Summary
China’s universal two-child policy was released in October of 2015. How would this new policy influence the rate of overall cesarean delivery (CD) in China? The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China (a tertiary hospital) in 2016. In this study, 22 530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were enrolled as research objects. Electronic health records of these selected objects were retrieved. According to the history of childbirth, the selected cases were divided into primiparous group containing 16 340 cases and multiparous group containing 6190 cases. Chi-square test was carried out to compare the rate of CD, neuraxial labor analgesia, maternity insurance between the two groups; t-test was performed to compare the in-hospital days and gestational age at birth between the two groups. Pearson correlation coefficient was used to evaluate the relationship among observed monthly rate of multiparas, overall CD rate, and Elective Repeat Cesarean Delivery (ERCD) rate. The results showed that the CD rate in multiparous group was 55.46%, which was higher than that in primiparous group (34.66%, P<0.05). The rate of neuraxial labor analgesia in multiparas group was 9.29%, which was lower than that in primiparas group (35.94%, P<0.05). However, the rate of maternity insurance was higher in multiparas group (57.00%) than that in primiparas group (41.08%, P<0.05). The hospital cost and in-hospital days in multiparas group were higher, and the gestational age at birth in multiparas group was lower than in primiparas group (P<0.05). The overall CD rate slightly dropped in the first 4 months of the year (P<0.05), then increased from 36.27% (April) to 43.21% (December) (P<0.05). The rate of multiparas women and ERCD had the same trend (P<0.05). There were linear correlations among the rate of overall CD, the rate of multiparas women and the rate of ERCD rate (P<0.05). With the opening of China’s two-child policy, the increasing rate of overall CD is directly related with the high rate of ERCD. Trials of Labor After Cesarean Section (TOLAC) in safe mode to reduce overall CD rate are warranted in the future.
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Khan A, Zaman S. Costs of vaginal delivery and caesarean section at a tertiary level public hospital in Islamabad, Pakistan. BMC Pregnancy Childbirth, 2010, 10:2
Moran AC, Jolivet RR, Chou D, et al. A common monitoring framework for ending preventable maternal mortality, 2015–2030: phase I of a multi-step process. BMC Pregnancy Childbirth, 2016,16:250
Kawakita T, Reddy UM, Landy HJ, et al. Indications for primary cesarean delivery relative to body mass index. Am J Obstet Gynecol, 2016,215(4):515.e1–e9
Boyle A, Reddy UM, Landy HJ, et al. Primary cesarean delivery in the United States. Obstet Gynecol, 2013,122(1):33–40
Souza JP, Betran AP, Dumont A, et al. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study. BJOG, 2016,123(3):427–436
Shearer EL. Cesarean section: medical benefits and costs. Soc Sci Med, 1993, 37(10):1223–1231
Quinlan JD, Murphy NJ. Cesarean delivery: counseling issues and complication management. Am Fam Phy-sician, 2015,91(3):178–184
Chen M, Xie L. Clinical evaluation of balloon occlusion of the lower abdominal aorta in patients with placenta previa and previous cesarean section: A retrospective study on 43 cases. Int J Surg, 2016,34:6–9
Cali G, Forlani F, Timor-Tritsch IE, et al. Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign. Ultrasound Obstet Gynecol, 2017,50(1): 100–104
Martin JM, Moore ES, Foster TL, et al. Transabdominal cerclage placement in patients with prior uterine incisions: risk of scar disruption. J Obstet Gynaecol, 2013,33(7):682–684
Litorp H, Kidanto HL, Nystrom L, et al. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth, 2013,8;13:107
Lumbiganon P, Laopaiboon M, Gülmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet, 2010,375(9713):490–499
Wang X, Hellerstein S, Hou L, et al. Caesarean deliveries in China. BMC Pregnancy Childbirth, 2017,17(1):54
Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol, 2013,27(2):297–308
Chai ZY, Hu HM, Ren XL, et al. Applying Lean Six Sigma methodology to reduce cesarean section rate. J Eval Clin Pract, 2017,23(3):562–566
Silver RM. VBAC should be encouraged as a means to reduce the caesarean section rate in China: AGAINST: This strategy won’t work! BJOG, 2016,123(Suppl 3):11
Ma RM, Duan T, Lao TT. VBAC should be encouraged as a means to reduce the caesarean section rate in China: FOR: VBAC reduces not only the caesarean section rate but also other associated issues. BJOG, 2016,123(Suppl 3):10
Zeng Y, Hesketh T. The effects of China’s universal two-child policy. Lancet, 2016,388(10054):1930–1938
Rogers AJ, Rogers NG, Kilgore ML, et al. Economic Evaluations Comparing a Trial of Labor with an Elective Repeat Cesarean Delivery: A Systematic Review. Value Health, 2017,20(1):163–173
Herstad L, Klungsøyr K, Skjærven R, et al. Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low-risk primiparous women. BMC Pregnancy Childbirth, 2016,16:230
Hu LQ, Flood P, Li Y, et al. No Pain Labor & Delivery: A Global Health Initiative’s Impact on Clinical Outcomes in China. Anesth Analg, 2016,122(6):1931–1938
Sharpe AN, Waring GJ, Rees J, et al. Caesarean section at maternal request—the differing views of patients and healthcare professionals: a questionnaire based study. Eur J Obstet Gynecol Reprod Biol, 2015,192:54–60
Olieman RM, Siemonsma F, Bartens MA, et al. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy Childbirth, 2017,17(1):195
Declercq E, Young R, Cabral H, et al. Is a rising cesarean delivery rate inevitable? Trends in industrialized countries, 1987 to 2007. Birth, 2011,38(2):99–104
Betrán AP, Merialdi M, Lauer JA, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol, 2007, 21(2):98–113
Feng XL, Xu L, Guo Y, et al. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ, 2012,90(1):30–39, 39A
Han H, Qin M, Xu HQ. The rate of cesarean section and its effect factors in Shanghai. Mater Child Health Care China, 2010,25(22):3077–3080
Qian JC. China National cesarean rate, analysis and suggestions. J Popul Dev, 2012,5:39–42
Deng W, Klemetti R, Long Q, et al. Cesarean section in Shanghai: women’s or healthcare provider’s preferences? BMC Pregnancy Childbirth, 2014,22;14:285
Hellerstein S, Feldman S, Duan T. China’s 50% caesarean delivery rate: is it too high? BJOG, 2015,122(2):160–164
Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol, 2004,103(5 Pt 1):907–912
Finger C. Caesarean section rates skyrocket in Brazil. Many women are opting for caesareans in the belief that it is a practical solution. Lancet, 2003,362(9384):628
Shanghai City health care statistics. [http://www.smhb.gov.cn/website/b/62348.shtmal]. Accessed 18 May 2012
Beijing Municipal Commission of Health and Family Planning. Beijing launched the program for advancing vaginal delivery and promoting maternal and infant health. http://www.bjhb.gov.cn/wsxw/201106/t20110620_35526.html. Accessed November 27, 2015
Health and Family Planning Commission of Zhejiang Province. Dinghai district took actions to reduce the rate of cesarean section. http://www.zjwjw.gov.cn/art/2012/5/4/art_24_35033.html. Accessed November 27, 201536–28030701
Li HT, Luo S, Trasande L, et al. Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008–2014. JAMA, 2017,317(1):69–76
Cui HS, Li HT, Zhu LP, et al. Secular trends in cesarean delivery and cesarean delivery on maternal request among multiparous women who delivered a full-term singleton in Southern China during 1993–2005. J of Peking University (Health Sciences), 2013,45(3):422–426
Liao Z, Zhou Y, Li H, et al. The Rates and Medical Necessity of Cesarean Delivery in the Era of the Two-Child Policy in Hubei and Gansu Provinces, China. Am J Public Health, 2019,109(3):476–482
Liang J, Mu Y, Li X, et al. Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births. BMJ, 2018,360:k817
American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol, 2010,116(2 Pt 1):450–463
Pang MW, Lee TS, Leung AK, et al. A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women. BJOG, 2007, 114(5):623–629
Qu ZQ, Ma RM, Xiao H, et al. The outcome of trial of labor after cesarean section. Zhonghua Fu Chan Ke Za Zhi (Chinese). 2016,51(10):748–753
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The authors are grateful to all the experts from the nongovernment project of No Pain Labor&Delivery (NPLD) and all the obstetricians, midwives and nurses of our center.
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This study was supported by the Health and Family Planning Commission of Hubei Province (No. WJ2018H0133).
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Du, Sg., Tang, F., Zhao, Y. et al. Effect of China’s Universal Two-child Policy on the Rate of Cesarean Delivery: A Case Study of a Big Childbirth Center in China. CURR MED SCI 40, 348–353 (2020). https://doi.org/10.1007/s11596-020-2190-4
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DOI: https://doi.org/10.1007/s11596-020-2190-4