Just kidding, but wanted your attention. Here's a sad recounting of the nonsense that is ligitation against obstetricians.
Who Will Deliver Our Grandchildren?
Implications of Cerebral Palsy Litigation
Alastair MacLennan, MD; Karin B. Nelson, MD; Gary Hankins, MD; Michael Speer, MD
"It has never been safer to have a baby and never more dangerous to be an obstetrician. In a recent survey, 76% of obstetricians in the United States reported having faced litigation at some point in their careers—most often for having allegedly caused cerebral palsy (CP)." (....)
"The median award for "medical negligence in childbirth cases" is $2.3 million.4 Consequently, obstetricians pay some of the highest premiums for malpractice insurance—up to $200 000 per year in some states. These figures might seem to indicate an epidemic of errors in the delivery room, except that the common assumption that obstetric caregivers can prevent CP by actions taken during labor and delivery is based largely on erroneous assumptions and obsolete science. Despite this, in the United States, 60% of malpractice insurance premiums paid by obstetricians cover lawsuits for alleged birth-related CP.5 Less than 10% of plaintiffs in CP cases receive any compensation, and more than 60% of obstetric premiums are spent on the legal process.5" (....)
Well-designed studies, however, have shown that lack of oxygen causes only a small proportion of CP cases,6-7 and despite serious efforts, CP due to birth asphyxia has not been shown to be preventable.8 Antenatal risk factors for CP under current investigation are indicators of viral infection, fetal thrombophilias, and polymorphisms of genes regulating inflammation, coagulation, and endothelial activation.9-10 Known risk factors for CP include chorioamnionitis, death of a co-twin in utero, arterial ischemic stroke in the fetus or newborn, an umbilical cord wrapped tightly around the neck of the fetus, and premature birth.11 In none of these problems has obstetric intervention been demonstrated to reduce the risk of CP, largely because useful and specific indicators of intrauterine events do not yet exist. In most cases of CP, the cause cannot be determined. Litigation based on assumptions to the contrary, there is no evidence that immediate delivery upon diagnosis of chorioamnionitis or a nonreassuring fetal heart rate pattern prevents or ameliorates CP.8, 12-13 Despite the dramatic account of legal action related to severe brain damage in a survivor of co-twin death,14 there is no evidence that rapid delivery of the survivor prevents CP.15 (....)
[electronic fetal monitoring is mentioned in most CP cases; the claim is made an OB should have acted on it, but] according to a Cochrane Collaborative systematic review of relevant randomized clinical trials, EFM as compared with monitoring by intermittent auscultation is associated with no decrease in perinatal deaths, no fewer admissions to neonatal intensive care units, no fewer Apgar scores below 7 or below 4, and no less incidence of CP (....)
All randomized trials of EFM to date have shown that such monitoring is associated with a higher rate of interventions... .17 In 10 developed countries including the United States, despite a 5-fold increase in cesarean deliveries over recent decades driven in part by the use of fetal monitoring, the incidence of CP has remained steady at about 1 in 500 births, ... with similar rates around the world.18 Thus, action based on interpretation of EFM tracings, which are notoriously difficult to interpret reliably and with validity, has not led to a decreased rate of CP.
Judges, jurors, and most plaintiffs in CP lawsuits may be unaware of the fallibility of the high-tech gadgetry of modern obstetrics, including EFM, and may not realize that these devices cannot reliably predict or influence obstetric outcome. The plaintiff’s attorney has the double advantage of the undeserved suffering by a child and family and a simple, seemingly reasonable explanation. That may not be enough for outright victory, but it is a potent weapon of intimidation. The result is that 86% of obstetrics malpractice claims are settled out of court, half of them with payment,1 at great cost to the profession, to insurers, and to society at large."
Proposed antidotes in the article:
--better self policing by OBs: "After anesthesiology departments took such measures a few years ago, adverse events and malpractice claims dropped substantially."
--special health courts
--a no fault compensation system
--better public education
--policing those who offer expert advice