Caesarean deliveries in China.
The caesarean section rate has risen rapidly in China. The purpose of this retrospective study was to estimate caesarean section rates and indications by hospital facility level in Mainland China to investigate reasons contributing to the high rate.



This cross-sectional hospital-based study collected data from 39 hospitals in three geographical regions in China, covering 14 different provinces, municipalities, and autonomous regions, including 20 tertiary health hospitals and 19 secondary hospitals. Data from all women who gave birth at these hospitals during 2011 were included.



A total of 112,138 women who gave birth after 24 weeks of gestation were surveyed. Of these pregnancies, 54.5% (61,084 cases) resulted in caesarean section, non-indicated caesarean section accounted for 38.4% of caesarean sections. Overall caesarean section rates were higher at the tertiary level hospitals (55.9%) compared to the secondary level hospitals (50.9%). The secondary level hospitals had higher rates of non-indicated caesarean section (48.9% of caesarean sections) compared to tertiary level hospitals (34.5% of caesarean sections). The rate of caesarean section on maternal request was higher in the secondary hospitals (16.6%) than in the tertiary hospitals (10%) (P < 0.001), as well as the caesarean section rate for CPD prior to labour. Operative vaginal deliveries were overall rare (1.2%) with 90.9% (1200/1320 cases) performed in the tertiary hospitals.



Caesarean section on maternal request accounts for a large portion of China's high caesarean section rate, especially in the secondary hospitals. The first step to reduced caesarean section rates is to decrease the number of non-indicated caesarean sections.
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 YaoJiayuan Road, Chaoyang District, Beijing, 100026, China.
Xin
X
Wang
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 01210, USA.
Susan
S
Hellerstein
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 YaoJiayuan Road, Chaoyang District, Beijing, 100026, China.
Lei
L
Hou
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 YaoJiayuan Road, Chaoyang District, Beijing, 100026, China.
Liying
L
Zou
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 YaoJiayuan Road, Chaoyang District, Beijing, 100026, China.
Yan
Y
Ruan
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 YaoJiayuan Road, Chaoyang District, Beijing, 100026, China. zhangwy9921@hotmail.com.
Weiyuan
W
Zhang
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002681:China; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D055815:Young Adult
Caesarean section; Indication; Secondary level hospital; Tertiary level hospital