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

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.