Cesarean Birth among Women Birthing in Asia: A Literature Synthesis using the Robson 10-Group Classification System

Abstract

There are increasing concerns about the advancing rates of Cesarean Birth (CB) worldwide as well as in Asia. However, less is known about the antecedent events and/or indicators contributing to rising CB rates. The Robson 10-Group Classification System (TGCS) facilitates comparisons of CB rates among subgroups of women with similar characteristics. While studies using the Robson TGCS have been conducted in Asia, findings from these studies have not been synthesized. This review article aimed to synthesize and critique the literature examining CB among women birthing in Asia using the Robson TGCS from January, 2011 to June, 2021. Of 396 publications, 25 studies met the inclusion criteria, were analyzed, and synthesized in this literature review. The findings show that the primary contributor to rising CB numbers/rates in Asian countries was Group 5 (multiparous women with a history of CB) followed by Group 2 (nulliparous women with induced labor or CB before labor began). Groups 6, 7, and 9 (women with fetal malpresentations) were the lowest contributors to overall CB rates. There was minimal variation in the distribution of Robson Groups across regions and HDI levels in Asia. The lack of consistency in reporting maternal age challenged understanding regarding the association between maternal age and Robson Group CB distribution patterns. Use of the Robson TGCS provides meaningful insight into antecedent events and indicators of CB numbers/rates. Future research should document maternal age, as prior literature suggests that older maternal age at delivery is associated with higher CB risk. These insights can provide opportunities for increased understanding of rising CB rates in Asia and, ultimately, the development of targeted and tailored interventions.