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

Denise Colter Smith, Julia C. Phillippi, Nancy K. Lowe, Rachel Blankstein Breman, Nicole S. Carlson, Jeremy L. Neal, Eric Gutierrez, Ellen L. Tilden

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Midwifery and Women's Health
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Midwifery
Parturition
Birth Rate
Induced Labor
Mothers
Comorbidity
Fetus
Vaginal Birth after Cesarean
Head
Human Development
Child Development
Cicatrix
Logistic Models
Odds Ratio
Demography

Keywords

  • cesarean birth
  • induction of labor
  • interprofessional
  • low-risk women
  • maternity care
  • midwife
  • Robson ten-group classification system
  • vaginal birth after cesarean

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Maternity and Midwifery

Cite this

Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives. / Smith, Denise Colter; Phillippi, Julia C.; Lowe, Nancy K.; Breman, Rachel Blankstein; Carlson, Nicole S.; Neal, Jeremy L.; Gutierrez, Eric; Tilden, Ellen L.

In: Journal of Midwifery and Women's Health, 01.01.2019.

Research output: Contribution to journalArticle

Smith, Denise Colter ; Phillippi, Julia C. ; Lowe, Nancy K. ; Breman, Rachel Blankstein ; Carlson, Nicole S. ; Neal, Jeremy L. ; Gutierrez, Eric ; Tilden, Ellen L. / Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives. In: Journal of Midwifery and Women's Health. 2019.
@article{6785e55635b34e5fa81f4919cd633f29,
title = "Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives",
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.",
keywords = "cesarean birth, induction of labor, interprofessional, low-risk women, maternity care, midwife, Robson ten-group classification system, vaginal birth after cesarean",
author = "Smith, {Denise Colter} and Phillippi, {Julia C.} and Lowe, {Nancy K.} and Breman, {Rachel Blankstein} and Carlson, {Nicole S.} and Neal, {Jeremy L.} and Eric Gutierrez and Tilden, {Ellen L.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jmwh.13035",
language = "English (US)",
journal = "Journal of Midwifery and Women's Health",
issn = "1526-9523",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

AU - Smith, Denise Colter

AU - Phillippi, Julia C.

AU - Lowe, Nancy K.

AU - Breman, Rachel Blankstein

AU - Carlson, Nicole S.

AU - Neal, Jeremy L.

AU - Gutierrez, Eric

AU - Tilden, Ellen L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - cesarean birth

KW - induction of labor

KW - interprofessional

KW - low-risk women

KW - maternity care

KW - midwife

KW - Robson ten-group classification system

KW - vaginal birth after cesarean

UR - http://www.scopus.com/inward/record.url?scp=85073945091&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073945091&partnerID=8YFLogxK

U2 - 10.1111/jmwh.13035

DO - 10.1111/jmwh.13035

M3 - Article

C2 - 31553129

AN - SCOPUS:85073945091

JO - Journal of Midwifery and Women's Health

JF - Journal of Midwifery and Women's Health

SN - 1526-9523

ER -