Conclusion
Our study demonstrates the considerable contribution that cesarean
without attempting vaginal birth makes to cesarean birth rates.
Evaluating cesarean without attempting vaginal birth using the Robson
classification helped identify patient groups where efforts to reduce
these cesareans may be most impactful, both within the group itself and
for the total cesarean birth rate.
Currently “pre-labor cesarean” is used interchangeably to describe
subtly different clinical scenarios and there may be no perfect
definition for this group. However, the most useful metric may be one
that encompasses both the decision not to attempt vaginal birth
at the time of admission (irrespective of labor status) and theindication for this decision.
Research to understand the factors behind clinician decisions to perform
“pre-labor” cesareans and barriers to attempting vaginal birth in
cases where there is no absolute contraindication to doing so, may lead
to strategies that enable a greater number of women to safely attempt
vaginal birth. Analysis of clinical, as opposed to administrative, data
is critical to quality improvement efforts in maternity care but is
rarely possible in the US due to a lack of clinical data, outside of
research studies. These data and analyses are important as we pursue a
national strategy to decrease cesarean birth in the US.