Abstract:Objective: To analyze the changes of cesarean section rate and cesarean section indications in a third-class a hospital of a city from 2014 to 2018 in order to analyze the reasons for the high cesarean section rate after the two-child policy. Methods: A retrospective analysis was conducted on the clinical data of 15,531 puerpera who were hospitalized in childbirth from 2014 to 2018 to analyze the cesarean section rate and the changes of cesarean section indications after the second child policy was gradually opened. Results: From 2014 to 2018, the highest rate of cesarean section was scar uterus (28.93%), which increased year by year, with statistically significant difference (P < 0.05). The proportion of pregnancy complications and complications in the first cesarean section increased year by year. The proportion of social factors in 2017 (23.88%), 2018 (24.17%), and the proportion of giant fetuses in 2017 (8.30%) and 2018 (4.92%) all decreased from 30.27% and 13.61% in 2014.According to the opening time of the second fetus, the ratio of scar uterus was statistically significant (P < 0.05), social factors and giant fetal factors were decreased, but pregnancy complications and complications were increased. Conclusion: The first cesarean section is the primary factor of high cesarean section rate. Control of the rate of the first cesarean section is the key, at the same time needs a variety of measures to intervene together, for pregnant women to give pre-pregnancy, pregnancy and prenatal health education is crucial.