Abstract
BackgroundWe aimed to appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China.MethodsIn a retrospective cohort study, temporal changes were examined in relation with maternal demographics, incidence of women with high risk pregnancies and resource statistics in our hospital in managing singleton viable pregnancies (birth from 28 weeks gestational age onwards) for the period 2005–2017.ResultsDuring this 13-year period, the number of singleton livebirths from 28 weeks gestational age onwards was 49,479. Annual numbers of births increased from 1,941 to 2005 to 5,777 in 2017. There were concomitant and significant increases in the incidence of multiparous women (10.6–50.8 %), of age ≥35 years (6.5–24.3 %), with prior caesarean Sec. (2.6–23.6 %), with ≥3 previous pregnancy terminations (1.0–4.9 %), with pre-gestational diabetes (0.2–0.9 %), and with chronic hypertension (0.2–1.2 %). There were associated increases in beds and staff complement and reduced average hospital stay. Nevertheless, while the workload of medical staff remained stable with increasing staff complement, that of midwives increased significantly as reflected by the total births: midwife ratio which increased from 194.1:1 to 320.9:1 (p < 0.001).ConclusionsIn our hospital, progressively increasing numbers of annual births in combination with an increased incidence of women with high risk pregnancies took place following the revised national childbirth policy. Only the increase in medical and nursing, but not midwifery, staff was commensurate with workload. Remedial measures are urgently required before the anticipated progressive increase in care demand would overwhelm maternity care with potentially disastrous consequences.
Highlights
We aimed to appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China
As the greatest and most consistent increase existed in singleton pregnancies with livebirths, we excluded 1,042 births (2.0 %) ending either in stillbirth at any gestational week or birth below 28 weeks gestational age and pregnancies terminated for fetal aneuploidy or major defects
Parameters analyzed We examined numbers and rates of total births, labour induction, caesarean section (CS), admission into the intensive care unit (ICU) for the mother and neonatal intensive care unit (NICU) for the infant, bed occupancy in the maternity ward and average maternal hospital stays, as parameters of workload
Summary
We aimed to appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China. Large scale migration from rural areas into cities is the major factor accounting for the enormous population growth in urbanized areas and cities [1,2,3] In association with this is a concomitant increase in individuals with underlying diseases and medical risk factors, which is translated into an escalating demand for health care [2, 4,5,6]. One of the more prominent demands has to do with maternity care, since the majority of the migrant population are young adults of reproductive age, seeking jobs and employment opportunities in the cities This follows the relaxation of the national one-child policy to allow two children per family since 2002, which has led to increasing numbers of births, and of women with high risk pregnancies and obstetric complications [7,8,9]. The magnitude of the challenges on existing maternity care and the rate of increasing demands, remain unclear in the absence of any studies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
