Use of a Classification Tool to Determine Groups of Women That Contribute to the Cesarean Section Rate: Establishing a Baseline for Clinical Decision Making and Quality Improvement

Abstract

OBJECTIVE:To identify the groups of women who are the largest contributors to the cesarean section rate at a maternity facility in South East Queensland, Australia. Examining the characteristics of these women will allow the development of unit-focused initiatives aimed at reducing cesarean sections in these groups of women. METHOD:A modified version of the Robson Ten Group Classification System was identified as the most appropriate tool to determine cesarean section rates in different groups of women. A prospective clinical audit was then carried out during a 6-month period in 2010 using the tool. FINDINGS:The Robson Ten Group Classification System identified that planned repeat cesarean section was the largest contributor to the cesarean rate. This was followed by women having their first baby, women having an induction, and women who have a breech presentation at term. CONCLUSIONS AND IMPLICATIONS:The Robson classification tool was useful in identifying groups of women at risk of a cesarean section. Unit-specific strategies can now be developed and implemented in an effort to lower the rate. These include increasing the vaginal birth after cesarean rate, the uptake of external cephalic version, supporting nonintervention birth environments, and implementing models of care where clinicians are skilled in facilitating normal birth. The value of using such a tool is the ability to monitor change over time as well as facilitating the comparison of data between units of a similar nature.

Financing Maternity and Early Childhood Healthcare in The Australian Healthcare System: Costs to Funders in Private and Public Hospitals Over the First 1000 Days

“…Given that the largest risk factor for having a caesarean section is having had a previous caesarean section, 42 attention should be given to reducing caesarean section rates in nulliparous women and those with previous caesarean section births. A number of interventions -caseload midwifery, 43 chart audit 44 and induction of labour 45 -have been shown to reduce the risk of caesarean section amongst low-risk nulliparous women.…”

Maternal Obesity and the First Birth: A Case for Targeted Contemporary Maternity Care

“…Although the authors of two systematic reviews (Caughey et al, 2009;Gülmezoglu, Crowther, & Middleton, 2006) concluded that IOL does not increase the CS rate, a significant methodological critique of this work calls into question the appropriateness of routine IOL for well women and fetuses before 42 weeks' gestation (King, Pilliod, & Little, 2010;Mozurkewich, Chilimigras, Koepke, Keeton, & King, 2009). There is also increasing evidence that primiparous women having an IOL are the largest group contributing to the CS rate (Brennan, Murphy, Robson, & O'Herlihy, 2011;Slavin & Fenwick, 2012). Certainly, one could argue that the risk of stillbirth in extremely obese pregnant women perhaps justifies IOL.…”