Current status of cesarean section in secondary maternal and child health hospitals under new fertility policies: using the Robson classification system

BACKGROUND: This study was conducted during the implementation period of China’s recent fertility policies, a context in which the management of cesarean section (CS) rates faces evolving challenges. This study evaluated temporal trends in CS practices using the modified Robson Classification System (RCS) at a coastal Chinese secondary maternal and child health(MCH) hospital. METHODS: We analyzed 11,755 deliveries (2019–2023) using electronic medical records categorized via the modified RCS. Statistical analyses included trend tests and regression models. RESULTS: Annual deliveries declined by 24.5% from 2019 to 2023, while maternal age increased significantly (p < 0.001). The overall CS rate was 41.4% (4,865/11,755). Most CSs were associated with nulliparous term singleton vertex pregnancies (R1; 40.7% of CSs) and women with a previous CS (R3; 35.9% of CSs), together constituting 76.6% of all CSs. The CS rate in R1 showed a significant upward trend (p < 0.001). CONCLUSION: This descriptive study of a secondary MCH hospital identifies notable obstetric practice and demographic trends against the backdrop of evolving fertility policies, with a high overall cesarean section rate driven predominantly by two patient groups. Annual delivery volumes see a substantial cumulative decline over the five-year study period, while maternal age rises significantly across the cohort. The overall cesarean section rate remains high, with the majority of cesarean procedures occurring in nulliparous women with term singleton vertex pregnancies and women with a prior cesarean section, who together account for the vast majority of all cesarean deliveries. The cesarean section rate for nulliparous women with term singleton vertex pregnancies also exhibits a marked upward trend during the study period. These trends indicate the need for targeted clinical interventions for key patient groups, including standardized labor management for nulliparous women and the promotion of vaginal birth after cesarean. Notably, this analysis coincides with national demographic and fertility policy shifts, but no causal relationship between the policies and the observed trends is established.