Odds of Cesarean Section, Childbirth Outcomes and Public Policy: An Empirical Study Using the Matched New York State Data

Research has shown that childbirth environment and outcomes have a long lasting impact on later-life outcomes such as physical and mental health, educational attainment and labor market outcomes. Childbirth and the surrounding issues have been a major concern of the public health care system.;This dissertation aims to examine how patient socioeconomic factors, provider characteristics and public policies affect childbirth and outcomes in different contexts in New York State, so as to provide guidance for the health care system to improve. Minority childbirth is also a chapter of this dissertation.;Chapter 1 studies the effect of the 1996 welfare reform on childbirth outcomes for low-educated immigrant mothers in New York State, using natal data files from the Nation Center for Health Statistics (NCHS) from 1995 to 1999. We adopted the Difference-in-Difference technique and found that the 1996 reform adversely affected immigrant childbirth outcomes by depressing childbirth weight and fetal growth rate for low-educated immigrant mothers, although the reform was never intended to do so.;Chapter 2 studies the dynamics and determinants of cesarean delivery in New York State using matched NYS Statewide Planning and Research Cooperative System (SPARCS) Inpatient data and Statewide Perinatal Data System (SPDS) data, 2012-2013. We used a two-equation sequential model to study the factors associated with woman's intent for vaginal delivery and the final delivery route. We also investigated the dynamics of overall C-section in its two components -- primary C-section and repeat C-section. Vaginal birth after cesarean (VBAC) is a key mechanism to reduce excessive Cesarean use in New York State.;Chapter 3 focuses on Minority childbirth health in the New York State. Over 40% of New Yorkers belong to racial and ethnic minority groups in 2014. It raises big concern to the New York State health care system. Fighting against poor childbirth outcomes as well as promoting quality prenatal and childbirth care to the minority groups is an ongoing long-term process.