Interventions to reduce the cesarean delivery rate in a tertiary hospital in China

Abstract

Introduction

High cesarean delivery rate has been a global public health concern. This study assesses the effect of medical interventions and societal changes on cesarean delivery rates in a Chinese tertiary hospital.

Material and methods

A retrospective study including all live births ≥34-week gestation between 2008 and 2016 from Guangzhou Women and Children’s Medical Center was divided into 5 stages: (1) no interventions; (2) patient-controlled epidural analgesia; (3) episiotomy restriction; (4) new labor management; (5) universal two-child policy. An interrupted time series design was used to measure the effect of interventions on overall cesarean rate, primary cesarean rate, maternal and neonatal outcomes.

Results

There were 126,609 deliveries including 49,092 cesarean deliveries and 77,517 vaginal deliveries in this period. Overall cesarean delivery rate declined after implementing patient-controlled epidural analgesia, episiotomy restriction and universal two-child policy. Primary cesarean rate decreased after implementing episiotomy restriction. Cesarean rate with previous cesarean dramatically increased, and maternal request cesarean rate decreased gradually. Low Apgar rate (score ≤7 at 5 min) increased after episiotomy restriction and maternal postpartum hemorrhage rate increased after new labor management.

Conclusions

Patient-controlled epidural analgesia, episiotomy restriction and the universal two-child policy showed the most significant effects to reducing the cesarean rate.

Keywords:

• Cesarean delivery rate
• episiotomy restriction
• labor management
• patient-controlled epidural analgesia
• universal two-child policy

Acknowledgments

We thank Jia Chen, Junjie Bao for their assistance with data reduction.

Disclosure statement

No potential conflict of interest was reported by the authors with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [grant # 81701456].