http://www.litigationandtrial.com Max Kennerly

      Thanks for the reply.

      Could you send some links to the mortality / C-section studies?

      More importantly, mortality isn’t the big question here, it’s morbidity. The “worst” (i.e., most financial liability) claim against an OB is that the OB failed to recognize / treat fetal distress, leading to hypoxia-ischemia, leading to cerebral palsy etc and a lifetime of care needs.

      If the morbidity rate has continued to fall as C-sections have gone up, then we’re having a different debate. We’re not debating ‘useless’ procedures, we’re debating one set of risks (the risks of delaying C-section under dangerous conditions, which include severe morbidities) versus another set of risks (the risks or dangers of C-section, which are minimal).

      Finally, the legal system asks more than if a C-section “might” have helped. That’s one question asked. Another question asked is if a C-section would have been the standard of care; if not, then there is no liability.

  • PJT

    >>No, I’m not referring to the overall US rate of lawsuits

    So, just to be clear, the overall U.S. rate of lawsuits is increasing? Can you give some actual figures over the last 20 years or so?

    >>That assumption is wrong because most obstetricians believe that their lifetime risk of being sued is 100%. So the rate in their particular state is irrelevant. The average size of awards is entirely irrelevant because they fear being sued, not losing the suit, and not the size of the judgment.>>

    Are these fears accurate or based in fact?

    >>Increased c-section rate due to increasing number of female physicians?…Just want to be sure you meant that before addressing how insane that statement is.>>

    Yes, that’s exactly what I meant. I don’t think there’s any dispute re: increasing numbers of female and decreasing numbers of male OB/GYNs over the last 20 years or so. I’m waiting for clarification on whether OB/GYNs’ fear of lawsuits is based in reality or not.

  • http://www.skepticalob.com Amy Tuteur, MD

    “OB/GYNs are paid more for C-sections.”

    Actually, most obstetricians do NOT get paid more for C-sections. In many states, obstetricians are reimbursed with a global fee covering all prenatal visits and the delivery. There is no difference in reimbursement for vaginal deliveries and C-sections. Moreover, a substantial proportion of obstetricians are salaried and therefore have no economic incentive to perform C-sections.

  • http://www.skepticalob.com Amy Tuteur, MD

    “More importantly, mortality isn’t the big question here, it’s morbidity.”

    No, that’s my point. Morbidity is only relevant if you are concerned about the size of the award. No doubt morbidity is a big issue for malpractice insurers because it means larger awards than a neonatal death.

    Obstetricians are worried about being sued, not whether they win or lose, and not the size of the award. Their behavior is determined by efforts to avoid being sued. Every obstetrician is well aware of the most important rule of malpractice suits: you can’t be sued for a good outcome.

    The critical thing to remember about intrapartum care is that we have no foolproof way of assessing fetal well being. All our tests (especially fetal monitoring) have low false negative rates, but very high false positive rates. Any obstetrician looking at a worrisome fetal monitor strip is well aware that the odds are high that the baby is fine despite the abnormal tracing. But no obstetrician can be SURE that the baby is fine if the strip is worrisome.

    There’s more at stake here than just the obstetrician’s liability. The health and wellbeing of the baby are at stake. What would you do when faced with even a small possibility that a baby might be rendered brain damaged by a wait and see approach? Would you wait and see? Or would you opt to perform a C-section to reduce any possibility of brain damage or death?

    • http://www.litigationandtrial.com Max Kennerly

      The health and wellbeing of the baby are at stake. What would you do when faced with even a small possibility that a baby might be rendered brain damaged by a wait and see approach? Would you wait and see? Or would you opt to perform a C-section to reduce any possibility of brain damage or death?

      That’s precisely my point. In the absence of data showing a genuine and unreasonable harm, we shouldn’t complain about rising C-section rates. We should be glad that OBs are being more cautious and diligent and thereby preventing serious morbidities. If liability concerns are what made them do it, then we should be glad for that, too.

  • PAUL MD

    Statistics are nice. Math guys and actuarialls love em. Here’s the deal as it was stated previously. Fear is EMOTIONAL. FEAR influences actions.

    When I go to the beach in Rockport, MA to body surf and play all day in the waves I have fear. I am competent in the water as a strong swimmer, kayaker ,scuba diver and former lobster diver. My education is deeply founded in marine biology and aquatics of other disciplines. Statistically, I should be fearing drowning, sunburn, boating accident, microbial disease, sand rash and lice…in that order.

    What do I really fear? You know. We all know. SHARK ATTACK! Rare but devastating and consumes a disproportionate amount of our currency of situational fear at the beach…yet there it is.

    The fear of being “eaten” is primordial. The social/legal equivalent of being “eaten” is being personally, professionally and financially eviscerated at a malpractice trial.

    Doctors will do as others and protect themselves from the “sharks” of the legal world and the public that calls upon them to seek their…”justice”.

    Look at the case of the OB-GYN residents at the Brigham in Boston. Somewhere in the area of $22,000,000 decision against them. I’m sure they are not “taking it personally”.

    I would find it hard to believe that the difference in reimbursement between C-section and NSVD would drive OB-GYNs to favor one over the other. My bet is that the far better proportion of the drive to C-section is due to medical appropriateness as well as the fins on the water.

    I also provide pivotal surgical procedures that have significant outcomes for better or worse. It’s hard sometimes not to feel like a survivor of the sinking of the USS Indianapolis.

    So please, play with your statistics…”crunch the numbers”, make a graph if it gives you something to present to your bosses. Unless you are bringing a solution to the table, or until you are walking in the shoes of a practicing OB-GYN, please just shut up.

    By the way, before I boil over. In my state, “standard of care” can be trumped by the legal concept of “loss of opportunity”.
    “Dr. Jones, the deceased victim of your negligence died of sepsis at you hands. We agree with the defense that the antibiotics you chose to administer to the deceased victim were considered ‘within the care standards’ for the treatment of the causative organism. However, there were other antibiotic choices that were also considered standard of care that MAY have given the patient a better “opportunity” for a better outcome. Our client therefore suffered a loss of opportunity for a better outcome because of your perfectly appropriate decision making within the confines of the once noble “standard of care”.

    We have nothing to apologize for.

  • dud

    Does this study normalize for premature births? Are there more babies being born now than in the mid 90′s who are 32 weeks or earlier? Aren’t the vast majority (if not all) premies at that stage delivered via c-section?
    Also, are there more multiples now versus then. It seems there is a fertility add in my newspaper every day now. (I’m very fine with that, by the way)
    It would seem the best way to analyze would be to examine “low risk” at term deliveries now versus then and see if there is the increase in section rates.

  • PJT

    >>Statistics are nice. Math guys and actuarialls love em. Here’s the deal as it was stated previously. Fear is EMOTIONAL. FEAR influences actions.>>

    Yes, that’s all true.

    The question remains: if the U.S. overall rate of lawsuits against OB/GYNs has not increased (I don’t know if that’s true or not, and am awaiting figures), why are OB/GYNs in 2010 exhibiting much greater fear of lawsuits by performing C-sections at a much higher rate vs. 1990?

    If this fear is not rational, one possible explanation would be differences in the demographics of the current population of practicing OB/GYNs causing the 2010 population to be more afraid of malpractice lawsuits vs. their 1990 counterparts. Differences like gender, for example.

  • mitchsmom

    Even assuming all this is true… we have to remember that in order to have a lawsuit, there generally has to be a bad outcome. What is causing the bad outcome in the first place? It’s NOT failure to do a c/s – that is secondary in order to “rescue” the already failing situation.

    Many times, we are the real cause when we do too many interventional births, i.e. elective induction, pitting to distress (made worse by early AROM), etc. etc… the snowball effect that everyone who works in OB (and many who don’t) know about and see every day.

    Although often, I don’t think the practitioners are always to blame for these interventions, however.

    I think a big contributing factor, that I think would probably correlate with the “global nature of the increase” is the epidemic obesity that has ALSO been growing during the same time frame. This results in patients with chronic htn (which seems likely to turn into preeclampsia), diabetes (macrosomic baby = c/s (and let’s not forget that NICU stay!), etc. etc.

    Add in no VBAC’s, and there ya go => cesarean city.

  • PJT

    >>What is causing the bad outcome in the first place? It’s NOT failure to do a c/s – that is secondary in order to “rescue” the already failing situation.>>

    Yes, that’s probably true in the vast majority of cases.

    >>Many times, we are the real cause when we do too many interventional births, i.e. elective induction, pitting to distress (made worse by early AROM), etc. etc… the snowball effect that everyone who works in OB (and many who don’t) know about and see every day.>>

    Then there are increased numbers of older mothers, increased rates of fertility treatments, increased numbers of multiple births, etc.. The list goes on, and it’s interesting to look at patients’ demographics, but the OP piqued my interest in physicians’ demographics and how this affects physicians’ behavior.

    >>Although often, I don’t think the practitioners are always to blame for these interventions, however.>>

    No, and I think practitioners frequently fight an uphill battle explaining “more” is not always “better”.

    >>I think a big contributing factor, that I think would probably correlate with the “global nature of the increase” is the epidemic obesity that has ALSO been growing during the same time frame.>>

    I’d guess obese patients are also at higher risk of complications following abdominal surgery. I’d also guess C-section in an obese patient is more technically challenging.

    But the OP seemed to be saying that if the rate of patients’ lawsuits against OB/GYNs suddenly dropped to zero, the rate of C-sections would also drop precipitously. Since that’s never going to happen, if the fears of OB/GYNs are not based in fact, I think it’s important to consider why the population of OB/GYNs currently practicing is apparently much less risk-tolerant than those practicing 10 or 20 years ago.

  • ls

    It’s not fear of lawsuits that triggers the rise in c-sections but rather the incentives of the lawsuits. I assert that given that potential malpractice awards may be in tens of millions, there is no level of acceptable risk to some poor shlub of an ob-gyn to wait and see on a borderline lab result, tracing, or medium risk pregnancy when they may be on the hook for several million dollars after their insurance pays out. And since the only defensible tactic is to perform a c-section, the rate of c-sections will only rise. And this trend will eventually eat it’s way into nurse midwife business as well. When the Commonwealth of Pennsylvania eventually makes a law that nurse midwives, PAs, and nurse practitioners contribute to the state’s catastrophic trust fund and carry a million dollars in liability insurance we’ll see how many home birthings there are.

  • Matt

    ” In my state, “standard of care” can be trumped by the legal concept of “loss of opportunity”.”

    Paul, you’re mixing and matching concepts. Standard of care remains the standard for establishing negligence. Loss of opportunity may refer to a type of damages, but the standard dictates negligence.

    As to your fears, that’s all well and good. But should we change things solely because of an irrational response to an irrational fear?

  • PJT

    >>It’s not fear of lawsuits that triggers the rise in c-sections but rather the incentives of the lawsuits. I assert that given that potential malpractice awards may be in tens of millions, there is no level of acceptable risk >>

    So, you’re saying if the number of lawsuits remained the same but damages were capped, the number of C-sections performed would be reduced markedly?

    This contradicts the OP: “it no longer matters how many other suits are filed, how high the monetary judgments are, or even whether malpractice premiums are rising.”

    • ls

      It won’t matter, because only the non-economic damages are capped. Even economic damages can still be well into the millions.

      • Matt

        So why arbitrarily cap the noneconomic damages if that doesn’t achieve the goal of reducing costs or reducing C-sections or increasing access?

  • http://www.skepticalob.com Amy Tuteur, MD

    “t no longer matters how many other suits are filed, how high the monetary judgments are, or even whether malpractice premiums are rising.”

    What matters is to obstetricians is the lifetime risk of being sued and that is approaching 100%.

    For obstetricians it is not a matter of IF you are sued, but how you will defend yourself WHEN you are sued. Even better, from the obstetrician’s point of view is to preempt the possibility of a lawsuit by performing a C-section at the drop of a hat. That deprives plaintiffs of the most common reason for obstetric malpractice suits.

    You cannot say to an obstetrician: “Give me a perfect baby or I will claim that you should have performed a C-section, and then be surprised that obstetricians perform lots of C-sections.

  • PJT

    >>What matters is to obstetricians is the lifetime risk of being sued and that is approaching 100%.>>

    Has the actual number of lawsuits in the U.S. risen over the last 20 years or not? If the actual number of lawsuits has not risen, is it spread more evenly amongst all OB/GYNs vs. 20 years ago?

    It’s not possible to determine whether this fear of lawsuits is based in fact or not without further information.

  • PJT

    >>So why arbitrarily cap the noneconomic damages if that doesn’t achieve the goal of reducing costs or reducing C-sections or increasing access?>>

    What if the goal of those who advocate capping non-economic damages is NOT decreasing the number of C-sections or cost reduction? Certainly, there may be other possible motives for capping damages.

  • http://www.skepticalob.com Amy Tuteur, MD

    What mystifies me is how people can accuse obstetricians of performing C-sections for extra money (a pittance, if anything) and saving time, while simultaneously insisting that obstetricians are not performing C-sections for fear of lawsuits potentially costing millions of dollars, consuming countless hours, and possibly ruining a professional reputation.

    If you think an obstetrician would be inclined to perform a C-section to make an additional $250, why wouldn’t you think that he or she would be far more inclined to perform a C-section to save $5 million dollars?

  • PAUL MD

    @Matt,
    So sorry for mismatching my concepts. You are both right and wrong in your facts. The standard of care has horizontal measures of acceptable standards. In some, if not many, if not all decision tree circumstances in medicine there are other ways to skin the cat. So, you see, if the standard of care you implemented resulted in “damages”, you chose the wrong standard of care….in this particular case.

    Result for physician is same. Call it what you want…lipstick on a pig and all that. I am just contributing my thoughts to a reality that many of us deal with on a daily basis.

    Regarding the “caps” that you are so fond of. Maybe there should be no caps at all. Let’s be realistic about what Malpractice is in..legal practice. It is a bad outcome and a calculated cost to defend, percentage of risk to lose case and estimated risk of loss amounts. When malpractice is really a screw up or malice then we can talk about no caps. As long as malpractice equates to bad outcome, it is essentially “bad outcome insurance” and we cannot guarantee success, so then it is another day in the legal meat grinder.

  • Matt

    “As long as malpractice equates to bad outcome,”

    If this were true, you would be right. But alas, it’s not. Now, having a bad outcome is a necessary element, true, because you can’t have a malpractice suit without damages.

    “So, you see, if the standard of care you implemented resulted in “damages”, you chose the wrong standard of care….in this particular case.”

    Again, you’re still mistaken in your concepts.

    As to your perception of reality, it remains purely your perception. Not the actual reality.

  • PJT

    >>If this were true, you would be right. But alas, it’s not. Now, having a bad outcome is a necessary element, true, because you can’t have a malpractice suit without damages.>>

    It is my understanding that in medicine there are many more bad outcomes than malpractice suits, including a number of bad outcomes that occurred as a result of actual malpractice.

  • Cynthia

    I had my last child in 2007 at the age of 42. She was delivered by c-section. I had 3 children previously all vaginal births. Any person that would opt for this delivery method when not medically required needs a mental evaluation. The recovery from natural birth is a million times easier and way less painful. Women should not be put through this hell unless it is actually needed. I am not saying some c-sections are not prudent. However, if the main reason is liability I consider this medically induced torture. Just wanted to let everyone know if there is an option- vaginal birth is definitely preferred. As for men speaking about their satisfaction with c-sections, I do not think they can conceive of what their wives actually experienced.