C-section rates and its association with lawsuits

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 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.

And here’s my comment on Kevin’s blog:

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.