Objective: The universal two-child policy was implemented in January 2016 in China. The objective of this study was to compare the influence of change in fertility policy on obstetric issues. Study design: 2016 was taken as the cut-off point, and a retrospective study was conducted on data of patients who delivered in the China-Japan Friendship Hospital from January 2014 to December 2018. Maternal characteristics, mode of delivery, and pregnancy outcomes were studied in detail. Results: Total 8931 babies were delivered from 2014 to 2018. There was a marked increase in the birth rate after the two-child policy. The percentage of elderly pregnant women and rate of cesarean sections increased significantly in 2017 and 2018. The primary cesarean section rates in 2017 and 2018 were significantly lower than those in 2014, 2015, and 2016. Increased incidence of placenta previa and postpartum hemorrhage were observed; however, no significant differences were seen in the rates of hypertensive disorders, gestational diabetes mellitus, and neonatal asphyxia within these five years. Conclusion: The implementation of two-child policy has changed the mode of obstetrics and has presented great challenges. With hierarchical management of high-risk patients and control of the cesarean section rate, we can ensure the safety of pregnant women and newborns. (C) 2020 Elsevier B.V. All rights reserved.