LCQ5: Delivery services provided by public hospitals
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Following is a question by the Hon Judy Chan and a reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (June 24):
Question:
It is learnt that at present, the obstetrics and gynaecology departments of public hospitals encourage pregnant women to opt for natural delivery whenever possible, and caesarean sections will only be performed under specific circumstances. In this connection, will the Government inform this Council:
(1) whether it knows the respective criteria adopted by public hospitals for encouraging pregnant women to opt for natural delivery, and determining to perform caesarean sections for the pregnant women concerned;
(2) whether it knows the number of caesarean sections performed in public hospitals in each of the past five years, and the respective reasons for performing the surgeries, together with a breakdown by type of hospital ward (i.e. general wards and private wards); and
(3) as it is learnt that at present, public hospitals in quite a number of countries allow pregnant women to opt for caesarean sections, whether the Government and the Hospital Authority will make reference to international practices and review the existing policy of public hospitals on caesarean sections; if so, of the details; if not, the reasons for that, and whether the relevant review will be conducted in future?
Reply:
President,
Hong Kong has high quality obstetric services and is one of the regions with the lowest neonatal mortality rate and maternal mortality rate in the world. In 2025, the neonatal mortality rate in Hong Kong was 1.0 per 1 000 live births, and there were even no case of maternal death during childbirth. The Government attaches great importance to providing appropriate obstetric services for pregnant women. The obstetric departments of the Hospital Authority (HA) adheres to the principles of evidence-based medical practice and conducts comprehensive risk assessments for every pregnant woman during antenatal care and the delivery process. Dedicated teams in the delivery suites provide vaginal deliveries and caesarean sections. In the absence of definitive medical necessity, the healthcare team will arrange natural delivery for the pregnant woman, while caesarean sections are used for pregnant women who are not suitable for vaginal delivery.
Vaginal delivery is a natural physiological process, which results in a small extent of wounds with fast maternal postpartum recovery. Research evidence indicates that vaginal delivery not only enables pregnant women to avoid the inherent risks associated with surgery, but also allow pregnant women to get out of bed almost immediately, or just a few hours postpartum, whereas those who deliver via caesarean section often require a longer rest period and only able to get out of bed at least 12 to even over 24 hours postpartum. Compared to caesarean sections, pregnant women who undergo vaginal delivery experience fewer discomforts such as physical pain and vomiting during the early postpartum period, and is conducive to maternal postpartum recovery, thereby enabling them to care for and accompany their newborns. They also encounter fewer difficulties in breastfeeding. For infants, natural delivery through the birth canal also helps lower the risk of neonatal respiratory complications.
Caesarean section is a major surgical procedure involving maternal abdomen and uterus, it may pose risks of anaesthetic complications, organ injury, haemorrhage, wound healing infection complications etc., as well as a longer hospital stay. According to global statistics, the risk of surgical site infection following a caesarean section ranges between 3 per cent and 10 per cent.
According to data collected by the HA, the incidence rate of postpartum haemorrhage, defined as blood loss exceeding 500 ml, is 34.9 per cent for caesarean sections, far exceeding the 9.1 per cent for vaginal deliveries by nearly four times. In addition, caesarean sections may cause organ injury, with the probability of urinary bladder injury ranging from 0.1 per cent to 1 per cent, and the risk of developing thromboembolic disease is also 3.7 times higher than that of vaginal deliveries. In the long run, it may also lead to long-term complications such as chronic pelvic pain induced by abdominal or pelvic adhesions, as well as leave a scar on the uterus, thereby significantly increasing the risks of placenta accreta, placenta praevia and uterine rupture in subsequent pregnancies.
For infants, caesarean sections carry a risk of causing neonatal respiratory distress syndrome and neonatal hypoglycaemia. Furthermore, medical research indicates that caesarean sections are associated with an increased risk of children developing cardiovascular diseases, asthma, overweight and autism spectrum disorder later in life.
Health authorities worldwide have pointed out that caesarean sections should only be reserved for cases with clear medical needs. The World Health Organization discourages non-essential caesarean sections and continuously promotes various initiatives to reduce such unnecessary caesarean section surgeries. The National Health Commission has also explicitly stipulated “encouraging vaginal delivery and implementing caesarean section where medical indications are met” be adopted as a working principle for maternal and child healthcare. In addition, the International Federation of Gynecology and Obstetrics, the American College of Obstetricians and Gynecologists as well as the Royal College of Obstetricians and Gynaecologists have all emphasised that unless medical indications arise for the mother or the fetus, vaginal delivery should be routinely recommended as the primary mode of delivery.
Therefore, the HA performs caesarean section surgeries for pregnant women based on clear medical necessity, and does not perform delivery for reasons such as a preferred delivery date and time in general. Reasons such as purely subjective choices regarding the mode of delivery generally do not account for deciding to perform caesarean section surgeries.
In consultation with the HA, the consolidated reply to the question raised by the Hon Judy Chan is as follows:
(1) All public hospitals under the HA determine the mode of delivery appropriate for pregnant women based on the principles of evidence-based medical practice. Only upon comprehensive assessment over the medical risk on the pregnant woman and embryo with medical needs, the healthcare team will arrange for the pregnant woman to undergo a caesarean section.
(2) During the period from 2020 to 2024, the total number of deliveries in public hospitals ranged from 19 488 to 26 494 per annum, while the number of caesarean sections per annum ranged from 6 196 to 8 234, i.e. on average, approximately 30 per cent to 35 per cent of pregnant women gave birth via caesarean sections each year.
According to the HA’s data on caesarean section in 2024, the major clinical indications for caesarean sections in public hospitals include uterine scar, i.e. previous caesarean section or myomectomy, at 37.7 per cent as the most prevalent indication; failed induction of labour at 17.8 per cent; fetal distress (abnormal fetal heart rate) at 14.2 per cent; abnormal fetal presentation at 13 per cent and hypertension at 7.2 per cent. Many other clinical indications include antepartum haemorrhage, multiple pregnancy, arrest of labour, cephalopelvic disproportion, failed assisted vaginal delivery, intra-uterine infection, fetal intra-uterine growth restriction, macrosomia and placenta praevia/placenta accreta. Regardless of whether a pregnant woman is admitted to a general ward or a private ward, the HA determines the necessity of a caesarean section surgery based on the actual clinical conditions. Therefore, the HA does not compile breakdown statistics according to ward types.
(3) As stated above, international standards as well as multiple health authorities worldwide have pointed out that caesarean sections should be reserved for cases with clear medical needs. Unnecessary caesarean section surgeries shall be avoided whenever possible.
Out of consideration for safeguarding patient health, the HA currently has no intention of adjusting the existing policy on caesarean sections.
Thank you, President.