Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital

Abstract

Background: To address the worldwide dramatically increased Cesarean section (CS) rate in the past decades, WHO has recommended the CS rate should not be higher than 10–15%. Whether it is achievable remains unknown.Methods: We collected the data of delivery from 2008 to 2017 in two typical regional hospitals in China: Longhua Hospital (national policies rigorously implemented) and Dongguan Hospital (national policies not rigorously implemented). We compared between the two hospitals the 10 years trend in annual rate of CS, standardized by age, education level, parity, and CS history, against the time of issuing relevant national, local, and hospital policies.Results: In 10 years, 42,441 women in Longhua and 36,935 women in Dongguan have given birth. China's first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was issued in 2015–2016. In Longhua, the standardized annual CS rate was around 35% in 2008–2009, which declined sharply since 2010 down to 13.1% in 2016 (p < 0.001) and then leveled off. In contrast, in Dongguan, the rate stayed around 25% at the beginning, increased to 36% in 2011, decreased sharply to 27% in 2012, and leveled off until 2015 (p < 0.001), and then bounced back to 35% in 2017. The proportion of women with the history of CS increased significantly in the two hospitals (both roughly from 6% before 2010 to 20% after 2015). Analyses stratified by modified Robson classification showed that CS rates reduced in all risk classes of delivery women in Longhua but only in the Robson class 2 group in Dongguan. Major complications did not differ by hospital.Conclusion: With vigorously implementing national policies at micro levels, the WHO-recommended CS rate could be achieved without increase in major complications.

Perinatal and Neonatal Outcomes of Refugee Infants in a Tertiary Hospital in Turkey

“…Although studies from Jordan and Turkey show that refugees have higher cesarean rates, our study found higher in Turkish mothers [21,22]. This is consistent with the worldwide increased rate of cesarean sections over the last decades, which is much beyond the WHO recommendation of 10-15% [23].…”

“…Although studies from Jordan and Turkey show that refugees have higher cesarean rates, our study found higher in Turkish mothers [ 21 , 22 ]. This is consistent with the worldwide increased rate of cesarean sections over the last decades, which is much beyond the WHO recommendation of 10-15% [ 23 ]. Higher medico-legal anxiety and a history of a cesarean section could explain why Turkish mothers have a higher number of cesarean sections.…”

Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean

“…In this study, the success rate of vaginal delivery induced by a balloon was about 70%, higher than reported in the literature [ 14 , 34 – 37 ]. The high success rate of TOLAC in our research may be related to doctor’s experience (i.e., obstetric department director), who was personally very supportive of vaginal birth, trained the team well, and promoted the use of midwifery techniques, which resulted in the absence of complications in most of the induced labor pregnant women [ 38 ]. In their study, Dodd et al reported that 68% of pregnant women with previous CS were willing to accept IOL [ 39 ], as it could help avoid unnecessary repeated CS and improve the success rate of vaginal delivery [ 40 ].…”