Maternity Ward Crowding, Birth Outcomes, and Future Fertility and Healthcare Decisions: Evidence from California

Abstract

We examine how maternity ward overcrowding impacts both concurrent birth outcomes and mothers' future fertility and hospital choices, leveraging quasi-random day-to-day variation in birth counts within Californian hospitals. Our findings reveal a significant reduction in medical interventions—C-sections, epidurals, inductions, and augmentations—on crowded days, without adverse effects on maternal or infant health. While we find no impact on future fertility, mothers, particularly those with a college degree, are more likely to switch hospitals or opt for a non-hospital setting for their subsequent birth. However, we do not observe systematic patterns in hospital selection, suggesting that the decision is primarily driven by negative first-birth experiences.

Keywords: Maternity Ward, Overcrowding, Fertility, Hospital Choice, Medical Procedure, Birth Outcomes

JEL Classification: I11, J13, M50