<p>This paper examines the impact of China’s evolving birth policies on maternal and neonatal health outcomes, particularly the shift from the one-child to the universal two-child policy. This narrative review synthesizes literature and national data on China’s birth policies and their impact on high-risk pregnancy, structuring the analysis around policy evolution, key health indicators, and healthcare system challenges. The policy changes have resulted in a rise in pregnancies among women of advanced maternal age (AMA), leading to increased risks during pregnancy, childbirth, and postpartum. The paper highlights the strain these shifts have placed on China’s healthcare system, especially concerning the allocation of maternal healthcare resources and the management of high-risk pregnancies. It also discusses the challenges posed by rising cesarean section rates, complications from previous pregnancies, and the need for improved prenatal care, emergency obstetric services, and postpartum support. The paper concludes with recommendations for enhancing healthcare delivery, such as integrating specialized care units, improving early risk detection, and expanding social support systems for working parents, to address the growing maternal and neonatal health challenges in China.</p>