According to the Center for Health Workforce Studies, eight counties in New York State have no obstetricians: Essex, Greene, Seneca, Tioga, Washington, Yates, Schoharie, and Hamilton. The center also found that 18 of New York’s counties have fewer than five practicing ob-gyns. If these trends continue, it may get to the point where we have to ask: who will deliver the babies of New Yorkers? New York is not alone: in fact, more than 1,500 counties in America — about half of all counties — do not have even a single obstetrician.

It has never been a safer time to have a baby, or a more dangerous time to be an obstetrician. During the past 30 to 40 years, technological innovations like ultrasound and electronic fetal heart rate monitoring have revolutionized obstetrical practice, while a variety of other advances have led to the virtual elimination of some potentially devastating fetal conditions and substantial improvement in the outcome of many pregnancies complicated by medical disorders. This has occurred despite the fact that increasing numbers of women are waiting to have their first child until they are considerably older than the generations that preceded them.

For the physicians and midwives who deliver babies, though, the news has not been so good. According to a 2006 study by the American College of Obstetricians and Gynecologists, nearly 90% of obstetricians report that they have been sued at least once in their careers, up from approximately 75% in 1996. Furthermore, about 40% of obstetrical residents have at least one claim filed against them during their four-year training period. That same survey found that almost 65% of ob-gyns made one or more changes to their practice as a result of the risk or fear of professional liability claims or litigation.

By far, the biggest source for malpractice lawsuits against ob-gyns is neurological damage to newborns, particularly manifested in the development of cerebral palsy. Families who have an infant with cerebral palsy almost always have substantial financial needs, for medical care, therapy, and other services for their children. With options for support often limited, it’s no surprise that these families frequently seek recourse in the tort system. The problem is that few cases of cerebral palsy actually have anything to do with the process of giving birth. Indeed, experts suggest that apart from taking steps to avoid exposure to associated risk factors in a small percentage of cases, there is little evidence to suggest that cerebral palsy can currently be prevented.

Not that efforts haven’t been made. The rate of caesarean deliveries in America has soared during the last 30 years, at least in part due to defensiveness on the part of physicians seeking to avoid birth-related lawsuits. But it hasn’t helped much. Despite a national c-section rate of close to 30% in 2005 — almost 5 times the rate in 1970 — the incidence of cerebral palsy has remained rock stable throughout that period, about one in every 500 births. Today, the tort system is like a lottery for medical injury victims. A few win large amounts, but most receive nothing. Most injuries go uncompensated, as shown by the Harvard Medical Practice Study, based on claims data from New York hospitals and follow-up studies. The system’s administrative costs are also very high, as much as 60 cents on the dollar, which means that whether a case is won in court or settled much more money goes to legal fees, expert witnesses, and other costs rather than to patients and families.

But the costs of raising neurologically impaired children are enormous for all those who face this challenge, not just those lucky enough to win the legal lottery. Moreover, obstetricians consistently face liability for adverse outcomes that they could not have prevented from occurring. This helps to drive up malpractice insurance premiums, and to create an environment which is increasingly unfavorable for all providers of care to pregnant women. With today’s high practice costs and relatively fixed reimbursements, obstetrical practitioners are leaving early at the far end of the pipeline — and fewer of our medical school graduates are entering today at the near end.

According to the chief of obstetrics at Oswego Hospital in Oswego, N.Y., Dr. Ronald Uva, a practicing obstetrician-gynecologist for nearly 30 years who has delivered seven thousand babies, “It is almost impossible for me or my colleagues to continue to practice obstetrics. I tried to stop practicing at age 55 to spend more time with family, but my group could not recruit a single obstetrician and my partners would have had to work every other night in the hospital. My group is still trying to recruit. No luck — not one decent candidate. There are really no obstetricians for hire. Also, high medical liability rates make it almost impossible for me to give care to the underserved.”

This is happening in an environment which is problematic for the medical community. There are constant challenges, such as the administrative hassles of practicing medicine, which are provoking startlingly high levels of physician discontent and distraction. In a survey conducted last year by the physician recruiting firm locumtenens.com, 97% of the 2,400 physician respondents said they were frustrated by nonclinical aspects of medicine.

Physicians — and families — in this state deserve better. We propose an alternative approach: a new program, financed with provider and public support, to provide comprehensive benefits to all eligible children with substantial neurological injuries using an approach similar to workers compensation. Such a program would remove these cases from the tort system.

Rather than filing a claim in court, all eligible families would obtain financial support in this administrative system, with oversight provided by highly qualified independent experts, and a rational process for determining awards. A case management program would evaluate every child individually to determine the assistance that each family requires. Eligible beneficiaries would gain access to the services they needed for their entire lives.

In addition to providing financial assistance to all families with impaired children who met the eligibility criteria, the program would also address patient safety, by performing a comprehensive review of the standard of care in each case. The failings identified would then be used to discipline those found to be negligent, and to educate every obstetrical caregiver in the state about delivering better, safer care.

Such an approach would compensate more children, more quickly, and in a more equitable way, as evidence suggests that similar programs have done in Florida and Virginia. Those programs have dramatically reduced the administrative costs associated with compensating birth-related injuries, and program administrators suggest that providing financial support to eligible cases though this approach will result in substantial savings over time. Moreover, this type of program will provide access to a lifetime of needed health care and other services for these vulnerable children, and should help to stabilize liability insurance premiums while improving the quality of care throughout the state.

In Albany, legislation was introduced in the Senate this past session that would have begun the process of creating a program like this in New York. We hope that our elected officials will carefully consider endorsing this equitable and rational proposal that has the promise of benefiting patients, families, obstetrical health care providers and society as a whole.

Mr. Barringer is the general counsel at Common Good, a nonprofit legal reform coalition. Dr. Berkowitz is a professor of obstetrics and gynecology at Columbia University Medical Center.