Do Cesarean Delivery rates rise when the economy declines? A test of the economic stress hypothesis

A growing body of research supports the Barker hypothesis that adverse conditions around the time of birth have a negative effect on health. Nevertheless, the mechanisms linking early life conditions with health are still unclear. This paper investigates one of such potential mechanisms, specifically, ambient stress, by analyzing the effect of economic downturns as a stressor on the probability of Cesarean Delivery (CD). I focus particularly on male CD since the literature reports that male fetuses are more sensitive to stressors in utero than female fetuses. Using data from Lifelines, a large cohort study from the northern Netherlands, I show that the probability of CD for male babies increases when unemployment levels rise. This result suggests that maternal stress might be one of the mechanisms how early life economic conditions affect health.