The Business of Birth

The Business of Birth examines the effects of malpractice and reproductive rights laws on maternity care practices in the US from 1995 to 2015. It is a common public belief that frivolous malpractice claims and women’s choices shape hospital birth practices. This book uses mixed methods to demonstrate that this belief is inaccurate. The Business of Birth carefully documents how there are interconnected systems of laws and policies, or legal “regimes,” that influence birth practices in unexpected ways. When it comes to malpractice, the standard of care that defines malpractice is internal to the medical profession. This means that tort laws do not exert the external pressure that physicians believe they do, although professional associations, liability insurers, risk managers, and hospital legal counsel reinforce a fear of liability risk. This fear can encourage obstetricians to intervene into labor and birth with scientifically unsupported technology or procedures with known risks. But reducing liability risk can encourage risky practices that promote organizational efficiency over patient safety. The Business of Birth also examines the implications of reproductive rights laws for maternity care practices, defining states that protect women’s reproductive rights as woman-centered and those that protect fetuses as fetus-centered. Reproductive justice theory argues that pregnant women’s rights during childbirth are connected to laws governing the full spectrum of reproduction. Woman-centered approaches to pregnancy and abortion promote choice, informed consent, and the right to bodily integrity when women give birth, while fetus-centered regimes limit women’s rights and choices during birth.