Table 1.
The relevant national policies/clinical guidelines and local policies and actions for the implementation.
| Year | Key provisions in national policies and clinical guidelines | Issuing body | Local policies and actions for the implementation | |
|---|---|---|---|---|
| Longhua hospital | Dongguan hospital | |||
| 2010 | • WHO report: China's CS rate was one of the highest in the world (9) | WHO | • Start to train the team of and promote the use of midwifery skills | • Responded to the nation's call to reduce CS through group meetings and communications, but no specific actions taken. |
| • National programme to promote vaginal delivery and improve maternal and infant health (Jun, 2010) ✓ Establish training centers to promote midwifery techniques for improvement of maternal and infant health ✓ Selection and appraisal of hospitals and departments with excellence in promoting virginal delivery |
CMCHA | |||
| • National protocol for performance assessment of maternal and child health services at county level (Dec, 2010) ✓ Reduce CS rate without medical indication ✓ Non-medical CS is listed as an indicator for performance appraisal of hospitals |
MOH | |||
| 2011 | • Guidelines of maternal health management services (Apr, 2011) ✓ Encouraging vaginal delivery ✓ Reducing CS without medical indications |
MOH | • Initiate research on the method to reduce CS among multiparous women with a scar uterus. | |
| 2012 | • Implementation plan of the Chinese women and children development guidelines in 2011–2020 (Feb, 2012) ✓ Promote spontaneous labor ✓ Encourage vaginal delivery ✓ Strengthen quality of midwifery skills |
MOH | • Local health authority monitor the non-medical CS rate, on quarterly basis. • Non-medical CS should be approved by the department director. | • Local health authority listed the non-medical CS rate as an indicator of hospital performance, but no site-monitoring. |
| 2013 | • Partial two child policy was issued (Dec, 2013) | SC | ||
| 2014 | • Notice on carrying out the review of the baby friendly hospital (Aug, 2014) ✓ List the number of non-medical CS as an indicator to assess the hospital performance ✓ Non-medical CS should be reviewed by hospital director |
NHFPC (former MOH) | • Strict implementation, trial of vaginal birth was required for women with <2 times of CS | |
| • The expert consensus on cesarean delivery operation (Nov, 2014) ✓ Updated medical indications for CS ✓ Protect doctor's right to refuse non-medical CS |
CSOG | |||
| 2015 | • Fully two child policy officially released (Oct, 2015) | SC | ||
| 2016 | • The expert consensus on the management of vaginal birth after CS (VBAC) (Aug, 2016) ✓ Indications and contradictions of VBAC was issued ✓ Clinical guidelines on implementing VBAC was issued. |
CSOG | • In early 2017, a case with uterus rapture took place and went for law suit. | |
WHO, World Health Organization; CMCHA, China Maternal and Child Health Association; MOH, Ministry of Health; NHFPC, National Health and Family Planning Commission; CSOG, Chinese Society of Obstetrics and Gynecology; SC, State Council.