Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification

Abstract

The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.

The Robson 10‐group classification in Iceland: Obstetric interventions and outcomes

“…16 The cesarean rate in both Brazil and the private sector in Australia has in fact been found to be high or around 47%. [2][3][4][5][6]13,15,17 In countries with lower cesarean rates such as The Netherlands (16%), France (21%), or the Nordic countries (15%-21%), the cesarean rate in group 5 has been found to be around 40%-60%, 7,8,14 which is similar to that observed in our study. In France, the relative size of group 2b was 1.5% and the size of group 4b was 0.7%.…”

“…8,[13][14][15]17 These studies report a cesarean rate ranging from 21% in France 14 to 35% in Latin America, 13 which is higher than in Iceland. 8,[13][14][15]17 These studies report a cesarean rate ranging from 21% in France 14 to 35% in Latin America, 13 which is higher than in Iceland.…”

Obstetric interventions, trends, and drivers of change: A 20‐year population‐based study from Iceland

“…Increasing rates of induction of labor have been reported in middle-and high-income countries since the early 1990s; for example in the United States rising from 9.5% to 23.3%, 26 a trend very similar to what we observed in Iceland. 28 The decrease in cesarean delivery was mostly because of a decrease in cesarean delivery among primiparous women with a single, term cephalic pregnancy. However, population-based annual data in the 2010 Euro-Peristat report describe a wide range in labor induction prevalence.…”

“…However, in a population-based study among Nordic countries (2000-2011) the instrumental delivery rate was 6.5%-8.1% of all births, 28 an incidence of 10%-13% has been reported in the UK, 25 and in the United States the average instrumental delivery rate was reported at 6% in a populationbased study between 2005 and 2013. 28 The stark difference in low cesarean prevalence and midto-high range prevalence of epidural analgesia and induction in Iceland highlights the importance of reporting on multiple obstetric interventions for a more complete picture of obstetric practice within a country. Instrumental delivery rates vary considerably by parity in our population and it may suggest that stratifying results by parity is imperative for a more complete understanding of obstetric practice.…”

In due time

“…In the Nordic countries, it is debated whether these findings are applicable to our health‐care settings and maternity services which differ considerably from the American system. The national rate of CS is below 20% in all of the Nordic countries with Denmark having the highest rate of 19,7% (2017) compared with the national rate of 32% in the U.S. (2017). Stock et al reported a very low CS rate (< 10%) in their study, and therefore, one could argue that the baseline difference in CS rates does not matter when evaluating the effect of IOL on CS rates.…”