Global backing for new C-section system

A system devised by an Irish doctor that allows hospitals to easily and reliably compare caesarean-section rates and outcomes has been endorsed for worldwide use by the World Health Organisation (WHO).

Global backing for new C-section system

The need for such a system is against a background of rising rates of C-sections, which the WHO describes as “a major public-health concern”.

The classification system, devised by obstetrician/gynaecologist Dr Michael Robson, former master of the National Maternity Hospital at Holles St, was selected ahead of 27 others, with the WHO describing it as “simple, robust, reproducible, and clinically relevant” and requiring minimal resources.

The Robson 10 system classifies women into one of 10 categories, based on:

  • The number of children they have previously given birth to (with and without previous C-section);
  • Onset of labour (spontaneous, induced, or pre-labour C-section);
  • Gestational age (pre-term or term);
  • Foetal presentation (head down, breech, or transverse);
  • Number of foetuses (single or multiple).


Dr Richard Greene, director of the National Perinatal Epidemiology Centre at Cork University Maternity Hospital, which analyses clinical audit data with the aim of improving maternity care, said the Robson 10 system had “enormous value to allow real comparisons between maternity units”.

“It will allow us drill down into why some hospitals may be carrying out more C-sections than others by putting the women into one of 10 defined categories,” he said.

“For instance we may see a high C-section rate with high use of induction in a particular category of women in one hospital. We can then look at why this is so and look at ways to make positive changes.”

Ultimately the Robson 10 system would allow doctors to look at more defined groups of women with shared obstetric characteristics whose outcomes could be expected to be broadly similar.

This would make it easier to identify hospitals where outcomes were out of kilter, said Dr Greene.

The WHO said the Robson classification system could “contribute to a better understanding of the drivers of increasing C-section rates and to the development of effective interventions to safely curb this trend”.”

Already 14 out of 19 maternity hospitals in Ireland have adopted the Robson 10 system. The WHO is developing guidelines for its use worldwide.

The C-section rate in some Irish hospitals is more than double the WHO ideal recommended rate of 10%-15%.

HSE figures in 2014 revealed that 38% of births were by C-section at St Luke’s Hospital in Kilkenny, making it the highest rate in the country and double that of the lowest — 19% at Sligo General Hospital.

Nationally the C-section rate is 26%.

UCD professor of obstetrics and gynaecology at the Coombe, Michael Turner, said the national rate was “not a worrying figure” and compares favourably with European countries.

Issues such as case complexity — including obesity, maternal age (which is on the increase), and multiple pregnancies due to IVF — were likely influences.

In Middle Africa, only 1.8% of all live birth deliveries occur by C-section, compared to 24.3% in North America and 31% and in Central America.


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