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Throwing out the baby with the bathwater: reform in the system for compensating obstetric accidents.

Lawsuits for medical malpractice are supposed to serve two purposes: compensation of injured patients and deterrence of negligent conduct by doctors and hospitals. However, those goals are not being served in the area of obstetric medicine. Malpractice liability insurance premiums are increasing rapidly for obstetric care providers,1 and as a result, delivery and perinatal care have become more expensive and less available. At the same time, compensation is distributed inequitably. The liability crisis is more acute in obstetrics than in any other medical specialty because the cost of compensating birth injury sufferers, who are disabled for their lifetimes, is very high and has escalated rapidly.2 The situation could improve if an alternative compensation system replaced malpractice lawsuits and insurance in the area of birthrelated injuries. Virginia and Florida recently enacted innovative no-fault programs for compensating infants with birth-related injuries, under which administrative agencies award compensation to infants who suffer from one of a designated list of birth-related injuries.3 In another proposed alternative, the physician or hospital