Appropriate cesarean rates using Robson’s Ten-Group Classification System in a Brazilian private practice

Abstract

Background The increasing rates of cesarean sections (CS) in places with adequate access to health care are a global concern because they are related to higher rates of maternal and neonatal complications and do not provide a positive childbirth experience for women. The objective is to highlight the possibility of achieving CS rates acceptable by WHO standards, such as Nordic countries, following evidence-based protocols in Brazil. Methods A cross-sectional study evaluated CS rates by Robson Groups for women who sought vaginal delivery in a private health practice in Brazil, comparing the rates with Swedish data. A collaborative practice with midwives and obstetricians adopting evidence-based guidelines was offered. The overall CS rate, CS rate by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions and vaginal birth, pre-labour CS and intrapartum CS proportions were estimated. The expected CS rate for the population was calculated by the WHO c-model tool. The analysis used Microsoft EXCEL and the software "R Studio" (version 1.2.1335. 2009-2019). Results The overall CS rate was 15.1% (as expected by the WHO c-model tool) in a population composed of 43.7% women in Robson Group 1, 11.4% in Group 2 and 14.9% in Group 5, the greatest responsible for higher rates of CS, who altogether contributed to 75.4% of all cesarean sections. Conclusions Multidisciplinary care following evidence-based protocols, associated with a high motivation of both women and professionals of childbirth care for a vaginal route for delivery, may lead to a significant and safe reduction of CS rates, obtaining better results even in contexts such as Brazil, where there is high medicalization of obstetric care and excess of CS.