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 ,Revised 23 April 2008 ,Accepted 8 July 2008.

References 

  1. Kolås T, Hofoss D, Daltveit AK, et al. Indications for cesarean deliveries in Norway. Am J Obstet Gynecol. 2003;188:864–870
  2. Savage W. The rising caesarean section rate: a loss of obstetric skill?. J Obstet Gynaecol. 2007;27:339–346
  3. Wax JR, Cartin A, Pinette MG, Blackstone J. Patient choice cesarean: an evidence-based review. Obstet Gynecol Surv. 2004;59:601–616
  4. Prosser LA, Kuntz KM, Bar-Or A, Weinstein MC. The relationship between risk attitude and treatment choice in patients with relapsing-remitting multiple sclerosis. Med Decis Making. 2002;22:506–513
  5. Holtgrave DR, Lawler F, Spann SJ. Physicians' risk attitudes, laboratory usage, and referral decisions: the case of an academic family practice center. Med Decis Making. 1991;11:125–130
  6. Allison JJ, Kiefe CI, Cook EF, Gerrity MS, Orav EJ, Centor R. The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Med Decis Making. 1998;18:320–329
  7. Fiscella K, Franks P, Zwanziger J, et al. Risk aversion and costs, a comparison of family physicians and general internists. J Fam Prac. 2007;49:7–12
  8. Franks P, Williams GC, Zwansiger J, Mooney C, Sorbero M. Why do physicians vary so widely in their referral rates?. J Gen Intern Med. 2000;15:163–165
  9. Pearson SD, Goldman L, Orav J, et al. Triage decisions for emergency department patients with chest pain: do physicians' risk attitudes make the difference?. J Gen Intern Med. 1995;10:557–564
  10. O'Leary CM, de Klerk N, Keogh J, et al. Trends in mode of delivery during 1984-2003: can they be explained by pregnancy and delivery complications?. BJOG. 2007;114:855–864
  11. Habiba M, Kaminski M, Da Frè M, et al. Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries. BJOG. 2006;113:647–656
  12. Localio AR, Lawthers AG, Bengtson JM, et al. Relationship between malpractice claims and cesarean delivery. JAMA. 1993;269:366–373
  13. Symon A. Litigation and defensive clinical practice: quantifying the problem. Midwifery. 2000;16:8–14
  14. Ghetti C, Chan BKS, Guise JM. Physicians' responses to patient-requested cesarean delivery. Birth. 2004;31:280–284
  15. Kwee A, Cohlen BJ, Kanhai H, Bruinse HW, Visser GHA. Caesarean section on request: a survey in the Netherlands. Eur J Obstet Gynecol Reprod Biol. 2004;113:186–190
  16. Jackson DN. Jackson personality inventory-revised manual. [CD-ROM] Port Huron (MI): Sigma Assessment Systems Inc; 2004;
  17. Baldwin RL, Green JW, Shaw JL, et al. Physician risk attitudes and hospitalization of infants with bronchiolitis. Acad Emerg Med. 2005;12:142–146
  18. Katz DA, Williams GC, Brown RL, et al. Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia. Ann Emerg Med. 2005;46:525–533
  19. Robinson G. Do general practitioners' risk-taking propensities and learning styles influence their continuing medical education preferences?. Med Teach. 2002;24:71–78
  20. Braspenning J, Sergeant J. General practitioners' decision making for mental health problems: outcomes and ecological validity. J Clin Epidemiol. 1994;47:1365–1372
  21. Jones TV, Gerrity MS, Earp J. Written case simulations: do they predict physicians' behavior?. J Clin Epidemiol. 1990;43:805–815
  22. Norman GR, Feightner JWA. Comparison of behaviour on simulated patients and patients management problems. Med Educ. 1981;15:26–32
  23. Harrison M, Young JM, Butow P, Salkeld G, Solomon MJ. Is it worth the risk? (A systematic review of instruments that measure risk propensity for use in the health setting). Soc Sci Med. 2005;60:1385
  24. Chauhan SP, Chauhan VB, Cowan BD, Hendrix NW, Magann EF, Morrison JC. Professional liability claims and central association of obstetricians and gynecologists members: myth versus reality. Am J Obstet Gynecol. 2005;192:1820–1826
  25. Chervenak JL. Overview of professional liability. Clin Perinatol. 2007;34:227–232
  26. Ogburn T, Espey E, Autry A, Leeman L, Bachofer S. Why obstetrics/gynecology, and what if it were not an option? (a survey of resident applicants). Am J Obstet Gynecol. 2007;197:538
  27. Savage W, Francome C. British consultants' attitudes to caesareans. J Obstet Gynaecol. 2007;27:354–359
  28. Jørstad RG, Thomsen MW, Foyn T, Hagen B, Øian P, Eraker R. Norsk Pasientskadeerstatning, en kilde til læring [The Norwegian Patient Injury Compensation—a source of learning]. Tidsskr Nor Laegeforen. 2007;127:760–762
  29. Infoplease.com: all the knowledge you need. 2000-2007 Pearson Education. Available at: http://www.infoplease.com/ipa/A0005067.html. Accessed Jan. 25, 2008.
  30. WrongDiagnosis.com: medical malpractice and childbirth. 2000-2007 Adviware Pty Ltd. Available at: http://wrongdiagnosis.com/c/childbirth/malpractice.htm. Accessed Jan. 25, 2008.
  31. Farrell SA. The choice of elective cesarean delivery in obstetrics: a voluntary survey of Canadian health care professionals. Int Urogynecol J. 2005;16:378–383
  32. Gonen R. Obstetricians' opinions regarding patient choice in cesarean delivery. Obstet Gynecol. 2002;99:577–580

 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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