Strengths and Limitations
Strengths of our study include large sample size and the depth of chart-abstracted clinical data allowing us to explore indications for pre-labor cesarean as well as the rates within Robson groups. Although our data are derived from a diverse group of hospitals, it is unknown whether our findings are generalizable to other populations in the US.
Data abstracted from medical records resulted in few non-classifiable births (0.5%) in the Robson classification. Additionally, Group 9 was appropriate in size and associated with a high cesarean birth rate, findings highlighted by Robson as indicators of the quality and completeness of cesarean birth datasets.12 Chart abstracted data also gave us greater insight into why these surgeries were performed.