Intervention using the Robson classification as a tool to reduce cesarean section rates in six public hospitals in Brazil

Abstract

Objectives: To analyze the effectiveness and safety of a multifaceted intervention to reduce cesarean section (CS) rates. Methods: This interrupted time series study involved six public hospitals with pre-intervention CS rates>35 %. We collected monthly data on overall and Robson group CS rates of 37,031 women who gave birth at the six hospitals during 30 months in the pre-intervention (12 months, n=14,836 women), intervention (6 months, n=6,431 women), and post-intervention (12 months, n=15,764 women) study periods. The intervention bundle included six components: audit and feedback using the Robson classification, goal setting for overall CS rate, distribution of evidence-based guidelines, informative meetings with hospital coordinators, newsletters, and inter-hospital mentoring. Results: There were no significant changes in mean overall CS rates between the three periods. However, five of the six hospitals had a significant decrease in CS rates in at least one Robson group during the study period: groups 1 and 5a (2 hospitals), group 2a (1 hospital), groups 4 and 4a (1 hospital), and group 5b (1 hospital). There were no significant increases in adverse events (maternal and perinatal mortality, neonatal asphyxia) in any of the hospitals with reductions in CS rates. Conclusions: The multifaceted intervention did not significantly reduce the overall CS rate in the participating hospitals. However, five of the six hospitals had significant reductions in CS rates in at least one Robson group, without increasing adverse maternal or perinatal outcomes.