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J Health Econ. 2019 Jan;63:182-196. doi: 10.1016/j.jhealeco.2018.11.006. Epub 2018 Dec 7.

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

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DERS, University of York, United Kingdom. Electronic address:


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.


Caesarean section; Instrumental variables; Maternal health; Millennium Cohort Study; Postnatal depression

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