Trends in cesarean delivery rates in primipara and the associated factors
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RESEARCH ARTICLE
Open Access
Trends in cesarean delivery rates in primipara and the associated factors Guoqiang Sun, Ying Lin, Honglian Lu, Wenjing He, Ruyan Li, Lijun Yang, Xian Liu, Hongyan Wang, Xuewen Yang and Yao Cheng*
Abstract Background: Few studies have focused on cesarean delivery (CD) trends among primipara under the one-child and the two-child policies. This study aimed to explore the trends in CD rates among primipara during 1995–2019 and the associated factors with CD risk. Methods: This study obtained clinical data on primiparous mothers and newborns from 1995 to 2019 at a large tertiary hospital in Wuhan, China. Trends in CD rates were calculated using the joinpoint regression analysis. The Chi-square tests and log-binomial regression analyses were used to evaluate the associations between primary variables and CD risk. Results: CD rates showed a significant upward trend with an average annual percentage change (APC) of 2.2% (95% CI: 0.6, 3.8%) during the study period. In 1995–2006, the CD rates continued to increase with an APC of 7.8% (95% CI: 4.8, 10.9%). After 2006, the CD rates started to decline by an APC of − 4.1% (95% CI: − 5.5, − 2.6%). The CD rates non-significantly increased from 36.2% in 2016 to 43.2% in 2019. Moreover, the highest CD rate during 2015– 2019 was observed on August 30 (59.2%) and the lowest on September 1 (29.7%). Primipara of older age and those with >3pregnancies had higher risks of CD. Furthermore, primipara who gave birth to newborns with low birth weight and macrosomia had higher risks of CD. Conclusions: Maternal and fetal as well as social and cultural factors may contribute to the rising trend of CD rates. Effective measures should be taken to control CD under the two-child policy, especially for primipara. Keywords: Primipara, Cesarean delivery, Annual percentage change, Average annual percentage changes, Child policy
Background Cesarean section is an effective way to improve the survival of mothers and newborns. However, the rapid increase in cesarean delivery (CD) adoption has not completely led a corresponding decrease in maternal and neonatal mortality. It has been suggested that the ideal CD rate to reduce maternal and neonatal mortality is approximately 19% [1]. In the past 25 years, the rising * Correspondence: [email protected] Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan 430070, Hubei, China
trend in CD rates has been observed worldwide. Recently, an increase in CD rates from 6.4% in 2010 to 14.4% in 2016 was observed in low- and middle-income countries [2]. It has been reported that the CD rate in China was 36.7% in 2018, one of the highest in the world [3]. Since the implementation of the family planning onechild policy in the 1980s, families having an ‘only-child’ have increased in number in the mainland China [4]. The two-child policy was proposed since 2007 and officially implemented in 2013. With t
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