Staffing and the Determinants of Caesarean Sections in the English NHS
Graham Cookson and Ioannis Laliotis
In this paper we attempt a formal modelling of the incidence of caesarean deliveries in the English NHS for the period 2000-2013. Using richer data sources than previous relevant studies, we separately model the elective and emergency caesarean section probabilities on a full set of maternal, clinical, provider and maternity workforce characteristics after removing any time, region and provider fixed effects. Regarding the maternal and clinical characteristics our results are in line with previous cross-sectional evidence. However, we further show that the greater use of consultants, doctors and midwives tends to lower the probability for a caesarean section. Moreover, caesareans are more likely to occur in providers with higher caesarean rates in the past, indicating significant levels of persistence.