1.Background In 2010, the World Health Organization (WHO) released an official report in The Lancet, an authoritative medical journal, showing that from October 2007 to May 2008, China’s caesarean section rate of 46,2% ranked first among the nine Asian countries sampled (12), which is more than three times the upper limit recommended by the World Health Organization (WHO), and 11,7% had no clear indications for surgery, and that the rate of caesarean sections in China and the United States was among the top 11 in the world, with China at 46,2% and the United States at 32,3%. In 2011, the World Health Organization (WHO) published the OECD Health Data on cesarean section rates for all countries in the world, showing that the cesarean section rates of China and the United States are among the top 11 in the world, with China’s 46.2% in the second place and the United States’ 32.3% in the 10th place.The “abnormally high” cesarean section rate has attracted worldwide attention. In the 1950s to 1970s, China’s cesarean section rate was only about 5%, and it has been rising ever since, rising rapidly to 30% to 40% after the 1980s, and rising even more markedly to 40% to 60% in the 1990s. 21st century, cesarean section has become even more common in China, and its utility has been magnified indefinitely, with cesarean section rates of 40% to 60% and above in most of the urban hospitals, and in a few cases exceeding 80%. 60% or more, a few have exceeded 80%, and certain hospitals have risen to more than 90%. Li Xiaoyan (13) of Fudan University and others used three national health service surveys to study the trend of cesarean section rate and factors affecting it in China in the 10 years from 1990 to 2003, and the data showed that the rate of cesarean section in China was rising rapidly from 1990 to 2003, from 6,73% (95% CI=5,99-7,47) in 1993 to 20,55% (95% CI=5,99-7,47) in 2003, and the rate of cesarean section was increasing rapidly. In 2003, the cesarean section rate was 39,51% (95% CI=37,19~41,83) and 12,77% (95% CI=11,75~13,79) in China’s urban and rural areas respectively; the cesarean section rate was significantly higher in rural areas than in urban areas, and the rate of increase in rural areas was twice as fast as that in urban areas. The most important non-medical reasons affecting cesarean section were urban and rural categories, and it was concluded that the rapid socio-economic development of urban and rural areas in China was the most important indirect reason for the sharp increase in cesarean section rate, and the direct reasons need to be further explored. Similarly, the cesarean section rate in the United States has also shown a continuous increase, the CDC’s National Center for Health Statistics NCHS data show that from 5% in 1960 to 32,3% in 2010, 2010 statistics show that: Florida’s cesarean section rate was 37,2%, Alaska 22,6%, Florida 22,6%, Alaska 22,6%, Florida 22,6%, Alaska 22,6%, and Alaska 22,6%. Alaska 22, 6%, and New Jersey 38, 3%. The cesarean section rate in China and the United States has risen from 1.5-5% in the 1950s and 1960s to the current situation, which exceeds the global average cesarean section rate of 15.90%. The obvious increase in cesarean section rate has aroused the common concern of government departments, health administrations, medical groups and societies in both countries. The increasing cesarean section rate does not bring medical and socio-economic benefits, but rather increases the consumption of health resources as well as the morbidity and mortality of mothers, which negatively affects the future reproductive function and subsequent pregnancies, and in the past five decades, the newborn and perinatal mortality rates have significantly decreased. In the past 50 years, neonatal and perinatal mortality rates have declined significantly, but the relationship between cesarean section and perinatal neonatal mortality is still unclear, and the reasonable cesarean section rate is still controversial. The World Health Organization recommends a cesarean section rate of 15%, and the global average cesarean section rate in 2011 was 15.9%. In some developed countries, such as Japan, the rate of cesarean section is 10% or a little bit higher, and the rate of cesarean section in Scandinavia is less than 15%, but these countries’ maternal and perinatal mortality rates are among the lowest in the world. Maternal and perinatal mortality rates in these countries are among the lowest in the world, fully demonstrating the level of perinatal medicine. 2, the two countries cesarean section rate growth focus and countermeasures For the growing cesarean section rate, China and the United States focus on different things. China in the past ten years focus on reducing cesarean section without medical indication, while the United States in the past ten years focus on reducing the history of cesarean section of pregnant women with cesarean section again. 2010 World Health Organization in the authoritative journal of medicine “The Lancet” published a report, China’s cesarean section rate increased, of which 11, 7% did not have a clear medical indication for surgery. A search of the literature shows that the percentage of cesarean section without indication varies greatly, for example, Wang Qimei and other statistics show that cesarean section without indication accounted for 27,48% of cesarean section, and Zhou Hong and other statistics show that it was 54,53%, and the authors found that the proportion of cesarean section without indication in a few hospitals was up to 80% or more when they were doing the grass-roots business guidance in the province, and the problem of cesarean section without definite indication is increasingly being explored by the industry at the moment. The potential risks of unspecified cesarean delivery include prolonged hospitalization, hemorrhage, neonatal respiratory disease, and uterine rupture, placenta implantation, and dangerous placenta previa in subsequent pregnancies. The definition of cesarean section without indication is based on the authors’ opinion that it should include two types of cesarean section: social factors and medically inaccurate cesarean section, of which social factors are the focus of attention at present, and there is a consensus that cesarean section with social factors as an indication should be lowered.In 2006, the National Institutes of Health (NIH) and the American College of Obstetricians and Gynecologists (ACOG) put forward a definition of cesarean section without indication and principles of its management: it is defined as cesarean section (cesar) that is requested by the mother. Cesarean delivery on maternal request (CDMR) is defined as cesarean delivery requested by the mother of a singleton pregnancy without clinical complications. The principles of management are that the decision to perform CDMR should be individualized and ethical, and that CDMR should not be performed prior to 39 weeks of gestation, unless there is evidence of fetal pneumoperitoneum. Also, delivery facilities should provide effective pain management for all women in labor, pain should not be a reason for choosing CDMR, and CDMR should not be promoted for mothers who need to give birth to more than one child.Therefore, clinicians in China should refer to the recommendations of the ACOG to adequately inform pregnant women of the advantages and disadvantages of CDMR and to avoid inappropriately-timed elective cesarean sections without a clear indication, in order to reduce the increasing cesarean section rate. In the United States, the focus of concern for increasing cesarean delivery rates has been on the question of whether the mode of delivery for a second pregnancy for pregnant women with a history of cesarean section (CS) is again elective cesarean delivery (planned repeated cesarean delivery, PRCD). In the past, the preferred mode of delivery for pregnant women with a history of CS was repeat elective cesarean delivery in most countries, and the rate of repeat cesarean delivery in the United States was as high as 89.4% in 2003, which has been widely discussed by the industry, and it is believed that repeat cesarean delivery significantly increases the incidence of intra- and postpartum hemorrhage, as well as the rates of blood transfusion, infections, bladder and intestinal injuries, and deep venous thrombosis. Pelvic adhesions from previous surgeries also increase the difficulty of surgery. And newborns are also prone to transient respiratory distress. Therefore, since 1996, pregnant women with a history of CS have been encouraged to opt for vaginal birth after caesarean (VBAC) for second pregnancies in the U.S. The ACOG began to advocate for VBAC in 1999; however, after nearly a decade of effort, there are still many difficulties that need to be explored and resolved, especially the possibility of uterine rupture and the maternal and fetal risks of failed trial of labor. Therefore, the current consensus in the U.S. academic community is that the first step in reducing the cesarean section rate is to reduce the cesarean section rate of the first child, which is precisely the outstanding problem that our country is currently facing. 3, take more countermeasures to reduce the growing cesarean section rate In 2011, the China Association for Maternal and Child Health launched the “promote natural childbirth, safeguard the well-being of mothers and children” program, from the national level through a series of measures to the cesarean section “cooling”. The overall goal of the five-year project is to create a social environment and philosophy that promotes natural childbirth, promote appropriate midwifery techniques and standardized health education content and methods, and reduce unnecessary caesarean sections and maternal and infant mortality rates. The specific objectives are: to establish a training center for “promoting natural childbirth and ensuring the well-being of mothers and infants”, to carry out continuous and effective training, to promote appropriate midwifery and prenatal health education techniques; to train teachers in appropriate midwifery techniques and prenatal health education; to bring at least 100 medical institutions nationwide up to the standard of model maternity and child health care centers or hospitals; to promote the professional title series and formal professional midwifery training programs; and to promote the development of the midwifery profession. The establishment of midwifery title series and formal midwifery specialties. At the same time, China’s health administrative department has also strengthened the control of cesarean section rate from the evaluation of the quality of midwifery technology, the evaluation standard of key specialty construction, free hospital delivery, and other quality management of maternal and child health care services, to continuously reduce the increasing cesarean section rate. When I read the journal Obstetrics and Gynecoligy, the editor-in-chief, Queenan J (11) 2011, put forward some countermeasures that will inspire our future work, which are as follows: Countermeasures 1, the most critical is to play the role of hospitals. He believes that each hospital should develop its own measures to reduce the cesarean section rate, including analyzing the composition of the cesarean section rate, influencing factors, interventions and professional research. In 2011, the author participated in midwifery technical guidance in some provincial municipalities across the province, and statistically the cesarean section rate in obstetrics departments of tertiary hospitals with the same level of technology ranged from a low of 38.5% to a high of 62.7%, which fully demonstrates the leading role of each hospital in controlling the increasing cesarean section rate. Countermeasure 2: Mothers and their families should be able to accurately understand the health information about the advantages and disadvantages of vaginal delivery and cesarean section delivery through different channels, especially in prenatal health education, so that mothers can independently choose scientific and reasonable delivery methods instead of just choosing cesarean section delivery. Countermeasure 3: Continuously improve the midwife delivery system in labor and delivery wards. He believes that since midwives cannot perform cesarean section, the willingness of pregnant women to choose vaginal delivery is even stronger. He cited some information showing that several countries around the world that have adopted the midwife-attended delivery system have low cesarean section rates. In China, our midwives will be worried about medical disputes, may not necessarily play a leading role in the mode of delivery of pregnant women, midwives should be encouraged to participate in the exchange of the International Confederation of Midwives, the establishment of China’s midwives union organization. Japan in Asia has been recognized worldwide for its efforts in this area, and as a result, the low rate of cesarean sections in Japan is of worldwide concern. Countermeasure 4: Provide the same health insurance for vaginal delivery and cesarean section, especially the reimbursement rate for vaginal delivery after cesarean section should be higher than that for vaginal delivery. It is worth exploring how to establish the same health insurance system for vaginal and cesarean deliveries in China. Countermeasure 5: Establish a midwifery training system for breech delivery to avoid unnecessary breech cesarean deliveries. China’s current breech delivery mode is also almost 100% cesarean section, young midwifery medical personnel can master the breech delivery technique has been very few, the authors suggest that midwifery training should be set up in provincial municipalities as a unit of the training base, standardized inheritance of breech delivery midwifery training. Because the rising cesarean section rate will affect the development of perinatal medicine and the health of mothers and infants in China, we call for advocating the choice of vaginal delivery as much as possible while ensuring the safety of mothers and infants, and at the same time carrying out a study on the grading and monitoring of cesarean section indications to improve the systematic project (including the participation of the whole society, the media and news, the administrative departments of health, the pregnant women and their families, the medical personnel, the medical insurance, laws and regulations), so as to jointly reduce the rising We have a long way to go to reduce the increasing rate of cesarean sections and truly emphasize the health of mothers and infants.