Obstetric Litigation: Effects on Clinical Practice1

Many claims concerning extent and consequences of litigation have been made, despite a lack of comprehensive and widely available data. It has been suggested that a rapidly increasing rate of litigation has caused problems in the recruitment and retention of obstetricians, and has also caused practitioners to practice 'defensively'. This article discusses meaning and significance of defensiveness within obstetrics and midwifery and quantifies the incidence of certain examples of defensive practice. Based on large-scale postal surveys of obstetricians and midwives in Scotland and England, as well as follow-up interviews, it clarifies the significance of what has become known as defensive medicine in maternity care, notably in relation to caesarean sections. It then examines the role of clinical risk management, and the growth of protocols and guidelines in particular, in trying to limit litigation.