Document Type

Article

Publication Date

11-2017

DOI

10.1371/journal.pone.0186304

Publication Title

PLoS One

Volume

12

Issue

e0186304

Pages

1-12

Abstract

The objective of this study was to evaluate the effect of institutional and policy interventions on reducing the rate of cesarean delivery on maternal request (CDMR) in Wenzhou, China. Institutional interventions included health education, painless delivery introduction, and doula care. Additionally, a series of health policies were developed by the Chinese central and local governments to control cesarean section rates, mostly through controlling CDMR rates. We conducted a pre-/post-intervention study using 131,312 deliveries between 2006 and 2014 in three tertiary-level public hospitals in Wenzhou, China. Chi-square tests and predictive models were used to examine changes in the CDMR rate before and after institutional and policy interventions. After institutional interventions were introduced, the overall CDMR rate increased from 15.76% to 16.34% (p = 0.053), but the average annual growth rate (AAGR) of the overall CDMR rate quickly declined from 20.11% to -4.30%. After policy interventions were introduced, the overall CDMR rate, the AAGR of the overall CDMR rate, and the probability of performing CDMR declined. Further, the overall probability of a woman undergoing CDMR decreased in all three age groups (group one:34) after institutional and policy interventions. These results show that institutional and policy interventions can reduce the CDMR rate. Additionally, the CDMR rate should be included in hospitals' performance assessment matrix to reduce the CDMR rate further.

Comments

This is an open access article distributed under the terms of the Creative Commons Attribution License.

Original Publication Citation

Yu, Y., Zhang, X., Sun, C., Zhou, H., Zhang, Q., & Chen, C. (2017). Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China. PLoS One, 12(e0186304), 1-12. doi:10.1371/journal.pone.0186304

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