Abstract
BackgroundCaesarean section (CS) rates around the world have been increasing and in Australia have reached 30% of all births. Robson's Ten-Group Classification System (10-group classification) provides a clinically relevant classification of CS rates that provides a useful basis for international comparisons and trend analyses. This study aimed to investigate trends in CS rates in New South Wales (NSW), including trends in the components of the 10-group classification.MethodsWe undertook a cross-sectional study using data from the Midwives Data Collection, a state-wide surveillance system that monitors patterns of pregnancy care, services and pregnancy outcomes in New South Wales, Australia. The study population included all women giving birth between 1st January 1998 and 31st December 2008. Descriptive statistics are presented including age-standardised CS rates, annual percentage change as well as regression analyses.ResultsFrom 1998 to 2008 the CS rate in NSW increased from 19.1 to 29.5 per 100 births. There was a significant average annual increase in primary 4.3% (95%CI 3.0-5.7%) and repeat 4.8% (95% CI 3.9-5.7%) CS rates from 1998 to 2008. After adjusting for maternal and pregnancy factors, the increase in CS delivery over time was maintained. When examining CS rates classified according to the 10-group classification, the greatest contributors to the overall CS rate and the largest annual increases occurred among nulliparae at term having elective CS and multipara having elective repeat CS.ConclusionsGiven that the increased CS rate cannot be explained by known and collected maternal or pregnancy characteristics, the increase may be related to differences in clinical decision making or maternal request. Future efforts to reduce the overall CS rate should be focussed on reducing the primary CS rate.
Highlights
Caesarean section (CS) rates around the world have been increasing and in Australia have reached 30% of all births
The rate of primary caesareans in New South Wales (NSW) increased from 11.9 per 100 births in 1998 to 17.8 per 100 births in 2008 (P-trend < 0.001, average annual increase 4.3% (95%CI 3.0-5.7%), with the largest increase occurring among term births
The rate of repeat caesareans increased from 7.8 per 100 births to 12.0 per 100 births from 1998 to 2008
Summary
Caesarean section (CS) rates around the world have been increasing and in Australia have reached 30% of all births. The rise in the CS rate in the US has been most rapid since 2000 and has been attributed to an increase in the primary CS rate and a decrease in the vaginal birth after caesarean rate [4,6] International concern over such increases have prompted the World Health Organisation to suggest that CS rates should not Understanding population trends in CS rates, including trends in primary versus repeat CS, and potential drivers of these trends provide important insights into target areas for reducing the overall CS rate. The CS rate for mothers with ‘no indicated risk’, that is, for term, cephalic presenting, singleton births with no reported medical risk factors in the mother, has increased over time. This research has been hampered by reliance on recording of factors indicating medical risk, many of which may be underestimated using reported data [6,24,25]
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