To analyze the changing trend of cesarean section rate and indications of cesarean section before and after the implementation of the comprehensive “two?child” policy， the clinical data of 34 528 pregnant women delivered in a provincial maternity and child health care hospital in Jiangsu Province，before and after the implementation of the comprehensive “two child” policy（January 1，2014 to December 31，2019） were selected. A retrospective analysis of the changes in cesarean section rate and the indication ratio of cesarean section were made in the study. A questionnaire survey was also deployed to understand the change in the degree of mothers’ awareness of delivery methods before and after the implementation of the policy， and analyze the factors that cause the change in cesarean section rate. Results showed that after the comprehensive “two?child” policy was released， the rate of cesarean section in the hospital decreased significantly. The number of cesarean sections indicated by scar uterus， pregnancy complications and complications， placenta previa， and prevascular vessels increased significantly. The number of cesarean sections indicated by fetal distress， macrosomia， cephalopelvic disproportion， social factors and pelvic abnormalities were significantly decreased. And also the level of mothers’ awareness of delivery methods had been on the rise. According to the changing trend of cesarean section indications， hospitals and relevant clinical departments should take effective management measures to provide evidence?based evidence for monitoring safe hospital delivery data， promoting hospital medical quality， improving maternal health management， and optimizing health policies.