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Implementation of the Robson classification for caesarean sections in Israel: a 10-year cross-sectional study
Noa Shtainmetz1, Riki Tesler2, Nachman Ash2
1Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel. noasht@ariel.ac.il.
Israel Journal of Health Policy Research
|November 4, 2025
Summary
Israel
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Health Services Research
Background:
- Rising global caesarean section (CS) rates present significant public health concerns.
- Understanding the drivers of CS trends is crucial for maternal and perinatal health.
- The Robson classification system offers a standardized method for analyzing CS rates.
Purpose of the Study:
- To characterize and evaluate caesarean section rates in Israel.
- To apply the Robson classification system to a national dataset.
- To identify key subgroups contributing to CS rates.
Main Methods:
- National retrospective cross-sectional study.
- Analysis of 1,061,786 live births (2014-2023).
- Application of the Robson ten group classification system (RTGCS).
Main Results:
- An increasing trend in CS rates was observed, reaching a high of 19.0%.
- Groups 3+4 (multiparous, no previous CS) and 1 (nulliparous, spontaneous labor) were most represented.
- Major contributors to CS included Groups 1, 3+4, 5 (previous CS), 8 (multiple pregnancies), and 10 (pre-term).
Conclusions:
- The study identified specific subgroups requiring targeted interventions for CS reduction.
- The Robson classification system (RTGCS) is valuable for optimizing maternity outcomes and informing policy.
- Integrating RTGCS into routine data collection and improving data quality are essential.
