Robson Group-1 caesarean section (CS) rate is a sensitive indicator of intrapartum care quality, reflecting outcomes among low-risk nulliparous women in spontaneous labour. Avoiding unnecessary primary caesarean sections in this group is essential to improve maternal outcomes and reduce repeat caesarean rates. Evidence from moderate-volume maternity units in low- and middle-income countries on sustaining low Group-1 CS rates through collaborative models of care remains limited. A retrospective cohort study was conducted at Fernandez Hospital Stork Home, a moderate-volume maternity unit in Hyderabad, India, from January 2018 to December 2024. All women meeting Robson Group-1 criteria were included. Women were clinically assessed at admission and allocated to either a low-risk or high/evolving-risk intrapartum care pathway. Low-risk women were primarily managed by midwives, while women with high or evolving risk were managed within a collaborative midwife–obstetric model with defined escalation pathways. Intrapartum care bundles included continuous one-to-one midwifery support, encouragement of mobility and upright positions, warm perineal compresses during the second stage, optimal birthing positions, and regular multidisciplinary audit and feedback. Over the 7-year study period, 16,347 births occurred, of which 3,357 (20.5%) were in Robson Group 1. Within this group, 80.4% achieved vaginal birth, and 19.6% underwent caesarean section. The Group 1 caesarean section rate decreased from 23.0% in 2018 to 15.5% in 2024. Maternal outcomes, including obstetric anal sphincter injury and postpartum haemorrhage, remained favourable despite sustained rates of assisted vaginal birth. Neonatal outcomes were stable throughout, with low rates of low Apgar scores and no neonatal deaths. A midwife–obstetric collaborative model, supported by structured intrapartum care bundles and clear escalation pathways, was associated with sustained low Robson Group-1 caesarean section rates in this moderate-volume Indian maternity unit, while maternal and neonatal outcomes remained favourable.
Depa et al. (Sat,) studied this question.