Malpractice Premiums, Rate of C-Sections Rise Together

MONDAY May 5, 2008 -- As medical malpractice premiums increase, so do the rates of Caesarean sections, new research shows.

The study provides a small snapshot of the association, drawing on data from the University of Connecticut Health Center in Farmington. The findings, while not national in scope, could further fuel the debate about whether higher malpractice rates boost the C-section rates, or visa versa.

"When I compared the malpractice rates to C-section rates prior to 1999, both were declining at a similar rate," says study author Dr. Jeffrey V. Spencer, a maternal-fetal medicine fellow at UConn. From 1999 to 2005, however, both were increasing.

The study was scheduled to be presented Monday at the American College of Obstetricians and Gynecologists annual meeting, in New Orleans.

Spencer and his team reviewed the center's perinatal database from 1991 to 2005, noting how many vaginal deliveries and how many C-sections took place. They got the average malpractice rates from the primary carrier at their institution and adjusted them for inflation over the years.

"I can't say one led to the other or vice-versa," Spencer said. But he speculates the medical malpractice rates are driving up the C-section rates. "The theory is, doctors are practicing more defensive medicine. Maybe doctors are fearful of litigation,'' he added, perhaps likely to decide on a C-section at the first sign of any potential problems.

In all, 23 percent (15,021) of the 64,767 deliveries studied were C-sections. Spencer's team also looked at first and repeat C-sections and compared those with the average malpractice premiums by year and found a relationship between increased malpractice rates and both first and repeat C-sections.

In a second study, Spencer and his colleagues looked at the impact of increasing malpractice rates on what is known as "operative vaginal deliveries" -- delivering a child by forceps or vacuum They found that 16 percent (10,299) of the 64,767 deliveries were this type. From 1991 to 2005, average malpractice rates increased from $50,345 to $126,806.

The rates for malpractice rose, he said, even though both types of vaginal deliveries declined. Forceps deliveries declined from 11 percent to less than 1 percent, and vacuum deliveries went from 17.2 percent to 6.2 percent.

Nationwide, C-section deliveries accounted for 30.2 percent of all deliveries in 2005, according to the U.S. Centers for Disease Control and Prevention, a record high for the nation. In 1996, in comparison, 20.7 percent of deliveries were by C-section.

Another expert said the findings are nothing new.

"These two papers do nothing more than substantiate what we already know," said Dr. Marsden Wagner, a perinatologist and former director of Women's and Children's Health for the World Health Organization.

One of the reasons for what Wagner refers to as the "scandalous" rate for C-sections is that "doctors are afraid of litigation."

"Any physician who picks up a scalpel and does major abdominal surgery, which is what a C-section is, because that doctor is afraid of litigation, is not practicing medicine but is practicing fear and greed," he said.

"The increasing C-section rate has not decreased the amount of litigation," Wagner said. "So their attempt to avoid litigation by doing C-section is not working."

Spencer agreed. "The only thing to my knowledge that has changed or lowered malpractice rates are states having legislation to place caps on malpractice settlements."

More information

To learn more about C-sections, visit the National Institutes of Health.

Posted: May 2008


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