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Malpractice risk linked to cesarean rise.

Fearing malpractice suits, are physicians performing more cesareans?

Perhaps. A study led by researchers at Penn State's Milton S. Hershey Medical Center has found a statistical link between the risk of a malpractice suit and the likelihood of a cesarean delivery.

They reported their results in the Journal of the American Medical Association.

"We found that the higher the malpractice premiums, or the more malpractice claims filed against obstetricians in the hospital, the greater the risk that a woman in the hospital will have a cesarean," says lead author A. Russell Localio, J.D., M.P.H., M.S.

Localio, a research associate in biostatistics, and his co-workers examined information on 60,490 deliveries at 31 New York state hospitals in 1984. The authors used computerized discharge records and hospital and physician malpractice claims records.

Localio notes that the "most significant predictors of cesarean delivery were where you lived and the physician's perceived risk of being sued." The number of claims filed against an institution was also a factor.

The researchers divided the state into four geographic regions. They found that "the odds of cesarean delivery in the high premium regions of the state were three times the odds in the low premium regions." Across each region, physician malpractice premiums might differ as much as three times.

While Localio cautions against drawing any conclusions about a cause-and-effect relationship, "our study might provide some evidence to support what the medical community is saying -- that typically an obstetrician will in a close case decide to do a cesarean out of fear of the consequences of not doing one," he says.

Of the approximately four million births in 1990 in the United States, slightly fewer than 24 percent -- or some 950,000 -- were by cesarean delivery. That marks a four-fold rise in the cesarean rate in the last 25 years. Most nations have lower rates: Japan, for example, is at 7 percent; Western European nations average roughly 12 percent.

Localio says that many doctors, debating a natural delivery versus a cesarean, might opt for the latter because "we know cesareans have very low mortality for both mother and infant, though the mother is in the hospital much longer than for a normal delivery.

Cesarean delivery involves abdominal surgery. "The mother stays in the hospital longer -- typically a week, as opposed to a day or two -- to recover from surgery, has higher hospital bills and may also miss more work hours," Localio notes.
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Publication:Nutrition Health Review
Date:Jan 1, 1993
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