Exclusive Breastfeeding Rates at Hospital Discharge Across the Robson Ten-Group Classification System: A Retrospective Study

Background: While the Robson Ten-Group Classification System is extensively used to assess and monitor caesarean section rates, its association with exclusive breastfeeding (EBF) outcomes at hospital discharge remains underexplored. To examine differences in exclusive breastfeeding at hospital discharge across Robson classification groups in births attended at Hospital Universitario de la Ribera (Spain) between 2010 and 2023. Methods: Retrospective observational study at a public hospital between January 1, 2010, and December 31, 2023. Births were retrospectively classified using the Robson Ten-Group Classification System. Exclusive breastfeeding at hospital discharge was analysed across the Robson groups. Sociodemographic, obstetric, and neonatal characteristics were collected. A binomial logistic regression model was developed to assess predictors of exclusive breastfeeding at discharge. Model fit was tested using the Hosmer–Lemeshow test and Nagelkerke’s R². Results: The study analysed 23,081 births classified using the Robson system, and 23,037 to breastfeeding analysis. The overall EBF rate at discharge was 74.2%, with significant variation across Robson groups. Group 1 had the highest exclusive breastfeeding rate (78.3%) and Group 8 the lowest (56.5%). Key factors positively associated with EBF included non-Spanish origin, nulliparity, cephalic presentation, singleton pregnancy, and term gestation. The regression model explained 6.5% of the variance in exclusive breastfeeding outcomes and correctly classified 74.3% of the cases. Conclusions: This study suggests that the Robson classification system can be a valuable tool for identifying maternal groups at higher risk of not exclusively breastfeeding at discharge. When combined with sociodemographic variables, it provides a more comprehensive understanding of the factors influencing breastfeeding outcomes. These findings underscore the need for targeted, evidence-based interventions to promote and sustain exclusive breastfeeding.