Comments on: OB/GYNs Talk about Litigation and Risk Reduction http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction Daily dose of women's health news and media analysis Wed, 08 Feb 2012 16:46:25 +0000 hourly 1 http://wordpress.org/?v=3.0.1 By: MomTFH http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction/comment-page-1#comment-2371 MomTFH Fri, 22 May 2009 11:38:07 +0000 http://www.ourbodiesourblog.org/?p=3219#comment-2371 I think the link between fear of litigation and cesareans needs to be examined more closely. First of all, it seems pretty clear based on the articles in this OP that litigation usually happens because something went wrong. I suppose a preemptive cesarean can prevent a non reassuring strip on a non VBAC patient. I need to go back and look over the original article, but I think that means intermittent monitoring is recommended, which I think is fantastic. As for the litigation and cesareans thing, I was born in and live near Miami. We <a href="http://momstinfoilhat.wordpress.com/2009/05/09/cesareans-done-in-most-miami-dade-mothers/" rel="nofollow">now have a more than 50% cesarean rate</a>. We also have the worst malpractice rates and payouts in the country. What is the connection here? I can't prove causality, but I can say it is unlikely that the excessive cesareans are decreasing malpractice rates and payouts. I think the link between fear of litigation and cesareans needs to be examined more closely. First of all, it seems pretty clear based on the articles in this OP that litigation usually happens because something went wrong. I suppose a preemptive cesarean can prevent a non reassuring strip on a non VBAC patient. I need to go back and look over the original article, but I think that means intermittent monitoring is recommended, which I think is fantastic.

As for the litigation and cesareans thing, I was born in and live near Miami. We now have a more than 50% cesarean rate. We also have the worst malpractice rates and payouts in the country. What is the connection here? I can’t prove causality, but I can say it is unlikely that the excessive cesareans are decreasing malpractice rates and payouts.

]]> By: Jackie http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction/comment-page-1#comment-2368 Jackie Fri, 22 May 2009 01:06:17 +0000 http://www.ourbodiesourblog.org/?p=3219#comment-2368 Time passes, and brings further accrual of proof that much of maternity care is practiced defensively and without regard to best evidence, and that fear of litigation drives practice. A Medscape article dated May 15 and entitled "ACOG 2009: Liability Fears May Be Linked to Rise in Cesarean Rates", makes the tacit admission that the rise in c-sections corresponds to "changes in obstetrical and gynecological practice behavior that were thought to affect the rate of cesarean delivery." It goes on: "It has been suggested that medical-legal pressures are a factor in the rise of cesarean deliveries. A number of studies have borne this out (studies cited) [which] found an association between professional liability premiums and rate of cesarean delivery". When did "do no harm" and the principle of beneficence get replaced by the self-interest of the caregiver, his/her safety, convenience, greed? If you can say there's a problem and then treat for it, with a c-section let's say, and there is no problem after all, everyone is happy. Would that be the case if every OB was mandated to tell ALL the consequences of cesarean..especially those done for the oft-stated "your baby is too big"? I have heard OBs say that an 8lb baby, measured by the nototiously inaccurate 38-week ultrasound, was "too big"! I hope ACOG keeps talking to itself this way. Perhap truth will out! And in that vein.. what a treat I had. I saw Judy Norsigian speak this past week, and shook that famous hand! Time passes, and brings further accrual of proof that much of maternity care is practiced defensively and without regard to best evidence, and that fear of litigation drives practice. A Medscape article dated May 15 and entitled “ACOG 2009: Liability Fears May Be Linked to Rise in Cesarean Rates”, makes the tacit admission that the rise in c-sections corresponds to “changes in obstetrical and gynecological practice behavior that were thought to affect the rate of cesarean delivery.” It goes on: “It has been suggested that medical-legal pressures are a factor in the rise of cesarean deliveries. A number of studies have borne this out (studies cited) [which] found an association between professional liability premiums and rate of cesarean delivery”. When did “do no harm” and the principle of beneficence get replaced by the self-interest of the caregiver, his/her safety, convenience, greed? If you can say there’s a problem and then treat for it, with a c-section let’s say, and there is no problem after all, everyone is happy. Would that be the case if every OB was mandated to tell ALL the consequences of cesarean..especially those done for the oft-stated “your baby is too big”? I have heard OBs say that an 8lb baby, measured by the nototiously inaccurate 38-week ultrasound, was “too big”! I hope ACOG keeps talking to itself this way. Perhap truth will out!
And in that vein.. what a treat I had. I saw Judy Norsigian speak this past week, and shook that famous hand!

]]> By: Rachel http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction/comment-page-1#comment-882 Rachel Fri, 09 Jan 2009 00:46:18 +0000 http://www.ourbodiesourblog.org/?p=3219#comment-882 MomTFH, just a note that they didn't republish them in the December article, but the August one includes checklists for mag sulfate, misoprostol and shoulder dystocia as figures, so you'll need to get that one for review. Let me know if you have trouble finding a copy. MomTFH, just a note that they didn’t republish them in the December article, but the August one includes checklists for mag sulfate, misoprostol and shoulder dystocia as figures, so you’ll need to get that one for review. Let me know if you have trouble finding a copy.

]]> By: MomTFH http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction/comment-page-1#comment-881 MomTFH Fri, 09 Jan 2009 00:10:15 +0000 http://www.ourbodiesourblog.org/?p=3219#comment-881 Absolutely, mrs. spock. I need to go read the articles. I am assuming their protocols are evidence based. I would have hoped that the report would specifically push for more evidence based medicine, which usually ends up advocating for less interventions. Absolutely, mrs. spock.

I need to go read the articles. I am assuming their protocols are evidence based. I would have hoped that the report would specifically push for more evidence based medicine, which usually ends up advocating for less interventions.

]]> By: labornurse@nursingjobs.org http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction/comment-page-1#comment-872 labornurse@nursingjobs.org Wed, 07 Jan 2009 02:48:42 +0000 http://www.ourbodiesourblog.org/?p=3219#comment-872 ditto, mrs spock. I also have heard quite a bit of talk about how many lawsuits are for cases in which a c-section wasn't done "quickly enough" that then resulted in injury to the fetus. ditto, mrs spock.

I also have heard quite a bit of talk about how many lawsuits are for cases in which a c-section wasn’t done “quickly enough” that then resulted in injury to the fetus.

]]> By: mrs spock http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction/comment-page-1#comment-871 mrs spock Tue, 06 Jan 2009 03:15:08 +0000 http://www.ourbodiesourblog.org/?p=3219#comment-871 In my opinion, as a nurse, a lot of this substandard care is a result of jam-packed schedules and overbooked physician practices, and hospitals that are more interested in squeezing blood from stones in order to build The Next Big Thing instead of ensuring adequate RN to patient ratios. If you want to improve birth outcomes in hospitals, ask for those hospitals to provide 1:1 nursing care throughout an entire labor- and for docs with the time to wait on a labor to progress naturally because they don't have 2 hysterectomies, 2 scheduled c-sections, 4 laboring patients, and office hours to cram into a day. In my opinion, as a nurse, a lot of this substandard care is a result of jam-packed schedules and overbooked physician practices, and hospitals that are more interested in squeezing blood from stones in order to build The Next Big Thing instead of ensuring adequate RN to patient ratios. If you want to improve birth outcomes in hospitals, ask for those hospitals to provide 1:1 nursing care throughout an entire labor- and for docs with the time to wait on a labor to progress naturally because they don’t have 2 hysterectomies, 2 scheduled c-sections, 4 laboring patients, and office hours to cram into a day.

]]> By: Jill http://www.ourbodiesourblog.org/blog/2009/01/obgyns-talk-about-litigation-and-risk-reduction/comment-page-1#comment-869 Jill Tue, 06 Jan 2009 00:03:36 +0000 http://www.ourbodiesourblog.org/?p=3219#comment-869 Interesting. The most common reason typically cited for the ridiculously high c-section rate in the U.S. is physician fear of being sued. The blame is often shifted back onto women for suing doctors for permanent birth injuries that were supposedly out of the doctor's control. But according to this, even treating providers and defense consultants are acknowledging that most payouts on obstetric malpractice cases are the result of actual substandard care and injuries that could have been prevented? Wow. Interesting. The most common reason typically cited for the ridiculously high c-section rate in the U.S. is physician fear of being sued. The blame is often shifted back onto women for suing doctors for permanent birth injuries that were supposedly out of the doctor’s control. But according to this, even treating providers and defense consultants are acknowledging that most payouts on obstetric malpractice cases are the result of actual substandard care and injuries that could have been prevented?

Wow.

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