1, pathological factors can be roughly subdivided into two factors: fetal factors and maternal factors. Fetal factors include difficult cephalic delivery, abnormal fetal position, intrauterine distress, low amniotic fluid, etc. Maternal factors include pregnancy complications, scarred uterus, pelvic stenosis, etc. (1) Fetal factors are the most important factors for the increase of cesarean delivery rate, with the general improvement of people’s living standard, the delivery rate of huge children has increased significantly, which increases the risk of vaginal delivery (such as shoulder obstructed labor), the development of modern medical technology (such as ultrasound) can predict some risks of natural delivery in advance, breech position, low amniotic fluid, umbilical cord around the neck, placental factors can be diagnosed in prenatal, surgical delivery to avoid Surgical delivery avoids the damage to mother and child caused by some complicated vaginal assisted delivery in the past, which expands the scope of cesarean section and increases the cesarean section rate. The use of fetal heart monitoring has increased the diagnosis of fetal distress and increased the rate of cesarean delivery. Caesarean sections due to fetal factors such as obstructed labor, abnormal fetal position, fetal distress, and low amniotic fluid account for about half of the caesarean deliveries due to pathological factors. (2) Maternal factors are secondary causes of the increase in cesarean delivery rate,pregnancy complications and complications such as gestational hypertension disease and intrahepatic cholestasis during pregnancy are almost routine for cesarean delivery because of the greater risk borne by pregnant women during delivery. In patients with a history of uterine surgery, late pregnancy or after delivery, the increased pressure in the uterine cavity can cause the muscle fibers to elongate and rupture, resulting in uterine rupture, especially in those with poorly healed postoperative scar, prompting us to strictly control the indications for cesarean delivery, and thus for scarred uterus, most doctors choose cesarean delivery, which increases the rate of secondary surgery. Cesarean section is the main means to deal with placenta praevia, at present, the marginal placenta praevia is also inclined to cesarean section, the rate of cesarean section in placenta praevia has reached 70%-90%, its advantages: one is to stop bleeding in time, the other is to reduce fetal hypoxia; especially in severe bleeding, cesarean section is almost the only way to stop bleeding quickly, which is beneficial to both mother and baby. 2, social factors At present, most people’s requirements for childbirth have changed from ensuring the safety of mother and child to giving priority to the “quality” of the child under the premise of ensuring the safety of the mother. At present, the indications for cesarean section have far exceeded the scope of purely medical indications, and the socio-economic and cultural backgrounds affect the rational choice of delivery methods. (1) Maternal factors
Contemporary young mothers are afraid of pain and cannot continue to endure labor pains when labor has started and there are no identified risk factors and they can deliver vaginally, and their families do not want to wait anxiously and insist on cesarean section, and even mistakenly believe that cesarean section is safer than vaginal delivery. Some women choose to have a cesarean section because they are afraid that natural birth will affect their figure, leave scarring after lateral incision, and that vaginal birth will loosen the birth canal and affect the harmony of their sex life in the future. Studies show that the method of delivery has no direct influence on sex life and does not affect the quality of sex life (except for vaginal delivery in multiple pregnancies). (2) The desire for eugenics makes mothers and their families reluctant to expose the fetus to the slightest risk of perinatal hypoxia and birth injury, and some even mistakenly believe that children born by cesarean section are smarter. The child is not squeezed by the birth canal and has a beautiful head shape. Some people even choose cesarean section to choose the auspicious day, so that the cesarean section rate remains high, so that the risk of neonatal pneumonia, hyperactivity, sensory integration disorder, poor coordination of movement is increased, easy to cause relatively poor immunity later. 3. Medical source factors Under the current development of medical technology, maternal and family legal awareness and awareness of rights, and the relative lag of the law doctors’ rights can not be effectively protected, the rate of cesarean delivery due to medical source factors such as lack of effective communication between doctors and patients is also on the rise. (1) Due to the increasing number of medical disputes and the implementation of the patient’s right to informed consent, doctors are required to explain the advantages and disadvantages of vaginal trial of labor at the time of admission, so many women are concerned about the failure of vaginal trial of labor and have to undergo a cesarean section. (2) Due to the increase of legal awareness and awareness of rights and the lack of awareness of the high risk of childbirth, there is a mismatch between doctors and patients and the lack of strong legal protection for the work of obstetricians, so that doctors are afraid of refusing to perform surgery and insisting on vaginal delivery and having an accident, which may lead to disputes and difficulties in bearing the consequences. (3) Due to the dilution of physicians’ responsibility, even some physicians can end the labor in a short time due to their skill in caesarean section, which saves the health care workers from the hard work and trouble of observing the labor process for a long time. Prematurely confirming the failure of the trial of labor and choosing cesarean section before entering the active phase. The current increase in medical disputes and litigation in obstetrics and the increased pressure on obstetric medical workers to practice are becoming one of the reasons for the high rate of cesarean delivery. The yearly increase in medical disputes in recent years has caused distress to physicians, especially with the introduction of the Medical Malpractice Regulation, which implements the reversal of proof causing physicians to adopt an indulgent or compromising attitude toward the demands of the mother and family. Because the process of transvaginal delivery is an unpredictable one, in case of a failed vaginal trial of labor or even an accidental delivery, there will be endless disputes for the hospital and the doctors personally, and individually even threats to personal safety. Therefore, due to the pressure of practice, obstetricians often choose to perform cesarean section when the mother has no indication for cesarean section, but at the request of the mother and her family. Therefore, to effectively reduce the cesarean delivery rate, we must first seek the support and understanding of society, families and management for obstetrics work. The high-risk nature of obstetrics should be fully recognized, and the pressure of obstetrical work should not be borne by obstetricians only. Facing the general climate of market economy, suitable conditions should be created for obstetricians, such as medical insurance, life insurance, and hiring permanent legal counsel, in order to create a good working atmosphere. Secondly, public opinion is needed to guide correctly, to understand and support the hard work of medical and nursing staff, to reduce the ideological pressure of medical and nursing staff in dealing with maternal trial of labor, and to improve the quality of labor. Thirdly, we need to change the mode of service during labor and create a harmonious doctor-patient relationship; obstetricians and gynecologists should keep learning and try to improve the technical level of handling vaginal delivery to enhance the confidence of families and pregnant women in vaginal delivery. In conclusion, cesarean delivery is only a midwifery procedure, a means to solve difficult labor and maternal and infant complications, and its correct use can save the lives of mothers and infants and ensure their safety, but it is not an ideal and perfect delivery method after all, and the increase of cesarean delivery rate increases the risk of recent and long-term complications for mothers and infants. Therefore, reducing the cesarean delivery rate is an important measure to implement to ensure the safety of mothers and infants. Only through the joint efforts of doctors and patients, society, and the reasonable control of the indications for cesarean delivery can the cesarean delivery rate be better reduced.