Cesarean Delivery on Maternal Request in Southeast China

OBJECTIVE: To estimate the incidence of overall cesarean delivery and cesarean delivery on maternal request in southeast China in the past decade. METHODS: We used data from a population-based maternal and child health surveillance system, which covers 21 cities and counties in two provinces in southeast China. We examined the rate of cesarean delivery and cesarean delivery on maternal request in 1.1 million singleton births from 1994 to early 2006. Cesarean delivery on maternal request was defined as a prelabor cesarean delivery for a singleton gestation without contraindications for vaginal delivery at 38 weeks of gestation or later. RESULTS: During the 13-year study period, the percentage of women who had high school or higher education increased from 13% to 46%. The overall cesarean rate increased from 22% in 1994 to 60% in 2003 and moderated to 56% in 2006. The corresponding rates of cesarean delivery on maternal request (per 100 all deliveries) were 0.8%, 22%, and 20%, respectively. The rates varied enormously among cities and counties. In some areas, cesarean delivery on maternal request accounted for half of all cesarean births. The patterns of rate change were diverse and uneven, and the pattern of risk factors changed substantially between 1994 and 2006. Nulliparity, higher education, older maternal age, having been delivered at provincial or county hospitals, and women's occupations were previously associated with rate of cesarean delivery on maternal request. The rate of cesarean delivery on maternal request no longer varies by age, hospital level, or occupation. CONCLUSION: The rate of cesarean delivery increased dramatically in southeast China in the past decade. Cesarean delivery on maternal request was the predominant contributor to the increase. LEVEL OF EVIDENCE: III.