Introduction
The popularity of Caesarean birth (C-section) is probably larger in
Brazil than in any other country,1 with 45% and 90%
of births in the public and private health sector respectively in
primiparous women; 55% of all such births.2 The large
number of C-sections may be due not to medical necessity but, it has
been suggested, to perverse financial incentives for doctors or doctor’s
fear of malpractice suits involving complications from natural
births.1 Financial incentives and fear of being sued
may partly explain why 56% of primiparous Brazilian women in the
private health sector expressed a desire to deliver vaginally at the
start of pregnancy, but only 9% ended up doing so.2
People, especially experts, are inherently skilled and experienced in
successfully making difficult decisions in real life
situations.3 On the other hand, certain circumstances
lead experts to make not the best decisions, but decisions that protect
them from being sued, are influenced by their innumeracy when
interpreting statistical evidence or are advantageous for them
financially. This “SIC ” syndrome (S elf-defense,I nnumeracy and C onflict of interest) is common among
physicians.4
One way to try and avoid the physicians “SIC ” syndrome, at
least partially,4 when trying to elucidate the causes
of medical decision making, is to ask the physician not what she thinks
is best for you , but rather, what she thinks is best forher . Or even better, is to find out what would she do if
she were you .5-13 In this way financial conflict of
interest and defensive medicine are avoided, though innumeracy remains.
In short, the number of C-sections in Brazil is very large compared to
other countries.14 Perverse financial incentives and
fear of being sued may partly explain why obstetricians in Brazil choose
C-section rather than vaginal birth for their patients1-2. Obstetricians are inherently skilled and
experienced in making decisions about child birth. However, due to the
“SIC ” syndrome,4 the decisions they make
regarding their patients may be diverted from the best interest of the
patients. Asking obstetricians what is their preferred mode of deliveryfor their own children unveils an answer that is true to their
expert skilled judgment (to the best of their knowledge), and is not
distorted by perverse financial interests or fear of being sued. Even
better, it is to find out what the obstetrician actually doeswhen she or he is in your position . In this way, suddenly, the
health (and convenience) of the mother and the health of the child
become the sole focus, stripped of possible perverse incentives.
The aims of this study were twofold: to find out the preferencesof obstetricians regarding the mode of delivery (C-section or vaginal)
for the birth of their own children or that of their partners; to find
out the actual mode of delivery amongst obstetricians and their
partners for the birth of their own children.