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Related Concept Videos

Methods Of Healthcare Delivery System01:26

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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
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Cost Containment
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Methods of Documentation VI: Case Management Model01:15

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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Updated: Jan 19, 2026

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Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and

Denise Colter Smith1, Julia C Phillippi2, Nancy K Lowe1

  • 1College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Journal of Midwifery & Women'S Health
|September 26, 2019
PubMed
Summary

Midwifery care in US birth centers is associated with lower cesarean birth rates and labor induction. This approach also supports higher rates of vaginal birth after cesarean, particularly for low-risk pregnancies.

Keywords:
Robson ten-group classification systemcesarean birthinduction of laborinterprofessionallow-risk womenmaternity caremidwifevaginal birth after cesarean

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Healthcare Quality Improvement

Background:

  • The Robson 10-group classification system is a global standard for analyzing cesarean birth rates.
  • Variations in cesarean birth rates exist across different healthcare settings and models of care.
  • Understanding the impact of midwifery care on cesarean utilization is crucial for improving maternal health outcomes.

Purpose of the Study:

  • To compare cesarean birth utilization in US birth centers with and without midwifery-led interprofessional care.
  • To analyze cesarean rates within specific Robson classification categories.
  • To evaluate the association between midwifery care and labor induction rates.

Main Methods:

  • Utilized data from the National Institute of Child and Human Development Consortium on Safe Labor (2002-2008).
  • Compared births in centers with interprofessional midwifery care (n=48,857) versus non-interprofessional centers (n=47,935).
  • Classified births into Robson categories to calculate cesarean rates and contributions, adjusting for maternal comorbidities using logistic regression.

Main Results:

  • Centers with midwifery care exhibited lower overall cesarean birth rates (26.1% vs 33.5%).
  • Nulliparous women (Robson category 2) had reduced labor induction rates (11.1% vs 23.4%) in midwifery settings.
  • Women with prior uterine scars (Robson category 5) had lower cesarean rates (73.8% vs 85.1%) with midwives.
  • Cesarean rates for high-risk pregnancies (e.g., breech) were similar between groups.

Conclusions:

  • Interprofessional care teams including midwives are linked to decreased labor induction and overall cesarean utilization.
  • Midwifery care is associated with increased rates of vaginal birth after cesarean.
  • Cesarean birth rates remain consistent for women with higher-risk pregnancies regardless of care model.