Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

• Type of Material: Article
• Authors: Denise Colter Smith, University of Colorado; Julia C. Phillippi, Vanderbilt University; Nancy K. Lowe, University of Colorado; Rachel Blankstein Breman, University of Maryland; Nicole Carlson, Emory University; Jeremy L. Neal, Vanderbilt University; Eric Gutierrez, University of Colorado; Ellen L. Tilden, Oregon Health and Science University
• Language: English
• Date: 2019-09-25
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 by the American College of Nurse-Midwives
• Final Published Version (URL): http://dx.doi.org/10.1111/jmwh.13035
• Title of Journal or Parent Work: JOURNAL OF MIDWIFERY & WOMENS HEALTH
• Volume: 65
• Issue: 1
• Start Page: 10
• End Page: 21
• Grant/Funding Information: The data included in this article were obtained from the Consortium on Safe Labor, supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health.
• Keywords: DELIVERY; midwife; cesarean birth; RISK; Life Sciences & Biomedicine; Science & Technology; MIDWIFERY CARE; LABOR INDUCTION; induction of labor; Robson ten-group classification system; ASSOCIATION; SECTION; WOMEN; vaginal birth after cesarean; ATTENDED BIRTHS; low-risk women; RATES; Nursing; HOSPITALS; maternity care; interprofessional
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Obstetrics and Gynecology

Abstract

Introduction: The Robson 10-group classification system stratifies cesarean birth rates using maternal characteristics. Our aim was to compare cesarean birth utilization in US centers with and without midwifery care using the Robson classification. Methods: We used National Institute of Child and Human Development Consortium on Safe Labor data from 2002 to 2008. Births to women in centers with interprofessional care that included midwives (n = 48,857) were compared with births in non-interprofessional centers (n = 47,935). To compare cesarean utilization, births were classified into the Robson categories. Cesarean birth rates within each category and the contribution to the overall rate were calculated. Maternal demographics, labor and birth outcomes, and neonatal outcomes were described. Logistic regression was used to adjust for maternal comorbidities. Results: Women were less likely to have a cesarean birth (26.1% vs 33.5%, P <.001) in centers with interprofessional care. Nulliparous women with singleton, cephalic, term fetuses (category 2) were less likely to have labor induced (11.1% vs 23.4%, P <.001), and women with a prior uterine scar (category 5) had lower cesarean birth rates (73.8% vs 85.1%, P <.001) in centers with midwives. In centers without midwives, nulliparous women with singleton, cephalic, term fetuses with induction of labor (category 2a) were less likely to have a cesarean birth compared with those in interprofessional care centers in unadjusted comparison (30.3% vs 35.8%, P <.001), but this was reversed after adjustment for maternal comorbidities (adjusted odds ratio, 1.21; 95% CI, 1.12-1.32; P <.001). Cesarean birth rates among women at risk for complications (eg, breech) were similar between groups. Discussion: Interprofessional care teams were associated with lower rates of labor induction and overall cesarean utilization as well as higher rates of vaginal birth after cesarean. There was consistency in cesarean rates among women with higher risk for complications.