Increased use of caesarean section: symptom of an excessive use of defensive medicine?

Background: in the field of professional liability the case law evaluates the doctor’s performance critically placing itself at the patient’s side at the expense of the physician. This attitude has convinced the doctors to try to protect themselves using the practice of defensive medicine. The defensive medicine does not want to protect the patient’s health but its aim is to avoid legal medical liability following the medical cares. Objectives: this paper has the purpose of searching the causes of the increase of caesarean section in Italy and if this is a clinical need or if it is a sign of the spread of defensive medicine, in particular with reference to the Italian case law and the recent issue of the guidelines. Methods: the authors analyzed: 1) the data of the Ministry of Health, CeDAP 2009, published in 2012; 2) the data published by the Agency for Public Health of the Lazio Region in February 2012; 3) the guidelines for caesarean section in 2011-2012. They also carried out a systematic review of the Italian case law in case of failed or delayed caesarean section. Results/Discussion and Conclusions: the available data show an increase of caesarean section in Italy, putting it at the first place in Europe for the use of this surgery. In particular, the national distribution is not uniform: in fact, it is more used in southern Italy and in private structures than in public ones and the incidence increases with the increasing age of the mother. The Lazio Region has several detailed data: they confirm what we have just said, and they underline an increase of births during working days. However, the increase in caesarean section is not associated with an increase in maternal and/or fetal benefits. The analyzed data attest that medical care is not appropriate; it does not protect health, but it protects the will of both the patient and the doctor and possible interests of health facilities: 1) patient prefers to give birth in small private clinics where the gynecologist works during working days; 2) the gynecologists satisfy their patient’s wishes to avoid anxieties of natural childbirth and to prevent the risk of contentious due to failed or delayed caesarean section; 3) possible interests of health facilities that see an increase of their refunds for health service. We think that the use of guidelines related to caesarean section and much information given to the mother about complications of caesarean section would limit the use of defensive medicine and would protect the health of both the pregnant woman and the unborn child.