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.
N1 - Funding Information:
The data included in this article were obtained from the Consortium on Safe Labor, supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health. Institutions involved in the Consortium include, in alphabetical order, Baystate Medical Center, Springfield, MA; Cedars-Sinai Medical Center Burnes Allen Research Center, Los Angeles, CA; Christiana Care Health System, Newark, DE; Georgetown University Hospital, MedStar Health, Washington, DC; Indiana University Clarian Health, Indianapolis, IN; Intermountain Healthcare and the University of Utah, Salt Lake City, UT; Maimonides Medical Center, Brooklyn, NY; MetroHealth Medical Center, Cleveland, OH; Summa Health System, Akron City Hospital, Akron, OH; The EMMES Corporation, Rockville, MD (Data Coordinating Center); University of Illinois at Chicago, Chicago, IL; University of Miami, Miami, FL; and University of Texas Health Science Center at Houston, Houston, TX. The authors alone are responsible for the views expressed in this article, which does not necessarily represent the decisions or the stated policy of the NICHD. We would like to thank the Principal Investigators who conducted the original Consortium of Safe Labor study, as well as the NICHD for funding the study and the NICHD Data and Specimen Hub for providing us with the data. We would like to acknowledge Kasey Abrahamson, MPH, for his statistical assistance.
Publisher Copyright:
© 2019 by the American College of Nurse-Midwives
PY - 2020/1/1
Y1 - 2020/1/1
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 - Robson ten-group classification system
KW - cesarean birth
KW - induction of labor
KW - interprofessional
KW - low-risk women
KW - maternity care
KW - midwife
KW - vaginal birth after cesarean
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U2 - 10.1111/jmwh.13035
DO - 10.1111/jmwh.13035
M3 - Article
C2 - 31553129
AN - SCOPUS:85073945091
SN - 1526-9523
VL - 65
SP - 10
EP - 21
JO - Journal of Midwifery and Women's Health
JF - Journal of Midwifery and Women's Health
IS - 1
ER -