Time trends in caesarean section rates and associations with perinatal and neonatal health: a population-based cohort study of 1 153 789 births in Norway
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Date
2023Metadata
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Abstract
Objectives To study caesarean section (CS) rates and
associations with perinatal and neonatal health in Norway
during 1999–2018.
Design Population-based cohort study.
Setting Medical Birth Registry of Norway.
Participants 1 153 789 births and 1 174 066 newborns.
Methods CS, intrapartum, perinatal and neonatal
mortality rates expressed as percentages (%) or per mille
(‰) with 95% CIs.
Primary and secondary outcome measures CS rates in
the Robson Ten-Group Classification System; intrapartum,
perinatal and neonatal mortality rates.
Results The overall CS rate increased from 12.9% in
1999 to 16.7% in 2008 (p<0.001), and then reduced to
15.8% in 2018 (p<0.001). The largest reductions were
observed in Robson groups 2 and 4. In Robson group 2,
the planned CS rate decreased from 9.6% in 2007–2008
to 4.6% in 2017–2018, the intrapartum CS rate decreased
from 26.6% in 2007–2008 to 22.3% in 2017–2018. In
Robson group 4, the planned CS rate decreased from
16.1% in 2007–2008 to 7.6% in 2017–2018, and the
intrapartum CS rate decreased from 7.8% in 2007–2008
to 5.2% in 2017–2018.
The intrapartum fetal mortality rate decreased from 0.51
per 1000 (‰) in 1999–2000 to 0.14‰ in 2017–2018.
Neonatal mortality decreased from 2.52‰ to 1.58‰.
Conclusions CS rates in Norway increased between 1999
and 2008, followed by a significant reduction between
2008 and 2018. At the same time, fetal and neonatal
mortality rates decreased. Norwegian obstetricians and
midwives have contributed to maintaining a low CS rate
under 17%. These findings indicate that restricting the use
of CS is a safe option for perinatal health.