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.