Changing trends in caesarean section rate in Ireland’s four largest maternity hospitals 2015–2021: which groups account for the rising caesarean section rate?

Objectives: To analyse the changing trends in Caesarean Section (CS) rates in Ireland’s four largest maternity hospitals between 2015 and 2021, utilizing the Robson Ten Group Classification System (TGCS). Methods: This retrospective cohort study reviewed 221,098 deliveries from Cork University Maternity Hospital, The National Maternity Hospital, Rotunda Hospital, and The Coombe Hospital, spanning from 2015 to 2021. Data, collected by each individual hospital and submitted to the National Perinatal Audit Centre (NPEC), was combined into a single dataset. Statistical analysis was performed using linear regression to identify trends in CS rates and group contributions according to the TGCS. Pearson’s coefficient was employed to assess statistical significance. Results: The overall CS rate significantly increased from 30.13 % in 2015 to 35.89 % in 2021 (p = 0.001). The primary drivers of this increase, accounting for over 90 % of the rise, were Group 2 and Group 5. Group 5 demonstrated a statistically significant increase in its Caesarean Section rate by 6.52 % (p = 0.001). Additionally, Group 10 (preterm birth) showed a significant increase in its Caesarean Section rate by 8 % (p = 0.046). Changes in Caesarean Section rates within other TGCS groups were not statistically significant. Conclusion: The rising Caesarean Section rate in Ireland’s largest maternity hospitals is predominantly influenced by an increasing proportion of Group 2 and Group 5 overall and a higher Caesarean Section rate in Group 5. Targeted interventions aimed at reducing the overall CS rate should focus on these specific groups, potentially through optimizing induction practices, promoting shared decision-making regarding pre-labour Caesarean Section.