Maternal and Child Health Journal

, Volume 16, Issue 7, pp 1484–1490 | Cite as

Clinical Indications and Determinants of the Rise of Cesarean Section in Three Hospitals in Rural China

  • Cheng Qin
  • Min Zhou
  • William M. Callaghan
  • Samuel F. Posner
  • Jun Zhang
  • Cynthia J. Berg
  • Gengli Zhao


This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.


Cesarean delivery rate Cesarean indication Rural China 



Dr. Jun Zhang is supported by the Intramural Program of the Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health.


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Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  • Cheng Qin
    • 1
  • Min Zhou
    • 2
  • William M. Callaghan
    • 1
  • Samuel F. Posner
    • 3
  • Jun Zhang
    • 4
  • Cynthia J. Berg
    • 1
  • Gengli Zhao
    • 2
  1. 1.Division of Reproductive HealthNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Women’s and Children’s Health CenterPeking UniversityBeijingPeople’s Republic of China
  3. 3.National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaUSA
  4. 4.National Institute of Child Health and Human Development, National Institute of HealthRockvilleUSA

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