Effect of second child intent on delivery mode after Chinese two child policy implementation: a cross sectional and prospective observational study of nulliparous women in Chongqing

Abstract

ObjectivesTo assess the influence of second child intent on the delivery preferences and final delivery modes of nulliparous women, particularly caesarean delivery on maternal request (CDMR), after implementation of China’s two child policy.DesignCross sectional and prospective observational study.SettingA tertiary teaching hospital in Chongqing, China.Participants1000 low risk nulliparous women were initially involved, and were divided into two groups based on their intent on having a second child. 814 women who completed all interviews were analysed.Main outcome measuresPreferred mode of delivery in second trimester and at admission; final delivery mode, CDMR.Results814 women who completed all interviews were analysed, in whom 51.2% intended to have a second child. The preference for caesarean delivery (CD) at the second trimester between the intent and no intent group was 6.2% versus 17.9% (adjusted RR 0.35, 95% CI 0.20 to 0.63) and increased to 24.2% versus 37.3% (adjusted RR 0.65, 95% CI 0.45 to 0.94) at admission, respectively. The overall CD rates between the two groups were 41.0% versus 50.4% (adjusted RR 0.84, 95% CI 0.60 to 1.18), and the CDMR rates were 16.7% versus 29.0% (adjusted RR 0.56, 95% CI 0.37 to 0.86), respectively.ConclusionsWomen who intend to have a second child are less likely to request a CD, and high rates of CD and CDMR in nulliparous women may have decreased after implementation of China’s two child policy.

Intent to have a second child among Chinese women of childbearing age following China’s new universal two-child policy: a cross-sectional study

“…In this cross-sectional study we found that the rate of intent for a second child was 39.4% of 11 991 Chinese women of childbearing age. This was much lower than the rate (61.25%) recorded under the one-child policy6 and was similar to rates reported by others during the two-child policy 9 10. According to the report by the China Women’s Federation in 2017, only 20.5% of parents wanted to have a second child 9.…”

“…According to the report by the China Women’s Federation in 2017, only 20.5% of parents wanted to have a second child 9. However, Zhao and colleagues,10 in a hospital-based cross-sectional study of 814 nulliparous pregnant women in 2017, reported that 51.2% of women intended to have a second child. The discrepancy between these studies might be related to the different characteristics of the study population, as we found that economic, childrearing, and health factors were the major barriers to fertility intent.…”

Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: A mixed-methods systematic review

“…In the stratification of the study design, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%–17%; χ 2 = 20.42; df = 5 [ p < 0.01]; I 2 = 76%) [ 9 , 14 , 15 , 35 , 68 , 69 ] and 21% in late pregnancy (95% CI 15%–26%; χ 2 = 109.02; df = 6 [ p < 0.01]; I 2 = 94%) [ 9 , 14 , 15 , 35 , 36 , 68 , 69 ]. In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%–20%; χ 2 = 36.61; df = 6 [ p < 0.01]; I 2 = 84%) [ 8 , 37 – 41 , 72 ], 22% in late pregnancy (95% CI 18%–25%; χ 2 = 697.67; df = 18 [ p < 0.01]; I 2 = 97%) [ 42 – 50 , 56 , 57 , 62 , 63 , 65 – 67 , 70 – 72 ], and 30% postpartum for the index pregnancy (95% CI 19%–40%; χ 2 = 809.43; df = 7 [ p < 0.01]; I 2 = 99%) [ 51 – 53 , 55 , 58 – 60 , 71 ].…”

“…Six longitudinal studies [ 9 , 14 , 15 , 35 , 68 , 69 ] investigated the change of preference from early or middle pregnancy to late pregnancy, whether prospectively or retrospectively. All 6 studies reported an increase in the preference for CS as birth time approached, and the mean difference to test the change was statistically significant (mean difference 7%, 95% CI 1%–13%; χ 2 = 63.76; df = 5 [ p < 0.01]; I 2 = 92%).…”

Changes in maternal age and prevalence of congenital anomalies during the enactment of China's universal two-child policy (2013–2017) in Zhejiang Province, China: An observational study

“…Some questions remain about the impacts of the birth policy changes on maternal and infant health. To date, the impact of birth policy changes on women's reproductive decisions, delivery mode, pregnancy complications, pregnancy age, and birth outcomes has been reported [6][7][8][9][10][11]. An association between certain maternal characteristics and birth defects (BDs) has also been reported, such as maternal age, maternal parity, use of assisted reproductive technology, and diabetes mellitus [12][13][14][15].…”