Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0005
L. Roth
This chapter analyzes changes over time in early-term births. Labor induction rates have risen over time and many experts speculate that at least half of inductions are elective. Popular accounts suggest that pregnant women are driving this by requesting inductions. Healthcare providers are also part of the story because they can refuse women’s requests, but hospitals and OB/GYN practices benefit enormously from scheduling births even though they pose medical risks. Analyses of early-term births in low-risk pregnancies reveal that providers are more likely to take unnecessary risks in states with tort reforms that limit their liability risk. This effect was strongest during the period before 2009, when the strength of professional recommendations against early elective induction had eroded.
{"title":"What’s the Rush?","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0005","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0005","url":null,"abstract":"This chapter analyzes changes over time in early-term births. Labor induction rates have risen over time and many experts speculate that at least half of inductions are elective. Popular accounts suggest that pregnant women are driving this by requesting inductions. Healthcare providers are also part of the story because they can refuse women’s requests, but hospitals and OB/GYN practices benefit enormously from scheduling births even though they pose medical risks. Analyses of early-term births in low-risk pregnancies reveal that providers are more likely to take unnecessary risks in states with tort reforms that limit their liability risk. This effect was strongest during the period before 2009, when the strength of professional recommendations against early elective induction had eroded.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124864867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0002
L. Roth
This chapter outlines the medical and midwifery models of childbirth. In most developed nations, the medical model of childbirth dominates maternity care and obstetricians have authoritative knowledge. This chapter defines the medicalization schema as a deep, largely unconscious conceptual framework that organizes beliefs about pregnancy and birth. The medicalization schema contains three key components: the pathologization of normal pregnancy and childbirth, scienciness, and technology fetishism. This chapter defines the concepts of scienciness and technology fetishism with respect to common obstetric practices and technologies that lack the support of scientific evidence. Lackluster public health results and critiques from women’s health movements challenge the validity of medicalization.
{"title":"Birth Matters","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0002","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0002","url":null,"abstract":"This chapter outlines the medical and midwifery models of childbirth. In most developed nations, the medical model of childbirth dominates maternity care and obstetricians have authoritative knowledge. This chapter defines the medicalization schema as a deep, largely unconscious conceptual framework that organizes beliefs about pregnancy and birth. The medicalization schema contains three key components: the pathologization of normal pregnancy and childbirth, scienciness, and technology fetishism. This chapter defines the concepts of scienciness and technology fetishism with respect to common obstetric practices and technologies that lack the support of scientific evidence. Lackluster public health results and critiques from women’s health movements challenge the validity of medicalization.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116316878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0004
L. Roth
This chapter explores the institutional culture of American maternity care and analyzes the common belief that malpractice lawsuits are arbitrary, unpredictable, and irrational threats. The high cost of liability insurance, the impossibility of guaranteeing perfect outcomes, and knowledge of lawsuits or experience with claims has produced a culture of anxiety and risk avoidance among obstetricians. At the same time, the rate of malpractice lawsuits has declined over time, largely because the cost of pursuing a case is very high. Healthcare professionals also wield enormous power to define the standard of care, which is the benchmark for medical negligence. Rather than many lawsuits being frivolous, there are many genuine victims of negligence who cannot find legal representation.
{"title":"Myths of Malpractice","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0004","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0004","url":null,"abstract":"This chapter explores the institutional culture of American maternity care and analyzes the common belief that malpractice lawsuits are arbitrary, unpredictable, and irrational threats. The high cost of liability insurance, the impossibility of guaranteeing perfect outcomes, and knowledge of lawsuits or experience with claims has produced a culture of anxiety and risk avoidance among obstetricians. At the same time, the rate of malpractice lawsuits has declined over time, largely because the cost of pursuing a case is very high. Healthcare professionals also wield enormous power to define the standard of care, which is the benchmark for medical negligence. Rather than many lawsuits being frivolous, there are many genuine victims of negligence who cannot find legal representation.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126173663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0007
L. Roth
This chapter examines the effects of malpractice on cesarean deliveries in light of historical trends and changes in the standard of care. Nearly one third of births in the US involve a cesarean delivery, and cesareans are usually the first thing that people think about when they think about defensive obstetric medicine. While some popular accounts attribute the rise in cesareans to women’s requests, most maternity care providers and public health experts are skeptical of the idea that “choice” is driving the trend. This chapter highlights the ways that providers respond to three types of risk when they do cesarean deliveries: medical risk, iatrogenic risk, and legal risk. A culture of malpractice fear encourages obstetricians to prioritize legal risk, and they know that patients are more likely to sue them for not doing a cesarean than for doing an unnecessary one. Providers also described expedience, organizational efficiency, and changes in medical training as important causes of medically questionable cesareans. Analyses reveal that the odds of a cesarean are higher in states where providers face more liability risk, but the effect is extremely small. Professional guidelines, which changed over time, also mediate this effect.
{"title":"If in Doubt, Cut It Out","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0007","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0007","url":null,"abstract":"This chapter examines the effects of malpractice on cesarean deliveries in light of historical trends and changes in the standard of care. Nearly one third of births in the US involve a cesarean delivery, and cesareans are usually the first thing that people think about when they think about defensive obstetric medicine. While some popular accounts attribute the rise in cesareans to women’s requests, most maternity care providers and public health experts are skeptical of the idea that “choice” is driving the trend. This chapter highlights the ways that providers respond to three types of risk when they do cesarean deliveries: medical risk, iatrogenic risk, and legal risk. A culture of malpractice fear encourages obstetricians to prioritize legal risk, and they know that patients are more likely to sue them for not doing a cesarean than for doing an unnecessary one. Providers also described expedience, organizational efficiency, and changes in medical training as important causes of medically questionable cesareans. Analyses reveal that the odds of a cesarean are higher in states where providers face more liability risk, but the effect is extremely small. Professional guidelines, which changed over time, also mediate this effect.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128327322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0006
L. Roth
This chapter explores the use of electronic fetal monitoring (EFM) as a prime example of technology fetishism. EFM is not evidence based, but most maternity care providers routinely use it. Obstetricians say that they use EFM to defend themselves against liability, and malpractice attorneys often fetishize the paper strips that the EFM produces as “evidence.” At the same time, an analysis demonstrates that EFM is more common in tort reform states that limit providers’ liability risk, which contradicts the idea that providers use it to reduce legal risk. The chapter then explores institutional motivations for EFM use, including scheduling, workload, and profit benefits. These institutional priorities can undermine patients’ rights, quality of care, and informed consent, which are issues of reproductive justice. This chapter then explores the effects of reproductive rights laws on EFM, finding that more fetus-centered laws encourage more EFM, while EFM is less common in states that protect women’s reproductive rights.
{"title":"The Machine That Goes Ping!","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0006","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0006","url":null,"abstract":"This chapter explores the use of electronic fetal monitoring (EFM) as a prime example of technology fetishism. EFM is not evidence based, but most maternity care providers routinely use it. Obstetricians say that they use EFM to defend themselves against liability, and malpractice attorneys often fetishize the paper strips that the EFM produces as “evidence.” At the same time, an analysis demonstrates that EFM is more common in tort reform states that limit providers’ liability risk, which contradicts the idea that providers use it to reduce legal risk. The chapter then explores institutional motivations for EFM use, including scheduling, workload, and profit benefits. These institutional priorities can undermine patients’ rights, quality of care, and informed consent, which are issues of reproductive justice. This chapter then explores the effects of reproductive rights laws on EFM, finding that more fetus-centered laws encourage more EFM, while EFM is less common in states that protect women’s reproductive rights.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126296139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0008
L. Roth
This chapter analyzes the effect of reproductive regimes on VBAC (vaginal birth after cesarean), midwife-attended birth, and homebirth. Many hospitals have formal or de facto bans on VBAC, even though 60–80% of women who attempt a VBAC will have a successful vaginal birth. Providers have increasingly restricted VBAC since July 1999, but forcing a woman to have major abdominal surgery (or any medical procedure) without her consent is a violation of her civil rights. An analysis of how state-level reproductive rights laws affected the odds of VBAC reveals that VBAC is less likely in fetus-centered regimes with restrictive abortion laws, especially after June 1999. Midwife-attended birth and out-of-hospital birth are also less likely in fetus-centered regimes. Taken together, these results point in the same direction: fetus-centered reproductive rights regimes constrain pregnant women’s ability to make reproductive decisions about birth, not just abortion.
{"title":"Choice Matters","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0008","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0008","url":null,"abstract":"This chapter analyzes the effect of reproductive regimes on VBAC (vaginal birth after cesarean), midwife-attended birth, and homebirth. Many hospitals have formal or de facto bans on VBAC, even though 60–80% of women who attempt a VBAC will have a successful vaginal birth. Providers have increasingly restricted VBAC since July 1999, but forcing a woman to have major abdominal surgery (or any medical procedure) without her consent is a violation of her civil rights. An analysis of how state-level reproductive rights laws affected the odds of VBAC reveals that VBAC is less likely in fetus-centered regimes with restrictive abortion laws, especially after June 1999. Midwife-attended birth and out-of-hospital birth are also less likely in fetus-centered regimes. Taken together, these results point in the same direction: fetus-centered reproductive rights regimes constrain pregnant women’s ability to make reproductive decisions about birth, not just abortion.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125230449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0003
L. Roth
This chapter explores theories about how laws and organizations influence each other. First, the chapter explores the purpose of tort laws and the goals of the tort reform movement and uses them to define provider-friendly and patient-friendly tort regimes. An analysis of the effects of tort laws on obstetric malpractice lawsuits illustrates that, contrary to expectations, the rate of lawsuits is higher in states where tort reforms have reduced healthcare providers’ liability risk. The chapter then uses reproductive justice theory to examine reproductive health laws that govern contraception, abortion, midwifery, prenatal substance use, and fetal rights. These laws define fetus-centered and woman-centered reproductive rights regimes.
{"title":"Law Matters","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0003","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0003","url":null,"abstract":"This chapter explores theories about how laws and organizations influence each other. First, the chapter explores the purpose of tort laws and the goals of the tort reform movement and uses them to define provider-friendly and patient-friendly tort regimes. An analysis of the effects of tort laws on obstetric malpractice lawsuits illustrates that, contrary to expectations, the rate of lawsuits is higher in states where tort reforms have reduced healthcare providers’ liability risk. The chapter then uses reproductive justice theory to examine reproductive health laws that govern contraception, abortion, midwifery, prenatal substance use, and fetal rights. These laws define fetus-centered and woman-centered reproductive rights regimes.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134629242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.18574/nyu/9781479812257.003.0009
L. Roth
This chapter argues that defensive medicine is not a significant problem in American obstetrics, despite strong myths about it. Maternity care providers intervene into labor and birth more than is optimal for maternal and infant health, but they do not do so primarily for legal reasons. An analysis of weekend births reveals that births are less likely to occur on the weekend in tort reform states. This suggests the opposite of defensive medicine: providers intervene more in the timing of births when they face less liability risk. Weekend births are also less likely in states with fetus-centered laws, so providers intervene more when women have fewer choices during pregnancy. This chapter then explores two cases as examples of a woman-centered and a fetus-centered regime: Oregon and Mississippi. From a policy perspective, laws that support women’s ability to make decisions for themselves and their fetuses encourage more evidence-based maternity care practices. Reproductive justice would also benefit from universal healthcare that covers all aspects of reproductive health.
{"title":"Reproductive Regimes","authors":"L. Roth","doi":"10.18574/nyu/9781479812257.003.0009","DOIUrl":"https://doi.org/10.18574/nyu/9781479812257.003.0009","url":null,"abstract":"This chapter argues that defensive medicine is not a significant problem in American obstetrics, despite strong myths about it. Maternity care providers intervene into labor and birth more than is optimal for maternal and infant health, but they do not do so primarily for legal reasons. An analysis of weekend births reveals that births are less likely to occur on the weekend in tort reform states. This suggests the opposite of defensive medicine: providers intervene more in the timing of births when they face less liability risk. Weekend births are also less likely in states with fetus-centered laws, so providers intervene more when women have fewer choices during pregnancy. This chapter then explores two cases as examples of a woman-centered and a fetus-centered regime: Oregon and Mississippi. From a policy perspective, laws that support women’s ability to make decisions for themselves and their fetuses encourage more evidence-based maternity care practices. Reproductive justice would also benefit from universal healthcare that covers all aspects of reproductive health.","PeriodicalId":354942,"journal":{"name":"The Business of Birth","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124014254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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