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 journalArticlepeer-review

10 Scopus citations


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)
Pages (from-to)10-21
Number of pages12
JournalJournal of Midwifery and Women's Health
Issue number1
StatePublished - Jan 1 2020


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

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Maternity and Midwifery


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