Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon

This paper examines how workload affects the provision of care in a large but understudied segment of the healthcare sector – maternity wards. I use detailed patient-level administrative data on childbirth, and exploit quasi-random assignment of unscheduled patients to different staffing ratios. I find that patients who at admission observe a higher ratio of patients-to-midwives are more likely to receive a C-section. I show that this result is not attributable to patients’ differential sorting across workload levels. Instead, I find evidence that C-sections are used to alleviate midwives’ workload -they are faster than vaginal births and performed by physicians. I also exploit patient’s civil status to determine whether the effect varies with patient’s bargaining power -single women are on average more likely to be alone in the delivery room. Consistent with induced demand, only single patients are more likely to receive a C-section when admitted at high workload levels.