Understanding labour productivity in maternity wards

This paper provides a causal estimate of labour productivity in maternity wards. We consider an Italian law that defines the staffing requirements of hospital maternity units according to the annual number of births. We exploit the discontinuities in the availability of medical staff caused by thresholds in the law to define both instrumental variables and a regression discontinuity framework that allows us to estimate the causal effect of different teams of professionals on the mode of delivery and on the health status of newborns and mothers at delivery. The analysis is based on detailed patient-level data on births in an Italian region. We find that maternity units with annual births above the thresholds are more likely to have a 'full team' of professionals at delivery. We find that having a full team has no effect on the mode of delivery (caesarean section vs vaginal birth). However, the presence of a full team has a significant impact on health outcomes. We find an improvement in both neonatal and maternal outcomes associated with a more intensive use of medical interventions, suggesting that larger hospitals are better than smaller units at managing deliveries with appropriate treatments to avoid complications. In addition, we do not find substantial heterogeneous effects across days of the week, time of day, or nationality of mothers.