What difference does a week make? : An empirical analysis evaluating the effect of induction of labor in gestational week 41 among births in Sweden

Sammanfattning: This thesis examines the relationship between gestational age and stillbirths, focusing on the effect of maternal age. Prolonged pregnancies have been associated with an increased risk of stillbirth, prompting the exploration of labor induction as a preventive measure. However, the existing literature suffers from limited sample sizes, leading to uncertainty in the findings.  This study utilizes regional variations in labor induction practices to in- crease the sample size substantially. Moreover, it incorporates the economical aspect by evaluating the cost of induction and how the current policy could be optimized. In Sweden, some regions modified their induction policies in 2019 while others did not, creating a quasi-experimental setting that is exploited in this thesis. The objective is to evaluate the impact of inducing labor before pregnancies are defined as prolonged on stillbirth rates. A panel from 2009 to 2021, comprising over 1.4 million laborers, is analyzed, focusing on approximately 13,500 prolonged pregnancies between 2019 and 2021.  The results suggest that implementing a new induction policy among mothers aged 30 or older would yield annual cost savings of 24.6 MSEK. Specifically, targeting this age group for induction reduces the number of inductions required in week 41 to prevent one stillbirth from 224 to 127, compared to inducing mothers of all ages. These findings contribute to understanding labor induction practices and their impact on stillbirth rates, especially how the current policy could be optimized from a monetary perspective, providing valuable insights to policymakers.