Midwifery-led care can lower caesarean section rates according to the Robson ten group classification system

Eur J Midwifery. 2020 Mar 31:4:7. doi: 10.18332/ejm/119164. eCollection 2020.

Abstract

Introduction: Midwifery-led care is recognised as the best choice of maternity care for low-risk women. Robson's Ten Group Classification System (TGCS) is an internationally recognised audit tool, however there is no midwifery-led service presenting their statistics in this way. The objective of this study was to analyse caesarean section rates for the women attending midwifery-led care at the National Maternity Hospital Dublin, Ireland, using the Robson TGCS.

Methods: This is a retrospective study of electronic records for a total of 1097 women who were booked to attend the community midwife team in the National Maternity Hospital, during 2016 and 2017.

Results: The rate of caesarean section in low-risk nulliparous women (Robson Group 1) was under 6%, without affecting the perinatal outcome. The induction rate in nulliparous women (Group 2) was 36%, less than the national average the cesarean rates were quadruple in this group.

Conclusions: Low-risk women who attend midwifery-led services, have a low caesarean section rate in this study. This was achieved with continuity of care, good antenatal preparation, and support throughout labour and birth by a dedicated team of midwives. Outcomes can only be truly compared if we use the same criteria to measure them. The TGCS demonstrates the effectiveness of midwifery-led care.

Keywords: Robson ten group classification system; audit; caesarean section; community midwifery; low-risk nulliparous women.