Reaching caesarean section rates below 15%: experience of a French tertiary maternity using the Robson classification system

Caesarean sections (CS) rates are constantly increasing. Despite being a life-saving procedure, this uncontrolled rise remains questionable. While international data suggest that increasing CS rates up to 10–15%, at the population level, is associated with a reduction of maternal and neonatal mortality, the benefit of higher CS rates remains debated. The aim of this study was to describe trends of delivery by CS, using the Robson classification and to assess maternal and perinatal outcomes accordingly to identify potential strategies to control the rise in CS rates. This retrospective observational study included all births ≥ 22 weeks of gestation that occurred in a tertiary university hospital in Besançon, France, from January 1st, 2017, to December 31st, 2023. All deliveries were classified using Robson Ten Group Classification System (TGCS). Relative size, CS rate and contribution to the overall CS rate were described for each group. Secondary outcomes were rates of adverse maternal and perinatal outcomes. A total of 19 082 women were included. The 7-year mean CS rate was 14.4% (n = 2753). A significant reduction of the overall CS rate from 15.4 to 13.0% (95% CI 0.5–4.2%) was observed between 2020 and 2023. This reduction was related to a significant reduction in overall CS rate among group 5 and an important trend towards reduction in group 6. The cesarean rate in group 1 remained stable over the period at 8% on average. During the study period, an increase in induction rates was observed. Maternal and perinatal outcomes were stable. A significant reduction of neonatal transfer was observed between 2020 and 2023 (1.4%; 95%CI 0.5-2.3%). An average CS rate below 15% was achieved without increasing maternal and neonatal complications in a tertiary university hospital. Potential target interventions include a better management of women with a previous CS and breech deliveries.