The Birth Crisis No One in Washington Will Fix

How a broken legal system is driving obstetricians out of the delivery room — and leaving millions of American women with nowhere to give birth

An obstetrician-gynecologist in Miami-Dade County pays more in malpractice insurance each year than most Americans earn.

The 2025 standard premium for an OB-GYN in that Florida county clocks in at $243,988 a year, nearly five times the national average of roughly $46,000 for the specialty. The cost has sent practitioners fleeing their field, shuttered labor and delivery wards from rural Pennsylvania to the high desert of New Mexico, and left millions of American women with nowhere to give birth within a reasonable drive of home.

The burden extends well beyond Florida: OB-GYNs in New Mexico pay roughly double what their counterparts in surrounding states pay, at $107,961 on average, compared to $59,133 in Arizona and $48,966 in Colorado.

Across all specialties, OB-GYNs rank among the most sued physicians in the country, with 139 claims filed per 100 physicians over their careers, and malpractice premiums have risen for seven consecutive years — a trend not seen since the early 2000s.

In 2025, nearly 40 percent of malpractice premiums across the country went up, continuing a seven-year streak that has squeezed obstetrics harder than almost any other field. The attrition shows: roughly 30 percent of OB-GYNs walk away from delivering babies within 12 years of starting, with insurance costs cited as a driving reason.

At the heart of this quiet catastrophe, critics contend, sits a legal system in urgent need of tort reform, limits on how much a patient can sue a doctor or hospital for, and a higher bar for what counts as genuine negligence. Advocates say it has turned the miracle of childbirth into the highest-stakes liability gamble in American medicine, and that Congress has, for decades, declined to act.

“Malpractice insurance is a costly reality of providing both gynecologic and particularly obstetric care,” Rachel Tetlow, vice president of government and political affairs at the American College of Obstetricians and Gynecologists, tells me. “The threat of malpractice suits looms over the heads of ob-gyns from the time they are in training — it is estimated that roughly 40 percent of ob-gyns experience a claim while in residency.”

So who, exactly, is being protected, and from what?

A critical specialty no one wants to practice

The figures tell a grim story. Seventy-nine percent of OB-GYNs will face at least one malpractice lawsuit during their career, not because the specialty attracts bad doctors, but because birth itself is inherently unpredictable, and American juries have historically awarded substantial damages to families of injured newborns.

Settlement payments in birth-related malpractice cases reported to the National Practitioner Data Bank totaled $4.8 billion in 2023, with a growing number of verdicts topping $10 million.

In Utah, a judge ordered bankrupt hospital operator Steward Health Care to pay a family $951 million — the largest medical malpractice award in state history — after inexperienced nurses gave a laboring mother excessive doses of a labor-inducing drug while the on-call physician slept nearby. Signs of fetal distress went unaddressed for more than 24 hours before a cesarean was performed, leaving the child with permanent brain damage.

Photo by Patricia Prudente on Unsplash

In Pennsylvania earlier this year, Jefferson Health was ordered to pay $108 million after a Philadelphia jury found physicians at Einstein Pediatrics liable for brain injuries sustained by a baby delivered by forceps in December 2018. Jefferson has disputed the verdict and plans to appeal.

A Philadelphia jury had not delivered an award of that size since 2023, when Penn Medicine was ordered to pay $183 million after a mother alleged that staff sat on a decision to perform a cesarean section while she was fighting a uterine infection. Her lawyers argued that the delay left her son with cerebral palsy and permanent brain damage. The verdict later grew to $207 million after a Pennsylvania appeals court unanimously upheld the award.

What makes obstetrics uniquely punishing in the liability landscape is a feature invisible to most patients: birth-related claims can be filed until an injured child reaches the age of majority — effectively a 21-year window, compared to two or three years in most other medical specialties. A physician who delivered a baby in 2010 may not face a lawsuit tied to that delivery until 2031.

Tennessee-based physician Dr. Matt Tipton, who has delivered between 30 and 50 babies across emergency medicine, EMS work, and military service, points to several compounding factors.

“A lot of states don’t have caps on malpractice, and several state medical boards have a punitive fee structure, like Florida, where if you get sued three times and lose you’re penalized,” he explains.

Florida’s so-called “three-strikes” rule, passed by voters in 2004, requires the state’s Board of Medicine to revoke a physician’s license after a third medical malpractice judgment against them. The practical effect, critics say, is that doctors facing even questionable claims rush to settle rather than fight them in court.

Dr. Tipton also points to why juries tend to award bigger sums in obstetric cases than in almost any other area of medicine.

“When you have a 26-year-old come in with what’s been a normal pregnancy, and something goes wrong, you lose the mother, the baby, or both — the family is devastated,” he explains. “The loss of total life years is just much higher when you lose an infant and a woman of childbearing age.”

In practical terms, that means the projected cost of a lifetime of care for a brain-damaged newborn, combined with a mother’s lost earnings and the family’s pain and suffering, routinely produces damages that dwarf what juries award in cases involving older patients. That makes birth injury claims among the most lucrative in all of medicine, and among the most aggressively pursued by plaintiffs’ attorneys.

Doctors are absorbing the financial hit directly. In 2025, 36 states reported premium increases. In Pennsylvania and New York, more than 90 percent of reported premiums went up. One Albuquerque OB-GYN’s premiums went from $44,908 in 2018 to $77,394 by 2023 — nearly double in five years. In 2024, she quit performing gynecological surgery. Her premiums dropped to $16,463. She had a word for it: survival.

Deserts spreading across the map

For millions of American women, this is not a policy debate. It is a drive of hours to reach the nearest delivery room.

A 2025 report found that nearly half of all counties in America lack a single obstetrician, midwife, or birthing facility. Between 2010 and 2022, more than 500 hospitals shut their obstetric units, with rural facilities accounting for over 200 of those closures. The pace accelerated in 2025, with rural labor and delivery hospital closures in just the first half of the year nearly matching the total for all of 2024.

Wyoming offers a window into how fast the situation can unravel. A Casper OB-GYN told state lawmakers that 18 months ago her city had six obstetricians. Now there are two.

“My personal assets are at risk,” Dr. Susan Sheridan said, pointing to the state’s lack of damage caps as the reason it has become nearly impossible to recruit specialists.

Meanwhile, the average Medicaid reimbursement for a birth in Wyoming runs approximately $7,500, while the actual cost of that delivery often nears $20,000 — making obstetric services a money-losing proposition even before malpractice costs are factored in.

Tetlow says ACOG sees the legal system itself as a primary force behind those closures.

“The current system is absolutely one of the myriad factors contributing to and exacerbating growing maternity care deserts and accelerating labor and delivery unit closures,” she tells me. “It cannot accurately distinguish bad outcomes from genuine negligence, and the escalating premium costs are borne by physicians and the hospital systems where they work.”

Arthur Caplan, the founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, says the system is failing both doctors and patients. Malpractice and government meddling, he tells me, “are the two major reasons my med students and those at other med schools I talk to give for avoiding OBGYN.”

He also points out that the tort system does little to protect the patients it is supposed to serve, because the doctors most likely to cause harm are rarely the ones who lose in court. Physicians with established patterns of negligence routinely avoid verdicts by settling claims quietly, while underfunded medical boards lack the teeth to pull licenses.

“Bad apples who truly are bad float through the health care world crossing state lines and getting jobs despite malpractice convictions and letters of censure,” Caplan observes.

Reform stalled, crisis deepening

The solutions most often proposed are not complicated. ACOG has long called on Congress and state legislatures to cap non-economic damages, pain and suffering awards, pointing to California and Texas as evidence that it works. In those two states, payouts were effectively capped, stabilizing premiums and reducing doctor turnover.

Federal action, however, has never materialized, and the reasons are more political than medical.

“Lawyers typically take 30 to 40 percent of the settlement, so they have a strong incentive to pursue the highest number and not settle,” Dr. Tipton says. “That creates perverse incentives throughout the system.”

Caplan is equally direct about why Washington has not moved.

“Lawyers run Congress. Lawyers respect torts and malpractice. Doctors and hospitals are seen as very rich, so no one cares. Costs of insurance are buried in hospital prices and admin overhead so there’s no pressure to reform.”

It has played out that way repeatedly. First of all, the Senate has voted down federal tort reform across multiple administrations, with trial lawyers’ groups pushing back hard each time and directing campaign money toward legislators who might otherwise have backed reform. During the Obama administration, capping judgments was quickly declared a nonstarter by Senate Democrats.

At the state level, the picture is fractured and in some places, moving in the wrong direction. In Colorado, the pain-and-suffering ceiling was raised from $300,000 and will reach $1.5 million by 2028. New Mexico went further still, raising the cap on hospital liability to $6 million while removing hospitals from a state fund that previously helped cover large verdicts. Hospitals and the OB-GYNs who work in them now face the full financial exposure of any judgment against them, with no backstop.

Just 82 percent of the nation’s OB-GYN needs are expected to be met by 2037. The shortfalls will not be evenly distributed. Rural towns, low-income communities, and the places already carrying the highest maternal mortality and preterm birth rates will be hit hardest.

Tetlow holds out little hope for a federal fix anytime soon.

“We are very frustrated by the lack of federal action to reform our broken medical liability system,” she says. “In recent years, even limited reforms garnering bipartisan support have failed to advance, we don’t see immediate opportunities for a clear path forward at the federal level.”

The delivery rooms are closing. And no one in Washington is doing anything about it.

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