{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:41:23Z","timestamp":1769150483996,"version":"3.49.0"},"reference-count":47,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T00:00:00Z","timestamp":1603843200000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this study was to assess the caesarean section (CS) rates using Robson\u2019s 10-Group Classification System among women who gave birth at Hawassa University Referral Hospital in southern Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross-sectional study design to determine CS rate using Robson\u2019s 10-Group Classification System.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Hawassa University Referral Hospital in south Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>4004 women who gave birth in Hawassa University Referral Hospital from June 2018 to June 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 4004 women gave birth to 4165 babies. The overall CS rate was 32.8% (95% CI: 31.4%\u201334.3%). The major contributors to the overall CS rates were: Robson group 1 (nulliparous women with singleton pregnancy at term in spontaneous labour) 22.9%; group 5 (multiparous women with at least one previous CS) 21.4% and group 3 (multiparous women without previous CS, with singleton pregnancy in spontaneous labour) 17.3%. The most commonly reported indications for CS were \u2018fetal compromise\u2019 (35.3%) followed by previous CS (20.3%) and obstructed labour (10.7%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A high proportion of women giving birth at this hospital were given a CS, and many of them were in a low-risk group. Few had trial of labour. More active use of partogram, improving fetal heartbeat-monitoring system, implementing midwife-led care, involving a companion during labour and auditing the appropriateness of CS indications may help to reduce the CS rate.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2020-039098","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T22:15:34Z","timestamp":1603923334000},"page":"e039098","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Caesarean section rates analysed using Robson\u2019s 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8538-8291","authenticated-orcid":false,"given":"Abdella Amano","family":"Abdo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sven Gudmund","family":"Hinderaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Achamyelesh Gebretsadik","family":"Tekle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6267-6984","authenticated-orcid":false,"given":"Bernt","family":"Lindtj\u00f8rn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,28]]},"reference":[{"key":"2020102815151504000_10.10.e039098.1","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/S0140-6736(18)30001-1","article-title":"Perioperative patient outcomes in the African surgical outcomes study: a 7-day prospective observational cohort study","volume":"391","author":"Biccard","year":"2018","journal-title":"Lancet"},{"key":"2020102815151504000_10.10.e039098.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rhm.2015.07.007"},{"key":"2020102815151504000_10.10.e039098.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(85)90673-7"},{"key":"2020102815151504000_10.10.e039098.4","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0043-6"},{"key":"2020102815151504000_10.10.e039098.5","unstructured":"Federal Ministry of Health . Implementationmanual for health care financing reports. Ethiopia: Addis Ababa, 2010."},{"key":"2020102815151504000_10.10.e039098.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-016-0412-y","article-title":"Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco","volume":"15","author":"Witter","year":"2016","journal-title":"Int J Equity Health"},{"key":"2020102815151504000_10.10.e039098.7","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-71"},{"key":"2020102815151504000_10.10.e039098.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39363.706956.55"},{"key":"2020102815151504000_10.10.e039098.9","article-title":"Mode of delivery and preterm birth in subsequent births: a systematic review and meta-analysis","volume":"14","author":"Zhang","year":"2019","journal-title":"PLoS One"},{"key":"2020102815151504000_10.10.e039098.10","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/1471-0528.12483","article-title":"Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: a nationwide comparative cohort study","volume":"121","author":"Kok","year":"2014","journal-title":"BJOG"},{"key":"2020102815151504000_10.10.e039098.11","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ejogrb.2011.05.006","article-title":"Cesarean delivery for first pregnancy and neonatal morbidity and mortality in second pregnancy","volume":"158","author":"Huang","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2020102815151504000_10.10.e039098.12"},{"key":"2020102815151504000_10.10.e039098.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31928-7"},{"key":"2020102815151504000_10.10.e039098.14","unstructured":"Ethiopia Demographic and Health Survey: CSA and ICF . Ethiopia demographic and health survey 2016. Ethiopia, and Rockville, Maryland, USA: Addis Ababa, 2016."},{"key":"2020102815151504000_10.10.e039098.15","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijgo.2011.07.011","article-title":"A national review of cesarean delivery in Ethiopia","volume":"115","author":"Fesseha","year":"2011","journal-title":"Int J Gynaecol Obstet"},{"key":"2020102815151504000_10.10.e039098.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-020520"},{"key":"2020102815151504000_10.10.e039098.17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0014566"},{"key":"2020102815151504000_10.10.e039098.18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0097769"},{"key":"2020102815151504000_10.10.e039098.19","doi-asserted-by":"crossref","DOI":"10.1111\/1471-0528.13267","article-title":"The Ten Group Classification System (TGCS) - a common starting point for more detailed analysis","volume":"122","author":"Robson","year":"2015","journal-title":"BJOG"},{"key":"2020102815151504000_10.10.e039098.20","unstructured":"WHO . Robson classification: implementation manual. Geneva: World Health Organization, 2017."},{"key":"2020102815151504000_10.10.e039098.21","unstructured":"Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF . Ethiopia mini demographic and health survey 2019: key indicators. Rockville, Maryland, USA: EPHI and ICF, 2019."},{"key":"2020102815151504000_10.10.e039098.22","unstructured":"Federal Ministry of Health . National health workforce update. Human resource development Directorate Bulletin. 2nd edn. Addis Ababa: Ethiopia, 2019."},{"key":"2020102815151504000_10.10.e039098.23","unstructured":"Bergsj\u00f8 P , Mlay J , Oneko O , et al . Instructions manual for registration of deliveries at the KCMC birth registry, revised edition: department of obstetrics and gynecology KCMC Moshi, Tanzania and. Norway: Department of Public Health and Primary Health Care University of Bergen Bergen, 2010."},{"key":"2020102815151504000_10.10.e039098.24","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1111\/j.1523-536X.2008.00241.x","article-title":"Recommendations for routine reporting on indications for cesarean delivery in developing countries","volume":"35","author":"Stanton","year":"2008","journal-title":"Birth"},{"key":"2020102815151504000_10.10.e039098.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027317"},{"key":"2020102815151504000_10.10.e039098.26","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1111\/1471-0528.13509","article-title":"A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study","volume":"123","author":"Souza","year":"2016","journal-title":"BJOG"},{"key":"2020102815151504000_10.10.e039098.27","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.midw.2018.06.017","article-title":"Comparison of midwife-led and obstetrician-led care in Lithuania: a retrospective cohort study","volume":"65","author":"Bartuseviciene","year":"2018","journal-title":"Midwifery"},{"key":"2020102815151504000_10.10.e039098.28","doi-asserted-by":"crossref","DOI":"10.1111\/ijn.12686","article-title":"Effect of midwife-led care on birth outcomes of primiparas","volume":"24","author":"Jiang","year":"2018","journal-title":"Int J Nurs Pract"},{"key":"2020102815151504000_10.10.e039098.29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03446.x"},{"key":"2020102815151504000_10.10.e039098.30","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.jmwh.2010.02.002","article-title":"Improving quality and safety in maternity care: the contribution of midwife-led care","volume":"55","author":"Sandall","year":"2010","journal-title":"J Midwifery Womens Health"},{"key":"2020102815151504000_10.10.e039098.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61406-3"},{"key":"2020102815151504000_10.10.e039098.32","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003766.pub6"},{"key":"2020102815151504000_10.10.e039098.33","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD003766.pub4","article-title":"Continuous support for women during childbirth","volume":"10","author":"Hodnett","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2020102815151504000_10.10.e039098.34","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00404-019-05182-0","article-title":"Who may accompany the parturient to the delivery room?","volume":"300","author":"Kadour-Peero","year":"2019","journal-title":"Arch Gynecol Obstet"},{"key":"2020102815151504000_10.10.e039098.35","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-11-55","article-title":"Caesarean section among referred and self-referred birthing women: a cohort study from a tertiary Hospital, northeastern Tanzania","volume":"11","author":"S\u00f8rbye","year":"2011","journal-title":"BMC Pregnancy Childbirth"},{"key":"2020102815151504000_10.10.e039098.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-018-1743-z","article-title":"Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the demographic and health survey, 2012-13","volume":"18","author":"Amjad","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"2020102815151504000_10.10.e039098.37","doi-asserted-by":"crossref","DOI":"10.1186\/s13104-019-4705-2","article-title":"Multilevel modelling of factors associated with caesarean section in Ethiopia: community based cross sectional study","volume":"12","author":"Azene","year":"2019","journal-title":"BMC Res Notes"},{"key":"2020102815151504000_10.10.e039098.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0213129","article-title":"Magnitude and correlates of caesarean section in urban and rural areas: a multivariate study in Vietnam","volume":"14","author":"de Loenzien","year":"2019","journal-title":"PLoS One"},{"key":"2020102815151504000_10.10.e039098.39","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ijgo.2013.05.011","article-title":"Analysis of cesarean delivery at Assiut university hospital using the ten group classification system","volume":"123","author":"Abdel-Aleem","year":"2013","journal-title":"Int J Gynaecol Obstet"},{"key":"2020102815151504000_10.10.e039098.40","doi-asserted-by":"crossref","DOI":"10.1186\/1742-4755-7-13","article-title":"Using a caesarean section classification system based on characteristics of the population as a way of monitoring obstetric practice","volume":"7","author":"Costa","year":"2010","journal-title":"Reprod Health"},{"key":"2020102815151504000_10.10.e039098.41","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-13-107","article-title":"Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania","volume":"13","author":"Litorp","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"2020102815151504000_10.10.e039098.42","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0148138","article-title":"Caesarean section in Peru: analysis of trends using the Robson classification system","volume":"11","author":"Tapia","year":"2016","journal-title":"PLoS One"},{"key":"2020102815151504000_10.10.e039098.43","first-page":"1","article-title":"Examining cesarean delivery rates using the Robson\u2019s ten-group classification","volume":"66","author":"Yadav","year":"2016","journal-title":"J Obstet"},{"key":"2020102815151504000_10.10.e039098.44","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033348"},{"key":"2020102815151504000_10.10.e039098.45","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220693","article-title":"Monitoring caesarean births using the Robson ten group classification system: a cross-sectional survey of private for-profit facilities in urban Bangladesh","volume":"14","author":"Begum","year":"2019","journal-title":"PLoS One"},{"key":"2020102815151504000_10.10.e039098.46","doi-asserted-by":"crossref","first-page":"292","DOI":"10.7196\/SAMJ.9405","article-title":"Utility of the Robson ten group classification system to determine appropriateness of caesarean section at a rural regional hospital in KwaZulu-Natal, South Africa","volume":"105","author":"Makhanya","year":"2015","journal-title":"S Afr Med J"},{"key":"2020102815151504000_10.10.e039098.47","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/5648938","article-title":"The ten-group Robson classification: a single centre approach identifying strategies to optimise caesarean section rates","volume":"2017","author":"Tanaka","year":"2017","journal-title":"Obstet Gynecol Int"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-039098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T22:15:51Z","timestamp":1603923351000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-039098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":47,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10,28]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/bmjopen-2020-039098"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-039098","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]}}}