Are we overscheduling our children even from the moment of their birth?
We live in an on-demand world. Movies are shown on request, food is delivered on call and drivers arrive when beckoned. As an economist, not a medical doctor, I was surprised to find new data that suggest more babies are showing up when scheduled rather than on their own time frame.
The baby boom
In the early 1970s, an influential review of when women gave birth found that “[m]ore human births occur between 1:00 and 6:00 am than at other times of day.” Today, this no longer happens, since most babies in the US are born midafternoon in the middle of the week.
Not only does this issue set the tone from the very beginning of our lives, but it also is occurring on an enormous scale. Currently, the US has about four million births each year. To put that number in context, Canada, our northern neighbor, has a population that is almost 36 million people. This means every decade more babies are born in the US than all the people living in Canada!
Not only are large numbers born, but childbirth is a big business since the “cumulative costs of approximately four million annual births is well over US$50 billion.”
When are babies born?
Starting in 2003, states across the US began switching to a new standardized birth certificate that gathers much more information than the old birth certificate. Part of the extra information is the exact time of day when each child was born. The below table shows the time and day when babies were born, taken from the five most recent years of publicly released information.
There is no reason to expect that babies prefer leaving the womb on any particular day of the week. This means that births should be roughly evenly spaced out throughout the week. However, the table’s shaded gray bottom row shows this even spacing doesn’t happen. Instead, only 20% of all babies are born on Saturday or Sunday. If births were evenly distributed, about 29% (two days out of seven) of all births should occur on the weekend.
Babies are also not born randomly throughout a particular day in the US. If babies were born evenly spaced during the day, each of the table’s four time slots should have about 25% of all births. However, the shaded gray far right column shows far more babies than expected are born between noon and 6:00 pm. Interestingly, the midnight to 6:00 am time frame is now the least likely period for a baby to be born, capturing only 16.4% of all births. This is a far cry from the 1972 review quoted above that found the early morning hours were the most likely time for women to give birth.
The yellow numbers in the center of the table show the most likely time for a baby to be born is Tuesday afternoon, closely followed by Wednesday and Thursday afternoons. The least likely time for a baby to be born, shaded in green, is very early Sunday or Monday morning.
Why the change?
There are primarily three ways to give birth: vaginal delivery, induced delivery and Cesarean section. Looking at the time of day when births occur using each method shows very different patterns (see graph here).
Vaginal births happen more or less evenly spaced out during the day, with a slight bump in the early morning hours. C-section births typically happen either around 8:00 am or noon. Induced deliveries typically happen around 3:00 pm.
Why are so many babies now born on Tuesday afternoons instead of early in the morning, like the data from the 1970s showed? Births today are more likely by C-section or induction.
The percentage of women who give birth by C-section has dramatically increased over time (see graph here). In 1991, about 23% of all women giving birth had a C-section, but by 2010 this was almost 33%. Since only about one-quarter of all women who undergo a C-section did a trial of labor, this indicates many C-sections are scheduled (see table 14 here). C-sections may be scheduled by the doctor, or by the mother, or as emergency procedures. Unfortunately, birth records don’t indicate why a C-section was performed.
The same trend occurred for births that were induced (see graph here). In 1990, about 10% of all women giving birth were induced, but by 2010 the share had more than doubled to almost 24%.
There are many potential reasons for the increases in C-sections and inductions. Examples range from improved medical imaging that lets doctors determine with more accuracy uterine and fetal conditions during the last few weeks of pregnancy to a desire by doctors to avoid any type of problem to either mother or unborn child.
Is scheduling a reason?
Scheduling to meet the convenience of doctors and other medical staff is likely one factor driving this shift in birth times. Data on when doctors and other medical professionals work show the vast majority are currently on the job from 8:00 am to 4:00 pm. Relatively few work during the wee hours of the night and early morning.
The shift from vaginal childbirth to C-section or induction has moved more babies from being born in the middle of the night to times more closely aligned with health care workers’ daily schedules. Research suggests that when doctors and patients have an opportunity to decide when to schedule a birth, the doctor’s preferences win out about three-quarters of the time, possibly because doctor’s value their leisure.
Scheduling by mothers might be a contributing factor in a small number of cases. Research has found that some Chinese mothers appear to be scheduling their sons’ births to avoid unlucky days and ensure a lucky birthday. Tax implications also have a small impact on births around New Year’s Eve.
The March of Dimes, a non-profit devoted to preventing birth defects, is concerned about scheduling; it runs a campaign asking mothers to wait until 39 weeks before giving birth. The National Institutes of Health convened an expert panel that estimated 2.5% of all births in the United States are cesarean deliveries done on maternal request, but cautioned that it has “little confidence in the validity of these estimates.”
Does it matter?
So what does this trend mean for the health of the baby and the mother?
There is research that suggests it is more dangerous to have a baby in the middle of the night, when less medical staff is available. But the actual riskiness of vaginal childbirth, C-section or induced delivery is affected by a whole host of factors depending on the mother’s, child’s and hospital’s characteristics.
This shift from unscheduled births to setting birth times is unparalleled in history. There is a clear benefit to scheduling a birth when there is a medical need. However, when there are no medical concerns, there are advantages to being flexible and spontaneous.
As a middle-aged male, I will never give birth. However, I think our lives are diminished when every event is scheduled, starting from the moment of birth. What do you think?
This article also appeared in The Conversation and can be found here.