Sexual and reproductive health

The Robson classification implementation manual

30 November 2017 | A caesarean section is a life-saving surgical procedure that can prevent maternal and perinatal mortality and morbidity. Over the last decades, however, the use of caesarean section as a mode of delivery has been increasing to unprecedented levels with parallel concern about its consequences. In order to understand what is driving this trend and propose and implement effective measures to ensure that it is not being used unnecessarily, a tool to monitor and compare caesarean section rates in a same setting over time and between different settings is needed.

In 2015, WHO proposed the use of the Robson classification (also known as the 10-group classification) as a global standard for assessing, monitoring and comparing caesarean section rates both within healthcare facilities and between them. The system classifies all women into one of 10 categories that are mutually exclusive and, as a set, totally comprehensive. The categories are based on 5 basic obstetric characteristics that are routinely collected in all maternities (parity, number of foetuses, previous caesarean section, onset of labour, gestational age, and fetal presentation).

Creative use of the icons of the Robson classification in medical records in a maternity ward, Brazil.
Creative use of the icons of the Robson classification in medical records in a maternity ward, Brazil.

WHO expects that this classification will help healthcare facilities to:

  • Identify and analyse the groups of women which contribute most and least to overall caesarean section rates
  • Compare practice in these groups of women with other units who have more desirable results and consider changes in practice
  • Assess the effectiveness of strategies or interventions targeted at optimizing the use of caesarean section
  • Assess the quality of care and of clinical management practices by analysing outcomes by groups of women
  • Assess the quality of the data collected and raise staff awareness about the importance of this data, its interpretation and use.

In order to assist healthcare facilities in adopting the Robson classification, WHO has developed guidelines for its use, implementation and interpretation, including standardization of terms and definitions.

This manual is targeted at healthcare professionals involved in the care of women admitted to deliver (e.g. obstetricians, nurses, midwives), as well as hospital managers and public health authorities.