A cross‐sectional study of caesarean deliveries performed by medical doctors and associate clinicians in nine district and regional hospitals in Sierra Leone using the Robson Ten Group Classification System

OBJECTIVE: Maternal and neonatal mortality remain high in Sierra Leone despite significant decline in the last decade. The aim of the present study was to evaluate obstetric care delivery using the Robson Ten Group Classification System (TGCS), focusing on caesarean delivery (CD) and task-sharing. METHODS: This cross-sectional study analyzed maternity and surgical registry data from nine governmental hospitals, collected over 4 months in 2021 or 2022. Variables included mode and outcome of delivery, TGCS parameters, and provider cadre: associate clinician (AC) or medical doctor (MD). RESULTS: Of 5748 women included in the study, 3806 (66.2%) delivered vaginally, 156 (2.7%) by assisted vaginal delivery and 1786 (31.1%) by CD. The largest TGCS groups were low risk primipara (28.8%) and multipara (47.0%). In the low risk primipara group, 450/1656 (27.2%) underwent CD; in the low risk multipara group, 604/2702 (22.4%) underwent CD. MDs performed 876 (49.1%) of the total CDs and ACs 830 (46.5%). ACs performed more CDs with the indication of twin pregnancy, previous CD, or malpresentation, whereas MDs performed more with the indication of breech, uterine rupture, and fetal distress. CONCLUSION: Facility-based CD rates in Sierra Leone are high, particularly among low risk primi- and multipara-Robson groups, while assisted vaginal delivery rates remain low. Nearly half of all CDs are performed by ACs, highlighting the importance of task-sharing in this context. Further in-depth analysis is warranted to understand the factors influencing CD decision making and the collaborative processes between ACs and MDs to improve maternal and neonatal outcomes.