Defensive Deliveries

HAVING A BABY IS NO HARDER OR RISKIER THAN IT ever was. So why are caesarean sections now used in 23% of all U.S. births, up from only 5% in 1965? Most people have long suspected, and many doctors agree, that fear of malpractice suits haunts the delivery rooms. When complications arise, or the labor is unusually long and hard, many physicians apparently feel safer bringing out the scalpel than trying to let nature take its course.

But evidence linking caesareans to malpractice fears was scant -- until a new report in the Journal of the American Medical Association. Scientists analyzed data on 60,490 births at New York hospitals and insurance premiums paid by doctors in various regions. Their finding: the odds of having a caesarean section were three times as great in areas where premiums -- and the frequency of suits -- were high as in regions where malpractice costs are lower. Critics charge that as many as half a million caesareans each year are medically unnecessary.