Achievement of appropriate cesarean rates using Robson's 10-Group classification system in Brazilian private practice

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Evidence-Based Medicine

Background:

• Rising cesarean section (CS) rates globally are linked to increased maternal and neonatal complications.
• Brazil's high CS rate (57% in 2019) exceeds WHO recommendations (10-15%) for optimal maternal and infant outcomes.
• Excessive CS rates negatively impact childbirth experiences and health outcomes.

Purpose of the Study:

• To assess if multidisciplinary care and a strong motivation for vaginal birth can reduce CS overuse in a Brazilian private practice.
• To compare CS rates in a Brazilian private practice with international data, specifically Swedish data.
• To evaluate the effectiveness of evidence-based protocols in a high-medicalization context.

Main Methods:

• A cross-sectional study analyzing CS rates by Robson group in a Brazilian private practice.
• Comparison of Brazilian data with Swedish CS rates and Robson group distributions.
• Utilized the WHO C-model tool to calculate expected CS rates.
• Collaborative care model involving midwives and obstetricians adhering to evidence-based guidelines.

Main Results:

• The private practice achieved an overall CS rate of 15.1%, lower than the WHO C-model expected rate of 19.8%.
• Robson Groups 1, 2, and 5 were analyzed, with Group 5 (previous CS) being a significant contributor to CS rates.
• Brazilian CS rate (15.1%) was comparable to Swedish rates (17.9%), despite differing Robson group compositions.

Conclusions:

• Multidisciplinary care and motivated professionals can significantly and safely reduce cesarean section rates.
• This approach is effective even in settings with high rates of medicalization and CS overuse, like Brazil.
• Evidence-based protocols are crucial for optimizing childbirth outcomes and reducing unnecessary interventions.