I recently had a conversation with a fellow midwife in which she discussed a frustrating encounter she had with a collaborating physician regarding her care of a woman receiving labor augmentation for premature rupture of membranes. The physician was concerned about the woman's rate of cervical dilation and expressed his opinion that she should have a cesarean if she did not give birth vaginally in the next few hours. The midwife cited a recent obstetric care consensus 1 as evidence to support her recommendation that the woman have more time to complete the latent phase of labor in the presence of normal maternal and fetal monitoring results. The physician was dismissive of this evidence and told the midwife, "No new study or guideline is going to save us if anything goes wrong with this baby. I'm not risking a medical malpractice case over this." Later, the midwife was pessimistic about evidence-based practice as she discussed the conversation with me, "Does it even matter if we have scientific evidence about clinical practice when the only thing guiding our decision making is the fear of a medical malpractice claim?"My friend brought up a very real threat to the work of improving health care quality via evidence-based practice. Since the Institute of Medicine first released the groundbreaking report "To Err is Human: Building a Safer Health System," efforts to reduce preventable medical errors through comprehensive health care safety and quality reforms have blossomed around the United States. 3,7 Despite these efforts, researchers who provided an updated estimate of preventable medical errors in the United States found that these errors are the third leading cause of death in the United States (estimated at 400,000 per year), ranking just after cancer-related death (584,881 deaths per year). 2,4 Fear of medical malpractice claims among health care providers does not improve patient safety for several reasons. First, medical malpractice claims do not differentiate good from bad clinical care. Approximately one-fourth of all malpractice claims with medical merit do not end in compensation for the patient, while one-fourth of malpractice claims with no medical merit do result in compensation. 6 Second, most health care errors are caused by problems in the health care system and are not the result of an individual practitioner's error, which is the focus of medical malpractice claims. 7 A medical malpractice case is a long and traumatic experience for the health care provider and has personal and