Haley Wilbert

Job Market Paper

“After the Cut: Cesarean Delivery and Subsequent Fertility” with Carson Homme    

Abstract: Cesarean delivery is the most common major surgery among women in the United States, yet its long-term implications for maternal fertility remain underexplored. This paper investigates how cesarean delivery, particularly the distinction between planned and unplanned procedures, affects subsequent childbirth decisions. Leveraging administrative and health claims data from the U.S. military, we construct a uniquely comprehensive dataset that enables precise tracking of maternal outcomes over time. We show that correlation estimates between cesarean delivery and future fertility are highly sensitive to controls for maternal health conditions, and causal interpretations of these correlation estimates suffer from endogeneity. To produce causal estimates, we implement two instrumental variable strategies: an examiner tendency design for unplanned cesareans and breech presentation for planned procedures. We find a 32% decrease in the likelihood of a subsequent delivery within four years following an unplanned cesarean delivery. Alternatively, following a planned cesarean delivery, we find small statistically insignificant effects on the likelihood of subsequent childbirth. Together, these findings suggest that the birth experience, rather than the procedure alone, plays a pivotal role in shaping maternal reproductive decisions.

Haley Wilbert | University of Notre Dame