University of Arizona This study will examine the effects of medical malpractice suits, tort laws, health insurance, and reproductive regulations on birth practices in the United States. The research will test organizational theories about how legal regulations and insurance practices affect practices in health care. The study will focus specifically on cesarean sections because many healthcare industry insiders view cesareans as a form of defensive medicine, although the effects of malpractice and health insurance on cesareans are unclear. The research design combines quantitative analysis of how cesarean deliveries vary across states and over time in relation to malpractice, health insurance, and reproductive laws, with qualitative analysis of 30-40 interviews with important stakeholders in maternity care (providers, liability insurers, health insurers, and malpractice attorneys). The study's broader impacts include uncovering any non-medical influences on maternity care which may reveal ways to reduce maternal and infant mortality and morbidity, and offering insights into the cost of maternity care. The results will have policy implications for improving maternity care and lowering healthcare costs.