This dissertation comprises three essays in labor and health economics, unified by a focus on how regulation, institutional structure, and public policy shape the maternal health workforce and access to care. Each chapter explores dimensions of provider behavior, labor allocation, and service availability in the context of U.S. maternal health, with particular attention to Medicaid and low-income populations. In Chapter one, I examine how granting Full Practice Authority (FPA) to Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) affects provider use and maternal outcomes. Using Medicaid claims data from 22 states (2016–2019), I find that FPA increases midwife-attended births—especially for low-risk deliveries without any adverse outcomes. The results point to more efficient provider sorting and greater utilization of the existing midwifery workforce, highlighting the labor supply response to scope-of-practice reform.

Chapter 2 examines how changes in hospital ownership, particularly transitions to for-profit status, affect the provision of obstetric services and local access to care. Drawing on hospital financial and staffing data (2004–2019), I show that ownership conversions are associated with cost-cutting behavior, including lower nurse wages and higher rates of obstetric unit closures. These changes reduce access to local care but have limited effects on observed maternal outcomes, emphasizing how financial incentives affect hospital labor decisions and service availability.

Chapter 3 explores how Medicaid expansion under the Affordable Care Act (ACA) influenced midwife use in delivery care. Using U.S. birth certificate data from 2010 to 2019, I find that expansions led to greater reliance on CNMs/CMs, particularly in states with reimbursement parity. The results reflect increased utilization of the midwifery workforce and suggest that insurance expansions can shift labor allocation in maternal care, conditional on supportive payment policy.

Collectively, these essays contribute to our understanding of how regulation and institutional change shape provider behavior, labor deployment, and access to essential health services.