Examination of cesarean, and normal births according to the Robson Classification

The World Health Organization recommends a maximum cesarean section rate of 15%, taking into account maternal and infant mortality rates. According to the most up-to-date 2021 data from the OECD, Turkey has the highest cesarean section rate (58.4%). This study has 2 main and 1 secondary objectives. The first main objective is to evaluate the obstetric and demographic characteristics of births that occurred in training and research hospitals, state hospitals and private hospitals in Bolu province between 2020-2021-2022, and the effect of the type of hospitalization on Robson Classification groups. The other main objective is to examine the effects of variables such as maternal age, length of stay, number of previous cesarean sections, parity, gravida and gestational age averages on cesarean section rates. The secondary objective is to compare the costs of cesarean and normal births based on birth package prices. Robson Classification categorizes births in 10 groups, helps determine which patient groups have unnecessary cesareans and contributes to the efficient use of limited resources. In this study, the quantitative method was applied. The data were obtained from the hospitals' information management system, birth reports, epicrisis and financial data were obtained from the hospitals' income units and the Health Application Circular (SUT). Excel and SPSS 27 programs were used for the analysis. Binary regression was applied to determine the variables affecting each Robson group. Since the variables affecting the cesarean rate were numerical, linear regression analysis was performed. The main findings of the study were that the average cesarean rate for the years 2020-2021-2022 in the training and research hospital, state hospital and private hospital in Bolu province was determined as 72.79%. While obstetric variables and hospital type variables significantly affected the Robson Classification variable (p<0.05), demographic variables were not significantly affected by the Robson Classification variable (p>0.05). The variables of maternal age, days spent in hospital, number of previous cesarean sections, parity, gravida and gestational week mean significantly affect the dependent variable of cesarean section (p<0.05). In terms of total reimbursement amounts, cesarean sections ($255,381.69) are significantly higher than normal birth reimbursement amounts ($145,707.77). The use of the Robson Classification system as a tool in the implementation of the plan published by the Ministry of Health in October 2024, the main purpose of which is to reduce cesarean section rates, and in the management of maternity services will provide efficiency in resource management and contribute to reaching WHO recommendation rates in terms of maternal and infant health.