Major Birth Interventions & Patients Health (Care) Outcomes - Evidence from Germany on the Key Role of Labor Induction
This paper provides novel evidence on the causal effect of non-medically indicated birth interventions on patients’ health and hospitals’ follow-up care. The analysis is based on data for Germany, where the timing of births reduces uncertainty in maternity unit management, leading to induced labor being twice as common in 2022 compared to 1985. Using two years of nationwide comprehensive hospital records, the empirical design allows identifying non-random and interdependent assignment of inductions, cesarean sections, and instrumented delivery (by forceps, spatula, vacuum). Identification exploits quasi-random delivery path dependencies among healthy first-time mothers that vary the intervention likelihood of women subsequently admitted to hospital. The results reveal evidence for the key role of induction in increased prevalence of uterine ruptures, placental separation problems, and substantially impaired neonatal fitness. The detrimental impact of induction triggers an ambiguous follow-up (care) response, which highlights how leniently medical guidelines treat induction, especially compared to cesarean section.