Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Aug 30;21(1):589.
doi: 10.1186/s12884-021-04060-5.

Using the Robson classification to assess caesarean section rates in Brazil: an observational study of more than 24 million births from 2011 to 2017

Enny S Paixao  1   2 , Christian Bottomley  3 , Liam Smeeth  3 , Maria Conceicao N da Costa  4   5 , Maria Gloria Teixeira  4   5 , Maria Yury Ichihara  4 , Ligia Gabrielli  5 , Mauricio L Barreto  4 , Oona M R Campbell  3
Affiliations
Observational Study

Using the Robson classification to assess caesarean section rates in Brazil: an observational study of more than 24 million births from 2011 to 2017

Enny S Paixao et al. BMC Pregnancy Childbirth. .

Abstract

Background: Applying the Robson classification to all births in Brazil, the objectives of our study were to estimate the rates of caesarean section delivery, assess the extent to which caesarean sections were clinically indicated, and identify variation across socioeconomic groups.

Methods: We conducted a population-based study using routine records of the Live Births Information System in Brazil from January 1, 2011, to December 31, 2017. We calculated the relative size of each Robson group; the caesarean section rate; and the contribution to the overall caesarean section rate. We categorised Brazilian municipalities using the Human Development Index to explore caesarean section rates further. We estimated the time trend in caesarean section rates.

Results: The rate of caesarean sections was higher in older and more educated women. Prelabour caesarean sections accounted for more than 54 % of all caesarean deliveries. Women with a previous caesarean section (Group 5) made up the largest group (21.7 %). Groups 6-9, for whom caesarean sections would be indicated in most cases, all had caesarean section rates above 82 %, as did Group 5. The caesarean section rates were higher in municipalities with a higher HDI. The general Brazilian caesarean section rate remained stable during the study period.

Conclusions: Brazil is a country with one of the world's highest caesarean section rates. This nationwide population-based study provides the evidence needed to inform efforts to improve the provision of clinically indicated caesarean sections. Our results showed that caesarean section rates were lower among lower socioeconomic groups even when clinically indicated, suggesting sub-optimal access to surgical care.

Keywords: Brazil; Caesarean section rates; Mode of delivery; Robson classification.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Caesarean delivery rates in Brazil using 10- group classification, stratified by HDI group, 2011–2017
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Betrán AP, et al. Rates of caesarean section: Analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007 doi: 10.1111/j.1365-3016.2007.00786.x. - DOI - PubMed
    1. Gibbons L, et al. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol. 2012 doi: 10.1016/j.ajog.2012.02.026. - DOI - PubMed
    1. Betran AP, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reproductive Health. 2015 doi: 10.1186/s12978-015-0043-6. - DOI - PMC - PubMed
    1. Sandall J, et al. Short-term and long-term effects of caesarean section on the health of women and children. The Lancet. 2018 doi: 10.1016/S0140-6736(18)31930-5. - DOI - PubMed
    1. Goleman D, Boyatzis, Mckee R, A. Robson Classification, Implementation manual. Journal of Chemical Information and Modeling (2019). doi:10.1017/CBO9781107415324.004.

Publication types