Classification of caesarean sections may need to be developed to improve obstetric care

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“This difference made us curious to see if there were risk factors that differed between countries, for example old age or maternal obesity, which could explain these dramatic differences,” says the study’s first author. Julia Moracaresearcher in Department of Medicine, SolnaKarolinska Institutet, and research assistant at McMaster University, Canada.

Factors beyond the rating system affect

In the next step, the research team performed the same analysis but now took into account more factors associated with cesarean delivery, but not included in Robson’s classification. These factors were, for example, maternal age, body mass index, medical history, and previous deliveries. Fetal size and head position at birth, as well as clinic management for childbirth, were also included.

Much but not all of the difference between countries can be explained on the basis of these additional factors. One explanation is that we have stable maternity care in Sweden, while comparisons of cesarean delivery rates classified by Robson could be incorrect if relevant maternal and obstetric practices and fetal factors are not taken into account, says Julia Moraka.