The 'Chagrin Factor' in Obstetrics

To the Editor. —Dr Feinstein's analysis of the "chagrin factor" in clinical decision making¹appears to parallel what we called the "maximin strategy" in critically evaluating the obstetrics' literature on the management of normal labor and delivery.² The maximin strategy is that which tries to produce the least worst outcome, assuming that the worst outcome of each option is the one to occur. Applying Feinstein's language to our analysis, we suggested that the typical obstetrician feels "chagrin" when labor managed "naturally" (ie, without maximum use of available technology) leads to morbidity or mortality in the mother or neonate. The obstetrician experiences much less chagrin if a good physiological outcome occurs following maximum use of technology against the preferences of the mother. Thus, the bias is in favor of routine use of technology, even though a strict probability analysis might show this option to be unwarranted. Feinstein has listed