The Rates and Medical Necessity of Cesarean Delivery in the Era of the Two-Child Policy in Hubei and Gansu Provinces, China

Abstract

Objectives. To describe the cesarean rates in different child policy periods and assess the medical necessity of cesareans during the 2-child policy period. Methods. We collected hospital-level aggregate data on 93 745 deliveries and individual-level data on 27 977 deliveries from 6 hospitals in the Hubei and Gansu provinces of China from 2013 to 2016. Experts in gynecology and obstetrics assessed the medical necessity of 1024 randomly selected cesareans in 2016. Results. The overall cesarean rate decreased significantly from 45.1% in the 1-child policy period (January 2013–September 2014) to 40.4% in the selective 2-child policy period (October 2014–July 2016) and further to 38.9% in the universal 2-child policy period (August 2016–December 2016). The rate of cesarean delivery on maternal request decreased by 46.3%, whereas the rate of cesarean delivery indicated by a previous cesarean delivery increased by 118.8% ( P  < .001). The experts assessed 222 (21.6%) cesareans as lacking medical necessity. Conclusions. The overall cesarean rate in Hubei and Gansu provinces decreased after the implementation of the 2-child policy, and one fifth of cesareans might be nonessential.