The Labor Market and Health Impacts of Reducing Cesarean Section Deliveries

This research was conducted as a part of the U.S. Census Bureau’s Evidence Building Project Series. The Census Bureau has ensured appropriate access and use of confidential data and has reviewed these results for disclosure avoidance protection (Project P-7523134: CBDRB-FY25-0281 and CBDRB-FY25-0435 and Project P-7503097: CBDRB- FY26-002 and CBDRB-FY26-0178). We are very grateful to Dr. Elliott Main, MD, the inaugural medical director of the California Maternal Quality Care Collaborative (CMQCC), for sharing data with us on hospitals’ participation in the CMQCC cesarean section intervention. We also thank Dr. Main and Dr. Amanda Williams, MD, for helpful discussions regarding clinical practice in obstetrics and gynecology and labor and delivery. We thank Joshua Bricker and Taegan Mullane for excellent research assistance. Research reported in this article was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD115606. We would also like to thank Ellen Badley, Sandra Bannerman, Colin Chew, Heather Fukushima, Steven Hoang, Amanda Jackson, Sibylla Leon Guerrero, Michelle Miles, Eric Neuhauser, Jenn Rico, Ping Yan, and other staff at the California Department of Public Health (CDPH) for their help in accessing restricted California birth records, and Victoria McCoy-Cosentino at NYU for help with data use agreements. We would also like to thank Gloria Aldana, Ashley Austin, Casey Blalock, Scott Boggess, Clint Carter, Melissa Chiu, Diane Cronkite, Denise Flanagan-Doyle, Adam Galemore, Katie Genadek, Katlyn King, Shawn Klimek, Shirley Liu, Kathryn Mcnamara, Bonnie Moore, Emily Wisniewski and other staff at Census, Robert Goerge and Leah Gjertson at Chapin Hall, and the Laura and John Arnold Foundation’s support under their initiative to use linked data to advance evidence-based policymaking for help with the linkages to Census-held data. All errors are our own. The views expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Census Bureau, the California Department of Public Health, other data providers, the National Institutes of Health or the National Bureau of Economic Research.

• December 10, 2025