Working Paper: NBER ID: w25986
Authors: David Card; Alessandra Fenizia; David Silver
Abstract: Treatment practices vary widely across hospitals, often with little connection to the medical needs of patients. We assess impacts of these differences in childbirth, where there is broad interest in reducing cesarean deliveries. Using a distance-based design and data from half a million births, we find that infants delivered at hospitals with higher c-section rates are born in better shape, are less likely to be readmitted to the hospital, are exhibit suggestive evidence of improved survival. These benefits are driven by the avoidance of prolonged labors that pose serious risks to infant health. In contrast, we document that these infants are substantially more likely to return to the emergency department for respiratory-related problems in the year after birth, providing some of the first design-based evidence consistent with a large observational literature linking cesarean delivery to chronic reductions in respiratory health.
Keywords: Childbirth; Cesarean delivery; Health outcomes; Hospital delivery practices
JEL Codes: D22; I11; I18; J13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| higher c-section rates (J13) | better infant health (I14) |
| higher c-section rates (J13) | lower probability of low 5-minute Apgar scores (I14) |
| reduction in prolonged labors at H hospitals (J19) | better infant health (I14) |
| higher c-section rates (J13) | increased likelihood of respiratory-related problems (I12) |
| delivery at H hospitals (I11) | lower rates of maternal complications (J13) |