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.