Introduction
The global concern over increasing caesarean section (CS) rates in the last decades has led to a rise in efforts to understand the determinants and drivers of this phenomenon. The increase of non-medically indicated CS, the variation in clinical practices and the differences in women’s risk profiles and expectations have all influenced the overall increase in global CS rates1. The long-term complications of CS and the associated unnecessary risk have been previously described2-4.
Australia has the eighth highest CS rate out of the 34 countries belonging to the Organisation for Economic Co-operation and Development with a CS rate of 34 per 100 live births 5. CS rates have been steadily increasing in Australia from 31% in 2007 to 35% in 2017 5, 6. This figure varies by state, from 37.8% in Western Australia to 31.5% in the Northern Territory; and by type of hospital, from 37.9% in the public sector to 47% in the private sector6.
The comparison of CS rates between institutions using a standardized tool can lead to a better understanding of the problem7. Since 2015, the world health organization (WHO) has recommended the use of the Robson classification system as a global standard tool for assessing, monitoring and comparing CS rates8. The Robson classification has become widely utilised due to its simplicity and reproducibility. It classifies women into ten mutually exclusive groups depending on routinely collected information regarding the pregnancy 9 see Box 1. However, the Robson classification does not specify indications for CS10 and does not look in detail into the demographics and characteristics of women.