Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria

Abstract Background: Caesarean section (CS) is a potentially lifesaving obstetric procedure. However, there are concerns about the rising CS rate in many countries of the world including Nigeria. The Ten-Group Robson classification system is presently recommended as an effective monitoring tool for comparing CS rates and identifying target groups for intervention aimed at reducing the rates. The aim of this study was to evaluate the cesarean section rate and the groups with the highest risk of CS at the Obstetric unit of Babcock University Teaching Hospital (BUTH), using the Robson classification system. Methods:A cross-sectional study involving 447 women who had their deliveries at the obstetric unit of BUTH between August 2020 and February 2022. Relevant information was retrieved from the delivery records of the study participants. Data were analyzed using the IBM-SPSS Statistics for Windows version 23.0 (IBM Corp., Armonk, NY, USA). Results: The overall caesarean section rate was 51.2%. Robson groups 2, 3, 5, and 10 had the largest contribution to CS rate accounting for 34.5%, 14.0%, 12.6%, and 10.0% of overall rate respectively. Maternal age greater than 30 years (AOR 2.1, CI 1.3-3.2; P=0.001) and non-cephalic presentation (AOR 19.7, CI 2.5-151.8; P= 0.004) increased the likelihood of caesarean delivery. However, gestational age between 37-40 weeks was associated with a 60% reduction in likelihood of caesarean births when compared with gestational age below 37 weeks (AOR 0.4, CI 0.2-0.8; P=0.008). Conclusions: The caesarean section rate in BUTH is high and Robson groups 2, 3, 5, and 10 are the major contributors to this high rate. Interventions targeted at these groups will assist in reducing caesarean section rates in BUTH. The Robson classification system is useful in providing a benchmark for future comparison of caesarean section rates within and across different obstetric units and regions in Nigeria.