No One Truly Benefits from Defensive Medicine

This is a cross-post from The Unnecesarean, which is in the midst of a fantastic series on defensive medicine. If you haven’t been reading the posts in this series, you can get caught up here.

By Desirre Andrews, President of ICAN

A woman’s pregnancy should be a positive time as she prepares for the birth of her baby.  Unfortunately, in this age of defensive medicine, a pregnant woman must arm herself with evidence-based information and self-advocacy skills.  She must be willing to act in a self-protective way to be certain she is getting individualized patient care versus the cookie cutter care modern medical practice normally affords.

This phenomenon of defensive medicine may largely be born out a very human response to the expectation of perfection we have in society today, especially with care providers.  We have developed a willingness to hand personal authority over to our care providers.

For years, doctors have been deified, treated as being better than everyone else.  Perhaps it is in their ability to save lives. We simply expect them to be able to do everything, but they can’t.  They are human.

Doctors and patients might be able to see the human face of medicine if the traditional practice style that valued provider-patient relationship came back into use.

Today, with OB appointments being no more than ten minutes each visit, how can a personal, trusting relationship build between the two parties? It cannot.  A woman can not be sure she can fully rely on her provider to know her well and help her make decisions that are in the best interest of her and her baby.  The provider must rely on what he or she is comfortable with offering and doing to patients instead of taking each mother and baby into consideration individually.  It is no surprise the circle of distrust and fear is palpable by all sides.

Prior to ever practicing medicine, the defensive attitude comes with the education a physician receives in medical school and the training in residency.  The lesson is that your patients are not as educated as you are, always practice to defend yourself and get the patient to agree to the course of action you want no matter what.

With this attitude, what sort of “care” practices is a woman facing? Higher induction rates to lessen the rare fetal demise that can occur “post dates”.  Higher cesarean rates because a physician does not want to incur risk of a VBAC mother going for a vaginal birth, even though catastrophic uterine ruptures are not common place.  Viewing all OB patients through a lens of high risk or as an emergency waiting to happen.

All aspects of managed and medicalized birth occur because a physician is not comfortable, has fears, has worries and/or is not willing to practice outside of that mode because tolerate risk has been depleted.  The physician desires to create a zero risk environment because of a lowered risk threshold either by training or by an adverse outcome in the years of practice.  The humanness of the mother has been left out of the equation, while the ideal of a “healthy” baby is elevated in this physician centered point of view.

We as ICAN believe that every mother has the ability, responsibility and intrinsic right to make medical care decisions for her pregnancy, labor birth and baby.  She should be able to obtain true and complete informed consent from her provider. We believe it is unethical for a physician to recommend and/or perform non-medically indicated cesareans (elective), to refuse to support VBAC (vaginal birth after cesarean) across the board without individualized assessment, or to skew cesarean as the easier, safer choice as a standard course of practice.

In the big picture no one truly benefits from a defensive medicine practice style. Providers and patients all lose.


  1. Naima Flint January 27, 2011 12:46 pm  Reply

    I live in southeastern VA and have become a witness to the demise of comprehensive patient care in relation to pregnancy and delivery. I have witnessed many women go in for labor and come out with a cesarean. I have heard of doctors telling their patients that they will have to transfer care if they want to VBAC because their hospital does not have 24 hour OB’s. IT is well understood that if labor goes past 12 hours, they will threaten to cut you open. I had a very successful HBAC after 3 cesareans, thanks entirely to the support of a well-informed friend in my church and her midwife-whom I saw only three times before the birth. I was told that I could not VBAC at my provider hospital unless I came in with the baby crowning. Now I tell my pregnant friends where they can and can’t deliver and how long to wait to go to the hospital and what not to allow, if they can. But it is obvious that doctors take advantage of a woman’s impaired thought in labor in order to push the unnecessary. I do want another vaginal birth, but I also know that unless I birth at home, I will face tremendous odds and that both saddens and terrifies because I know that the other three cesareans didn’t have to be and I also know that the hospitals were not always so anti-childbirth. I commend ICAN for all that you all are doing, you were a great source of strength and encouragement to me when I decided to vbac and I recommend you to everyone.

  2. Hellen December 11, 2015 11:06 pm  Reply

    After 6 consecutive mirearsiagcs in the first trimester, I’m finally at 33 weeks. I asked my OB about doing a planned c-section right away as it seemed the right choice for me but given the controversy, I’ve done a ton of research both with personal interviews of those gone before me and statistical with ACOG. The only two main reasons still making me question the c-section are the recovery time (since I’m very active and not one to sit still) and the shared drugs while breastfeeding. I could care less about a natural birth experience, my high risk OB only does c-sections (doesn’t deliver natural births), I’ve had several major back issues, surgery doesn’t intimidate me (I’ve had 3 miscarriage D&Cs), and given my losses, I really just want a healthy baby in the most controlled way. I know surgery is always a risk, but so many things can go wrong with natural labor. Since an emergency c-section is more risky than planned, it also scares me to death to start with natural labor and then have to end up there anyway (and then having had to go through both!) Any additional insights? What haven’t I considered?

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