After the Cut: Cesarean Delivery and Subsequent Fertility with Carson Homme
Abstract: Cesarean delivery (C-section) is the most common major surgery among women in the United States, yet its long-term effects on maternal fertility remain unclear. This paper provides new causal evidence on how C-section, specifically the distinction between planned and unplanned procedures, affects subsequent childbearing. Using a proprietary linked dataset of Army health claims and administrative records, we implement two instrumental variable strategies to isolate the impact of birth experience from underlying maternal health and the surgical procedure. We find that likely-unplanned C-sections reduce the probability of subsequent childbirth within four years by 28 to 34%, while planned procedures have small and statistically insignificant effects. These results suggest that the birth experience surrounding C-section delivery plays a critical role in shaping future fertility decisions. To explore mechanisms, we examine short-term maternal outcomes and find that unplanned procedures are associated with increased hospital readmission and mental health visits, consistent with physical and psychological pathways that may influence reproductive behavior. Because childbirth in the military setting is nearly costless and insulated from financial incentives, our estimates likely represent a lower bound. In broader populations, where repeat C-sections carry higher financial and logistical burdens, the fertility impacts may be even larger. Our findings underscore the importance of distinguishing between planned and unplanned C-sections when evaluating maternal outcomes and highlight the need for policies that consider both clinical necessity and experiential consequences of C-section.
“Breakthroughs in Historical Record Linking Using Genealogy Data – The Census Tree Project” with Kasey
Buckles, Joseph Price, and Adrian Haws
Explorations In Economic History, forthcoming
“Family Trees and Falling Apples: Historical Intergenerational Mobility Estimates for Women and Men” with
Kasey Buckles, Joseph Price, and Zach Ward
“Intergenerational Mobilty and Family Size: Evidence from the Census Tree”