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October 5, 2005

Who Will Deliver Our Grandchildren?Implications of Cerebral Palsy Litigation

Author Affiliations

Author Affiliations: Department of Obstetrics and Gynaecology, Women’s and Children’s Hospital, University of Adelaide, Adelaide, Australia (Dr MacLennan); Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md (Dr Nelson); Department of Obstetrics, University of Texas Medical Branch, Galveston (Dr Hankins); and Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Speer).

JAMA. 2005;294(13):1688-1690. doi:10.1001/jama.294.13.1688

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).1 Similar trends have been seen in Australia, where the 2% of physicians who are obstetricians are now associated with 18% of the cost of all medical indemnity claims.2,3 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