Alessandra Fenizia, GWU

with David Card and David Silver

Abstract: Hospital treatment practices vary widely, often with little connection to the medical needs of patients. We assess the impact of these differences in the context of childbirth. We focus on low-risk first births, where cesarean delivery rates vary enormously across hospitals, and where policymakers have focused much of their attention in calls for reducing unnecessary c-sections. We find that proximity to hospitals with high c-section rates leads to more cesarean deliveries, fewer vaginal births after prolonged labor, and higher average Apgar scores. Infants whose mothers’ choice of a high c-section hospital is attributable to distance are more likely to visit the emergency department for a respiratory-related problem in the year after birth but are less likely to be readmitted to hospital. They also have lower mortality rates, driven by a reduction in the joint probability of prolonged labor and subsequent death. We conclude that delivery practices at high c-section hospitals have benefits as well as costs for infant health that should be considered in developing policies to regulate delivery practices.

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