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Objective To analyze the frequency of cesarean delivery using the Robson 10‐group classification. Methods A multicenter retrospective cohort study was conducted at three university hospital labor units in the Slovak Republic. The medical records of all women who gave birth at these centers from January 1 to December 31, 2017, were assessed. Results In all, 1437 of 3361 (42.8%), 729 of 2795 (26.1%), and 303 of 2080 (14.6%) births recorded at the three centers during the current study period were by cesarean delivery. Among the nulliparous term singleton vertex deliveries (Robson group 1 and 2), the frequency of cesarean delivery at the three centers was 613 of 1653 (37.1%), 278 of 1389 (20.0%), and 91 of 898 (10.1%). Among term multiparas with one fetus in a cephalic position and at least one previous cesarean delivery (Robson group 5), the frequency of cesarean delivery at the three centers was 405 of 418 (96.9%), 261 of 343 (76.1%), and 55 of 115 (47.8%). Conclusion Analysis of the frequency of cesarean delivery by Robson classification could help to identify possibilities for safely decreasing cesarean delivery rates in the clinic. Robson groups 1, 2, and 5 were the most modifiable groups.

In the last decades the exponential increase in frequency of Caesarean sections is being observed. At the same time, there is growing amount of epidemiologic data showing higher lifetime risk of incidence of several diseases in offspring who do not experience natural labour. These findings lead to investigation of mechanisms which are responsible for maladaptation of several organ systems. Authors of this article describe these mechanisms, focusing especially on epigenetic programming, production of microbiome and positive effect of peripartal stress on successful beginning of extrauterine life.The best prevention strategy is following the strict indications of elective Caesarean sections. The current trend worldwide is to prepare the chronically ill patient for vaginal birth instead of indicating elective Caesarean section. From obstetric point of view it is possible to offer the external version of the foetus in breech presentation, the possibility of vaginal birth after Caesarean section and leave out controversial indications. The inevitable elective Caesarean sections should be planned close to term or after the beginning of spontaneous labour. The composition of intestinal microbiome could be partially influenced by application of vaginal secretion on newborn born by Caesarean section but there is not enough data proving long term positive outcomes (Ref. 48).