Cesarean section rate trends in the Netherlands using the Robson classification system: a registration based 10-year population study

Abstract

Abstract Background Worldwide, the average cesarean section rate is rising, including in the Netherlands. In 2018 the World Health Organization changed its norm from an optimum percentage towards preventing unnecessary cesarean sections and recommended to use the Robson Ten Group Classification System. This study aims to describe trends of cesarean section and corresponding perinatal and neonatal outcomes according to the Robson classification system, to analyze the women who contribute most to the cesarean section rate in the Netherlands, in order to identify appropriate interventions to reduce unnecessary cesarean sections. Methods Population-based descriptive study using data of the Dutch Perinatal Registry between 2011–2020. All women who gave birth from 24 weeks onwards and a known mode of birth between 2011 and 2020 in the Netherlands (n = 1,592,656) were included. The data are presented descriptive, as absolutes and percentages. Results The overall cesarean section rate was 16.6%. The Trial of Labor After Cesarean Section and successful Vaginal Birth After Cesarean rates decreased by respectively 16.3% and 12.2%. Robson 1, 2a and 5 showed the biggest impact in the time period 2011 to 2020. Robson 1 was one of the biggest groups (27.7%). Robson 5 showed the biggest increase in the cesarean section rate (13.8%) and in the contribution to the number of cesarean births (10.0%). Over the whole study period, the overall perinatal mortality and neonatal outcomes did not differ. Conclusion Analyzing cesarean section rates by Robson criteria helps identifying areas for improvement. Robson 1, 2a en 5 were the biggest contributors to the cesarean section rate in the Netherlands. Trial of Labor After Cesarean Section and successful Vaginal Birth After Cesarean percentages decreased the past 10 years.