American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 48.e1-48.e8, January 2009

Obstetricians' choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation?

Presented at the Annual Meeting of the Norwegian Society of Gynecology and Obstetrics, Førde, Norway, Aug. 30-Sept. 1, 2007, and at the 29th Annual Meeting of the Society for Medical Decision Making, Pittsburgh, PA, Oct. 20-24, 2007.

  • Dorthe Fuglenes, MD

      Affiliations

    • Institute of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
    • Corresponding Author InformationReprints: Dorthe Fuglenes, MD, Institute of Health Management and Health Economics, Faculty of Medicine, University of Oslo, PO Box 1089, Blindern, NO-0317 Oslo, Norway
    • ,
  • Pål Øian, MD, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, University Hospital of North Norway and the Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
    • ,
  • Ivar Sønbø Kristiansen, MD, PhD

      Affiliations

    • Institute of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
    • Institute of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark

Received 5 February 2008; received in revised form 23 April 2008; accepted 8 July 2008. published online 03 November 2008.

Objective

The aim of this study was to test the hypothesis that obstetricians' choice of delivery method is influenced by their risk attitude and perceived risk of complaints and malpractice litigation.

Study Design

The choice of delivery method in ambiguous cases was studied in a nationwide survey of Norwegian obstetricians (n = 716; response rate, 71%) using clinical scenarios. The risk attitude was measured by 6 items from the Jackson Personality Inventory-Revised.

Results

The proportion of obstetricians consenting to the cesarean request varied both within and across the scenarios. The perceived risk of complaints and malpractice litigation was a clear determinant of obstetricians' choice of cesarean in all of the clinical scenarios, whereas no impact was observed for risk attitude.

Conclusion

Obstetricians' judgments about cesarean request in ambiguous clinical cases vary considerably. Perceived risk of complaints and litigation is associated with compliance with the requested cesarean.

Key words: cesarean section, fear of litigation, maternal request, risk attitude

 

 Cite this article as: Fuglenes D, Øian P, Kristiansen IS. Obstetricians' choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation? Am J Obstet Gynecol 2009;200:48.e1-48.e8.

 This study was financed by the University of Oslo.

PII: S0002-9378(08)00802-8

doi:10.1016/j.ajog.2008.07.021

American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 48.e1-48.e8, January 2009

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