Stabilising the caesarean rate: which target population?

Abstract

Objective Caesarean rate increased in France between 1995 and 2003, but remained stable between 2003 and 2010. Our objective was to analyse these trends by identifying the groups of women who contributed to the increase and those who contributed to the stabilisation.Design Cross-sectional population-based study from the French national perinatal surveys.Setting All maternity units in France.Population Representative samples of women delivering in 1995 (n = 13 147), 2003 (n = 14 482), and 2010 (n = 14 681).Methods Robson classification, based on pregnancy and delivery characteristics, was used for each group. Results Overall caesarean rates were 15.4% in 199515.4% in , 19.7% in 200315.4% in and 20.5% in 201015.4% in . Between 199515.4% in and 2003, the contribution to the overall caesarean rate of all groups but one rose. Between 2003 and 2010, the contribution of all groups but three stabilised or decreased: nulliparous women in spontaneous labour with singleton cephalic fetuses at term (D = + 0.5%, 95% CI 0.1-0.9%), an increase explained by their higher caesarean rate; nulliparous women with induced labour at term (D = + 1.1%, 95% CI 0.8-1.4%) caused by an increase in both the caesarean rate and the relative size of this group; and women with previous caesarean (D = + 0.8%, 95% CI 0.3-1.3%), because of the growing size of this group.Conclusion Proposing and evaluating interventions for improving the management of labour in nulliparous women could help to maintain caesarean rates and mitigate increases among multiparous women in the future.

Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth

“…The same authors also pointed out that the proportion of this group in the population was similar between institutions, reinforcing the hypothesis that there are variations in the CS rate in this group that affect the overall rate. In our study, the proportion of groups 1 and 2 combined was 39 %, similar to that found in Latin America (36.4 %) [31], France (38.2 %) [21], Canada (39.7 %) [30] and the Netherlands (39.9 %) [22]. However, in Brazil, we found that the group of CSs before labor (group 2b) impacted more on the contribution of term nulliparous women (14.9 %).…”

“…The current analysis of CS by Robson classification revealed, as with other studies, that the nulliparous group, term, cephalic presentation is one that contributes most to the total rate of CS [21, 29, 30]. Analyzing nine institutions, Brennan et al [29] showed that 98 % of institutional variation in the CS rate may be attributed to this group, which contributed to over 30 % of CSs performed in France and the Netherlands [21, 22].…”

“…The low use of labor induction in the private sector (only 3.5 %) was also remarkable, reinforcing the preference for CS before labor as a form of immediate delivery. Even in the public sector, the rate of induced deliveries was lower than in countries with low CS rates, such as France and the Netherlands [21, 22], and also lower than previously reported in Latin America [28]. …”

“…First, it was based on a national survey that covers all Brazilian states and was representative of 2,337,475 births (80 %) occurring in 2011 [19]. To our knowledge, it is the third study that used the Robson classification to assess CS rates at a national level and the second to use primary data [21, 22]. We collected all essential information included in the Robson classification, and only a few women could not be classified into one of the Robson groups.…”

“…Analyzing nine institutions, Brennan et al [29] showed that 98 % of institutional variation in the CS rate may be attributed to this group, which contributed to over 30 % of CSs performed in France and the Netherlands [21, 22]. The same authors also pointed out that the proportion of this group in the population was similar between institutions, reinforcing the hypothesis that there are variations in the CS rate in this group that affect the overall rate.…”