The Health Effects of Cesarean Delivery for Low-Risk First Births

Card, David; Fenizia, Alessandra; Silver, David

doi:10.3386/w24493

Cited by 13 publications

(15 citation statements)

References 53 publications

(78 reference statements)

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“…Economic studies analysing the health consequences of caesarean section have instead focused mostly on the baby's health (e.g. Jensen and Wüst, 2015;Costa-Ramon et al, 2018) and the mother's fertility and labour decisions (Halla et al, 2016;Card et al, 2018).…”

Section: Related Literaturementioning

confidence: 99%

Mother’s mental health after childbirth: Does the delivery method matter?

Tonei

2019

Journal of Health Economics

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The dramatic increase in the utilization of caesarean section has raised concerns on its impact on public expenditure and health. While the financial costs associated with this surgical procedure are well recognized, less is known on the intangible health costs borne by mothers and their families. We contribute to the debate by investigating the effect of unplanned caesarean deliveries on mothers' mental health in the first nine months after the delivery. Differently from previous studies, we account for the unobserved heterogeneity due to the fact that mothers who give birth through an unplanned caesarean delivery may be different than mothers who give birth with a natural delivery. Identification is achieved exploiting exogenous variation in the position of the baby in the womb at the time of delivery while controlling for hospital unobserved factors. We find that mothers having an unplanned caesarean section are at higher risk of developing postnatal depression and this result is robust to alternative specifications.

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Section: Related Literaturementioning

confidence: 99%

Mother’s mental health after childbirth: Does the delivery method matter?

Tonei

2019

Journal of Health Economics

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“…To eliminate the potential impact of unobserved factors, following [31][32]11], we also applied instrumental variables regressions, i.e. used potentially exogenous variables that affect the probability of C-section but are otherwise independent of mental health, such as the day of birth (weekday vs. weekend), the relative distance of the mother from hospitals with high vs. low C-section rates, or the presentation of the foetus.…”

Section: Discussionmentioning

confidence: 99%

Caesarean delivery and the use of antidepressants

Bíró

Elek

2020

European Journal of Public Health

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Background The high ratio of caesarean sections (C-sections) is a major public health issue in the developed world; but its implications on maternal mental health are not well understood. Methods We use individual-level administrative panel data from Hungary between 2010 and 2016 to analyze the relationship between caesarean delivery and antidepressant consumption, an objective indicator of mental health. We focus on low-risk deliveries of mothers without subsequent birth in 3 years, and include around 135 000 observations. Results After controlling for medical and socio-economic variables, antidepressant use before delivery is associated with an elevated risk of C-section (adjusted OR = 1.10, 95% CI 1.05–1.14) and C-section is associated with a higher probability of antidepressant use within 1–3 years after delivery (e.g. adjusted OR = 1.21, 95% CI 1.12–1.30, within 3 years after delivery, among mothers without pre-delivery antidepressant consumption). Our data restriction ensures that the results are not driven by a mechanical impact of decreasing fertility on the continuation of antidepressant use after a C-section. Conclusions The results suggest that C-section is associated with worse mental health over the 1- to 3-year horizon after birth. This relationship is particularly important if a caesarean delivery is not necessary due to medical reasons, and physicians as well as expectant mothers should be made aware of the potential mental health implications of the mode of delivery.

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“…Following the literature (e.g., [13,21,37]), we use the relative distance from setor censitário to the nearest hospital (following the road network using GIS network analyst tools) as an instrument to patient hospital/clinic choice and, eventually, their death location. Distance from their residence to the nearest hospital as an instrument to patient choice for healthcare is reasonable for two reasons.…”

Section: Validating Heat Vulnerability Against Excess Deaths During Hmentioning

confidence: 99%

Health effects of heat vulnerability in Rio de Janeiro: a validation model for policy applications

Prosdocimi

Klima

2020

SN Appl. Sci.

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Extreme heat events can lead to increased risk of heat-related deaths. Furthermore, urban areas are often hotter than their rural surroundings, exacerbating heat waves. Unfortunately, validation is difficult; to our knowledge, most validations, even if they control for temperatures, really only validate a social vulnerability index instead of a heat vulnerability index. Here we investigate how to construct and validate a heat vulnerability index given uncertainty ranges in data for the city of Rio de Janeiro. First, we compare excess deaths of certain types of circulatory diseases during heat waves. Second, we use demographic and environmental data and factor analysis to construct a set of unobserved factors and respective weightings related to heat vulnerability, including a Monte Carlo analysis to represent the uncertainty ranges assigned to the input data. Finally, we use distance to hospital and clinics and their health record data as an instrumental variable to validate our factors. We find that we can validate the Rio de Janeiro heat vulnerability index against excess deaths during heat waves; specifically, we use three types of regressions coupled with difference in difference calculations to show this is indeed a heat vulnerability index as opposed to a social vulnerability index. The factor analysis identifies two factors that contribute to >70% of the variability in the data; one socio-economic factor and one urban form factor. This suggests it is necessary to add a step to existing methods for validation of heat vulnerability indices, that of the difference-in-difference calculation.

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The Health Effects of Cesarean Delivery for Low-Risk First Births

Cited by 13 publications

References 53 publications

Mother’s mental health after childbirth: Does the delivery method matter?

Mother’s mental health after childbirth: Does the delivery method matter?

Caesarean delivery and the use of antidepressants

Health effects of heat vulnerability in Rio de Janeiro: a validation model for policy applications

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