Abstract: Objective To analyze the changes of the rate and the indications of cesarean section before and after the implementation of two-child policy.Methods 12 230 medical records of hospitalized pregnant women in A third grade hospital from January 2014 to December 2017 were randomly selected and retrospectively analyzed. Changes of cesarean section rate and the order of cesarean section indications in a third-class A hospital before and after the implementation of the comprehensive second-child policy.Results After the implementation of two-child policy, the cesarean section rate was 57.31%, significantly lower than 68.75% before the implementation (P<0.001). After implementation, the top five indicators of cesarean section were scar uterus, pregnancy complications, social factors, abnormal fetal position and dystocia. After implementation, the proportion of scar uterus as the cesarean section indicator was 33.42%, significantly higher than 16. 67% before implementation (P<0.001). After implementation, the proportions of fetal distress, dystocia, macrosomia and multiple pregnancies as the cesarean section indicators were significantly higher than those of before implementation (P<0.001). After implementation, the proportion of abnormal fetal position as the cesarean section indicator increased significantly (P<0.05), and the proportions of social factors decreased significantly (P<0.001).Conclusions After the implementation of the two-child policy, the cesarean section rate shows a downward trend, The order of indications for cesarean section changed. The rate of cesarean section due to social factors decreased significantly, however, the rate of cesarean section indicated by scar uterus increased. Therefore, it is suggested that we should control the mode of delivery and strengthen the management of scar uterus and vagina trial delivery.