Obstetrics has the most critical medical malpractice problems. Routine prenatal care and delivery are the cornerstones of community health. These are imperiled by fears, both real and imagined, of litigation. Physicians in rural areas find it increasingly difficult to obtain affordable malpractice insurance coverage. Urban physicians turn away indigent patients in a mistaken belief that they pose an elevated risk of malpractice litigation. Under federal antidumping regulations, physicians will face these same patients as emergency admissions late in labor, when they may present a greater legal risk.

It is not possible to prevent every birth-related lawsuit. It is possible to limit systems failures and attendant negligent injuries, to correct patient and attorney misapprehensions about birth injuries, and to document better the nonnegligent basis of most birth injuries. Such strategies will greatly reduce the incidence of birth- related lawsuits while providing excellent, cost-effective medical care.