Comparing Cesarean Birth Utilization Between US Hospitals: A Demonstration of the Robson Ten-Group Classification System for Use in Quality Improvement and Benchmarking.
Denise Colter Smith, Julia C Phillippi, Ellen L Tilden and 4 others
PMID 37494690WHAT IT FOUND
Across 12 US birth sites, overall cesarean rates ranged from 20.5% to 44.3%.
Robson groups separated variation by spontaneous labor, induced labor, previous cesarean, and preterm birth.
Key findings
01The final analysis included 228,438 births, and overall cesarean rates across 12 sites ranged from 20.5% to 44.3%.
02Group 2a, nulliparous women with induced labor, made up 9.2% to 27% of births and had cesarean rates of 20.2% to 42.1%.
03Group 5, multiparous women with a previous uterine scar, made up 9.4% to 14.1% of births and had cesarean rates of 62% to 97%; repeat cesarean births contributed 5.9% to 13.7% of overall cesarean births.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data are from 2002 to 2008, and the authors state that changes in practice and quality indicators limit current clinical applicability. The paper did not test any intervention, nursing care, or patient outcome, so it cannot show that any practice caused a higher or lower cesarean rate. The analysis is facility-level and descriptive, so it does not identify individual clinicians, units, or specific reasons for cesarean birth. The paper excluded 124 births for missing or incomplete key variables.
The easy way to misread this
Do not read the hospital-level variation as evidence that cesarean births are inappropriate or that a specific practice caused them. The paper is a descriptive classification of old data and did not test an intervention or patient outcomes.